title: Piecewise Mixed Effects Model to Compare the Weight-gain Patter ns Before and After Diagnosis of Asthma in Children Younger than 5 Years.
abstract: Asthma and obesity are two significant public health problems that both originate in early childhood and have shared risk factors and manifestations. Studies suggest a strong association between asthma development and subsequent accelerated weight gain. Children are diagnosed with asthma in early childhood and are often exposed to factors associated with rapid weight gain. This article intends to demonstrate an innovative application of the piecewise mixed effects model to characterize the difference in the temporal rate of change in BMIz, the standardized scores of body mass index and weight-for-length that measure weight status, before and after asthma diagnosis in children younger than 5 years. The data consist of unique sequences from 1194 children's clinic visits during the first 5 years of life. We used a knot at the time of diagnosis and detected a differential weight-gain pattern before and after asthma diagnosis. The pre- and post-asthma-diagnosis weight-gain patterns further differ by sex and race-ethnicity. After asthma diagnosis, female children showed a higher increase in the rate of change in BMIz than males. Non-Hispanic African Americans and Hispanics had higher post-diagnosis rates of change in BMIz than Caucasians. The differential weight-gain patterns between male and female children were mainly contributed by Caucasian children. These findings could have important implications in the clinical care of children after asthma diagnosis.
authors.affiliation: Department of Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; Department of Applied Economics and Statistics, University of Delaware, Newark, DE, USA.
authors.forename: Md Jobayer
authors.initials: MJ
authors.lastname: Hossain
authors.affiliation: Department of Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Xie
authors.affiliation: Division of Pulmonary and Sleep Medicine, Nemours Children's Hospital, Orlando, FL, USA.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Lang
authors.affiliation: Department of Biomedical Research, Nemours Children's Clinic, Jacksonville, FL, USA.
authors.forename: Timothy T
authors.initials: TT
authors.lastname: Wysocki
authors.affiliation: Department of Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Shaffer
authors.affiliation: Department of Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: H Timothy
authors.initials: HT
authors.lastname: Bunnell
keywords: Asthma; BMI; Mixed effects; Piecewise; Weight gain; Weight-for-length