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American Journal of Epidemiology Advance Access originally published online on April 8, 2009
American Journal of Epidemiology 2009 169(10):1167-1178; doi:10.1093/aje/kwp047
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

PRACTICE OF EPIDEMIOLOGY

Life Course Path Analysis of Birth Weight, Childhood Growth, and Adult Systolic Blood Pressure

Michael Gamborg, Per Kragh Andersen, Jennifer L. Baker, Esben Budtz-Jørgensen, Torben Jørgensen, Gorm Jensen and Thorkild I. A. Sørensen

Correspondence to Michael Gamborg, Institute of Preventive Medicine, Copenhagen University Hospital and Center for Health and Society, University of Copenhagen, Øster Søgade 18, 1357 Copenhagen K, Denmark (e-mail: mga{at}ipm.regionh.dk).

Received for publication March 20, 2008. Accepted for publication October 14, 2008.

The inverse associations between birth weight and later adverse health outcomes and the positive associations between adult body size and poor health imply that increases in relative body size between birth and adulthood may be undesirable. In this paper, the authors describe life course path analysis, a method that can be used to jointly estimate associations between body sizes at different time points and associations of body sizes throughout life with health outcomes. Additionally, this method makes it possible to assess both the direct effect and the indirect effect mediated through later body size, and thereby the total effect, of size and changes in size on later outcomes. Using data on childhood body size and adult systolic blood pressure from a sample of 1,284 Danish men born between 1936 and 1970, the authors compared results from path analysis with results from 3 standard regression methods. Path analysis produced easily interpretable results, and compared with standard regression methods it produced a noteworthy gain in statistical power. The effect of change in relative body size on adult blood pressure was more pronounced after age 11 years than in earlier childhood. These results suggest that increases in body size prior to age 11 years are less harmful to adult blood pressure than increases occurring after this age.

birth weight; blood pressure; body mass index; child; epidemiologic methods; growth

Abbreviations: BMI, body mass index; SBP, systolic blood pressure

Editor's note: An invited commentary on this article appears on page 1179.


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