Association Between Body Fat and Body Mass Index from Incomplete Longitudinal Proportion Data: Findings from the Fels Study

Obesity rates continue to exhibit an upward trajectory, particularly in the US, and is the underlying cause of several comorbidities, including but not limited to high blood pressure, high cholesterol, diabetes, heart disease, stroke, and cancers. To monitor obesity, body mass index (BMI) and proportion body fat (PBF) are two commonly used measurements. Although BMI and PBF changes over time in an individual’s lifespan and their relationship may also change dynamically, existing work has mostly remained cross-sectional, or separately modeling BMI and PBF. A combined longitudinal assessment is expected to be more effective in unravelling their complex interplay. To mitigate this, we consider Bayesian cross-domain latent growth curve models within a structural equation modeling framework, which simultaneously handles issues such as individually varying time metrics, proportion data, and potential missing not at random data for joint assessment of the longitudinal changes of BMI and PBF. Through simulation studies, we observe that our proposed models and estimation method yielded parameter estimates with small bias and mean squared error in general, however, a mis-specified missing data mechanism may cause inaccurate and inefficient parameter estimates. Furthermore, we demonstrate application of our method to a motivating longitudinal obesity study, controlling for both time-invariant (such as, sex), and time-varying (such as diastolic and systolic blood pressure, biceps skinfold, bioelectrical impedance, and waist circumference) covariates in separate models. Under time-invariance, we observe that the initial BMI level and the rate of change in BMI influenced PBF. However, in presence of time-varying covariates, only the initial BMI level influenced the initial PBF. The added-on selection model estimation indicated that observations with higher PBF values were less likely to be missing.