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Foraita R, Witte J, Börnhorst C, Gwozdz W, Pala V, Lissner L, Lauria F, Reisch LA, Molnár D, De Henauw S, Moreno L, Veidebaum T, Tornaritis M, Pigeot I, Didelez V. A longitudinal causal graph analysis investigating modifiable risk factors and obesity in a European cohort of children and adolescents. Sci Rep 2024; 14:6822. [PMID: 38514750 PMCID: PMC10957936 DOI: 10.1038/s41598-024-56721-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/10/2024] [Indexed: 03/23/2024] Open
Abstract
Childhood obesity is a complex disorder that appears to be influenced by an interacting system of many factors. Taking this complexity into account, we aim to investigate the causal structure underlying childhood obesity. Our focus is on identifying potential early, direct or indirect, causes of obesity which may be promising targets for prevention strategies. Using a causal discovery algorithm, we estimate a cohort causal graph (CCG) over the life course from childhood to adolescence. We adapt a popular method, the so-called PC-algorithm, to deal with missing values by multiple imputation, with mixed discrete and continuous variables, and that takes background knowledge such as the time-structure of cohort data into account. The algorithm is then applied to learn the causal structure among 51 variables including obesity, early life factors, diet, lifestyle, insulin resistance, puberty stage and cultural background of 5112 children from the European IDEFICS/I.Family cohort across three waves (2007-2014). The robustness of the learned causal structure is addressed in a series of alternative and sensitivity analyses; in particular, we use bootstrap resamples to assess the stability of aspects of the learned CCG. Our results suggest some but only indirect possible causal paths from early modifiable risk factors, such as audio-visual media consumption and physical activity, to obesity (measured by age- and sex-adjusted BMI z-scores) 6 years later.
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Affiliation(s)
- Ronja Foraita
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany.
| | - Janine Witte
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Claudia Börnhorst
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany
| | - Wencke Gwozdz
- Department of Consumer Research, Communication and Food Sociology, Justus-Liebig-University, Gießen, Germany
- Department of Management, Society and Communication, Copenhagen Business School, Frederiksberg, Denmark
| | - Valeria Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fabio Lauria
- Institute of Food Sciences, CNR, Avellino, Italy
| | - Lucia A Reisch
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany
- El-Erian Institute of Behavioural Economics and Policy, University of Cambridge, Cambridge, UK
| | - Dénes Molnár
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Stefaan De Henauw
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Luis Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain
| | - Toomas Veidebaum
- Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia
| | | | - Iris Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Vanessa Didelez
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
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Wong DH, Teman NR. Commentary: Variable in disguise: Using graphical modeling in cardiac surgery to stay ahead of the curve. J Thorac Cardiovasc Surg 2023; 166:e463-e464. [PMID: 36192226 DOI: 10.1016/j.jtcvs.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Daniella H Wong
- Division of Cardiac Surgery, University of Virginia Health System, Charlottesville, Va
| | - Nicholas R Teman
- Division of Cardiac Surgery, University of Virginia Health System, Charlottesville, Va.
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