小于胎龄早产儿超重风险增加了吗？过度调整身体尺寸测量值的统计学陷阱。
Are small-for-gestational-age preterm infants at increased risk of overweight? Statistical pitfalls in overadjusting for body size measures.
机构信息
Department of Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Nutrition Services, Alberta Health Services, Calgary, AB, Canada.
出版信息
J Perinatol. 2021 Aug;41(8):1845-1851. doi: 10.1038/s41372-021-01050-5. Epub 2021 Apr 13.
OBJECTIVE
The objective of this study is to analyze the effect of adjusting for body measures on the association between small for gestational age (SGA) and overweight at 3 years.
STUDY DESIGN
Data were obtained from the Preterm Infant Multicenter Growth Study (n = 1089). Logistic regression was used, to adjust for confounders with additional adjustments separately for weight and height at 21 months. Marginal structural models (MSMs) estimated the direct effect of SGA on overweight.
RESULTS
The crude and adjusted for confounders models yielded null associations between SGA and overweight. Adjusting for height yielded a positive association (odds ratio (OR): 2.31, 95% CI: 0.52-10.26) and adjusting for weight provided a significantly positive association (OR: 6.60, 95% CI: 1.10-37.14). The MSMs, with height and weight held constant, provided no evidence for a direct effect of SGA on overweight (OR: 0.83, 95% CI: 0.14-5.01, OR: 0.71, 95% CI: 0.18-2.81, respectively).
CONCLUSION
Adjusting for body measures can change the association between SGA and overweight, providing spurious estimates.
目的
本研究旨在分析调整身体指标对小胎龄儿（SGA）与 3 岁时超重之间关联的影响。
研究设计
数据来自早产儿多中心生长研究（n=1089）。使用逻辑回归，在 21 个月时分别对体重和身高进行额外调整，以调整混杂因素。边缘结构模型（MSM）估计了 SGA 对超重的直接影响。
结果
未调整混杂因素和调整混杂因素的模型均显示 SGA 与超重之间存在零关联。调整身高会产生正关联（比值比（OR）：2.31，95%置信区间：0.52-10.26），而调整体重则提供了显著的正关联（OR：6.60，95%置信区间：1.10-37.14）。MSM 在身高和体重保持不变的情况下，没有证据表明 SGA 对超重有直接影响（OR：0.83，95%置信区间：0.14-5.01，OR：0.71，95%置信区间：0.18-2.81）。
结论
调整身体指标会改变 SGA 与超重之间的关联，提供虚假的估计。
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