SITAR growth curve analysis - a statistical method to assess longitudinal growth and development data
Lead Research Organisation:
University College London
Department Name: Institute of Child Health
Abstract
The pattern of growth in individual children, as represented by their growth curve of successive measurements (e.g. weight or height) plotted against age, may be informative about their circumstances at earlier ages, or conversely it may predict their risk of disease later in life, for example heart disease, stroke or type 2 diabetes. To investigate this it is useful to summarise the shape of each individual's growth curve in a simple way, so that its shape can be related to their earlier or later experiences. The SITAR method of growth curve analysis is a recently developed approach that does just this - it summarises each individual growth curve as just three numbers, reflecting respectively their size (i.e. whether they are tall or short, or heavy or light, as compared to others), their growth tempo (i.e. whether they are relatively mature or delayed in their timing of growth, e.g. when girls reach menarche), and velocity (how fast they are growing compared to others, e.g. in puberty). So for example an individual might be relatively tall, with early puberty, and growing relatively fast. In addition SITAR estimates a smooth average growth curve against which each individual's growth pattern can be compared. The surprising thing is that this model explains nearly all of the variability in growth between individuals, so that their size, tempo and velocity can be viewed as a complete summary of their growth pattern. Put another way, when adjusted for size, tempo and velocity all their growth curves look the same (the SITAR acronym mean Super-Imposition by Translation And Rotation). It is then simple to relate the values of size, tempo and velocity in individuals to their earlier or later experiences, and to look for links with their growth pattern.
Technical Summary
The SITAR method of growth curve analysis summarises individual growth patterns of e.g height or weight in three parameters (size, tempo and velocity) that are estimated as subject-specific random effects, plus a cubic spline estimate of the average growth curve. It explains over 95% of the age-specific variance in the outcome measure, and as such is an effective summary of individual growth patterns. The subject-specific random effects can then be related to earlier growth-affecting exposures or later health outcomes. Thus it is relevant in translational medicine and life course epidemiology. The aims of the project are (i) to further develop the SITAR methodology, (ii) to apply it to a series of existing growth studies, and (iii) to develop an existing SITAR software library in the R statistical language for its wider dissemination. Methodological developments will include applying the method to developmental as well as growth outcomes, and allowing the fitting of multiple mean curves rather than just one. The application studies are collaborations involving longitudinal data covering height, weight, spirometry and brain growth in childhood and puberty. The R library allows other statisticians and epidemiologists to apply the method relatively simply.
Planned Impact
Who will benefit from this research, and how?
o Academia
All researchers, national and international, interested in the analysis of longitudinal growth will find SITAR of interest, as it will allow them to summarise individual growth patterns in a simple way and then link the pattern to other aspects of the individual's health and lifestyle.
o Public Sector
National policy makers concerned with the high and rising levels of childhood obesity will want to explore the idea from SITAR that overweight children have an advanced maturational age, and look for lifestyle interventions that might counteract this accelerated age pattern.
o Business/Industry
The international pharmaceutical industry will value a statistical tool that simplifies and sharpens the assessment of growth-affecting treatments. SITAR's efficient use of data will mean that clinical trials involving growth outcomes need not be as large as before, and hence may reach conclusions more quickly and certainly more cheaply. This in turn should make cheaper the development of new growth-affecting drugs.
o Parents and children
Parents and children worldwide will benefit from improved growth assessment through the development of more effective evidence-based growth charts, particularly in puberty.
o Academia
All researchers, national and international, interested in the analysis of longitudinal growth will find SITAR of interest, as it will allow them to summarise individual growth patterns in a simple way and then link the pattern to other aspects of the individual's health and lifestyle.
o Public Sector
National policy makers concerned with the high and rising levels of childhood obesity will want to explore the idea from SITAR that overweight children have an advanced maturational age, and look for lifestyle interventions that might counteract this accelerated age pattern.
o Business/Industry
The international pharmaceutical industry will value a statistical tool that simplifies and sharpens the assessment of growth-affecting treatments. SITAR's efficient use of data will mean that clinical trials involving growth outcomes need not be as large as before, and hence may reach conclusions more quickly and certainly more cheaply. This in turn should make cheaper the development of new growth-affecting drugs.
o Parents and children
Parents and children worldwide will benefit from improved growth assessment through the development of more effective evidence-based growth charts, particularly in puberty.
People |
ORCID iD |
Timothy Cole (Principal Investigator) |
Publications
Shirley M
(2018)
Metabolic rate of major organs and tissues in young adult South Asian women
in European Journal of Clinical Nutrition
Marphatia AA
(2016)
Associations of gender inequality with child malnutrition and mortality across 96 countries.
in Global health, epidemiology and genomics
Cole T
(2017)
What predicts intergenerational change in anthropometry?
in Indian Pediatrics
Kuh D
(2016)
Pubertal timing and bone phenotype in early old age: findings from a British birth cohort study.
in International journal of epidemiology
Cole TJ
(2016)
Using Super-Imposition by Translation And Rotation (SITAR) to relate pubertal growth to bone health in later life: the Medical Research Council (MRC) National Survey of Health and Development.
in International journal of epidemiology
Fagg J
(2015)
After the RCT: who comes to a family-based intervention for childhood overweight or obesity when it is implemented at scale in the community?
in Journal of epidemiology and community health
Viner RM
(2015)
Life course epidemiology: recognising the importance of adolescence.
in Journal of epidemiology and community health
Harmatz P
(2017)
The effect of galsulfase enzyme replacement therapy on the growth of patients with mucopolysaccharidosis VI (Maroteaux-Lamy syndrome).
in Molecular genetics and metabolism
Woo JG
(2017)
Assessing adiposity using BMI z-Score in children with severe obesity.
in Obesity (Silver Spring, Md.)
Wright CM
(2018)
Pathways into and out of overweight and obesity from infancy to mid-childhood.
in Pediatric obesity
Rolland-Cachera M
(2018)
Does the age at adiposity rebound reflect a critical period?
in Pediatric Obesity
Salt C
(2017)
Growth standard charts for monitoring bodyweight in dogs of different sizes.
in PloS one
Besser R
(2018)
Exploring C-peptide loss in type 1 diabetes using growth curve analysis
in PLOS ONE
Cole T
(2017)
The Remarkable Life of Frances Wood
in Significance
Cole TJ
(2016)
Weight centile crossing in infancy: correlations between successive months show evidence of growth feedback and an infant-child growth transition.
in The American journal of clinical nutrition
Millington GW
(2015)
Growth and hormonal profiling in children with congenital melanocytic naevi.
in The British journal of dermatology
Lum S
(2015)
How "healthy" should children be when selecting reference samples for spirometry?
in The European respiratory journal
Stanojevic S
(2015)
Global Lung Function Initiative equations improve interpretation of FEV1 decline among patients with cystic fibrosis.
in The European respiratory journal
Lum S
(2015)
Lung function in children in relation to ethnicity, physique and socioeconomic factors.
in The European respiratory journal
Peters C
(2016)
Defining the Newborn Blood Spot Screening Reference Interval for TSH: Impact of Ethnicity.
in The Journal of clinical endocrinology and metabolism
Description | MRC Research Grant |
Amount | £72,596 (GBP) |
Funding ID | MR/M012069/1 |
Organisation | Medical Research Council (MRC) |
Sector | Public |
Country | United Kingdom |
Start | 03/2015 |
End | 02/2018 |
Description | MRC research grant |
Amount | £120,518 (GBP) |
Funding ID | MR/R010692/1 |
Organisation | Medical Research Council (MRC) |
Sector | Public |
Country | United Kingdom |
Start | 03/2018 |
End | 08/2019 |
Title | sitar library |
Description | a library package written in R to fit my sitar growth curve model. It is available free to download from CRAN (the Comprehensive R Archive Network) and the source code is available free at Github (URL below). |
Type Of Material | Computer model/algorithm |
Year Produced | 2013 |
Provided To Others? | Yes |
Impact | The sitar package has been used by several research groups who have downloaded it from CRAN. The sitar model has been the basis for my research for the past few years, and it has resulted in 19 publications and 78 citations (as of March 2019). Update March 2020. The original SITAR (Cole et al 2010) paper now has 100 citations. The sitar package is now at version 1.1.2. |
URL | https://github.com/statist7/sitar |
Description | Charlotte Wright |
Organisation | University of Glasgow |
Department | Maternal and Child Health Glasgow |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | data and statistical analysis |
Collaborator Contribution | clinical expertise |
Impact | 26883079 29998577 |
Start Year | 2011 |
Description | Crozier |
Organisation | University of Southampton |
Department | MRC Lifecourse Epidemiology Unit |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | advice on growth modelling |
Collaborator Contribution | provision of data and shared authorship |
Impact | 30719940 |
Start Year | 2011 |
Description | MRC LHA |
Organisation | University College London |
Department | MRC Unit for Lifelong Health and Ageing |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | advice on growth and statistical analysis |
Collaborator Contribution | provision of data and other analyss |
Impact | publications: 27466311 27401728 |
Start Year | 2013 |
Description | MRC Nutrition ICH |
Organisation | University College London |
Department | Institute of Child Health |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | advice on aspects of growth and statistical analysis |
Collaborator Contribution | provision of data and joint authorship |
Impact | publications: 17429924 17667912 18239656 16770333 16894361 17179023 17209191 23076617 22580078 27604768 |
Description | Portex |
Organisation | University College London |
Department | Institute of Child Health |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | advice on growth and statistical analysis |
Collaborator Contribution | provision of data and joint authorship |
Impact | publications: 19574442 19065626 17197485 18006882 20351026 20817707 23045209 22743675 22474159 22183491 25254426 25700391 25837028 26493801 27831907 |
Title | sitar library |
Description | Software to fit the SITAR method to growth curves, submitted as the sitar package to the Comprehensive R Archive Network (CRAN). |
Type Of Technology | Software |
Year Produced | 2013 |
Open Source License? | Yes |
Impact | The availability of the open source software within R, the widely used free statistical software environment, has simplified its dissemination and encouraged others to try the method out. |
URL | http://cran.r-project.org/web/packages/sitar/index.html |
Description | BBC Radio 4 More or Less |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Type Of Presentation | Keynote/Invited Speaker |
Geographic Reach | International |
Primary Audience | Media (as a channel to the public) |
Results and Impact | In 2011 I spoke on the BBC Radio 4 programme More or Less, two successive weeks, about predicting a child's adult height from their current height. In 2013 I discussed a new index that had been proposed by Professor Trefethen to improve on the body mass index. In 2015 I was asked the question "Are tall people more likely to get cancer?" (URL below) Several friends and colleagues remarked that they'd heard the programme. |
Year(s) Of Engagement Activity | 2011,2013,2015 |
URL | http://www.bbc.co.uk/programmes/p0343hhk |
Description | Dental age assessment furore |
Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Media (as a channel to the public) |
Results and Impact | MP David Davies proposed using dental age assessment on child migrants to the UK. I was interviewed by BBC 5 Live, BBC News, Sky News and New Scientist to say that the assessment was inaccurate and should not be used.The Government stated at the time and subsequently that they would not use dental age assessment. |
Year(s) Of Engagement Activity | 2016 |
URL | https://www.newscientist.com/article/2109703-dental-checks-cant-verify-the-age-of-child-asylum-seeke... |
Description | Interview for Newshour |
Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Media (as a channel to the public) |
Results and Impact | A 5-minute interview with Lyce Douset on the BBC World Service Newshour radio programme about the proposal by the German CSU party to introduce dental age assessment for asylum seekers The interview runs from 40-45 minutes on the URL. |
Year(s) Of Engagement Activity | 2017 |
URL | http://www.bbc.co.uk/programmes/w172vr1jvxkjn7n |
Description | Slimboy Fat - the problem with BMI |
Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Media (as a channel to the public) |
Results and Impact | A radio programme introduced by Dr Mark Porter entitled "Slimboy Fat - the problem with BMI", where I discussed the pros and cons on the BMI. |
Year(s) Of Engagement Activity | 2015 |
URL | http://www.bbc.co.uk/programmes/b064z553 |
Description | Sun story on tallest couple |
Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Media (as a channel to the public) |
Results and Impact | An article about the height of twins of a very tall couple. The article was accompanied by a commentary by me. |
Year(s) Of Engagement Activity | 2017 |
URL | https://www.thesun.co.uk/living/3071810/britains-tallest-couple-add-twin-boys-to-their-lofty-brood-w... |
Description | Swedish TV programme on age assessment |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | Malin Attefall edits and produces the weekly science programme Vetenskapens värld at SVT television in Sweden. She included interviews and film of me in a programme about developmental age assessment of child migrants that screened in October 2016. The programme was in Swedish, with some interviews in English (including mine). I understand that the programme generated some discussion within Sweden about the problems of assessing age in migrants. |
Year(s) Of Engagement Activity | 2016 |