Latent Class Growth Modeling Research Articles

Co-developmental trajectories of aggression and rule-breaking from middle childhood to early adolescence: individual and environmental predictors.

This study examined the heterogeneous co-developmental trajectories of aggression and rule-breaking from middle childhood to early adolescence, as well as how these identified, distinct trajectories related to individual and environmental predictors. A total of 1944 Chinese elementary school students in grade 4 (45.5% girls, Mage = 10.06, SD = 0.57) completed measures on five occasions across two and a half years, using six-month intervals. Findings included: (a) Parallel process latent class growth modeling revealed four distinct co-developmental trajectory groups of aggression and rule-breaking: congruent-low (84.0%); moderate-decreasing aggression and high-decreasing rule-breaking (3.8%); moderate-increasing aggression (5.9%); and moderate-increasing rule-breaking (6.3%); (b) Multivariate logistic regression analyses revealed that children belonging to the high risk groups were more likely to experience multiple individual and environmental difficulties. Implications for prevention of aggression and rule-breaking were discussed.

BMI growth trajectory from birth to 5 years and its sex-specific association with prepregnant BMI and gestational weight gain.

The purpose of the study was to identify the latent body mass index (BMI) z-score trajectories of children from birth to 5 years of age and evaluate their sex-specific association with prepregnant BMI and gestational weight gain (GWG). This was a retrospective longitudinal cohort study performed in China. In total, three distinct BMI-z trajectories from birth to 5 years of age were determined for both genders using the latent class growth modeling. The logistic regression model was used to assess the associations of maternal prepregnant BMI and GWG with childhood BMI-z growth trajectories. Excessive GWG increased the risks of children falling into high-BMI-z trajectory relative to adequate GWG (OR = 2.04, 95% CI: 1.29, 3.20) in boys; girls born to mothers with prepregnancy underweight had a higher risk of low-BMI-z trajectory than girls born to mothers with prepregnancy adequate weight (OR = 1.85, 95% CI: 1.22, 2.79). BMI-z growth trajectories of children from 0 to 5 years of age have population heterogeneity. Prepregnant BMI and GWG are associated with child BMI-z trajectories. It is necessary to monitor weight status before and during pregnancy to promote maternal and child health.

Predictors and trajectories of fear of cancer recurrence in Chinese breast cancer patients

ObjectiveFear of cancer recurrence (FCR) is one of the most common and aversive psychological phenomena among cancer patients. This study explored the trajectories of FCR over the 18 months following discharge, and evaluated the associations between baseline demographic and clinical variables and FCR trajectories among Chinese women treated for breast cancer. MethodsThis is a longitudinal prospective study. All participants were asked to completed a battery of questionnaires (FCR-7, PHQ-9, GAD-7 and MPQ-VAS) at baseline, 6, 12, and 18 months after discharge. Generalized linear mixed model and group-based trajectory analyses were conducted. ResultsThree hundred women with breast cancer were recruited. Latent class growth modeling analysis showed that three-group trajectory solution was the best fitting (i.e., ‘intermediate level-stable group’ (63.3%), ‘low level-increasing group’ (18.3%), and ‘high level-decreasing group’ (18.3%). Patients reported significant higher FCR at baseline assessment compared to other time points. Significant positive associations were found between anxiety, depression and FCR. Patients who had no baseline depression (estimate = −2.14, 95% CI: −2.78-(−1.51), P < 0.001) or anxiety (estimate = −2.77, 95% CI: −3.44-(−2.10), P < 0.001) tended to report significant lower FCRs over time. Women with none/mild life stress exhibited significant lower FCRs than those with moderate/high life stress, and participants with a family history of cancer or pessimism reported higher FCRs. Conclusion>60% of the breast cancer women showed intermediate level-stable FCRs over the 18 months after discharge. Baseline anxiety, depression, life stress, family cancer history and pessimism predicts higher FCR levels. Clinical teams responsible for continuing patient care following treatment should develop clearer strategies for management of FCR.

The trajectories and associations of insomnia symptoms with addictive behaviours in adolescents: A two-year longitudinal study.

Insomnia displays heterogeneous trajectories across adolescence, which may induce addictive behaviours, including internet gaming disorder and substance use. This study aimed to investigate the latent trajectory classes of insomnia symptoms over 2 years and to examine the associations between insomnia trajectories and these addictive behaviours. Participants were 910 adolescents from six middle schools in Shanghai, China (52.7% males; mean age=13.17 years). The three-wave survey measured insomnia symptoms, internet gaming disorder, substance use, depressive symptoms, and sociodemographic characteristics from 7th to 9th grade. Latent class growth modelling was performed to identify the latent trajectory classes of insomnia symptoms. Then multivariable logistic regressions were conducted within the best-fitting latent class growth model to examine the associations of insomnia trajectories with internet gaming disorder and substance use. Two latent trajectory classes of insomnia symptoms were recognised: the non-insomnia group (71.8%) and the insomnia group (28.2%). In the multivariable analysis controlling for baseline demographic variables and depressive symptoms, the insomnia group had a higher risk of developing internet gaming disorder (OR=2.203 [95% CI: 1.258-3.858]) and substance use (OR=2.215 [95% CI: 1.324-3.705]) compared with the non-insomnia group. These findings add to a growing body of research on heterogeneous trajectories of insomnia symptoms during adolescence, suggesting that intervention strategies are needed to target the characteristics or developmental patterns of different insomnia subgroups. The ultimate goal is to mitigate the impact of insomnia symptoms on adolescent addictive behaviours.

Associations of Long-Term Physical Activity Trajectories With All-Cause Mortality in a General Population.

Objectives: We investigated the associations of mean levels of leisure-time physical activity (LTPA) and latent LTPA trajectories with all-cause mortality risk. Methods: Trajectories of LTPA were established using group-based trajectory analysis with a latent class growth model in a population-based cohort between 1996 and 2014. A Cox-proportional hazard model was conducted to examine the associations of LTPA quintiles and LTPA trajectories with all-cause mortality. Results: A total of 21,211 participants (age 18-90years) were analyzed (median follow-up 16.8 years). The study participants were divided into five groups according to percentiles of LTPA (<20th, 20th-<40th, 40th-<60th, 60th-<80th, ≥80th) and LTPA trajectories (low/stable, medium/stable, increasing, decreasing, and fluctuating), respectively. Participants with a decreasing trajectory did not have a significantly lower risk of all-cause mortality despite having the highest baseline level of LTPA. In contrast, participants with a medium/stable (HR 0.84, 95% CI 0.72-0.98, p = 0.031) or an increasing (HR 0.57, 95% CI 0.33-0.97, p = 0.037) trajectory had a significantly lower risk of all-cause mortality. Conclusion: Promotion of maintaining stable LTPA is beneficial for public health and survival.

Tajectories of the self-efficacy of HIV testing among MSM based on latent class growth model

Objective: To analyze the trajectories of HIV testing self-efficacy among men who have sex with men (MSM) based on latent class growth model. Methods: From August 2019 to May 2021, 404 MSM were recruited in Shandong Province and subjected to a 1-year follow-up study with individual intervention (pushing intervention pictures and videos in WeChat and follow-up questionnaires) and community intervention (forwarding to friends and sharing and discussing HIV testing-related information in WeChat groups). The level of HIV testing self-efficacy among MSM was measured. The long-term trend of HIV testing self-efficacy was analyzed using the latent class growth model (LCGM), and the influencing factors of the trend were analyzed. Results: A total of 404 MSM were (28.25±8.95) years old, with the oldest being 58 and the youngest being 18. The scores of HIV testing self-efficacy M(Q1, Q3) at baseline and 4 follow-ups were 18.00 (17.00, 21.00), 19.00 (18.00, 22.00), 19.00 (18.00, 22.00), 19.00 (18.00, 22.00) and 19.00 (18.00, 22.00). The results of the freely estimated two-category LCGM model showed that the trend of HIV testing self-efficacy among MSM could be divided into two classes, "intervention response group" [255(63.1%)] and "intervention non-response group" [149(36.9%)]. The former had a higher level of HIV testing self-efficacy which tended to increase at first and then decrease over time, while the latter had a lower and more stable level. The results of the multifactorial logistic regression analysis showed that the OR values of MSM in business or service and jobless or unemployed were 0.261 (95%CI: 0.108-0.633) and 0.186 (95%CI: 0.057-0.610), respectively, using the students as the reference group. Conclusion: There is a group heterogeneity in the trend of HIV testing self-efficacy in the intervention conditions among MSM, and occupation may be an influencing factor.

Trajectories of Posttraumatic Stress Symptoms Among Young Adults Exposed to a Typhoon: A Three-Wave Longitudinal Study.

Objective: We used a latent class growth model to identify distinct PTSS trajectories and correlates of these trajectories among young adults who experienced Typhoon Hato, the strongest storm to strike China in the last 50years. Methods: A longitudinal survey (three-waves) was conducted to explore the mental health status and its correlates among young adults exposed to the typhoon. Data from 362 participants were analyzed via a latent class growth model and multinomial logistic regression. Results: Three distinct classes of PTSS trajectories were identified, including: "resilience" (86.46%), "recovery" (9.12%), and "deterioration" (4.42%). The higher levels of direct typhoon exposure, media use, and posttraumatic growth significantly predicted the higher likelihood of participants being in the "recovery'' class. In addition, more social support significantly predicted the higher possibility of being in the "resilience" class. Finally, more severe depressive and anxiety symptoms significantly predicted the higher likelihood of being in the "deterioration" class. Conclusion: Further research should develop interventions to enhance protective factors (e.g., posttraumatic growth, media use), decrease risk factors (e.g., depressive and anxiety symptoms), and thereby prevent PTSS.

The 30-year cardiovascular risk trajectories and their independently associated factors in participants of a Brazilian cohort (CUME Study).

We aimed to analyze the different trajectories of 30-year cardiovascular risk (CVR) and its independently associated factors in participants of the CUME Study, a prospective study with alumni from federal universities of Minas Gerais State, Brazil. In this study, 1,286 participants who answered the baseline (2016) and follow-up (2018 and 2020) questionnaires were included. Trajectories of CVR, according to the Framingham score, were identified with the latent class growth modelling technique with the use of the censored normal model. Analysis of the factors independently associated with each of the trajectories was conducted with multinomial logistic regression technique. Three CVR trajectories were identified: Low-Low (68.3%), Medium-Medium (26.2%), and High-High (5.5%). Male sex, living in a stable union, and having moderate and high intakes of ultra-processed foods were positively associated with the Medium-Medium and High-High CVR trajectories. Having non-healthcare professional training and working were positively associated with the Medium-Medium CVR trajectory, whereas being physically active was negatively associated with the High-High CVR trajectory. In conclusion, more than one-third of participants had CVR trajectories in the Medium-Medium and High-High categories. Food consumption and physical activity are modifiable factors that were associated with these trajectories; thus, implementing health promotion measures could help prevent the persistence or worsen of CVR. On the other hand, sociodemographic and labor characteristics are non-modifiable factors that were associated with Medium-Medium and High-High trajectories, which could help identify people who should be monitored with more caution by health services.

Developmental trajectories at a high risk for childhood overweight/obesity.

The associations between developmental patterns (trajectories) in children and maternal factors have been widely investigated, but paternal effects on these trajectories are unclear. This study aimed to determine children's and parental factors involved in developmental trajectories at a high risk for having adverse cardiovascular (CV) profiles in children. We analysed longitudinal anthropometric data from birth to present and CV profiles of 1832 healthy volunteers (51% girls) aged 3-15 years who participated in a nationwide study between July 2012 and January 2014. Six-trajectory latent class growth models were developed using body mass index Z-scores. Predictors for being in developmental trajectories at a high risk for adverse CV profiles were determined by multivariate regression analysis. The mean number of anthropometric data points was 12±3 for both boys and girls. Among the six trajectories, the infantile onset and continual increase groups had significantly worse levels of many CV profiles than those in the remaining groups. Paternal overweight/obesity was an independent predictor for boys being in the infantile onset group and for girls being in the continual increase group. Additionally, maternal pre-pregnancy overweight/obesity in boys and maternal excessive gestational weight gain in girls were independent predictors for being in the infantile onset group. Having no other sibling in boys and an older maternal age were independent predictors for being in the continual increase group. Interventions to prevent childhood obesity should include strategies that focus on fathers and mothers and those that focus on children with some familial backgrounds.

Growth trajectories in lipid profile and fasting blood sugar in prediabetic people over a 16- year follow-up and future risk of type2 diabetes mellitus: A latent growth modeling approach

ABSTRACT Introduction The current study aimed to investigate whether the pattern of changes in lipid profile and fasting blood sugar (FBS) can predict the future risk of type 2 diabetes mellitus (T2DM) incidence in prediabetic people. Methods In a prospective cohort study, 1228 prediabetic patients were followed from 2003 until 2019 and longitudinal data on lipid indices (CHOL: cholesterol; HDL: high-density lipoprotein; LDL: low-density lipoprotein; TG: triglyceride) and fasting blood sugar (FBS) were recorded. The latent class growth model (LCGM) was used to estimate growth trajectories and to determine distinct subgroups (latent class) with a similar trajectory for lipid profile and FBS over time. The incidence of T2DM in extracted latent classes was compared. Results Finally, 946 people with complete data were included in statistical analysis. Two latent classes were identified based on the change in FBS including high-risk and low-risk classes (class size: 5.2% vs. 94.8%) with T2DM incidence rates 100% and 35.9%, respectively (P < 0.001). Two distinct subgroups were identified based on changes in lipid profile. Latent classes with abnormal TG, CHOL, HDL, and LDL included 18.8%, 21.8%, 38.8%, and 24% of study participants, respectively. The incidence rates of T2DM and remaining prediabetic in abnormal TG latent class were 57.2% and 30.8%, and in abnormal HDL latent class were 41.5% and 31.7% were significantly different from normal latent classes (P < 0.001). While in the extracted latent classes based on CHOL and LDL the incidence rates were not statistically significant differences (P > 0.05). Conclusions We identified two subgroups with high and low risk of future T2DM based on the changes in FBS and lipid profile by applying LCGM. The incidence of T2DM in extracted latent classes was significantly different. LCGM is a reliable approach for predicting the risk of T2DM incidence based on trajectories of risk factors.

결혼이주여성들의 건강상태 변화유형과 예측요인 탐색: 잠재계층성장분석을 활용하여

This study aimed to examine different types of health status trajectories among married immigrant women in South Korea. This study also identified individual and environmental factors contributing to the development of each type. The sample was 1237 mothers who participated in the Multicultural Adolescents Panel Study. Using latent class growth modeling, results identified three class trajectories with their unique timing and course of health status: high-stable, high-decrease, and low-stable. Also, the multinomial logistic regression analysis indicated that each class membership was conditional to different individual and environmental factors, including age, self-esteem, household economic status, social network, and residential area. These findings suggest the importance of specific and targeted programs and policies promoting married immigrant women's health.

PHYSICAL FUNCTIONING AND BODY SIZE IN MID-LIFE WOMEN: THE STUDY OF WOMEN’S HEALTH ACROSS THE NATION

Abstract To evaluate patterns of age-related changes in physical functioning (PF) and associations with body size, we utilized data from the longitudinal Study of Women’s Health Across the Nation (SWAN). Participants (n=1,793) with self-reported SF-36 PF data at visit 4 (2000-01; mean age:50.0 years ±2.7), visit 15 (2016-17), plus one additional visit were included. Body weight and waist circumference were measured at each visit; change from visits 4 to 15 was calculated. Five PF trajectories were identified using latent class growth modeling (% of women): (1) persistently low (4.1%); (2) start moderate and improve slightly (5.4%); (3) start high and decline slightly (24.0%); (4) persistently high (59.5%); and (5) start high and decline substantially (7.0%). Participants with persistently low PF (Group 1) lost weight during follow-up (mean change: -3.2% body weight) whereas there was little change in all other groups (ANOVA p&amp;lt; 0.0001). Women with persistently low PF (Group 1) had &amp;lt; 2% increase in waist circumference over follow-up; all other groups had more than double that increase (range: 4.1%-6.1%; ANOVA p=0.002). No statistically significant differences in anthropometry changes across the PF groups were observed after adjustment for sociodemographic and time-variant health characteristics. PF trajectories may be associated with changes in body weight or waist circumference during midlife and transition to older adulthood; however, these associations may be explained by other major health-related variables. Future research is needed to understand the complex interplay between PF and body size, particularly for women at-risk for late-life disability that may benefit from preventive efforts in mid-life.

CHRONIC NEGATIVE SOCIAL TIES: IMPLICATIONS FOR EXPOSURE AND REACTIVITY TO DAILY SOCIAL INTERACTIONS

Abstract Negative relationships (i.e., irritating, demanding) predict poor well-being and daily processes may account for these links. This study examined longitudinal trajectories of negative ties and their links with daily social interactions and well-being. A total of 169 individuals ages 33 to 91 reported negative relationship quality (spouse/child/friend) in 1992, 2005, 2015, and 2018 and completed 4-5 days of surveys every three hours regarding positive and negative social interactions and negative affect. Latent class growth models revealed two trajectories of negative relationships (moderate-stable and low-decreasing). Individuals in the moderate-stable trajectory reported more frequent daily interpersonal tensions but no link with positive interactions. The link between negative relationship trajectories and daily negative affect was moderated by daily positive interactions such that the association was reduced when individuals had positive interactions. Thus, negative ties may increase exposure but not reactivity to daily tensions and daily positive interactions buffer the negative tie-well-being link.

Developmental trajectories of Korean and heritage language proficiencies and their association with maladjustment among Korean multicultural adolescents.

This study identified changes in Korean and heritage language proficiencies across five waves (2011-2015) and examined the association between linguistic acculturation trajectories and adjustment (2016) among Korean adolescents with immigrant family backgrounds (N=1441; 51.21% female; Mage(baseline) =9.97). All adolescents were from multiethnic families with 91.65% comprising a non-Korean Asian mother (e.g., Japan, Philippines, China, Thailand) and Korean father. Parallel process latent class growth modeling and multivariate regression analysis were conducted to estimate the trajectories of linguistic acculturation and their effects on adolescents' future adjustment. Linguistic acculturation trajectories were classified into three latent groups. Bilingual adolescents demonstrated better adjustment over adolescents in other trajectories. Findings highlight the importance of considering patterns of change in linguistic acculturation for understanding Korean multicultural adolescents' adjustment.

Longitudinal correlation between cell phone use and sleep quality in college students

Objective: To investigate the current situation of cell phone use and sleep quality among college students, establish a sleep quality trajectory model and explore the influence of cell phone use on the sleep quality trajectory. Methods: Based on data from the College Student Behavior and Health Cohort Study 2019-2020, a latent class growth modeling was used to establish a sleep quality trajectory model among college students. The baseline influencing factors of sleep quality trajectories among college students were analyzed by χ2 test, and the effects of cell phone use on sleep quality trajectories were analyzed by binary logistic regression. Results: A total of 1 092 college students were included in the analysis. The detection rates of cell phone use and poor sleep quality were 24.5% and 13.3%. Latent class growth model identified two groups of sleep quality trend trajactories: an improved sleep quality group (86.0%) and a decreased sleep quality group (14.0%). The result of binary logistic regression showed that the cell phone use was a risk factor of sleep quality trajectories. Conclusion: The cell phone use during college period could increase the risk of poor sleep quality. Targeted intervention measures about cell phone use should be adopted to improve the sleep quality among college students.

Pulse pressure trajectories predict brain microstructure in an APOE‐dependent manner among cognitively normal older adults

AbstractBackgroundArterial stiffness is associated with increased risk of cognitive decline and dementia in older adults; however, the mechanisms by which arterial stiffness impacts brain health remain unclear. We examined whether trajectories of pulse pressure (PP), a surrogate marker of arterial stiffness, beginning in midlife predicted brain microstructure at older age, using the multicompartment diffusion MRI technique restriction spectrum imaging (RSI). We assessed whether effects of PP on executive function were mediated by brain microstructure, and whether APOE genotype modified associations between PP and microstructure.MethodWe included 146 cognitively normal adults (mean age=76.6, SD=6.8 years) who underwent RSI and cognitive testing in 2014‐2016 and measurements of PP up to eight times before MRI, from 1984‐2016. Participants were classified according to PP trajectory using latent class growth modeling. Restricted isotropic diffusion (RI), neurite density, isotropic free water (IFW), and hindered isotropic diffusion (HI) were computed in five subcortical regions and 15 white matter tracts. Multiple linear regression examined associations between PP trajectories and microstructure, and between microstructure and Trails B performance. Mediation analyses, adjusted for covariates, evaluated whether microstructure mediated effects of PP trajectories on executive function. Age‐and‐sex‐adjusted partial correlations tested associations between continuous PP and RSI metrics by APOE genotype (ε4 carriers versus non‐carriers).ResultParticipants with high PP trajectories (n=50) had lower RI and higher HI and IFW in multiple subcortical regions and fiber tracts compared to those with low PP trajectories (n=96), and of these, eight were also associated with Trails B performance. Associations between high PP trajectories and worse executive function were mediated by lower RI in the amygdala (βa*βb=4.13, 95%CI=0.91‐11.01) and in several fiber tracts including the parachippocampal cingulum (βa*βb=3.77, 95%CI=0.95‐9.93) and fornix (βa*βb=3.71, 95%CI=0.59‐10.19). High PP more strongly correlated with lower RI in the hippocampus, uncinate fasciculus, and inferior fronto‐occipital fasciculus (IFO); with high IFW in the IFO and superior corticostriatal fasciculus, and with high amygdala HI, among APOE4 ε4 carriers than non‐carriers (Figure).ConclusionProlonged elevated PP predicts subcortical and white mater microstructural abnormalities, particularly for those at greater risk for dementia, and may contribute to impaired executive function via microstructural injury.

Association between markers of left atrial cardiopathy and cognitive decline in the absence of atrial fibrillation

AbstractBackgroundWhether atrial cardiopathy is independently associated with cognitive impairment in the absence of atrial fibrillation (AF) remains unknown. This longitudinal cohort study aims to investigate associations between markers of left atrial cardiopathy and cognitive decline, and to identify longitudinal trajectories of cognitive decline in aging adults without AF over time.MethodA cohort of adults ≥45 years of age with no prior AF or cognitive impairment (N=21,869) was ascertained from the REGARDS (Reasons for Geographic and Racial Differences in stroke) prospective cohort study database. Markers of left atrial cardiopathy included atrial premature complexes (APCs) and N‐Terminal pro‐Brain Natriuretic Peptide (NTpro‐BNP). Cognitive status was measured using Six‐Item Screener (SIS) and an SIS score &lt;5 was defined as cognitive impairment. Cox proportional hazards regression was used to estimate the cause‐specific hazard for primary (cognitive impairment) and secondary outcomes (stroke). Cognitive status trajectories were identified using latent class growth models. Baseline characteristics associated with each trajectory were identified using multinomial logistic regression.ResultDuring a mean follow‐up of 9.9 years, 6,060 participants had incident cognitive impairment and 876 had a stroke. APCs increased the hazard of cognitive impairment by 10% (hazard ratio [HR], 1.10, 95%CI: 1.00‐1.20) and stroke by 9% (HR, 1.09, 95%CI: 1.01‐1.18). Elevated NTpro‐BNP increased the hazard of cognitive impairment by 55% (HR, 1.55, 95%CI: 1.17‐2.04) and stroke by 35% (HR, 1.35, 95%CI: 1.13‐1.60). Three unique cognitive trajectories were identified: while 85% showed a normal and stable trajectory of SIS scores, 13% showed a progressively decreasing trajectory, and 2% showed a dramatic decrease in SIS scores. Age, coronary artery disease, diabetes, and NTpro‐BNP were all associated with worse cognitive trajectories.ConclusionWe showed that markers of left atrial cardiopathy including APCs and elevated NTpro‐BNP were associated with an increased risk of cognitive impairment and stroke in the absence of AF. Adults with these markers followed three unique longitudinal cognitive trajectories. These findings indicate that markers of left atrial cardiopathy (APCs and NTpro‐BNP) may have significant implications for early diagnosis and prevention of cognitive impairment.

Higher baseline BMI and lower estimated median income associated with increasing BMI after endometrial cancer diagnosis

IntroductionEndometrial cancer is often directly related to obesity and interventions for weight loss have mixed results. Risk factors for continued weight gain after diagnosis are not clearly defined in the literature. The objective of this study is to describe risk factors associated with increased body mass index (BMI) trajectory among endometrial cancer patients. MethodsPatients who were surgically treated for endometrial cancer at a single institution between 2010 and 2015 were identified. Demographics including age, race/ethnicity and estimated median income at diagnosis were obtained. BMI at five time points after diagnosis were calculated. BMI trajectories were estimated by latent class growth modeling using the PROC TRAJ procedure in SAS. Chi-squared tests and ANOVA were used to assess differences between trajectory groups. Statistical significance was set to a p-value < 0.05. ResultsOf 695 patients included in the study, the average age at diagnosis was 62 years and over 70% of patients were obese at baseline. Patients experienced increasing, stable, or decreasing BMI over 2 years following diagnosis. Patients with younger age and lower estimated median income were most likely to be in the increasing BMI group. Among obese patients, those with Class I obesity (BMI 30 to 34.9 kg/m2) were most likely to experience decreasing BMI and those with Class III obesity (BMI > 40 kg/m2) were most likely to experience increasing BMI, p < 0.0001. ConclusionA third of endometrial cancer survivors experience increasing BMI. Severity of obesity at diagnosis matters, patients with severe obesity (Class III) were most likely to experience weight gain.

WITHDRAWN: Higher baseline BMI and lower estimated median income associated with increasing BMI after endometrial cancer diagnosis

Endometrial cancer is often directly related to obesity and interventions for weight loss have mixed results. Risk factors for continued weight gain after diagnosis are not clearly defined in the literature. The objective of this study is to describe risk factors associated with increased body mass index (BMI) trajectory among endometrial cancer patients. Patients who were surgically treated for endometrial cancer at a single institution between 2010 and 2015 were identified. Demographics including age, race/ethnicity and estimated median income at diagnosis were obtained. BMI at five time points after diagnosis were calculated. BMI trajectories were estimated by latent class growth modeling using the PROC TRAJ procedure in SAS. Chi-squared tests and ANOVA were used to assess differences between trajectory groups. Statistical significance was set to a p-value<0.05. Of 695 patients included in the study, the average age at diagnosis was 62years and over 70% of patients were obese at baseline. Patients experienced increasing, stable, or decreasing BMI over 2years following diagnosis. Patients with younger age and lower estimated median income were most likely to be in the increasing BMI group. Among obese patients, those with Class I obesity (BMI 30 to 34.9kg/m2) were most likely to experience decreasing BMI and those with Class III obesity (BMI>40kg/m2) were most likely to experience increasing BMI, p<0.0001. A third of endometrial cancer survivors experience increasing BMI. Severity of obesity at diagnosis matters, patients with severe obesity (Class III) were most likely to experience weight gain.

Developmental trajectories of positivity from mid-childhood to early adolescence: Family and school environmental predictors.

This study examined the heterogeneity in positivity trajectories and the predictive roles of family and school environments (i.e., perceived parental warmth and basic psychological need satisfactions at school) from mid-childhood to early adolescence. Elementary school students in China (N= 2204, 54.9% boys, Mage = 9.47 years) completed relevant measures on six occasions, every 6 months. Latent class growth modeling revealed four heterogeneous developmental trajectories of positivity: High-Increasing (50.6%), Moderate Low-Increasing (33.2%), Low-Stable (11.0%), and High-Decreasing (5.2%). Perceived parental warmth and satisfaction of relatedness and competence needs at school significantly predicted trajectory class membership. Findings underscore the value of identifying group difference in positivity development in youth and the need for specific interventions targeting their unique characteristics.