# A multilevel and structural equation modeling approach to understand longitudinal growth, obesity, and cardiometabolic risk among Samoan children

> **NIH NIH F31** · BROWN UNIVERSITY · 2020 · $45,520

## Abstract

PROPOSAL SUMMARY
Despite considerable investments in prevention and treatment of obesity in children, prevalence continues to
increase with catastrophic individual and societal costs. Pacific Islanders are among the most at risk, with obesity
prevalence rising disproportionately faster among Pacific Islanders compared to other ethnic groups. Obesity
prevention strategies are clearly needed, but a) the early determinants of obesity among Pacific Islanders are
poorly understood, and b) for optimal efficacy, it is necessary to first understand both the age at which elevated
cardiometabolic risk markers are established and the periods of growth that are most sensitive to environmental
or behavioral risk factors during childhood. As such, we established the Ola Tuputupua’e “Growing Up” cohort
in Samoa; the first longitudinal cohort study of children among the Pacific Island nations. To date, the cohort
includes 450 children and their biological mothers with serial anthropometric measurements from 2015 (2-4 years
old) and 2017-2018 (3.5-7 years old). Cross-sectional findings from the study demonstrate that this cohort is
ideal for research focused on childhood obesity given the high prevalence and early emergence of
cardiometabolic risk. The objective of this proposal is to develop a comprehensive model of childhood obesity
development in Samoa that 1) describes growth and body composition during a critical age period for obesity
development, 2) captures influences of individual and household factors and the age periods during which growth
is most sensitive to them, and 3) quantifies the influence of longitudinal growth on cardiometabolic disease
markers. We will focus on body mass index (BMI) to assess growth over time, diet and physical activity as
modifiable individual-level factors, and household urbanicity and socioeconomic status as structural household-
level factors. We plan to collect data in 2019 from the same children (5.5-9 years old) to provide a third time point
for analysis, utilize newly collected dual energy-x-ray absorptiometry body composition data, and employ
longitudinal modeling approaches to address the following specific aims: 1) Use multilevel modeling to identify
individual and household-level factors associated with childhood BMI trajectories, 2) Use multilevel modeling to
assess the association of childhood BMI trajectories with (a) body composition (b) blood pressure, and (c)
glycosylated hemoglobin at 5.5-9 years old, and 3) Use structural equation modeling to assess the direct and
indirect effect of individual-and household-level factors on childhood BMI and body composition. This research
will be among the first to use a longitudinal, multilevel design to examine the time-fixed and time-varying effects
of individual and household-level factors on growth, body composition, and cardiometabolic disease markers
among children in the Pacific Island nations. The findings will likely apply to other settings and enhance our
unde...

## Key facts

- **NIH application ID:** 9925647
- **Project number:** 5F31HL147414-02
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Courtney Cheu Lin Choy
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $45,520
- **Award type:** 5
- **Project period:** 2019-04-01 → 2021-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9925647

## Citation

> US National Institutes of Health, RePORTER application 9925647, A multilevel and structural equation modeling approach to understand longitudinal growth, obesity, and cardiometabolic risk among Samoan children (5F31HL147414-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/9925647. Licensed CC0.

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