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Worm plot: a simple diagnostic device for modelling growth reference curves.

S van Buuren1, M Fredriks

  • 1Department of Statistics, TNO Prevention and Health, Leiden, P.O. Box 2215, 2301 CE Leiden, The Netherlands. S.vanBuuren@pg.tno.nl

Statistics in Medicine
|April 17, 2001
PubMed
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The worm plot is a diagnostic tool that helps create accurate growth reference curves by assessing data normality. It aids in refining the LMS model for better age-conditional mean and skewness modeling in anthropometric studies.

Area of Science:

  • Statistics
  • Biostatistics
  • Growth Monitoring

Background:

  • Growth reference curves are essential for monitoring child development.
  • The LMS model provides a flexible framework for constructing these curves.
  • Assessing the fit of the LMS model, particularly age-conditional normality, is crucial for accurate curve generation.

Purpose of the Study:

  • To introduce and evaluate the worm plot as a diagnostic tool for assessing age-conditional normality in the context of growth reference curve construction.
  • To demonstrate the application of the worm plot in refining the LMS model parameters for the Fourth Dutch Growth Study.
  • To compare the performance of the LMS model in capturing different aspects of data distribution (mean, skewness, variation, kurtosis).

Main Methods:

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  • Utilized the worm plot to visualize differences between observed and expected distributions of transformed anthropometric data.
  • Applied the LMS (Lambda, Mu, Sigma) model, with age-dependent smooth parameter curves for median, variation, and skewness.
  • Assessed the fit of various LMS models by examining features of the worm plot, such as offset, slope, and curvature.
  • Main Results:

    • The worm plot effectively assessed age-conditional normality of transformed data under different LMS models.
    • Application to the Dutch Growth Study data yielded satisfactory anthropometric reference curves.
    • The LMS method demonstrated superior performance in modeling age-conditional mean and skewness compared to variation and kurtosis.

    Conclusions:

    • The worm plot is a valuable tool for diagnostic checks in growth curve modeling.
    • The LMS model, when refined using worm plot diagnostics, provides reliable growth reference curves.
    • The study highlights the importance of assessing age-conditional normality for accurate anthropometric data analysis.