{ "abstract": "Background\n\nWhen investigating effects of baseline exposures on changes in continuous outcomes in longitudinal studies, the change-score model is increasingly recommended, while baseline adjustment is debated. Limited empirical evidence exists on the extent to which these choices matter. We examined how different modeling strategies influence estimated effects using alcohol and prospective changes in cardiometabolic health markers as an example.Methods\n\nWe used data from the German National Cohort (NAKO; ∼205 000 participants at baseline, ∼140 000 at 4-5-year follow-up). Participants reported alcohol consumption at baseline (2014-19) and were classified as light, moderate, heavy, former, or never drinkers. Triglycerides (TG), systolic and diastolic blood pressure (SBP and DBP), high-density lipoprotein cholesterol (HDL-C), and glycated hemoglobin were measured at baseline and 5 years later. Longitudinal effects were estimated using a change-score model informed by directed acyclic graphs without baseline adjustment, and compared to a baseline-adjusted model and a model that adjusted for the average of baseline and follow-up (Oldham's). Statistical tests assessed whether changes in the outcome depended on baseline levels.Results\n\nChange-score and Oldham's models produced highly consistent results across all five cardiometabolic markers, whereas baseline-adjusted change-score models yielded different results for all. Statistical tests assessing the relationship between baseline levels and subsequent change did not indicate whether baseline adjustment would materially alter the results. Based on the change-score models, former drinkers had lower 5-year TG change and higher SBP, DBP, and HDL-C changes compared with light drinkers, while heavy drinkers had lower DBP change.Conclusion\n\nWhen exposure precedes the baseline outcome, baseline adjustment in change-score analyses may substantially alter effect estimates.", "abstract_shown": true, "affiliations": [ "Molecular Epidemiology Research Group, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.", "Institute for Public Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.", "Epidemiology Research Group, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.", "Department for Biostatistics and Clinical Epidemiology, Centre for Stroke Research, Charité - Universitätsmedizin Berlin, Berlin, Germany.", "Population Sciences in the Pacific, University of Hawai'i Cancer Center, Honolulu, HI, United States.", "Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Neuherberg, Germany.", "Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany.", "DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.", "German Center for Diabetes Research (DZD e. V.), Neuherberg, Germany.", "Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.", "Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.", "Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelbrerg, Germany.", "Cancer Prevention Graduate School, German Cancer Research Center (DKFZ), Heidelberg, Germany.", "Department of Epidemiology, Helmholtz Zentrum für Infektionsforschung, Brausnchweig, Germany.", "Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.", "Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.", "Institute of Epidemiology and Prevention, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany.", "Institute for Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Germany.", "Biobank Technology Platform, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.", "Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany." ], "article_type": "research article", "arxiv": null, "author_total": 19, "authors": [ { "affs": [ 0, 1 ], "name": "Martina Bouka", "orcid": "0009-0006-8827-6723" }, { "affs": [ 0, 2 ], "name": "Katharina Nimptsch" }, { "affs": [ 3 ], "name": "Ulrike Grittner" }, { "affs": [ 0 ], "name": "Solange Gonzalez Chiappe" }, { "affs": [ 0, 4 ], "name": "Gertraud Maskarinec", "orcid": "0000-0002-8129-958X" }, { "affs": [ 5, 6, 7, 8 ], "name": "Annette Peters" }, { "affs": [ 9 ], "name": "Claudia Meinke-Franze" }, { "affs": [ 10 ], "name": "Hansjörg Baurecht", "orcid": "0000-0002-9265-5594" }, { "affs": [ 11 ], "name": "Heiko Becher" }, { "affs": [ 9 ], "name": "Henry Völzke", "orcid": "0000-0001-7003-399X" }, { "affs": [ 12 ], "name": "Hermann Brenner", "orcid": "0000-0002-6129-1572" }, { "affs": [ 13 ], "name": "Isti Rodiah" }, { "affs": [ 14 ], "name": "Lilian Krist" }, { "affs": [ 10 ], "name": "Michael Leitzmann" }, { "affs": [ 15 ], "name": "Nadia Obi", "orcid": "0000-0002-0903-9142" }, { "affs": [ 16 ], "name": "Peggy Sekula", "orcid": "0000-0003-2263-447X" }, { "affs": [ 14 ], "name": "Stefan N Willich" }, { "affs": [ 17 ], "name": "Rafael Mikolajczyk", "orcid": "0000-0002-3125-7859" }, { "affs": [ 0, 18, 19 ], "name": "Tobias Pischon", "orcid": "0000-0003-1568-767X" } ], "bibtex": "https://research.draconitic.com/paper/a9bcy1k7zmqrg.bib", "cited_by": 0, "doi": "10.1093/ije/dyag245", "fulltext_url": "https://europepmc.org/articles/PMC13728845", "id": "a9bcy1k7zmqrg", "issns": [ "0300-5771", "1464-3685" ], "landing_url": "https://europepmc.org/article/MED/42974917", "language": "eng", "licence": "CC-BY-NC-ND", "licence_label": "CC BY-NC-ND", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "AcademicSubjects/MED00860" ], [ "heading", "Original Article" ], [ "openalex", "2734|Alcohol Consumption and Health Effects" ] ], "openalex": "W7225151125", "pdf_url": "https://europepmc.org/articles/PMC13728845?pdf=render", "pmcid": "PMC13728845", "pmid": "42974917", "published": "2026-10-01", "publisher": "Oxford University Press", "ris": "https://research.draconitic.com/paper/a9bcy1k7zmqrg.ris", "sources": [ { "first_seen": "2026-11-04T15:20:49Z", "native_id": "MED:42974917", "source": "europepmc", "url": "https://europepmc.org/article/MED/42974917" }, { "first_seen": "2026-11-07T12:21:44Z", "native_id": "PMC13728845", "source": "pmc", "url": "https://doi.org/10.1093/ije/dyag245" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2734|Alcohol Consumption and Health Effects", "subfield": "general" } ], "title": "Comparison of modeling strategies to study the effect of an exposure on changes in continuous outcomes: evaluating the impact of alcohol consumption on changes in cardiometabolic health markers based on the German National Cohort (NAKO).", "title_text": "Comparison of modeling strategies to study the effect of an exposure on changes in continuous outcomes: evaluating the impact of alcohol consumption on changes in cardiometabolic health markers based on the German National Cohort (NAKO).", "type": "peer-reviewed", "updated_at": "2026-11-07T12:21:44Z", "url": "https://research.draconitic.com/paper/a9bcy1k7zmqrg", "venue": "International journal of epidemiology", "versions": [] }