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Infection, not antibiotic use, linked to childhood obesity risk
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Infection without antibiotic use in infancy is associated with an increased risk for childhood obesity, whereas both broad- and narrow-spectrum antibiotics were not associated with an increased obesity risk, according to findings from a longitudinal birth cohort study.
“To isolate the effect of antibiotic use, we compared antibiotic users with those who had similar underlying infection diagnostic codes but who did not use antibiotics,” De-Kun Li, MD, senior research scientist at the Kaiser Foundation Research Institute at Kaiser Permanente Northern California, and colleagues wrote. “We used several analytical methods, including propensity score, and our findings showed that once underlying infection types and severity are controlled for, exposure to antibiotics in infancy overall is not associated with an increased risk of childhood obesity, whereas infection during infancy was associated with an increased risk. The association between infection and childhood obesity was further supported by a clear dose–response relation.”
Li and colleagues analyzed electronic medical records from 260,556 infants in the Kaiser Permanente Northern California population born between 1997 and March 31, 2013, including antibiotic use, infection diagnosis and BMI/obesity status from birth up to age 18 years. Researchers established three cohorts: patients with untreated infections (those with infection diagnosis but no prescription for antibiotics; n = 77,889), antibiotic users (those with an infection diagnosis and use of antibiotics; n = 138,417) and unexposed controls (n = 44,250). Mixed-effects logistic regression analysis for repeated measurements was used to analyze multiple BMI measurements per child (median, five measurements) and to obtain ORs for obesity risk. Researchers also performed a substudy in 547 same-sex twin pairs with discordant exposure status to substantiate findings.
Researchers found that infection alone without antibiotic exposure in infancy was associated with an increased risk for obesity in childhood vs. controls without an infection (OR = 1.25; 95% CI, 1.2-1.29); results persisted after adjusting for maternal age, race, prepregnancy BMI, preterm delivery, low birth weight, and maternal antibiotic use and infection during pregnancy. There was a dose–response association between the number of infection episodes and obesity risk, according to researchers (P < .0001 for trend), with ORs increasing from 1.15 for one infection episode (95% CI, 1.1-1.2) to 1.4 for three or more infection episodes (95% CI, 1.33-1.47). The timing of infection had no effect on the risk for childhood obesity, according to researchers.
Researchers also found that the treatment of infection with antibiotics in infancy was not associated with an increased risk for childhood obesity (OR = 1.01; 95% CI, 0.98-1.04); results persisted after controlling for multiple factors, including underlying infection types and severity. Use of neither broad-spectrum nor narrow-spectrum antibiotics was linked to childhood obesity risk, the researchers wrote.
The discordant twin substudy supported the researchers’ findings, with twins who sustained an untreated infection in infancy more likely to develop childhood obesity vs. twins with no infection (OR = 1.55; 95% CI, 0.65-3.72) and no increased risk associated with antibiotic use in infancy vs. twins with untreated infections (OR = 1.04; 95% CI, 0.57-1.88).
“While there are many other reasons for deciding whether antibiotics should be used, in the context of preventing childhood obesity, treating infant infections with antibiotics is not likely to increase childhood obesity,” Li told Endocrine Today. “In fact, not treating infections in infancy could increase the risk of childhood obesity that you are worried about.” – by Regina Schaffer
For more information:
De-Kun Li, MD, PhD, can be reached at the Kaiser Foundation Research Institute, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612; email: de-kun.li@kp.org.
Disclosure: The researchers report no relevant financial disclosures.
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