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Infant antibiotic use associated with obesity at age 2 years
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Infants exposed to antibiotics in the first 6 months of life were more likely to develop obesity by age 2 years vs. infants not exposed to antibiotics, according to a study of Latino infants from San Francisco.
“Our results do not support an association between later antibiotic exposure or the number of courses from 6 to 12 months and risk for obesity at 2 years, but these associations require further study,” Annette P. Ville, of the division of gastroenterology, hepatology and nutrition at the University of California, San Francisco, and colleagues wrote. “Our findings concur with prior studies showing greatest risk from early exposure as gut microbiota is particularly sensitive during the formative time frame before homeostasis and the immune system become well established.”
Ville and colleagues analyzed data from 97 pregnant self-identified Latina women recruited before delivery at prenatal clinics at San Francisco General Hospital in 2012 and 2013 (infants, 46% boys; mean gestational age, 39.17 weeks; 23% delivered via caesarean section). Mothers self-reported type and frequency of antibiotic use in offspring at 6 months and 1 year; medical records were not assessed for prescription details. Antibiotic use was stratified by age (0-6 months; 6-12 months and 0-12 months), including duration of antibiotic course and number of courses. Mothers completed food frequency questionnaires for infants at age 4 to 6 weeks, and at age 6, 12 and 24 months; a 24-hour dietary recall at age 6 months; and a 48-hour recall at age 1 and 2 years. Researchers analyzed gut hormones in infant cord blood. Primary outcome was child obesity at age 2 years; primary predictor of interest was antibiotic exposure from age 0 to 6 months.
Within the cohort, obesity was present in 7.2% of newborns, 13.4% at age 6 months, 16.5% at age 1 year and 11.8% at age 2 years. At age 6 months, 18.4% of infants were exposed to one course of antibiotics; 31.4% were exposed to antibiotics between age 6 and 12 months; 40% were exposed to any antibiotics between birth and age 12 months, overall; 6.8% were exposed to antibiotics at both birth to age 6 months and age 6 to 12 months.
At age 2 years, children exposed to antibiotics in the first 6 months of life were more likely to have obesity (40%) vs. those not exposed to antibiotics (13%; P = .03). Among children aged 2 years with obesity, 30% were exposed to antibiotics at both birth to age 6 months and age 6 to 12 months vs. 3% of children without obesity, according to the researchers.
In assessing multivariate predictors of obesity at age 2 years, researchers found that exposure to antibiotics during the first 6 months of life independently predicted obesity at age 2 years, after adjustment for maternal BMI, weight for length z score at birth, any breast-feeding at age 6 months, rapid infant weight gain and infant sex (OR = 6.15; 95% CI, 1.03-36.7). Rapid infant weight gain was also independently associated with obesity at age 2 years (OR = 6.42; 95% CI, 1.17-35.06).
“Pediatric antibiotic prescribing patterns have been scrutinized for improvement with some success in reducing dispensing rates, but continued efforts are needed to decrease [the] use of antibiotics, particularly broad-spectrum agents,” the researchers wrote. “Our findings support recent calls for continued improvement in antimicrobial stewardship interventions for appropriate antibiotic use during infancy, especially to minimize exposure in the first 6 months and use of broad-spectrum agents.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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