Total infections in infancy more significant than antibiotic use for childhood obesity
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The number of infections in the first year of life was significantly associated with childhood obesity and was a stronger risk factor than antibiotic use, according to study data.
“In particular, a greater number of bronchitis, otitis media and upper respiratory infections in the first year of life are associated with a significant increased risk of obesity in childhood,” Adrienne M. Ohler, PhD, associate research professor in child health, and Amy Braddock, MD, MSPH, associate professor of clinical family and community medicine, both at the University of Missouri, wrote in a study published in the International Journal of Obesity.
Previous studies had identified a positive association between antibiotic use and obesity in childhood but failed to account for confounding by indication, according to Ohler and Braddock.
“We [evaluated] the direct effect of infection on obesity and the indirect effect mediated by antibiotics by performing a mediation analysis of the infection-obesity association,” they wrote.
Ohler and Braddock compiled a Missouri Medicaid cohort of children aged 2 to 14 years between 2015 and 2019 (n = 61,330) and performed a mediation analysis of infection type — bronchitis, pharyngitis, otitis media or upper respiratory — and antibiotic use during the first year of life and obesity in childhood.
Researchers found that each additional infection during infancy heightened the risk for obesity in childhood (adjusted incidence rate ratio = 1.05; P < .001), although antibiotic use mediation was clinically and statistically insignificant. Data also indicated that antibiotic use as a risk factor for obesity was overstated when researchers did not consider the number of infections in the analysis (adjusted incidence rate ratio = 1.037 vs. 1.013; P < .001).
“Although our study found an antibiotics-obesity association, our mediation model provides evidence to the supposition this association is confounded by indication,” Ohler and Braddock wrote. “Given the ongoing concern of antibiotic-resistant bacteria and the small association we found, we recommend the continued need for the judicious use of antibiotics in the first year of life.”
They added that even more noteworthy was the significant, consistent and positive relationship between the number of reported infections in the first year of life and obesity in childhood, which they posited may result from alterations in gut microflora, immune or inflammatory pathways, or family environments, which increase the risks for infection and obesity.
“Future research is needed to further evaluate the association between early childhood infections and risk for obesity, including potential biological and environmental pathways, and interventions that reduce the risk of infection and obesity,” Ohler and Braddock concluded.
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