Early Antibiotic Exposure and Weight Outcomes in Young Children

Abstract

: media-1vid110.1542/5839981580001PEDS-VA_2018-0290Video Abstract OBJECTIVES: To determine the association of antibiotic use with weight outcomes in a large cohort of children.

Methods: Health care data were available from 2009 to 2016 for 35 institutions participating in the National Patient-Centered Clinical Research Network. Participant inclusion required same-day height and weight measurements at 0 to <12, 12 to <30, and 48 to <72 months of age. We assessed the association between any antibiotic use at <24 months of age with BMI z score and overweight or obesity prevalence at 48 to <72 months (5 years) of age, with secondary assessments of antibiotic spectrum and age-period exposures. We included children with and without complex chronic conditions.

Results: Among 1 792 849 children with a same-day height and weight measurement at <12 months of age, 362 550 were eligible for the cohort. One-half of children (52%) were boys, 27% were African American, 18% were Hispanic, and 58% received ≥1 antibiotic prescription at <24 months of age. At 5 years, the mean BMI z score was 0.40 (SD 1.19), and 28% of children had overweight or obesity. In adjusted models for children without a complex chronic condition at 5 years, we estimated a higher mean BMI z score by 0.04 (95% confidence interval [CI] 0.03 to 0.05) and higher odds of overweight or obesity (odds ratio 1.05; 95% CI 1.03 to 1.07) associated with obtaining any (versus no) antibiotics at <24 months.

Conclusions: Antibiotic use at <24 months of age was associated with a slightly higher body weight at 5 years of age.

FIGURE 1

Dose-response relationship for association of antibiotic episodes at <24 months of age with BMI z scores at ages 48 to <72 months. This figure shows the difference in BMI z score at 48 to <72 months of age (5 years) according to the number of antibiotic episodes a child received at <24 months of age. Results reveal BMI z score differences and 95% CIs for 1, 2, 3, and ≥4 antibiotic episodes overall and for narrow- and broad-spectrum antibiotics compared with the reference of 0 antibiotic episodes. Results are stratified by whether a child had a complex chronic condition. The model was corrected for clustering by site and adjusted for sex, race, ethnicity, preterm birth, asthma, corticosteroid episodes (continuous, 0–≥4) at 0 to <24 months of age, number of encounters (continuous, log transformed) at 0 to <24 months of age, infection episodes (continuous, log transformed) at 0 to <24 months of age, and age at outcome.