Exposure to antibiotics and precocious puberty in children: A school-based cross-sectional study in China

Yabin Hu; Juan Li; Tao Yuan; Tingting Yu; Yao Chen; Huijun Kong; Cuilan Lin; Zhemin Shen; Ying Tian; Shilu Tong; Xiaodan Yu; Shijian Liu

doi:10.1016/j.envres.2022.113365

Exposure to antibiotics and precocious puberty in children: A school-based cross-sectional study in China

Environ Res. 2022 Sep;212(Pt C):113365. doi: 10.1016/j.envres.2022.113365. Epub 2022 Apr 29.

Authors

Yabin Hu¹, Juan Li², Tao Yuan³, Tingting Yu⁴, Yao Chen⁵, Huijun Kong⁶, Cuilan Lin⁷, Zhemin Shen³, Ying Tian⁸, Shilu Tong⁹, Xiaodan Yu¹⁰, Shijian Liu¹¹

Affiliations

¹ Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
² Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
³ State Environmental Protection Key Laboratory of Environmental Health Impact Assessment of Emerging Contaminants, School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai, China.
⁴ Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
⁵ Department of Endocrinology, Genetics and Metabolism, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁶ Department of Pediatrics, People's Hospital of Qu Fu, Shandong, China.
⁷ Department of Developmental and Behavioral Pediatrics, Bo Ai Hospital of Zhongshan City, The Second School of Clinical Medicine, Southern Medical University, Guangdong, China.
⁸ Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; MOE-Shanghai Key Lab of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁹ Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
¹⁰ Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; MOE-Shanghai Key Lab of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: xdyu1108@163.com.
¹¹ Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, China. Electronic address: arrow64@163.com.

PMID: 35490828
DOI: 10.1016/j.envres.2022.113365

Abstract

Foods and water can be contaminated with antibiotics in China, which may affect children's health, but evidence on antibiotic exposure with precocious puberty (PP) is limited. This study explored the association of antibiotic exposure with PP in a school-based setting. A cross-sectional study with multistage stratified cluster random sampling was conducted in Zhongshan City, Guangdong Province and Qufu City, Shandong Province in China from October 11 to December 5, 2019. A first-morning urine sample was collected to detect antibiotic exposure. We detected 33 of 45 types of antibiotics from eight categories in 928 primary school children aged 6-12 years using HPLS-MS/MS. Detection rate of antibiotics was stratified by sex, study site, and BMI. The Tanner stages were assessed by professional pediatricians from local hospitals. PP is defined as the onset of secondary characters before 8-year-old or menarche before 10-year-old for girls and before 9-year-old for boys. Multivariable logistic regression was performed to examine the association between antibiotic exposure and PP after adjusting potential confounders. The overall detection rate of antibiotics was 93.0% in 928 children. We found the detection rate of tetracyclines and fluoroquinolones in children with PP was significantly higher than that of children with normal puberty (41.4% vs 29.9%, 56.8% vs 50.6%, respectively, all p < 0.05). Both fluoroquinolones (odds ratio (OR): 1.835, 95% confidence interval (CI): 1.066-3.158) and tetracyclines (OR: 2.120, 95% CI: 1.175-3.825) were associated with increased OR of PP after adjusting sex, age, BMI, study site, and family income. Specifically, compared to the values less than the limits of detection, low concentration of ofloxacin from fluoroquinolones (OR: 2.056, 95% CI: 1.091-3.875) and high concentration of chlortetracycline (OR: 3.027, 95% CI: 1.126-8.140) and tetracycline from tetracyclines (OR: 2.756, 95% CI: 1.167-6.506) were associated with increased OR of PP. Exposure to antibiotics, especially fluoroquinolones and tetracyclines was positively associated with precocious puberty.

Keywords: Antibiotics; Association; Children; Exposure; Precocious puberty.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents
Child
China / epidemiology
Cross-Sectional Studies
Female
Fluoroquinolones
Humans
Male
Puberty
Puberty, Precocious* / chemically induced
Puberty, Precocious* / diagnosis
Puberty, Precocious* / epidemiology
Schools
Tandem Mass Spectrometry
Tetracyclines

Substances

Anti-Bacterial Agents
Fluoroquinolones
Tetracyclines