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Infection, but not antibiotic use, during infancy associated with childhood obesity.

Li DK, Chen H, Ferber J, Odouli R. 2017. Infection and antibiotic use in infancy and risk of childhood obesity: a longitudinal birth cohort study. Lancet Diabetes Endocrinol; 5: 18-25.

The rapid rise in childhood obesity rates has become a public health crisis worldwide, with increasing importance placed on understanding the factors underlying its development. The intestinal microbiome has emerged as a key contributor to disease risks, including risk of childhood obesity. Animal studies have suggested that disturbances in microbial composition are associated with obesity. Furthermore, data from previous studies have suggested a possible association between antibiotic use in infancy and risk of childhood obesity. These studies, however, have not well separated the effects of the antibiotics from the underlying infection being treated. Accordingly, authors of this study aimed to disentangle the effect of antibiotic use in infancy from that of underlying infection on the risk of childhood obesity.

The longitudinal birth cohort study used infants in the Kaiser Permanente Northern California (KPNC) population, born between Jan 1, 1997 and March 31, 2013. Individuals who did not have continuous paediatric care at KPNC during the first 12 months of birth were not included in the study to avoid missing information on antibiotic use and infection diagnoses. All infections diagnosed in infancy (the first 12 months of life) were identified from KPNC electronic medical records, which captured all clinical diagnoses of infection from outpatient visits, hospital admissions, emergency department visits, urgent care clinics, and telephone consultation. The KPNC pharmacy database captured and provided information on all prescription medications, including antibiotics. The electronic records of 260,556 individuals were used to ascertain data regarding antibiotic use, infection diagnosis, and anthropometric measurements (to calculate BMI and obesity status) from birth up to age 18 years. A sub-study was also undertaken in 547 same-sex twin pairs with discordant exposure status to substantiate findings.

Of the 260,556 participants included in the analysis, 44,250 had no infection and no antibiotic use in the first 12 months of birth, and acted as the control group. Of the remaining participants, 77,889 infants had untreated infection, and 138,417 were antibiotic users. Maternal, birth and infant characteristics were generally more similar between the antibiotic users and untreated infection groups than between the groups and the control, which was in line with the authors' expectations since the first two groups had underlying infections. The three cohorts, however, were similar with respect to potential risk factors for childhood obesity, including maternal smoking during pregnancy, mode of delivery, breastfeeding, mean duration of follow-up, and postnatal factors such as timing of solid food initiation, physical activity, screen time, and eating habits.

After controlling for potential confounders such as maternal age, race or ethnic origin, pre-pregnancy BMI, preterm delivery, low birthweight, maternal antibiotic use, and infection during pregnancy, infection without antibiotic use in infancy was associated with an increased risk of childhood obesity compared with controls without infection. In contrast, antibiotic use during infancy was not associated with risk of childhood obesity when compared with infants with untreated infection. Additionally, a dose-response relationship was seen between infection episodes and risk of childhood obesity. These findings were verified in an analysis of same-sex twins with discordant antibiotic exposure status.

The authors concluded that their findings suggest that infection, rather than antibiotic use, during infancy is associated with an increased risk of subsequent childhood obesity. It is also noted that these results do not necessarily rule out a potential effect of antibiotics on microbiome composition. This study provides further information into factors associated with risk of childhood obesity; however, more research is required to provide further understanding.
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Title Annotation:Reviews of medical journal articles
Author:Tester, Jodie
Publication:Australian Journal of Herbal Medicine
Article Type:Report
Date:Jun 1, 2017
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