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Published on: February 2, 2017
Association of Early Antibiotic Exposure With Childhood Body Mass Index Trajectory Milestones
Izzuddin M Aris1, Pi-I D Lin1, Sheryl L Rifas-Shiman1
1Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Insights
Early antibiotic exposure in children is linked to minor changes in body mass index (BMI) trajectory milestones. These small shifts are unlikely to significantly impact clinical decisions regarding antibiotic prescriptions for young children.
Area of Science:
- Pediatric Health
- Pharmacology
- Epidemiology
Background:
- Previous research indicates a connection between antibiotic use and children's weight outcomes.
- However, limited studies have explored how early-life antibiotic exposure affects body mass index (BMI) trajectory milestones throughout childhood.
Purpose of the Study:
- To investigate the association between antibiotic use in the first 48 months of life and BMI trajectory milestones in children.
- To analyze the impact of early antibiotic exposure on the age and magnitude of BMI peak and rebound.
Main Methods:
- Retrospective cohort study utilizing electronic health records from 26 institutions.
- Included 183,444 children with height and weight measurements at multiple age intervals up to 131 months.
- Analyzed antibiotic exposure (broad- and narrow-spectrum) before 48 months of age.
Main Results:
- Antibiotic exposure before 48 months was associated with statistically significant, though small, alterations in BMI trajectory milestones.
- Early antibiotic exposure (0-5 months) correlated with a later BMI peak age and higher BMI at peak.
- Exposure was also linked to an earlier BMI rebound age and higher BMI at rebound, with stronger associations for more frequent antibiotic use.
Conclusions:
- Early-life antibiotic exposure shows a statistically significant association with minor changes in BMI trajectory milestones during infancy and early childhood.
- The observed effects on BMI trajectory patterns are small and likely not a primary consideration for prescribing antibiotics to children.
Importance:
Past studies have showed associations between antibiotic exposure and child weight outcomes. Few, however, have documented alterations to body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) trajectory milestone patterns during childhood after early-life antibiotic exposure.
Objective:
To examine the association of antibiotic use during the first 48 months of life with BMI trajectory milestones during childhood in a large cohort of children.
Design, Setting, And Participants:
This retrospective cohort study used electronic health record data from 26 institutions participating in the National Patient-Centered Clinical Research Network from January 1, 2009, to December 31, 2016. Participant inclusion required at least 1 valid set of same-day height and weight measurements at each of the following age periods: 0 to 5, 6 to 11, 12 to 23, 24 to 59, and 60 to 131 months (183 444 children). Data were analyzed from June 1, 2019, to June 30, 2020.
Exposures:
Antibiotic use at 0 to 5, 6 to 11, 12 to 23, 24 to 35, and 36 to 47 months of age.
Main Outcomes And Measures:
Age and magnitude of BMI peak and BMI rebound.
Results:
Of 183 444 children in the study (mean age, 3.3 years [range, 0-10.9 years]; 95 228 [51.9%] were boys; 80 043 [43.6%] were White individuals), 78.1% received any antibiotic, 51.0% had at least 1 episode of broad-spectrum antibiotic exposure, and 65.0% had at least 1 episode of narrow-spectrum antibiotic exposure at any time before 48 months of age. Exposure to any antibiotics at 0 to 5 months of age (vs no exposure) was associated with later age (β coefficient, 0.05 months [95% CI, 0.02-0.08 months]) and higher BMI (β coefficient, 0.09 [95% CI, 0.07-0.11]) at peak. Exposure to any antibiotics at 0 to 47 months of age (vs no exposure) was associated with an earlier age (-0.60 months [95% CI, -0.81 to -0.39 months]) and higher BMI at rebound (β coefficient, 0.02 [95% CI, 0.01-0.03]). These associations were strongest for children with at least 4 episodes of antibiotic exposure. Effect estimates for associations with age at BMI rebound were larger for those exposed to antibiotics at 24 to 35 months of age (β coefficient, -0.63 [95% CI, -0.83 to -0.43] months) or 36 to 47 (β coefficient, -0.52 [95% CI, -0.72 to -0.31] months) than for those exposed at 0 to 5 months of age (β coefficient, 0.26 [95% CI, 0.01-0.51] months) or 6 to 11 (β coefficient, 0.00 [95% CI, -0.20 to 0.20] months).
Conclusions And Relevance:
In this cohort study, antibiotic exposure was associated with statistically significant, but small, differences in BMI trajectory milestones in infancy and early childhood. The small risk of an altered BMI trajectory milestone pattern associated with early-life antibiotic exposure is unlikely to be a key factor during prescription decisions for children.
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