The association between antibiotic use in infancy and childhood overweight or obesity: a systematic review and meta‐analysis

Miller, Susan A.; Wu, Rong; Oremus, Mark

doi:10.1111/obr.12717

Cited by 74 publications

(63 citation statements)

References 51 publications

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“…11 However, there is concern that previous positive studies have not adequately accounted for potential confounders, including genetic and environmental factors. [8][9][10] In particular, very few studies have examined siblings or twins to account for possible unmeasured confounders, and the studies that did include these analyses reported no associations between antibiotic exposure and risk of childhood obesity. 5,6,12 Nonetheless, these studies were not without limitations, because they consisted of small cohorts and did not include national data or analyses on both siblings from singleton pregnancies (henceforth referred to as "siblings") and those from multiple pregnancies (henceforth referred to as "twins").…”

Section: Introductionmentioning

confidence: 99%

Associations of Prenatal and Childhood Antibiotic Exposure With Obesity at Age 4 Years

et al. 2020

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IMPORTANCE Although antibiotics are associated with obesity in animal models, the evidence in humans is conflicting. OBJECTIVE To assess whether antibiotic exposure during pregnancy and/or early childhood is associated with the development of childhood obesity, focusing particularly on siblings and twins. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional national study included 284 211 participants (132 852 mothers and 151 359 children) in New Zealand. Data analyses were performed for 150 699 children for whom data were available, 30 696 siblings, and 4188 twins using covariateadjusted analyses, and for 6249 siblings and 522 twins with discordant outcomes using fixedeffects analyses. Data analysis was performed November 2017 to March 2019. EXPOSURE Exposure to antibiotics during pregnancy and/or early childhood. MAIN OUTCOMES AND MEASURES The main outcome is odds of obesity at age 4 years. Anthropometric data from children born between July 2008 and June 2011 were obtained from the B4 School Check, a national health screening program that records the height and weight of 4-year-old children in New Zealand. These data were linked to antibiotics (pharmaceutical records) dispensed to women before conception and during all 3 trimesters of pregnancy and to their children from birth until age 2 years. RESULTS The overall study population consisted of 132 852 mothers and 151 359 children (77 610 [51.3%] boys) who were aged 4 to 5 years when their anthropometrical measurements were assessed. Antibiotic exposure was common, with at least 1 course dispensed to 35.7% of mothers during pregnancy and 82.3% of children during the first 2 years of life. Results from covariateadjusted analyses showed that both prenatal and early childhood exposures to antibiotics were independently associated with obesity at age 4 years, in a dose-dependent manner. Every additional course of antibiotics dispensed to the mothers yielded an adjusted odds ratio (aOR) of obesity in their children (siblings) of 1.02 (95% CI, 0.99-1.06), which was similar to the odds across pregnancy for the whole population (aOR, 1.06; 95% CI, 1.04-1.07). For the child's exposure, the aOR for the association between antibiotic exposure and obesity was 1.04 (95% CI, 1.03-1.05) among siblings and 1.05 (95% CI, 1.02-1.09) among twins. However, fixed-effects analyses of siblings and twins showed no associations between antibiotic exposure and obesity, with aORs of 0.95 (95% CI, 0.90-1.00) for maternal exposure, 1.02 (95% CI, 0.99-1.04) for child's exposure, and 0.91 (95% CI, 0.81-1.02) for twins' exposure. CONCLUSIONS AND RELEVANCE Although covariate-adjusted analyses demonstrated an association between antibiotic exposure and odds of obesity, further analyses of siblings and twins (continued) Key Points Question Is antibiotic exposure during pregnancy and/or during early childhood associated with the development of childhood obesity? Findings This cross-sectional national study of 284 211 participants (132 852 mothers and 151 359 children) in New Zealand found that...

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Section: Introductionmentioning

confidence: 99%

Associations of Prenatal and Childhood Antibiotic Exposure With Obesity at Age 4 Years

et al. 2020

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“…Multiple baseline risks can be presented to decision makers so that different recommendations can be made for different populations. Software from the GRADE (grading of recommendations, assessment, development, and evaluation) Working Group (GRADEPro, McMasters University, Hamilton, Ontario, Canada) enables different absolute effects to be calculated and presented to help decision makers 21…”

Section: Conversion To Binary Relative and Absolute Measuresmentioning

confidence: 99%

When continuous outcomes are measured using different scales: guide for meta-analysis and interpretation

Murad

Wang

Chu

et al. 2019

BMJ

164

124

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It is common to measure continuous outcomes using different scales (eg, quality of life, severity of anxiety or depression), therefore these outcomes need to be standardized before pooling in a meta-analysis. Common methods of standardization include using the standardized mean difference, the odds ratio derived from continuous data, the minimally important difference, and the ratio of means. Other ways of making data more meaningful to end users include transforming standardized effects back to original scales and transforming odds ratios to absolute effects using an assumed baseline risk. For these methods to be valid, the scales or instruments being combined across studies need to have assessed the same or a similar construct

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“…Long-term use of antibiotics, especially early in life, has been linked with obesity, allergies, and other chronic disorders [6][7][8][9]. In the Nurses' Health Study (NHS), selfreported retrospective history of antibiotic use has been linked to increased risk of colorectal adenoma [10].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Use of Antibiotics and Risk of Parkinson’s Disease in the Nurses’ Health Study

Palacios

O’Reilly

Schwarzschild

et al. 2020

Parkinson's Disease

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Objective. Antibiotic use is one of the strongest environmental predictors of an altered and less diverse gut microbiome, which has been linked to Parkinson’s disease. To our knowledge, no prior study has examined the association between long-term antibiotic use and Parkinson’s disease. Design. We conducted a prospective study of 59,637 women in the Nurses’ Health Study who reported total duration of antibiotic use at ages 20–39, 40–59, 60 +, or during the past 4 years. We used Cox Proportional Hazard regression to estimate hazard ratios and 95% confidence intervals for the association between categories of antibiotic use and risk of PD. Results. One hundred and eighty cases of PD were confirmed during the follow-up. Self-reported antibiotic use at ages 20–39, 40–59, and 60 +, as assessed in 2004, was not significantly associated with PD risk in our cohort. The hazard ratio comparing participants who used antibiotics for 2 or more months vs. 1–14 days at age 20–39 was 0.98 (95% CI: 0.54, 1.78), at age 40–59 was 1.44 (95% CI: 0.88, 2.33), and at age 60 +was 0.88 (95% CI: 0.53, 1.47). Antibiotic use during the past four years, as assessed in 2008, was also not associated with future risk of PD (HR: 1.14, 95% CI: 0.62, 2.10). Conclusion. In this cohort study, we did not observe a significant association between antibiotic use and incidence PD. A major limitation of our study is assessment of exposure, which required many participants to recall their antibiotic use decades in the past. Thus, although the results of this study do not support an effect of antibiotic use on PD risk, larger investigations relying on records of antibiotic prescriptions would provide more definitive evidence.

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The association between antibiotic use in infancy and childhood overweight or obesity: a systematic review and meta‐analysis

Abstract: Antibiotic exposure in infants, aged < 24 months, was associated with a small increase in odds of childhood overweight or obesity in some subgroups of children.

Cited by 74 publications

References 51 publications

Associations of Prenatal and Childhood Antibiotic Exposure With Obesity at Age 4 Years

Associations of Prenatal and Childhood Antibiotic Exposure With Obesity at Age 4 Years

When continuous outcomes are measured using different scales: guide for meta-analysis and interpretation

Long-Term Use of Antibiotics and Risk of Parkinson’s Disease in the Nurses’ Health Study

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