Antibiotic exposure in early life and childhood overweight and obesity: A systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational studies
PubMed 29359849 · doi:10.1111/dom.13230
What was done
Authors conducted a systematic review and meta-analysis of observational studies evaluating the association between antibiotic exposure during infancy and subsequent childhood overweight or obesity. The review identified 13 studies comprising 527,504 children, with 8 studies providing data suitable for quantitative meta-analysis.
What was found
Antibiotic exposure in infancy was associated with an increased odds of childhood overweight and obesity (OR 1.11, 95% CI 1.02–1.20). Risk varied by timing and dose: exposure to only a single treatment course or exposure between 6 and 24 months showed no significant association. In contrast, exposure to more than one treatment course was associated with higher odds (OR 1.24, 95% CI 1.09–1.43), as was exposure specifically within the first 6 months of life (OR 1.20, 95% CI 1.04–1.37).
Why it matters
These findings suggest that timing and frequency of early-life antibiotic exposure may be relevant risk factors for pediatric weight gain, supporting antimicrobial stewardship in early infancy. However, the effect size is modest, and whether the link reflects a causal microbiome alteration or confounding by underlying infection remains unproven.
Limits
The analysis relied entirely on observational studies, which are susceptible to residual confounding, particularly confounding by indication (the underlying infection rather than the antibiotic itself). Only 8 of the 13 identified studies could be pooled quantitatively, and the abstract provides no data on specific antibiotic classes, dietary factors, or mechanistic biomarkers.
Cited by
- supports Repeated antibiotic use in early infancy increases a child's risk for obesity.