Antibiotic Exposure During the First 6 Months of Life and Weight Gain During Childhood
Antibiotic Exposure During the First 6 Months of Life and Weight Gain During Childhood
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DOI：
10.1001/jama.2016.2395
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发表时间：
2016-03-22
影响因子：
120.7
通讯作者：
Zaoutis, Theoklis E.
中科院分区：
文献类型：
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作者：
Gerber, Jeffrey S.;Bryan, Matthew;Zaoutis, Theoklis E.
在动物模型中，早期抗生素暴露与通过肠道微生物组介导的肥胖增加有关。婴儿抗生素暴露是常见的，往往是不适当的。婴儿抗生素与儿童期体重增加之间的相关性研究报告了不一致的结果。目的评估早期抗生素暴露与儿童期体重增加之间的相关性。设计与设置回顾性，在30个儿科初级保健实践网络中进行的一项单胎分娩纵向研究和双胞胎配对纵向研究，为20多万不同种族和性别的儿童提供服务。参与者：2001年11月1日至2011年12月31日出生的儿童，胎龄35周或以上，出生体重2000 g或以上，胎龄第五百分位数或以上，并且在出生后14天内接受过预防性健康检查，并且在出生后第一年内至少接受过2次额外检查。患有复杂慢性疾病的儿童和接受长期抗生素或多种全身性皮质类固醇处方的儿童被排除在外。我们纳入了38522名单胎儿童和92名双胞胎（46对配对）抗生素暴露不一致。随访的最终日期为2012年12月31日。暴露在生命的前6个月全身使用抗生素。主要结果和指标体重，在6个月至7岁的预防性健康访视时测量。（50%为女性;平均出生体重为3.4 kg），5287（14%）例在出生后前6个月（平均年龄为4.3个月）暴露于抗生素。抗生素暴露与体重变化率无显著相关性（0.7%; 95% CI，-0.1%至1.5%; P = 0.07，相当于2岁至5岁之间体重增加约0.05 kg; 95% CI，-0.004至0.11 kg）。在92对双胞胎（38%为女性，平均出生体重2.8 kg）中，46对在出生后6个月内接触抗生素的双胞胎在平均4.5个月时接受了抗生素治疗。抗生素暴露与体重差异无显著相关性（-0.09 kg; 95%CI，-0.26至0.08 kg; P = 0.30）。结论和相关性在出生后6个月内暴露于抗生素与未暴露于抗生素相比，在7岁时体重增加无统计学显著差异。有很多理由限制年轻健康儿童的抗生素暴露，但体重增加可能不是其中之一。
IMPORTANCE Early-life antibiotic exposure has been associated with increased adiposity in animal models, mediated through the gut microbiome. Infant antibiotic exposure is common and often inappropriate. Studies of the association between infant antibiotics and childhood weight gain have reported inconsistent results.OBJECTIVE To assess the association between early-life antibiotic exposure and childhood weight gain.DESIGN AND SETTING Retrospective, longitudinal study of singleton births and matched longitudinal study of twin pairs conducted in a network of 30 pediatric primary care practices serving more than 200 000 children of diverse racial and socioeconomic backgrounds across Pennsylvania, New Jersey, and Delaware.PARTICIPANTS Children born between November 1, 2001, and December 31, 2011, at 35 weeks' gestational age or older, with birth weight of 2000 g or more and in the fifth percentile or higher for gestational age, and who had a preventive health visit within 14 days of life and at least 2 additional visits in the first year of life. Children with complex chronic conditions and those who received long-term antibiotics or multiple systemic corticosteroid prescriptions were excluded. We included 38 522 singleton children and 92 twins (46 matched pairs) discordant in antibiotic exposure. Final date of follow-up was December 31, 2012.EXPOSURE Systemic antibiotic use in the first 6 months of life.MAIN OUTCOMES AND MEASURES Weight, measured at preventive health visits from age 6 months through 7 years.RESULTS Of 38 522 singleton children (50% female; mean birth weight, 3.4 kg), 5287 (14%) were exposed to antibiotics during the first 6 months of life (at a mean age of 4.3 months). Antibiotic exposure was not significantly associated with rate of weight change (0.7%; 95% CI, -0.1% to 1.5%; P =.07, equivalent to approximately 0.05 kg; 95% CI, -0.004 to 0.11 kg of added weight gain between age 2 years and 5 years). Among 92 twins (38% female; mean birth weight, 2.8 kg), the 46 twins who were exposed to antibiotics during the first 6 months of life received them at a mean age of 4.5 months. Antibiotic exposure was not significantly associated with a weight difference (-0.09 kg; 95% CI, -0.26 to 0.08 kg; P =.30).CONCLUSIONS AND RELEVANCE Exposure to antibiotics within the first 6 months of life compared with no exposure was not associated with a statistically significant difference in weight gain through age 7 years. There are many reasons to limit antibiotic exposure in young, healthy children, but weight gain is likely not one of them.