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Pediatrics. 2018 Dec;142(6). pii: e20180290. doi: 10.1542/peds.2018-0290. Epub 2018 Oct 31.

Early Antibiotic Exposure and Weight Outcomes in Young Children.

Author information

Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute and
Applied Clinical Research Center and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute and.
Environmental Influences on Child Health Outcomes Program, National Institutes of Health, Bethesda, Maryland.
North Fork School District, Utica, Ohio.
Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
Nationwide Children's Hospital, Columbus, Ohio.
Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts.
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Pennington Biomedical Research Center, Baton Rouge, Louisiana.
Departments of Population Health and.
Department of Family Medicine and Community Health, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio.
Therapeutics Research and Infectious Disease Epidemiology Group and.
Pediatrics, School of Medicine, New York University, New York City, New York; and.


: media-1vid110.1542/5839981580001PEDS-VA_2018-0290Video Abstract OBJECTIVES: To determine the association of antibiotic use with weight outcomes in a large cohort of children.


Health care data were available from 2009 to 2016 for 35 institutions participating in the National Patient-Centered Clinical Research Network. Participant inclusion required same-day height and weight measurements at 0 to <12, 12 to <30, and 48 to <72 months of age. We assessed the association between any antibiotic use at <24 months of age with BMI z score and overweight or obesity prevalence at 48 to <72 months (5 years) of age, with secondary assessments of antibiotic spectrum and age-period exposures. We included children with and without complex chronic conditions.


Among 1 792 849 children with a same-day height and weight measurement at <12 months of age, 362 550 were eligible for the cohort. One-half of children (52%) were boys, 27% were African American, 18% were Hispanic, and 58% received ≥1 antibiotic prescription at <24 months of age. At 5 years, the mean BMI z score was 0.40 (SD 1.19), and 28% of children had overweight or obesity. In adjusted models for children without a complex chronic condition at 5 years, we estimated a higher mean BMI z score by 0.04 (95% confidence interval [CI] 0.03 to 0.05) and higher odds of overweight or obesity (odds ratio 1.05; 95% CI 1.03 to 1.07) associated with obtaining any (versus no) antibiotics at <24 months.


Antibiotic use at <24 months of age was associated with a slightly higher body weight at 5 years of age.


Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Among the collaborative authors, Dr Dempsey serves on advisory boards for Merck and Pfizer and is a consultant for Pfizer; the other authors have indicated they have no potential conflicts of interest to disclose.

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