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Antibiotics, H2RAs and PPIs linked to child obesity

Microbiota-altering medications in early childhood might influence weight gain, finds research

Louise Prime

Wednesday, 31 October 2018

Babies and toddlers prescribed antibiotics, acid suppressants or a combination of multiple medications are more likely than other children to have a diagnosis of obesity, indicating that microbiota-altering medications administered in early childhood might influence weight gain, US research* published today in Gut has shown.

It has already been established that gut microbiota alterations are associated with obesity, and also that early exposure to medications, including acid suppressants and antibiotics, can alter gut biota and may increase the likelihood of developing obesity. So, this team of researchers conducted a retrospective cohort study to investigate the association between antibiotic, histamine-2 receptor antagonist (H2RA) and proton pump inhibitor (PPI) prescriptions during early childhood and a diagnosis of obesity, by analysing data from the US Military Health System (MHS) database.

The database covered 333,353 eligible children born between October 2006 and September 2013. Of these, during their first two years of life, 241,502 (72.5%) had been prescribed an antibiotic; 39,488 (just under 12%) an H2RA; 11,089 (just over 3%) a PPI; and 5,868 children all three types of drug. Around one in seven of all subjects (46,993, just over 14%) became obese, of whom 9,628 (11%) had not been prescribed any antibiotics or acid suppressants.

The researchers reported that antibiotic prescriptions were significantly associated with obesity (hazard ratio, HR 1.26), and this association not only persisted regardless of antibiotic class, it also strengthened with each additional class of antibiotic prescribed. Prescriptions for H2RA and PPI were also associated with obesity, and the strength of this association increased for each 30-day supply prescribed. Furthermore, the HR increased commensurately with exposure to each additional medication group prescribed. They added that birth by caesarean section was associated with an increased risk of developing obesity in childhood, as were male sex and being born to parents below officer rank.

The authors of the study said their results had shown that combinations of multiple microbiota-altering medication groups are associated with a commensurate increase in obesity, and that their results further quantify the potential long-term risk of obesity associated with early exposure to acid-suppressing medications and antibiotics.

They noted that because their study was observational it could not show causality. They also pointed out that they were missing potentially important data on whether or not the children were breastfed, as well as their mothers’ weight, smoking status and comorbidity.

They concluded: “Antibiotics, acid suppressants and the combination of multiple medications in the first two years of life are associated with a diagnosis of childhood obesity. Microbiota-altering medications administered in early childhood may influence weight gain.”

And they added: “There is an important therapeutic role for microbiota-altering medications. The long-term risks to health must be weighed against the short-term benefits. Overprescription is a significant problem for antibiotics and antiacid medications.”

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, pointed out that there has already been a significant reduction in the use of antibiotics in recent years, because of concerns about emerging resistance. She commented: “This new study, linking antibiotic and antacid use with obesity, is extremely interesting, but does not prove causation. As such, it is very important that more research is conducted in this area, and that as further high-quality evidence emerges, it is taken into account as new clinical guidelines are updated and developed.

“People whose children have already been prescribed these medications should certainly not stop them on the basis of this research.”

* Stark CM, Susi A, Emerick J, et al. Antibiotic and acid-suppression medications during early childhood are associated with obesity. Gut 2018; epub ahead of print: doi 10.1136/gutjnl-2017-314971.

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