Use of antibiotics during infancy and risk of developing childhood obesity

Childhood overweight and obesity is becoming a major public health concern worldwide. An estimated 43 million pre-school children would develop overweight and obesity – a report from 2010 says. Alongside the developed countries, the prevalence of childhood obesity is alarmingly increasing in developing countries. Childhood obesity tends to be continued in adulthood and increases the risk of developing high blood pressure, cardiovascular diseases e.g. stroke, heart attack, diabetes and cancers in the later stage of life. Given the magnitude of future health risks associated with childhood obesity, strong public health preventive actions are imperative.
The researchers from US recently found an association between antibiotic uses in infancy (0-23 months) with early childhood obesity. In recently published research article in Journal of American Medical Association (JAMA) Pediatrics, they showed the findings from a study with 64,580 children. They were followed up to identify obesity until they reached 5 years of age.
The researchers found that 69% of the infants were prescribed antibiotics before the age of 24 months. They were prescribed for 2 times on average within this period.
Antibiotic use during infancy would increase the risk of getting obese in early childhood by 11% which could go as far as 21%. They found use of narrow spectrum antibiotics (e.g. those who act on certain types of bacteria) was not increasing the risk of obesity in those children.
However use of broad spectrum antibiotics (e.g. those who kills a wide range of bacteria) had the most risk associated with getting obesity. The risk was 16% higher in compared to children not getting any antibiotics in this period. This risk would increase as high as 29%.
As wide spectrum antibiotics kill a wide range of bacteria, they also kill the normal flora in our intestine which is actually beneficial. Previous studies suggest that use of broad spectrum antibiotic changes the composition and diversity of gut bacteria and thus alters the energy consumption which causes obesity.
Meanwhile another study from American Society for Microbiology found that a certain species of intestinal bacteria – named “Clostridium Ramosum” can stimulate weight gain in mice.
However the study does not confirm that use of broad-spectrum antibiotics is a causal factor for childhood obesity which means there might be an association by evidence; but we need more research to establish this as a risk factor.
Still the major risk factors of childhood obesity are high caloric food intake (e.g. fast foods, soft drinks), physical inactivity, genetic predisposition etc.
As obesity has a multifactorial causation, identifying and controlling multiple risk factors would be crucial to reduce its burden and subsequent future health risks.
Bangladesh perspective
To date there is no study exploring the percentage of infant exposed to antibiotics in Bangladesh. However, from the high burden of infectious diseases like diarrhoea, pneumonia and widespread use of antibiotics at every level of healthcare, we can assume that almost every child is prescribed broad-spectrum antibiotics during infancy.
Moreover antibiotics are irrationally prescribed by the quacks and found as over-the-counter (OTC) drug all over the country. If proven as causal, this high use of antibiotics all around would contribute immensely to the increasing burden of childhood obesity in the country.

N.B. This article was published in “The Independent Bangladesh” on Monday 15 December 2014

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