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Childhood overweight after establishment of the gut microbiota: the role of delivery mode, pre-pregnancy weight and early administration of antibiotics
Abstract
Objective To investigate whether delivery mode (vaginal versus by caesarean section), maternal pre-pregnancy body mass index (BMI) and early exposure to antibiotics (<6 months of age) influence child's risk of overweight at age 7 years, hence supporting the hypotheses that environmental factors influencing the establishment and diversity of the gut microbiota are associated with later risk of overweight.Design Longitudinal, prospective study with measure of exposures in infancy and follow-up at age 7 years.Methods A total of 28 354 mother-child dyads from the Danish National Birth Cohort, with information on maternal pre-pregnancy BMI, delivery mode and antibiotic administration in infancy, were assessed. Logistic regression analyses were performed with childhood height and weight at the 7-year follow-up as outcome measures.Results Delivery mode was not significantly associated with childhood overweight (odds ratio (OR):1.18, 95% confidence interval (CI): 0.95-1.47). Antibiotics during the first 6 months of life led to increased risk of overweight among children of normal weight mothers (OR: 1.54, 95% CI: 1.09-2.17) and a decreased risk of overweight among children of overweight mothers (OR: 0.54, 95% CI: 0.30-0.98). The same tendency was observed among children of obese mothers (OR: 0.85, 95% CI: 0.41-1.76).Conclusion The present cohort study revealed that a combination of early exposures, including delivery mode, maternal pre-pregnancy BMI and antibiotics in infancy, influences the risk of overweight in later childhood. This effect may potentially be explained by an impact on establishment and diversity of the microbiota.
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“The use of antibiotics in early life is associated with obesity in both people and mice”
From Diet–microbiota interactions as moderators of human metabolism (2016) · cites this paper as [122]
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Pre-pregnancy weight, gestational weight gain, and the gut microbiota of mothers and their infants
Stanislawski, M. A., Dabelea, D., Wagner, B. D., Sontag, M. K., Lozupone, C., & Eggesbø, M. Å. (2017) · Microbiome · doi:10.1186/s40168-017-0332-0 · Cited by 190
“However, gut microbiota during infancy has been associated with rapid early growth and later overweight and obesity [14, 15], and numerous exposures known to impact the early gut microbiota, such as birth via cesarean section and antibiotics, have also been associated with increased obesity risk [16, 17].”
BackgroundAntibiotics detected in urines and adipogenesis in school children
Wang, H., Wang, N., Wang, B., Fang, H., Fu, C., Tang, C., Jiang, F., Zhou, Y., He, G., Zhao, Q., et al. (2016) · Environment International · doi:10.1016/j.envint.2016.02.005 · Cited by 173
Murphy, R., Stewart, A. W., Braithwaite, I. E., Beasley, R. W., Hancox, R. J., Mitchell, E. A., & the ISAAC Phase Three Study Group (2013) · International Journal of Obesity · doi:10.1038/ijo.2013.218 · Cited by 169
Stanislawski, M. A., Dabelea, D., Wagner, B. D., Iszatt, N., Dahl, C., Sontag, M. K., Knight, R. D., Lozupone, C., & Eggesbø, M. Å. (2018) · mBio · doi:10.1128/mbio.01751-18 · Cited by 179
Gomez-Arango, L. F., Barrett, H. L., McIntyre, H. D., Callaway, L. K., Morrison, M., & Nitert, M. D. (2017) · Scientific Reports · doi:10.1038/s41598-017-03066-4 · Cited by 168
Antibiotics in the first year of life and subsequent neurocognitive outcomes
Slykerman, R. F., Thompson, J., Waldie, K. E., Murphy, R., Wall, C., & Mitchell, E. A. (2017) · Acta Paediatrica · doi:10.1111/apa.13613 · Cited by 166
“In animal models, antibiotic use in early life has been shown to increase risk of central adiposity and obesity in rodents (16), and this has more recently been shown in human studies (17,18).”
BackgroundHoen, A. G., Li, J., Moulton, L. A., O’Toole, G. A., Housman, M. L., Koestler, D. C., Guill, M. F., Moore, J. H., Hibberd, P. L., Morrison, H. G., et al. (2015) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2015.02.049 · Cited by 167
ElRakaiby, M. T., Dutilh, B. E., Rizkallah, M. R., Boleij, A., Cole, J. N., & Aziz, R. K. (2014) · OMICS A Journal of Integrative Biology · doi:10.1089/omi.2014.0018 · Cited by 169
“Furthermore, the administration of antibiotics in early childhood has been associated with serious conditions such as Crohn’s disease (Virta et al., 2012), asthma (Risnes et al., 2011), and obesity (Ajslev et al., 2011).”
Pediatrics Consequences of Caesarean Section—A Systematic Review and Meta-Analysis
Słabuszewska-Jóźwiak, A., Szymański, J. K., Ciebiera, M., Sarecka‐Hujar, B., & Jakiel, G. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17218031 · Cited by 162
“[72] Denmark Cohort Prospective 28,354 7 y Obesity”
BackgroundThe Infant Gut Microbiome: Evidence for Obesity Risk and Dietary Intervention
Koleva, P. T., Bridgman, S. L., & Kozyrskyj, A. L. (2015) · Nutrients · doi:10.3390/nu7042237 · Cited by 158
“Data from two large birth cohorts, the Danish National Birth Cohort and the UK Avon Longitudinal Study of Parents and Children, found modest increases in risk for overweight at age 7 years and 38 months, respectively, with antibiotic exposure before six months of life [43,47].”
Lee, P. C., Yacyshyn, B., & Yacyshyn, M. B. (2018) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13561 · Cited by 159
“Early exposure to antibiotics is correlated with an increased risk of overweight children from mothers with normal body weight and a decreased risk of child obesity from overweight mothers.(83) The timing of antibiotic exposure seems to be important.”
BackgroundEarly-onset Sepsis and Antibiotic Exposure in Term Infants
Fjalstad, J. W., Stensvold, H. J., Bergseng, H., Simonsen, G. S., Salvesen, B., Rønnestad, A. E., & Klingenberg, C. (2015) · The Pediatric Infectious Disease Journal · doi:10.1097/inf.0000000000000906 · Cited by 152
Vidal, A. C., Murphy, S. K., Murtha, A. P., Schildkraut, J. M., Soubry, A., Huang, Z., Neelon, S. E. B., Fuemmeler, B. F., Iversen, E. S., Wang, F., et al. (2013) · International Journal of Obesity · doi:10.1038/ijo.2013.47 · Cited by 150
García‐Mantrana, I., Selma‐Royo, M., González, S., Llorca, A. P., Martínez‐Costa, C., & Collado, M. C. (2020) · Gut Microbes · doi:10.1080/19490976.2020.1730294 · Cited by 155
“Early exposure to antibiotic use, unbalanced diets, and the increased ratios of C-section deliveries could disrupt this adequate early infant colonization, which have been linked to the risk of childhood obesity.(14,15) Maternal overweight and obesity have an impact on the infant microbiota and can influence the risk…”
BackgroundLinking microbiota to human diseases: a systems biology perspective
Wu, H., Tremaroli, V., & Bäckhed, F. (2015) · Trends in Endocrinology & Metabolism · doi:10.1016/j.tem.2015.09.011 · Cited by 150
“to the development of obesity in humans [21], and mouse studies demonstrated that early administration of antibiotics decreases ileal expression of host immune genes by depleting the microbiota and induces obesity in adulthood, potentially by affecting host liver metabolism [22,23].”
BackgroundKuzniewicz, M. W., Walsh, E. M., Li, S. X., Fischer, A. F., & Escobar, G. J. (2016) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(16)42030-1 · Cited by 148
Stinson, L. F., Payne, M. S., & Keelan, J. A. (2018) · Frontiers in Medicine · doi:10.3389/fmed.2018.00135 · Cited by 154
“Aberrations in the establishment of this ecosystem in infants and children underpin the risk for immune-mediated diseases, such as asthma (18–21), allergies (22–25), and inflammatory bowel disease (26, 27), as well as metabolic conditions, such as obesity (28) and a variety of behavioral, cognitive, and mental health…”
BackgroundFactors influencing the gut microbiome in children: from infancy to childhood
Kumbhare, S. V., Patangia, D. V., Patil, R. H., Shouche, Y. S., & Patil, N. P. (2019) · Journal of Biosciences · doi:10.1007/s12038-019-9860-z · Cited by 143
“It is observed that antibiotic uptake during early life increases the risk of overweight and obesity in children in later life (Ajslev et al. 2011; Trasande et al. 2013; Bailey et al. 2018).”
BackgroundNormal neonatal microbiome variation in relation to environmental factors, infection and allergy
Madan, J. C., Farzan, S. F., Hibberd, P. L., & Karagas, M. R. (2012) · Current Opinion in Pediatrics · doi:10.1097/mop.0b013e32835a1ac8 · Cited by 149
Pardon, B., Hostens, M., Duchateau, L., Dewulf, J., De Bleecker, K., & Deprez, P. (2013) · BMC Veterinary Research · doi:10.1186/1746-6148-9-79 · Cited by 138
“In human medicine, antimicrobial use at young age in infants from mothers with a normal body weight has been associated with an increased risk of overweight at the age of 7 [63].”
BackgroundRasmussen, S. H., Shrestha, S., Bjerregaard, L. G., Ängquist, L. H., Baker, J. L., Jess, T., & Allin, K. H. (2018) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13230 · Cited by 138
“arises from the fact that children who are prescribed antibiotics are inherently different from children who are not, and that these children may have a different risk of overweight than unexposed children independent of exposure to antibiotics.(3) This was not acknowledged by a recently published meta-analysis which…”
ResultSelf-citationImportance of gut microbiota in obesity
Cornejo-Pareja, I. M., Muñoz‐Garach, A., Clemente‐Postigo, M., & Tinahones, F. J. (2018) · European Journal of Clinical Nutrition · doi:10.1038/s41430-018-0306-8 · Cited by 147
Childhood BMI in relation to microbiota in infancy and lifetime antibiotic use
Korpela, K., Zijlmans, M. A. C., Kuitunen, M., Kukkonen, A. K., Savilahti, E., Salonen, A., de Weerth, C., & de Vos, W. M. (2017) · Microbiome · doi:10.1186/s40168-017-0245-y · Cited by 143
Kan, H., Zhao, F., Zhang, X., Ren, H., & Gao, S. (2015) · Environmental Science & Technology · doi:10.1021/acs.est.5b02990 · Cited by 132
Antibiotics, obesity and the link to microbes - what are we doing to our children?
Turta, O., & Rautava, S. (2016) · BMC Medicine · doi:10.1186/s12916-016-0605-7 · Cited by 132
“The clinical significance of this phenomenon is demonstrated by a recent systematic review and metaanalysis of epidemiological studies indicating that the risk of childhood obesity in infants born by CS is 1.34- fold (95 % CI 1.18–1.51) as compared to vaginally-born subjects even if maternal BMI is taken into consider…”
InfluentialCurrent understanding of antibiotic-associated dysbiosis and approaches for its management
Kesavelu, D., & Jog, P. P. (2023) · Therapeutic Advances in Infectious Disease · doi:10.1177/20499361231154443 · Cited by 156
Early life events influence whole-of-life metabolic health via gut microflora and gut permeability
Kerr, C. A., Grice, D. M., Tran, C. D., Bauer, D. C., Li, D., Hendry, P. L., & Hannan, G. N. (2014) · Critical Reviews in Microbiology · doi:10.3109/1040841x.2013.837863 · Cited by 129
“For example, of all children treated with antibiotics in this study, those with mothers with a healthy pre-pregnancy BMI had an increased risk of developing obesity, whereas those of obese mothers were at decreased risk of developing obesity (Ajslev et al., 2011).”
BackgroundInfluential
Metadata
- Authors
- Ajslev, T. A., Andersen, C. S., Gamborg, M., Sørensen, T. I. A., & Jess, T.
- Affiliations
- Copenhagen University Hospital (DK)
- Corresponding author
- Ajslev, T A
- Venue
- International Journal of Obesity
- Published
- 2011-03-08
- Volume
- 35
- Issue
- 4
- Pages
- 522-529
- ISSN
- 0307-0565 (ISSN-L)
- 1476-5497
- OpenAlex
- W2003202328
- Cited by
- 534
- References
- 36
- Citations by year
- 2026: 12 · 2025: 12 · 2024: 17 · 2023: 20 · 2022: 27 · 2021: 36 · 2020: 51 · 2019: 54 · 2018: 51 · 2017: 51 · 2016: 54 · 2015: 59 · 2014: 32 · 2013: 33 · 2012: 21
- FWCI
- 11.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- International Journal of Obesity (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Keywords
- childhood overweight, gut microbiota, mode of delivery, cesarean section, vaginal delivery, maternal pre-pregnancy BMI, maternal obesity, early antibiotic exposure, infancy, environmental risk factors
- MeSH terms
- Adolescent, Adult, Anti-Bacterial Agents, Cesarean Section, Child, Female, Humans, Infant, Newborn, Longitudinal Studies, Male, Mothers, Obesity, Pregnancy, Prospective Studies, Surveys and Questionnaires, Risk Factors, Body Mass Index, Delivery, Obstetric, Gastrointestinal Tract, Metagenome, Young Adult
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