Objective Gut microbiota alterations are associated with obesity. Early exposure to medications, including acid suppressants and antibiotics, can alter gut biota and may increase the likelihood of developing obesity. We investigated the association of antibiotic, histamine-2 receptor antagonist (H2RA) and proton pump inhibitor (PPI) prescriptions during early childhood with a diagnosis of obesity.
Design We performed a cohort study of US Department of Defense TRICARE beneficiaries born from October 2006 to September 2013. Exposures were defined as having any dispensed prescription for antibiotic, H2RA or PPI medications in the first 2 years of life. A single event analysis of obesity was performed using Cox proportional hazards regression.
Results 333 353 children met inclusion criteria, with 241 502 (72.4%) children prescribed an antibiotic, 39 488 (11.8%) an H2RA and 11 089 (3.3%) a PPI. Antibiotic prescriptions were associated with obesity (HR 1.26; 95% CI 1.23 to 1.28). This association persisted regardless of antibiotic class and strengthened with each additional class of antibiotic prescribed. H2RA and PPI prescriptions were also associated with obesity, with a stronger association for each 30-day supply prescribed. The HR increased commensurately with exposure to each additional medication group prescribed.
Conclusions Antibiotics, acid suppressants and the combination of multiple medications in the first 2 years of life are associated with a diagnosis of childhood obesity. Microbiota-altering medications administered in early childhood may influence weight gain.
- proton pump inhibition
- enteric bacterial microflora
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Contributors CMS, AS and CMN offered substantial contributions to the conception and design of the work, acquisition, analysis and interpretation of data, drafting the work, critical revision and final approval of the completed manuscript. JE offered substantial contributions to the conception and design of the work, acquisition, analysis and interpretation of data, critical revision and final approval of the completed manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer The views expressed are those of the authors and do not reflect the official policy or position of the US Army, the US Air Force, the US Navy, the US Department of Defense or the US Government.
Competing interests None declared.
Patient consent Not required.
Ethics approval Approved by the Institutional Review Board of the Uniformed Services University of the Health Sciences.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The Military Health System Data Repository (MDR) is the centralised data repository that captures, archives, validates, integrates and distributes Defense Health Agency corporate health care data worldwide. It receives and validates data from the Department of Defense’s (DoD) worldwide network of more than 260 healthcare facilities and from non-DoD data sources. Access to the MDR can be requested through the Military Health System website at www.health.mil.