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Duong QA, Pittet LF, Curtis N, Zimmermann P. Antibiotic exposure and adverse long-term health outcomes in children: a systematic review and meta-analysis. J Infect 2022; 85:213-300. [PMID: 35021114 DOI: 10.1016/j.jinf.2022.01.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Antibiotics are among the most commonly used drugs in children. In addition to inducing antibiotic resistance, antibiotic exposure has been associated with long-term adverse health outcomes. METHODS A systematic search using PRISMA Guidelines to identify original studies reporting associations between antibiotic exposure and long-term adverse health outcomes in children. Overall pooled estimates of the odds ratios (ORs) were obtained using fixed or random-effects models. RESULTS We identified 160 observational studies investigating 21 outcomes in 22,103,129 children. Antibiotic exposure was associated with an increased risk of atopic dermatitis (OR 1.40, 95% confidence interval (CI) 1.30-1.52, p<0.01), allergic symptoms (OR 1.93, 95%CI 1.66-2.26, p<0.01), food allergies (OR 1.35, 95%CI 1.20-1.52, p<0.01), allergic rhinoconjunctivitis (OR 1.66, 95%CI 1.51-1.83, p<0.01), wheezing (OR 1.81, 95%CI 1.65-1.97, p<0.01), asthma (OR 1.96, 95%CI 1.76-2.17, p<0.01), increased weight gain or overweight (OR 1.18, 95%CI 1.11-1.26, p<0.01), obesity (OR 1.21, 95%CI 1.05-1.40, p<0.01), juvenile idiopathic arthritis (OR 1.74, 95%CI 1.21-2.52, p<0.01), psoriasis (OR 1.75, 95%CI 1.44-2.11, p<0.01), autism spectrum disorders (OR 1.19, 95%CI 1.04-1.36, p=0.01) and neurodevelopment disorders (OR 1.29, 95%CI 1.09-1.53, p<0.01). Dose-response effects and stronger effects with broad-spectrum antibiotic were often reported. Antibiotic exposure was not associated with an altered risk of allergic sensitisation, infantile colic, abdominal pain, inflammatory bowel disease, celiac disease, type 1 diabetes, fluorosis, and attention deficit hyperactivity disorder. CONCLUSION Although a causal association cannot be determined from these studies, the results support the meticulous application of sound antibiotic stewardship to avoid potential adverse long-term health outcomes.
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Affiliation(s)
- Quynh Anh Duong
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Laure F Pittet
- Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia; Unit of Pediatric Infectious Diseases, Department of Pediatrics, Gynecology & Obstetrics, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland; Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland.
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Calcaterra V, Verduci E, Magenes VC, Pascuzzi MC, Rossi V, Sangiorgio A, Bosetti A, Zuccotti G, Mameli C. The Role of Pediatric Nutrition as a Modifiable Risk Factor for Precocious Puberty. Life (Basel) 2021; 11:1353. [PMID: 34947884 PMCID: PMC8706413 DOI: 10.3390/life11121353] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 12/19/2022] Open
Abstract
Puberty is a critical phase of growth and development characterized by a complex process regulated by the neuroendocrine system. Precocious puberty (PP) is defined as the appearance of physical and hormonal signs of pubertal development at an earlier age than is considered normal. The timing of puberty has important public health, clinical, and social implications. In fact, it is crucial in psychological and physical development and can impact future health. Nutritional status is considered as one of the most important factors modulating pubertal development. This narrative review presents an overview on the role of nutritional factors as determinants of the timing of sexual maturation, focusing on early-life and childhood nutrition. As reported, breast milk seems to have an important protective role against early puberty onset, mainly due to its positive influence on infant growth rate and childhood overweight prevention. The energy imbalance, macro/micronutrient food content, and dietary patterns may modulate the premature activation of the hypothalamic-pituitary-gonadal axis, inducing precocious activation of puberty. An increase in knowledge on the mechanism whereby nutrients may influence puberty will be useful in providing adequate nutritional recommendations to prevent PP and related complications.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Elvira Verduci
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
- Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Vittoria Carlotta Magenes
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
| | - Martina Chiara Pascuzzi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
| | - Virginia Rossi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
| | - Arianna Sangiorgio
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
| | - Alessandra Bosetti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, 20157 Milan, Italy
| | - Chiara Mameli
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.); (V.C.M.); (M.C.P.); (V.R.); (A.S.); (A.B.); (G.Z.); (C.M.)
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, 20157 Milan, Italy
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Martinón-Torres N, Carreira N, Picáns-Leis R, Pérez-Ferreirós A, Kalén A, Leis R. Baby-Led Weaning: What Role Does It Play in Obesity Risk during the First Years? A Systematic Review. Nutrients 2021; 13:nu13031009. [PMID: 33800994 PMCID: PMC8003981 DOI: 10.3390/nu13031009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
Childhood is a window of opportunity for the prevention of the obesity pandemic. Since “the first 1000 days of life” is a period in which healthy eating habits must be acquired, it should be the target for preventive strategies. Baby-led weaning (BLW) is an emergent way of weaning that could influence children’s health. The nutrition committees of the main pediatric societies affirm there is not enough evidence to support which is the best method of weaning. The aim was to determinate the influence of BLW on the infant’s weight gain compared to the traditional spoon-feeding, and to assess if it could decrease the risk of obesity in children. A systematic review was conducted, following the PRISMA method. Pubmed, Web of Science, Embase, and Cochrane Library were searched. Out of 747 articles, eight studies (2875 total infants) were included (two randomized control trials, 6 observational studies). Results were indecisive, while some studies seem to demonstrate lower weight gain in infants that apply BLW, others show inconclusive results. The risk of bias in all included studies was moderate or high. In conclusion, more clinical trials and prospective studies should be done prior to providing a general recommendation about the best method of weaning to reduce the risk of obesity.
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Affiliation(s)
- Nazareth Martinón-Torres
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Service, University Clinical Hospital of Santiago (CHUS), 15706 Santiago de Compostela, Spain; (N.M.-T.); (N.C.)
- Pediatric Nutrition Research Group, Institute of Sanitary Research of Santiago de Compostela (IDIS), CHUS-USC, 15706 Santiago de Compostela, Spain
| | - Nathalie Carreira
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Service, University Clinical Hospital of Santiago (CHUS), 15706 Santiago de Compostela, Spain; (N.M.-T.); (N.C.)
- Pediatric Nutrition Research Group, Institute of Sanitary Research of Santiago de Compostela (IDIS), CHUS-USC, 15706 Santiago de Compostela, Spain
| | - Rosaura Picáns-Leis
- Department of Pediatrics, University Clinical Hospital of Santiago (CHUS), 15706 Santiago de Compostela, Spain;
| | - Alexandra Pérez-Ferreirós
- Unit of Investigation in Human Nutrition, Growth and Development of Galicia (GALINUT), University of Santiago de Compostela (USC), 15701 Santiago de Compostela, Spain; (A.P.-F.); (A.K.)
| | - Anton Kalén
- Unit of Investigation in Human Nutrition, Growth and Development of Galicia (GALINUT), University of Santiago de Compostela (USC), 15701 Santiago de Compostela, Spain; (A.P.-F.); (A.K.)
| | - Rosaura Leis
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Service, University Clinical Hospital of Santiago (CHUS), 15706 Santiago de Compostela, Spain; (N.M.-T.); (N.C.)
- Pediatric Nutrition Research Group, Institute of Sanitary Research of Santiago de Compostela (IDIS), CHUS-USC, 15706 Santiago de Compostela, Spain
- Department of Pediatrics, University Clinical Hospital of Santiago (CHUS), 15706 Santiago de Compostela, Spain;
- Unit of Investigation in Human Nutrition, Growth and Development of Galicia (GALINUT), University of Santiago de Compostela (USC), 15701 Santiago de Compostela, Spain; (A.P.-F.); (A.K.)
- CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-981-951-116
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Calcaterra V, Cena H, Regalbuto C, Vinci F, Porri D, Verduci E, Mameli C, Zuccotti GV. The Role of Fetal, Infant, and Childhood Nutrition in the Timing of Sexual Maturation. Nutrients 2021; 13:419. [PMID: 33525559 PMCID: PMC7911282 DOI: 10.3390/nu13020419] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 12/28/2022] Open
Abstract
Puberty is a crucial developmental stage in the life span, necessary to achieve reproductive and somatic maturity. Timing of puberty is modulated by and responds to central neurotransmitters, hormones, and environmental factors leading to hypothalamic-pituitary-gonadal axis maturation. The connection between hormones and nutrition during critical periods of growth, like fetal life or infancy, is fundamental for metabolic adaptation response and pubertal development control and prediction. Since birth weight is an important indicator of growth estimation during fetal life, restricted prenatal growth, such as intrauterine growth restriction (IUGR) and small for gestational age (SGA), may impact endocrine system, affecting pubertal development. Successively, lactation along with early life optimal nutrition during infancy and childhood may be important in order to set up timing of sexual maturation and provide successful reproduction at a later time. Sexual maturation and healthy growth are also influenced by nutrition requirements and diet composition. Early nutritional surveillance and monitoring of pubertal development is recommended in all children, particularly in those at risk, such as the ones born SGA and/or IUGR, as well as in the case of sudden weight gain during infancy. Adequate macro and micronutrient intake is essential for healthy growth and sexual maturity.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Unit, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (C.M.); (G.V.Z.)
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (H.C.); (D.P.)
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy
| | - Corrado Regalbuto
- Pediatric Unit, Fond, IRCCS Policlinico S. Matteo and University of Pavia, 27100 Pavia, Italy; (C.R.); (F.V.)
| | - Federica Vinci
- Pediatric Unit, Fond, IRCCS Policlinico S. Matteo and University of Pavia, 27100 Pavia, Italy; (C.R.); (F.V.)
| | - Debora Porri
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (H.C.); (D.P.)
| | - Elvira Verduci
- Pediatric Unit, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (C.M.); (G.V.Z.)
- Department of Health Sciences, University of Milano, 20142 Milano, Italy
| | - Chiara Mameli
- Pediatric Unit, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (C.M.); (G.V.Z.)
- “L. Sacco” Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
| | - Gian Vincenzo Zuccotti
- Pediatric Unit, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (C.M.); (G.V.Z.)
- “L. Sacco” Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
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Differding MK, Benjamin-Neelon SE, Hoyo C, Østbye T, Mueller NT. Timing of complementary feeding is associated with gut microbiota diversity and composition and short chain fatty acid concentrations over the first year of life. BMC Microbiol 2020; 20:56. [PMID: 32160858 PMCID: PMC7065329 DOI: 10.1186/s12866-020-01723-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/07/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Early introduction of complementary foods has been associated with various immune disorders, oxidative stress, and obesity in childhood. The gut microbiota and the short chain fatty acids (SCFAs) they produce are postulated to be on the causal pathway. The objective of this study was to determine if early complementary feeding (i.e. consumption of solids or non-water/formula liquids at or before 3 months) is prospectively associated with infant gut microbiota composition, diversity and SCFAs at 3 and 12 months of age in the Nurture birth cohort. RESULTS Mother-infant dyads in the early complementary feeding group (n = 18) had similar baseline characteristics to those in the later feeding group (n = 49). We assessed differential abundance of microbial taxa (measured by 16S rRNA gene sequencing of the V4 region) by timing of complementary feeding using beta-binomial regression models (considering a two-sided FDR corrected p-value of < 0.05 as significant), and we fittted linear regression models to assess the association between early complementary feeding and SCFA concentrations (quantified using gas chromatography). After multivariable adjustment for breastfeeding, delivery method, birth weight, and gestational age, there were 13 differentially abundant microbial amplicon sequence variants (ASVs) by timing of introduction to complementary foods at 3 months and 20 ASVs at 12 months. Infants introduced to complementary foods early (vs. later) had higher concentrations of the SCFA butyric acid (mean difference = 0.65, 95% CI: 0.27, 1.04, p < 0.01) and total SCFAs (mean difference = 38.8, 95% CI: 7.83, 69.7) at 12 months. Bilophila wadsworthia and Lachnospiraceae Roseburia were associated with early (vs. later) complementary feeding and with higher butyric acid concentrations at 3 and 12 months, respectively. CONCLUSIONS Our findings are consistent with the hypothesis that early (vs. later) introduction to complementary foods is associated with altered gut microbiota composition and butyric acid concentrations measured in stool until at least 1 year of age. Further research is needed to determine if these changes mediate future development of metabolic and immune conditions.
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Affiliation(s)
- Moira K. Differding
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Sara E. Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Cathrine Hoyo
- Department of Biological Sciences, North Carolina State University, 3510 Thomas Hall, Raleigh, NC USA
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University, Durham, NC USA
| | - Noel T. Mueller
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, 2024 E. Monument St, Suite 2-500, Room 2-521, Baltimore, MD 21205 USA
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