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Pediatrics

The association between antibiotic use in infancy and overweight during childhood and adolescence: a historical cohort study

International Journal of Obesity (2025)Cite this article

Subjects

Abstract

Background and objective

The role of the microbiome and gut flora alterations in childhood obesity has drawn increasing scientific attention. However, large-scale, long-term cohort studies with real-world data on exposure and outcomes are lacking. We aimed to examine the association between exposure to antibiotics during infancy and the development of overweight and obesity during childhood and adolescence.

Methods

We conducted a historical cohort study using data from a large Israeli health provider (Maccabi Healthcare Services, MHS). Eligible patients born between 1998-2002 who received antibiotics before age 2 years were compared with unexposed infants. Valid body mass index (BMI) data were available for 76,840 eligible infants, including 65280 exposed to antibiotics (52.2% males) and 11,560 unexposed (46.1% males). Study outcomes were overweight and obesity during childhood/ adolescence.

Results

Compared to unexposed, antibiotic-exposed infants had significantly higher mean ( ± SE) BMI percentiles in all age groups: childhood (57.8 ± 0.1 vs 55.0 ± 0.2), early adolescence (58.2 ± 0.1 vs. 55.1 ± 0.3), and late adolescence (57.4 ± 0.2 vs. 55.0 ± 0.4), all p < 0.001. The odds of overweight and obesity versus unexposed infants increased significantly (p < 0.001) with the number of dispensed narrow-spectrum antibiotic packs, from an odds ratio of 1.15 (95%CI: 1.02–1.29) for 1–2 packs, to 1.52 (95%CI: 1.13–2.05) among those exposed to 10 or more packs. No such association was found for broad-spectrum antibiotics.

Conclusions

Exposure to narrow spectrum antibiotics during infancy was associated with a higher BMI and an increased likelihood of overweight and obesity in childhood and adolescence.

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Data availability

De-identified individual participant data will not be made available.

Code availability

Code for all published analyses are available upon written request.

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Author information

Authors and Affiliations

  1. School of Public Health, Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel-Aviv, Israel

    Eilon Heyman & Gabriel Chodick

  2. Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel

    Noga Fallach

  3. Pediatric Exercise and Lifestyle Clinic, Safra Children’s Hospital, Sheba Medical Center, Tel HaShomer, Ramat-Gan, Israel

    Gal Dubnov-Raz

  4. Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel-Aviv, Israel

    Gal Dubnov-Raz

Authors
  1. Eilon Heyman
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  2. Gabriel Chodick
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  3. Noga Fallach
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  4. Gal Dubnov-Raz
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Contributions

EH interpreted data and results, revised, and approved the final manuscript. GC contributed to data interpretation analyzed data and wrote the first draft of manuscript, NF contributed to data collection, analysis, and interpretation of findings, and GDR contributed to study conceptualization, analysis, and interpretation of findings. All authors approved final version of manuscript.

Corresponding author

Correspondence to Gabriel Chodick.

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Competing interests

The authors declare no competing interests.

Ethical approval and informed consent

All data transferred from MHS study investigators was consisted of de-identified and anonymous information. The study was approved by the Maccabi Healthcare Service internal review board and met the exemption criteria for informed consent. This research study followed the STROBE (Strengthening the reporting of observational studies in epidemiology) guidelines for cohort studies, and the corresponding checklist is included in the Supplementary Materials.

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Heyman, E., Chodick, G., Fallach, N. et al. The association between antibiotic use in infancy and overweight during childhood and adolescence: a historical cohort study. Int J Obes (2025). https://doi.org/10.1038/s41366-025-01972-6

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