Turta Olli, Rautava Samuli
Department of Paediatrics, University of Turku and Turku University Hospital, Turku, Finland.
BMC Med. 2016 Apr 19;14:57. doi: 10.1186/s12916-016-0605-7.
Childhood obesity and overweight are among the greatest health challenges in the pediatric population. Obese individuals exhibit marked differences in the composition of the intestinal microbial community as compared to lean subjects. These changes in the gut microbiota precede the clinical manifestation of overweight. Convincing experimental data suggest a causal role for intestinal microbes in the development of obesity and associated metabolic disorders.
Exposure to antibiotics exerts a devastating impact on the intestinal microbial community. Epidemiological studies have provided evidence indicating that early or repeated childhood exposure to antibiotics is associated with increased risk of overweight later in childhood but the causal role of this exposure in obesity development is not clear. However, data from studies conducted using experimental animal models indicate that antibiotic-induced changes in the gut microbiota influence host metabolism and lead to fat accumulation. The intestinal microbiota perturbation caused by antibiotic exposure in the perinatal period appears to program the host to an obesity-prone metabolic phenotype, which persists after the antibiotics have been discontinued and the gut microbiota has recovered. These observations may have serious implications in the clinical setting, since a substantial number of human infants are subjected to antibiotic treatment through the mother during delivery or directly in the immediate neonatal period. The clinical significance of these exposures remains unknown. Prudent use of antibiotics is paramount not only to reduce the propagation of antibiotic-resistant organisms but also to minimize the potentially detrimental long-term metabolic consequences of early antibiotic exposure. Improved means of reliably detecting neonates with bacterial infection would reduce the need for empirical antibiotic exposure initiated based on nonspecific symptoms and signs or risk factors. Finally, means to support healthy microbial contact in neonates and infants requiring antibiotic treatment are needed.
儿童肥胖和超重是儿科人群面临的最大健康挑战之一。与瘦人相比，肥胖个体的肠道微生物群落组成存在显著差异。肠道微生物群的这些变化先于超重的临床表现出现。有说服力的实验数据表明肠道微生物在肥胖及相关代谢紊乱的发生中起因果作用。
接触抗生素会对肠道微生物群落产生毁灭性影响。流行病学研究提供的证据表明，儿童早期或反复接触抗生素与儿童后期超重风险增加有关，但这种接触在肥胖发生中的因果作用尚不清楚。然而，使用实验动物模型进行的研究数据表明，抗生素引起的肠道微生物群变化会影响宿主代谢并导致脂肪堆积。围产期抗生素暴露引起的肠道微生物群扰动似乎使宿主形成易肥胖的代谢表型，这种表型在停用抗生素且肠道微生物群恢复后仍会持续。这些观察结果在临床环境中可能具有严重意义，因为大量人类婴儿在分娩期间通过母亲或在新生儿期直接接受抗生素治疗。这些暴露的临床意义仍然未知。谨慎使用抗生素不仅对于减少抗生素耐药菌的传播至关重要，而且对于将早期抗生素暴露的潜在有害长期代谢后果降至最低也至关重要。改进可靠检测细菌感染新生儿的方法将减少基于非特异性症状、体征或风险因素进行经验性抗生素暴露的必要性。最后，需要采取措施支持需要抗生素治疗的新生儿和婴儿建立健康的微生物接触。
