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Early childhood infections and body mass index in adolescence



The incidence of childhood overweight and obesity is rising. It is hypothesized that infections in early childhood are associated with being overweight. This study investigated the association between the number of symptomatic infections or antibiotic prescriptions in the first 3 years of life and body mass index (BMI) in adolescence.


The current study is part of the Prevention and Incidence of Asthma and Mite Allergy population-based birth cohort study. Weight and height were measured by trained research staff at ages 12 and 16 years. The 3015 active participants at age 18 years were asked for informed consent for general practitioner (GP) data collection and 1519 gave written informed consent. Studied exposures include (1) GP-diagnosed infections, (2) antibiotic prescriptions, and (3) parent-reported infections in the first 3 years of life. Generalized estimating equation analysis was used to determine the association between each of these exposures and BMI z-score.


Exposure data and BMI measurement in adolescence were available for 622 participants. The frequencies of GP-diagnosed infections and antibiotic prescriptions were not associated with BMI z-score in adolescence with estimates being 0.14 (95% CI −0.09–0.37) and 0.10 (95% CI −0.14–0.34) for the highest exposure categories, respectively. Having ≥6 parent-reported infections up to age 3 years was associated with a 0.23 (95% CI 0.01–0.44) higher BMI z-score compared to <2 parent-reported infections.


For all infectious disease measures an increase in BMI z-score for the highest childhood exposure to infectious disease was observed, although only statistically significant for parent-reported infections. These results do not show an evident link with infection severity, but suggest a possible cumulative effect of repeated symptomatic infections on overweight development.

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Fig. 1: Flowchart of general practitioner (GP) data collection.


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The authors gratefully thank the contribution of all participating children and parents or caregivers of the PIAMA study. We thank the general practitioners for their participation in the collection of the infectious disease data. We thank Ada Wolse, Marjan Tewis, and Marieke Oldenwening for their contribution to the data collection and data management. We thank Barbara Strijbosch, Simone Ruijs, Jonathan Eindhoven, Willem Miellet, Lisanne Verbruggen, Kirsty Verheggen, Maxime de Jong, and Rowan van Rooijen for their contribution to the general practitioner data collection.


The PIAMA study is supported by The Netherlands Organization for Health Research and Development, The Netherlands Organization for Scientific Research, The Netherlands Asthma Fund, The Netherlands Ministry of Spatial Planning, Housing, and the Environment, and The Netherlands Ministry of Health, Welfare, and Sport.

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Correspondence to Annemarijn C. Prins-van Ginkel.

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Supplementary information

Appendix 1. Febrile infections and corresponding ICPC codes if applicable.


Appendix 2. Characteristics of the population for analysis, the eligible study population (participants asked for informed consent for GP data collection) and the total PIAMA study population.


Appendix 3. Difference in BMI z-score (>3 to 18 years) at all available ages between exposed and reference group after multiple imputation.


Appendix 4. Difference in BMI z-score at age 12 and/or 16 years between exposed and reference group for first year of life after multiple imputation. BMI data from the medical examinations were used.


Appendix 5. Anthropometric measures of study population with GP data on at least one of the first three years of life and BMI measurement at age 12 and/or 16 years (N=622).

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Prins-van Ginkel, A.C., Wijga, A.H., Bruijning-Verhagen, P.C.J. et al. Early childhood infections and body mass index in adolescence. Int J Obes 45, 1143–1151 (2021).

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