Impact of early-life weight status on urinary tract infections in children: a nationwide population-based study in Korea

Abstract

Objectives: We aimed to evaluate the association between early-life weight status and urinary tract infection (UTI) risk in children.

Methods: A nationwide study was conducted using Korean National Health Screening (NHS) data and National Health Insurance Service data. A sample cohort was selected using data from the 2014 and 2015 NHS for infants and children (4-71 months) and followed up until the end of 2017. Participants were divided into 4 groups (underweight, normal weight, overweight, and obese) based on the weight-for-age (< 2 years) or body mass index (≥ 2 years). Hazard ratios (HRs) with 95% confidence intervals (CIs) for developing UTIs, cystitis, and acute pyelonephritis (APN) were calculated using a Cox proportional hazard model.

Results: Of 1,653,106 enrolled children, 120,142 (7.3%) developed UTIs, cystitis, and APN during follow-up. The underweight, overweight, and obese groups had higher risks of UTIs than the reference group after adjusting for age, sex, birth weight, and preterm birth. Between 2 years and 6 years of age, boys with underweight had a high risk of UTI and APN, while girls with overweight and obesity revealed elevated risks of UTIs, cystitis, and APN. The HRs for APN in boys with underweight and in girls with obesity were 1.46 (95% CI, 1.03 to 2.07) and 1.41 (95% CI, 1.13 to 1.75), respectively, after adjusting for age, sex, birth weight, and preterm birth. The incidence of APN did not decrease with age in underweight and obese children aged 2-6 years.

Conclusions: Children with underweight, overweight, and obesity may be at high risk for UTIs.

Keywords: Adiposity; Body weight; Malnutrition; Pediatrics; Urinary tract infections.

Figure 1.

Flow chart of study enrollment. ICD-10, International Classification of Dis eases, 10th revision; UTI, urinary tract infection; APN, acute pyelonephritis.

Figure 2.

Incidence rates of (A) urinary tract infection (UTIs), (B) cystitis, and (C) acute pyelonephritis (APN), stratified by age groups and body mass index (BMI) categories. U-shaped associations between BMI categories and the incidence rates of UTIs, cystitis, and APN were found in children aged 42-48 months.