Predictors of becoming overweight among pediatric patients at risk for urinary tract infections

Abstract

The association between obesity and urinary dysfunction in childhood has been described, albeit through retrospective analysis, making temporal relationships difficult to establish. The objective of this study was to determine risk factors for significant weight gain in children at risk for recurrent urinary tract infections. A secondary analysis of the Randomized Intervention for Children with Vesicoureteral Reflux and Careful Urinary Tract Infection Evaluation trials was conducted. The outcome of interest in these children was significant increase in body mass index (BMI) percentile (>85th BMI percentile for sex and age) in previously normal-weight children. Multivariable logistic regression was used to determine the independent effects of predetermined risk factors. In total, 446 patients were included in the study. Most patients aged less than 1 year at study entry (229, 51%), and 399 (89%) of patients were female. Eighty-four patients (17%) became clinically overweight. Patients assigned to prophylactic antibiotics were not more likely to gain significant BMI percentiles (adjusted odds ratio [aOR]=1.1, 95% confidence interval [CI]=0.6-1.8). Significant BMI percentiles were gained in Hispanic/Latino patients compared with whites (aOR=3.3, 95% CI=1.7-6.4), in children who were infants at study enrollment compared with non-infants (aOR=2.1, 95% CI=1.2-3.8), and in those with persistent reflux during the study period (aOR=2.1, 95% CI=1.0-4.3). Neither patients assigned to prophylactic antibiotics (aOR=1.1, 95% CI=0.6-1.8) nor patients with bladder and bowel dysfunction (BBD) (aOR=1.2, 95% CI=0.6-2.3) were more likely to gain significant BMI percentiles. Significant BMI percentile gain is common in patients at risk for UTIs. Hispanic/Latino ethnicity, persistent reflux, and younger age, specifically infants than non-infants, were identified as independent risk factors for becoming overweight in this population. Exposure to prophylactic antibiotics and BBD were not associated with becoming overweight. Risk for becoming overweight should be discussed when managing patients at risk for UTIs, especially in the subpopulations identified.