Long-term use of antibiotics and risk of type 2 diabetes in women: a prospective cohort study.

BACKGROUND: Accumulating evidence suggested that long-term antibiotic use may alter the gut microbiome, which has, in turn, been linked to type 2 diabetes. We undertook this study to investigate whether antibiotic use was associated with increased risk of type 2 diabetes. METHODS: This prospective cohort study included women free of diabetes, cardiovascular disease and cancer in the Nurses' Health Study (NHS 2008-2014) and NHS II (2009-2017). We evaluated the overall duration of antibiotics use in the past 4 years and subsequent diabetes risk with Cox proportional-hazards regression adjusting for demography, family history of diabetes and lifestyle factors. RESULTS: Pooled analyses of NHS and NHS II (2837 cases, 703 934 person-years) revealed that a longer duration of antibiotic use in the past 4 years was associated with higher risk of diabetes [Trend-coefficient = 0.09, 95% confidence interval (CI) 0.04 to 0.13]. Participants who received antibiotics treatment for a medium duration of 15 days to 2 months [hazard ratio (HR) 1.23, 95% CI 1.10 to 1.39] or long duration of >2 months (HR 1.20, 95% CI 1.02 to 1.38) had higher risk of type 2 diabetes as compared with non-users. Subgroup analyses suggested that the associations were unlikely to be modified by age, family history of diabetes, obesity, smoking, alcohol drinking, physical activity and overall diet quality. CONCLUSIONS: A longer duration of antibiotic use in recent years was associated with increased risk of type 2 diabetes in women. Physicians should exercise caution when prescribing antibiotics, particularly for long-term use.

Regular use of proton pump inhibitor and risk of rheumatoid arthritis in women: a prospective cohort study.

BACKGROUND: Proton pump inhibitors (PPIs) have a significant impact on the gut microbiome, which in turn, might increase the risk of rheumatoid arthritis (RA). AIM: To evaluate regular use of PPIs and risk of RA. METHODS: This is a prospective analysis of the US nurses who reported PPI use data, and were free of RA from the Nurses' Health Study (NHS 2002-2014) and NHS II (2003-2015). The exposure was regular use of PPI in the past 2 years, which was repeatedly evaluated in biennial surveys. RA was confirmed by the 1987 or 2010 American College of Rheumatology criteria. We estimated the hazard ratios (HRs) and confidence interval (CIs) with time-dependent Cox regression adjusting for potential confounders. RESULTS: We documented 421 cases of RA over 1 753 879 person-years of follow-up. Regular PPI users had a 44% higher risk of RA as compared with non-regular users (adjusted HR = 1.44; 95%CI, 1.10-1.89). The risk of RA increased with the total duration of PPI use (P-trend = 0.008). Compared with non-regular users, the adjusted HRs were 1.22 (95%CI, 0.93-1.62) for women with >0 to 4 years' use and 1.73 (95% CI, 1.14 to 2.61) for >4 years' use. CONCLUSIONS: Regular use of PPI was associated with increased risk of RA in women, with a higher risk observed in individuals with a longer duration of PPI use. Due to the observational study design, large prospective trials are still required to confirm our finding.