The Role of the Gut Microbiota During the First Two Years of Life in the Early Programming of Obesity, Type 2 Diabetes, and Hypertension

Abstract

The first two years of life constitute a critical window for the establishment of the gut microbiota and the early programming of cardiometabolic risk. The aim of this review was to analyze the influence of the gut microbiota during the first two years of life and its association with obesity, type 2 diabetes, and arterial hypertension. The reviewed studies suggest that early dysbiosis is associated with increased cardiometabolic vulnerability, linked to low-grade inflammation and alterations in energy metabolism. Associations are described between maternal metabolic conditions (such as obesity or gestational diabetes) and a less favorable initial intestinal ecosystem in the child, characterized by lower microbial diversity and reduced abundance of bacteria considered protective. In childhood obesity, longitudinal studies indicate that less mature microbiomes during the first year of life are associated with a higher risk of overweight, particularly when early antibiotic exposure and unhealthy dietary patterns coexist. In contrast, exclusive breastfeeding is associated with more functional microbial profiles. Regarding arterial hypertension, the findings suggest an influence mediated by microbial metabolites such as short-chain fatty acids and mechanisms involved in vascular regulation. Overall, the first thousand days represent a priority axis for promoting early-life practices that support a balanced gut microbiota as a potential strategy for cardiometabolic disease prevention.