Prospective associations of infant food exposures and appetitive traits with early childhood diet quality

Background: Early-life food exposures may influence food preferences and receptivity, thereby impacting long-term diet quality. Infant exposure to discretionary foods may be more detrimental for infants with high food approach traits; conversely, early exposure to fruits and vegetables may be more important for those with high food avoidance traits. This study investigated associations of infant food exposures with early childhood diet quality and whether these associations are modified by infant appetitive traits.

Methods: Data are from the Pregnancy Eating Attributes Study (PEAS) and Sprouts follow-up study, a prospective cohort assessed from the first trimester of pregnancy through early childhood. Birthing parents completed the Baby Eating Behavior Questionnaire assessing food-approach and food-avoidance appetitive traits at 6 months and food frequency questionnaires assessing infant age at introduction to and frequency of consuming food groups at ages 6 months, 1 year, and 2 years. At child ages 3.5 and 5 years, parents provided two 24-h dietary recalls, from which the Healthy Eating Index-2020 was calculated to measure diet quality. Structural equation models using maximum likelihood estimation examined associations of age at introduction to, and intake frequency of, fruit/vegetables and discretionary foods, and their interactions with food-approach and food-avoidance appetitive traits, on child diet quality at ages 3.5 & 5 years, controlling for income, education, and breastfeeding duration.

Results: Higher childhood diet quality was associated with later infant age at introduction to discretionary foods, lower intake of discretionary foods at ages 1 and 2 years, and greater intake of fruits and vegetables at age 2 years. Childhood diet quality was not associated with infant age at introduction to fruits and vegetables. Intake of fruits and vegetables at age 1 year interacted with food avoidance traits, indicating that the association of fruit and vegetable intake with childhood diet quality was magnified by greater food avoidance.

Conclusions: Exposure to discretionary food in the first two years of life was consistently associated with lower diet quality in early childhood regardless of the strength of appetitive traits. Findings suggest that improving child diet quality may require stronger efforts to limit exposure to discretionary foods in infancy.