[Association between feeding pattern before age 2 years and preschool children's diet quality]

Objective: To analyze the longitudinal association between feeding pattern before age 2 years and dietary quality in preschool-aged children, and provide the oretical evidence for targeted dietary guidance and nutritional interventions. Methods: Based on Shanghai Maternal-Child Pairs Cohort, the information about the feeding pattern before age 2 years and dietary intake during preschool period were collected through questionnaires. The dietary balance index for preschool children was used to evaluate the overall dietary quality, with specific metrics including the high bound score (HBS), low bound score (LBS), and diet quality distance (DQD). Higher scores on these indices indicate poorer dietary quality. Multiple linear regression analyses were conducted to evaluate the association between feeding pattern before age 2 years and subsequent dietary quality during preschool period. Results: Compared with children who had breastfeeding within 1 hour after birth, preschool children who started breastfeeding after >1 hour had higher DQD scores (β=0.96, 95%CI: 0.03-1.88). Mixed feeding at 4 months of age was associated with elevated LBS (β=1.33, 95%CI: 0.23-2.44) and DQD (β=1.24, 95%CI: 0.25-2.23) scores during preschool years compared with exclusive breastfeeding. Preschool children who did not meet the Minimum Dietary Diversity (MDD) at 12 months had LBS and DQD scores that were 2.17 points (β=2.17, 95%CI: 0.66-3.68) and 1.69 points (β=1.69, 95%CI: 0.35-3.02) higher, respectively, than those who met the MDD requirement. For each 1-point increase in pressure-to-eat, the LBS and DQD scores of preschool children increased by an average of 1.59 points (β=1.59, 95%CI: 0.90-2.29) and 1.58 points (β=1.58, 95%CI: 0.97-2.19), respectively. Conversely, each 1-point increase in parental monitoring of children's eating behaviors was associated with a reduction of 0.97 points (β=-0.97, 95%CI: -1.55 - -0.38) and 0.69 points (β=-0.69, 95%CI: -1.21 - -0.18) in LBS and DQD scores, respectively. The impact of feeding pattern before age 2 years on the diet quality of preschool children was more pronounced in boys and children whose mothers perceived that their families had common economic status. Conclusion: Feeding pattern before age 2 years significantly influence dietary quality in preschool children.