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The association between early-life nutrition and palatine tonsil grading in preschool children: a cross-sectional

Guangwei Guo1, Wanyun Yan2, Ruifa Zhou2

  • 1Department of Otorhinolaryngology, Yulin Maternal and Child Health Care Hospital, Yulin, Guangxi, China.

Frontiers in Nutrition
|April 6, 2026
PubMed

Insights

Early formula feeding in female infants may increase palatine tonsil grading risk. Breastfeeding and other nutritional factors showed no significant association in this study of preschool children.

Area of Science:

  • Pediatric Nutrition
  • Otolaryngology
  • Child Health Research

Background:

  • Early-life nutrition is vital for child health but its link to palatine tonsil size is unclear.
  • Palatine tonsil grading is a potential indicator of upper airway health in children.
  • Understanding nutritional impacts can inform preventative health strategies.

Purpose of the Study:

  • To investigate the association between early-life nutrition and palatine tonsil grading in preschool children.
  • To identify specific nutritional factors that may influence tonsil size.
  • To explore potential sex-based differences in these associations.

Main Methods:

  • Cross-sectional study of 2,786 preschool children (aged 2-7 years).
  • Palatine tonsil grading assessed via physical examination.
  • Early-life nutrition data collected via parent questionnaires; 816 valid records analyzed.
  • Age-adjusted logistic regression used, stratified by sex.

Main Results:

  • 5.28% of children had palatine tonsillar hypertrophy (grades III-IV).
  • Younger females (2-4 years) had lower risk than males; no sex difference in older children.
  • Exclusive formula feeding (0-6 months) linked to higher tonsil grading in females (OR=2.625, p=0.013).
  • Formula introduction at 6-12 months associated with decreased risk in females (OR=0.494, p=0.047).
  • No significant associations found for males or other nutritional factors.

Conclusions:

  • Exclusive formula feeding in early infancy (0-6 months) may be associated with increased palatine tonsil grading in girls.
  • Formula introduction between 6-12 months might reduce this risk in girls.
  • Further research with larger cohorts is needed to confirm these findings, especially regarding sex-specific effects.
Abstract

Keywords:
breastfeedingcomplementary food introductionearly-life nutritionformula feedingpalatine tonsil grading

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