Toddler diet quality: a factor associated with childhood growth?

Childhood growth is crucial for long-term overall health and well-being. Diet quality is an essential component of nutritional status reflecting dietary patterns and nutrient intake. While research in adults has shown that higher diet quality is associated with a lower risk of obesity, its association with childhood growth has remained unclear. This study aims to evaluate the association between diet quality among toddlers and their growth in later childhood.

Mothers from Upstate KIDS, a prospective cohort study, reported numbers of servings/day for specific foods, such as dairy, fruit, vegetables, and meat, fed to their toddlers at 2.5- and 3-years along with behaviors such as breakfast intake. Accordingly, the Youth Healthy Eating Index (YHEI) was calculated to measure toddler diet quality (range 0-65) with higher scores indicating better toddler diet quality. Children's height, weight, and waist circumference were reported up to three times in questionnaires from 7- to 9-years, and corresponding height-for-age (HAZ), weight-for-age (WAZ), body mass index-for-age (BMIZ) z-scores and obesity status were calculated. Mixed effects models were used to estimate associations with YHEI scaled per five-unit increase, adjusting for maternal age, race/ethnicity, education, insurance status, government assistance, fertility treatment, smoking, parity, pre-pregnancy BMI, child age, sex, plurality, breastfeeding duration, and complementary feeding.

Among 1322 children (52.0% male), the mean YHEI score in toddlerhood was 44.4 $\pm$ 8.52 (mean  $\pm$ standard deviation). Higher YHEI scores were significantly associated with lower odds of developing central obesity (adjusted OR = 0.74, 95% CI: 0.56, 0.98). YHEI scores were not associated with HAZ, WAZ, BMIZ, waist circumference, and obesity after adjusting for covariates.

Higher toddler diet quality is associated with reduced odds of central obesity in later childhood. Interventions aimed at improving early diet quality are needed to promote healthy growth in childhood.