Feeding characteristics in infancy affect fruit and vegetable consumption and dietary variety in early childhood

{"Background": "Previous research has established that breastfeeding is associated with higher fruit and vegetable consumption and greater dietary variety in children, while formula feeding may be linked to lower acceptance of flavors and less dietary diversity. However, few studies have comprehensively examined the association between specific feeding characteristics\u2014such as feeding type, duration of breastfeeding or formula feeding, and timing of introduction\u2014and later dietary outcomes. This study aimed to investigate how infant feeding characteristics relate to fruit and vegetable consumption and dietary variety in children aged 2\u20133 years, using data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2013 to 2017.", "Methods": "From an initial pool of 914 subjects, 802 participants aged 2\u20133 years were included after excluding those with birth weight <2.5 kg (n=60), missing feeding questionnaire data (n=6), missing total energy intake (n=2), and missing weight values (n=44). Feeding characteristics were collected via a 10-item parent-reported questionnaire covering breastfeeding and formula feeding (yes/no), duration (months), and age at first introduction (months). Feeding type was categorized as exclusive breastfeeding, partial breast and formula feeding, or exclusive formula feeding. Duration of total breastfeeding was classified as \u22646 months, 7\u201311 months, or \u226512 months. Age at starting formula feeding was dichotomized as >4 months or \u22644 months. Dietary assessment used 24-hour recall data. Fruit and vegetable consumption was classified into six groups: non-salted vegetables (NSV), salted vegetables (SV), fruit (F), total vegetables (TV), non-salted vegetables + fruit (NSVF), and total vegetables + fruit (TVF). Dietary variety was measured using the dietary variety score (DVS), counting individual food items consumed per day (excluding drinks \u226430 g and powdered/dried foods \u22641 g). Outcomes were dichotomized at the mean into low and high groups. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI), adjusting for child variables. Statistical analyses used PROC SURVEY in SAS 9.4 with complex sampling weights.", "Key Results": "The study included 802 children (53.5% boys, mean age 35.8 months). Compared to exclusive breastfeeding, exclusive formula feeding was significantly associated with a lower DVS (OR 0.42, 95% CI 0.23\u20130.77). Compared to total breastfeeding duration \u22646 months, breastfeeding for \u226512 months was significantly associated with higher intake of NSVF (OR 1.85, 95% CI 1.20\u20132.85) and TVF (OR 1.89, 95% CI 1.22\u20132.92). A borderline significant association was observed for fruit consumption (OR 1.52, 95% CI 1.02\u20132.27). Early introduction of formula feeding at \u22644 months was significantly associated with lower intake of fruit (OR 0.59, 95% CI 0.38\u20130.91) and NSVF (OR 0.63, 95% CI 0.40\u20130.99). No significant associations were found for duration of total formula feeding or duration of exclusive breastfeeding with any outcome. Mean DVS was 58.4 for exclusive breastfeeding, 55.6 for partial feeding, and 49.3 for exclusive formula feeding (p=0.03). Mean TV consumption was 94.6 g/day for exclusive breastfeeding vs. 73.0 g/day for partial feeding (p=0.004). Mean NSV consumption was 75.4 g/day for exclusive breastfeeding vs. 58.1 g/day for partial feeding (p=0.01).", "Clinical Implications": "These findings confirm that breastfeeding is associated with higher fruit and vegetable consumption and greater dietary variety in early childhood, while formula feeding\u2014particularly when introduced early\u2014is associated with lower intake. The results support WHO recommendations for exclusive breastfeeding for the first 6 months and suggest that prolonged breastfeeding (\u226512 months) may promote healthier dietary patterns. The early introduction of formula before 4 months may be a risk factor for lower fruit and vegetable intake. These findings highlight the importance of early feeding characteristics as modifiable factors for establishing healthy eating habits in children. Limitations include the cross-sectional design (precluding causal inference), lack of maternal dietary data, and reliance on 24-hour recall. Nonetheless, the large Korean national sample strengthens the evidence base for nutrition education programs targeting infant feeding practices."}