Infants’ dietary pattern characterized by ultra-processed foods is associated with rapid weight gain and overweight/obesity risk: National Health and Nutrition Examination Survey 2009–2018

Background Global trends toward childhood obesity have been associated with several factors, including suboptimal infant feeding practices, the increasing availability of ultra-processed foods in the world's food supply, and the corresponding changes in children's dietary patterns. Objective To describe infants’ dietary patterns and assess their associations with weight status outcomes in a nationally representative sample of U.S. infants. Design Cross-sectional analyses were performed on data collected from infants participating in the 2009-2018 National Health and Nutrition Examination Survey. Participants/setting Participants included 744 infants aged 6–12 months, who had data from at least 1 day of valid 24-hour dietary recall data. Main outcome measures Rapid weight gain and overweight/obesity risk. Statistical analyses performed Principal component analysis was used to identify dietary patterns considering the energy intake of 39 Nova food subgroups (expressed in calories/day), including breast milk. Associations were evaluated using logistic regression adjusted for potential confounders. Results A total of 42% infants experienced rapid weight gain, and 33% were at risk of overweight/obesity. Most infants (65.5%) were started on solid foods early. Three main dietary patterns were derived. The first pattern, labeled “Natural or minimally processed foods” had positive loadings for a variety of natural or minimally processed foods, some processed culinary ingredients, and a few processed and ultra-processed foods. The second pattern labeled “Infant formula” had high negative loading for breastmilk, and high positive loading for infant formula and breakfast cereal. The third pattern labeled “Ultra-processed foods” had negative loadings for natural or minimally processed foods and processed culinary ingredients, positive loadings for ‘other processed foods’ and for a variety of ultra-processed foods, and negative loading for infant formula. Infants who adhere to the “Ultra-processed foods” dietary pattern were more likely to present rapid weight gain (AOR 1.3, 95% CI 1.1 - 1.5) and overweight/obesity risk (AOR 1.2, 95% CI 1.0 - 1.4). Conclusions Higher adherence to a dietary pattern characterized by ultra-processed foods was associated with a greater likelihood of both rapid weight gain and overweight/obesity risk early in life. Promoting breastfeeding and increasing consumption of unprocessed/minimally processed foods during early infancy while restricting ultra-processed foods are key components to reducing the growing burden of childhood obesity.