Infant diet quality and federal nutrition assistance program participation predict later diet quality in U.S. children 2-5 years old.

BACKGROUND: Infant diet quality has been associated with early childhood dietary behaviors and nutritional outcomes. For U.S. children in low-income households, programs like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the Supplemental Nutrition Assistance Program (SNAP), and Medicaid provide benefits to improve health outcomes. Examining the role of dietary exposures during infancy is important to understand how duration in these programs is associated with childhood diet quality and weight status. OBJECTIVE: To examine whether infant nutrition, measured by Infant Diet Quality Index and participation duration in WIC, SNAP, and Medicaid are associated with child diet quality (Healthy Eating Index-2020) and weight status (body mass index Z-scores) from 2 to 5 years. METHODS: Data analyzed were from the WIC Infant-Toddler Feeding Practices Study-2, a national cohort of children followed from around birth up to 9 years (unweighted N=3,051; weighted N=413,211). Associations between the durations of program participation were estimated with each outcome in survey-weighted multivariable regression analyses; mediation through IDQI was assessed using causal mediation. RESULTS: Children who consistently participated in WIC through age 5 had higher HEI-2020 scores than those who were sporadically on WIC, with modest mediation by IDQI at 2 years only (p<0.10). Children in households with any SNAP participation had lower HEI-2020 scores at most ages compared to those never on SNAP, and differences were mediated by having lower IDQI, which explained up to 23%, 30%, and 15% of the differences in HEI-2020, HEI-2020 adequacy, and HEI-2020 moderation scores, respectively (p<0.05) at 2-5 years. Medicaid was not associated with any outcome. CONCLUSIONS: Supporting improved dietary exposures during the first year of life through the provision of nutrition support services and caregiver nutrition education may be effective at improving later nutritional outcomes among children, particularly among those participating in SNAP.