Caregiver feeding practices, dietary intake and weight status of very low birthweight infants compared to term-born peers at school-entry.

Very low birth weight (VLBW; <1250g) infants have an elevated risk of early onset cardiometabolic disease. While likely multi-factorial, the role of early caregiver feeding practices is unknown. We explored associations between primary caregiver feeding practices, diet, and weight of VLBW vs. socio-economically matched term-born peers at school-entry. VLBW children (n=74; 61% female; median [IQR] birth gestation of 27.8 [26.2, 29.1] weeks) and term-born controls (n=74; 57% female) participated at 5-7 years of age (school entry). We evaluated associations between caregiver-observed (videorecorded standardized lunch) and self-reported feeding practices (Comprehensive Feeding Practices Questionnaire) with diet quality (Healthy Eating Index-2015), nutrition risk (NutriSTEP®), and body mass index (BMI) z-scores using linear mixed models with interaction terms (feeding practice x birth group), adjusted for parent ethnicity. Children were 6.1 + 0.4 years at the research visit. VLBW caregivers self-reported more coercive feeding than term-born caregivers, but no differences were observed during the videorecorded standardized lunch. More VLBW children had high nutrition risk (32%) than term-born peers (13%; p=0.02), but there was no difference in diet quality nor prevalence of underweight, overweight, or obesity. Caregiver self-reported restriction was associated with higher BMI z-scores (ß= 0.3 SD, 95% CI 0.05, 0.6) among VLBW children only, while self-reported pressure to eat (ß=-0.5 SD, 95% CI -0.9, -0.2) and feeding to avoid underweight (ß=-0.4 SD, 95% CI -0.6, 0.1) were associated with lower BMI z-scores. Caregiver feeding practices were associated with clinically relevant BMI z-scores among VLBW children. Future research should explore the most appropriate feeding guidance for VLBW infants during the transition home and post-discharge throughout the early years (https://clinicaltrials.gov/ct2/show/NCT04308902). TRIAL REGISTRY: OptiMoM Grows Up: 5.5-year Follow-up of the OptiMoM Fortifier Study, NCT04308902, https://clinicaltrials.gov/ct2/show/NCT04308902.