BackgroundGlobal trends toward childhood obesity have been associated with several factors, including suboptimal infant feeding practices, the increasing availability of ultraprocessed foods in the world's food supply, and the corresponding changes in children's dietary patterns. ObjectiveTo describe infants’ dietary patterns and assess their associations with weight status outcomes in a nationally representative sample of US infants. DesignCross-sectional analyses were performed on data collected from infants participating in the 2009-2018 National Health and Nutrition Examination Survey. Participants/settingParticipants included 744 infants aged 6 to 12 months who had data from at least 1 day of valid 24-hour dietary recall data. Main outcome measuresRapid weight gain and overweight/obesity risk. Statistical analyses performedPrincipal component analysis was used to identify dietary patterns considering the energy intake of 39 Nova food subgroups (expressed in calories per day), including breast milk. Associations were evaluated using logistic regression adjusted for potential confounders. ResultsA 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 ultraprocessed foods. The second pattern, labeled Infant Formula, had high negative loading for breast milk, and high positive loading for infant formula and breakfast cereal. The third pattern, labeled Ultraprocessed 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 ultraprocessed foods, and negative loading for infant formula. Infants who adhere to the Ultraprocessed Foods dietary pattern were more likely to present rapid weight gain (adjusted odds ratio 1.3, 95% CI 1.1 to 1.5) and overweight/obesity risk (adjusted odds ratio 1.2, 95% CI 1.0 to 1.4). ConclusionsHigher adherence to a dietary pattern characterized by ultraprocessed 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 ultraprocessed foods are key components to reducing the growing burden of childhood obesity.

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