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 (β = 0.3 SD, 95 % CI 0.03, 0.6) among VLBW children only, while self-reported pressure to eat (β = -0.5 SD, 95 % CI -1.0, -0.1) and feeding to avoid underweight (β = -0.4 SD, 95 % CI -0.7, -0.07) were associated with lower BMI z-scores. In conclusion, 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.