Early feeding choices may shape a child's palate and dietary trajectory for years — a finding with significant implications for public health nutrition. While the immediate benefits of breastfeeding are well-established, evidence linking infant feeding mode to the quality of food choices in later childhood has remained comparatively sparse, making this prospective cohort contribution particularly timely.
The CoAlHaS study followed 574 children from birth through age six in Santander, Spain, classifying foods using the NOVA processing framework. Exclusive breastfeeding at six months was associated with a 2.2-fold higher likelihood of high minimally-processed food intake at age four — though this association attenuated by age six after full adjustment. More strikingly, exclusive breastfeeding was associated with roughly half the odds of high ultra-processed food (UPF) consumption at age six (OR 0.46; 95% CI 0.23–0.91), a relationship that held after controlling for sociodemographic, anthropometric, and lifestyle factors. Continued breastfeeding through twelve months showed a similar, if slightly weaker, protective signal against UPF intake at age six (OR 0.55; 95% CI 0.31–0.97).
This work adds meaningful texture to a growing body of literature suggesting that the sensory experience of breastfeeding — exposure to flavor variety through maternal diet — may calibrate early food preferences in ways formula feeding does not replicate. However, several caveats warrant careful attention. The cohort is geographically and culturally specific to northern Spain, limiting generalizability. Dietary data at ages four and six relied on a propensity questionnaire rather than weighed records, introducing potential recall error. Critically, observational design cannot rule out residual confounding: mothers who breastfeed exclusively are also more likely to model healthful eating behaviors throughout childhood, making causal inference inherently difficult. The attenuating effect at age six is also worth noting — suggesting that dietary trajectories may be malleable beyond early childhood, for better or worse. Overall, this is a solid confirmatory contribution to infant nutrition science, reinforcing current exclusive breastfeeding recommendations without yet resolving the mechanism behind the association.
