Diet Quality and Weight Status are Predicted by Federal Nutrition Assistance Program Participation, Health, and Demographics

Abstract Background Social safety net programs, such as Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), provide access to vital medical and nutrition services. Few studies have investigated if demographic, social, and economic determinants of health, including length of time spent on these safety net programs, are associated with diet quality and weight status in early childhood. Objective Classification and regression tree (CART) analysis, a machine learning method, was used to determine health predictors to identify patterns of children with higher vs. lower diet quality and higher vs. lower weight status. Methods Using the WIC Infant and Toddler Feeding Practices Study-2 (unweighted N=3,051; weighted N=413,211), CART identified the sequence of binary splits that best differentiated the sample on Healthy Eating Index-2020 (HEI-2020; range 0-100) and HEI-2020 subscales (adequacy and moderation), and body mass index z-score (BMIz) at 2-5 years. Predictors including maternal BMI, child birthweight, sociodemographics, and length of time spent on safety net programs were considered. Results Higher HEI-2020 scores were primarily predicted by race and ethnicity (e.g., Hispanic Spanish or not Non-Hispanic White), and longer WIC and shorter SNAP duration. In examining HEI-2020 subscales, higher HEI adequacy was primarily predicted by higher education, older maternal age, longer WIC duration, and race and ethnicity. Higher HEI moderation was primarily predicted by race and ethnicity and longer WIC duration. Higher BMIz was primarily predicted by higher birth weight. Conclusions Child diet quality and weight status were associated with different social determinants of health, which included maternal weight status, race and ethnicity, and food assistance program participation, particularly WIC.