Association Between Food Portions During Complementary Feeding and Later Overweight Risk: Analysis From European Childhood Obesity Project

BACKGROUND AND AIM: Early-life nutrition plays a critical role in long-term health. Although complementary feeding has been widely studied, the influence of portion size during this stage on subsequent overweight risk remains unclear. This study aimed to evaluate whether portion size during complementary feeding is associated with overweight risk in childhood and preadolescence. METHODS: Secondary analysis of the European Childhood Obesity Project, a randomised clinical trial across five European countries. Dietary data was collected at 6, 12, 18 and 24 months using 3-day food records and food portions standardised as internal z-scores; anthropometry was assessed at 2, 8 and 11 years. Associations between early portion size and later overweight were examined using logistic regression (adjusted for feeding type, country, parental education, birth weight, meal frequency and energy intake) and structural equation modelling. RESULTS: Larger portion sizes at 6 months were associated with more than a twofold higher risk of overweight at 2 years (OR 2.36, p = 0.031). Portion size at later complementary feeding stages showed positive trends with overweight at 2, 8 and 11 years and indirect associations with overweight at 8 and 11 years mediated by portion size at 8 years. CONCLUSION: Larger portion sizes early in life are associated with increased risk of overweight later in childhood. These findings highlight portion size guidance during complementary feeding as a potential early target for obesity prevention.