# The association between early-life nutrition and palatine tonsil grading in preschool children: a cross-sectional study

## TL;DR

This study explores how early-life nutrition affects the size of palatine tonsils in preschool children, finding a possible link in females.

## Contribution

The study is the first to examine the association between early-life nutrition and palatine tonsil grading in preschool children.

## Key findings

- Exclusive formula feeding during 0–6 months may increase the risk of higher palatine tonsil grading in females.
- Formula introduction at 6–12 months was linked to a decreased risk in females.
- No significant associations were found in males or for other nutritional factors.

## Abstract

Early-life nutritional factors play a crucial role in child health, but their association with palatine tonsil grading is not well understood. This study aimed to investigate the relationship between early-life nutrition and palatine tonsil grading in preschool children.

A cross-sectional study of 2,786 children from 17 kindergartens in Yulin City was conducted. Palatine tonsil grading was assessed via physical examination, and early-life nutritional data were collected through parent questionnaires, with 816 valid matches to examination records. Associations between early-life nutrition and palatine tonsil grading were analyzed using age-adjusted ordered logistic regression, stratified by sex.

Among 2,786 preschool children aged 2–7 years, palatine tonsillar hypertrophy (grades III–IV) was observed in 5.28%. Females aged 2–4 years had a significantly lower risk than males (OR = 0.438, p = 0.028), with no sex difference in older children. Univariate analysis of 454 males revealed no significant associations between feeding patterns (0–6, 6–12, 12–24 months), durations of breastfeeding and formula feeding, timing of formula milk introduction, or timing of complementary food introduction feeding and palatine tonsil grading. In 362 females, exclusive formula feeding during 0–6 months was significantly associated with increased risk of higher palatine tonsil grading (OR = 2.625, p = 0.013), whereas formula introduction at 6–12 months was linked to a decreased risk (OR = 0.494, p = 0.047). Multivariable analysis suggests a possible increased risk for exclusive formula feeding during the first 6 months (OR = 2.409, p = 0.066), whereas formula introduction between 6 and 12 months showed no statistically significant (OR = 0.729, p = 0.494).

Our results suggested a possible association between exclusive formula feeding during 0–6 months and a higher palatine tonsil grading in females, while larger studies are needed for confirmation. Other early nutritional exposures showed no significant effect, and no associations were observed in males.