Relationships of neophobia and pickiness with dietary variety, dietary quality and diabetes management adherence in youth with type 1 diabetes

Abstract

BACKGROUND/OBJECTIVES Neophobia, pickiness and diet variety are associated with diet quality and health outcomes in young children. Limited research has examined these associations among youth with type 1 diabetes (T1D), a population at risk for poor health outcomes when dietary quality is inadequate. SUBJECTS/METHODS Youth (n = 252, age 13.2±2.8 years, 92% white, diabetes duration 6.3±3.4 years) with T1D and their parents completed 3-day youth diet records; parents completed questionnaires regarding youth neophobia, pickiness and diabetes management adherence. Medical records provided biomedical data. Dietary quality indicators included Nutrient-Rich Foods Index 9.3 (NRF9.3), Healthy Eating Index-2005 (HEI-2005), Whole Plant Food Density (WPFD) and key single nutrients. Dietary variety was operationalized as a count of 20 recommended food groups consumed. Relationships of dietary quality and diabetes management adherence with neophobia, pickiness and dietary variety as independent variables were examined using multiple linear regression analyses adjusted for total energy intake, age, height and weight. RESULTS In multiple linear regression analyses, NRF9.3 and HEI-2005 were each inversely associated with neophobia and pickiness, and positively associated with dietary variety. WPF and potassium were each positively associated and saturated fat was inversely associated with dietary variety. However, in models simultaneously including neophobia, pickiness and dietary variety as independent correlates of dietary quality, only relationships with dietary variety remained significant. Diabetes management adherence was negatively associated with both neophobia and pickiness and positively associated with dietary variety. CONCLUSIONS Findings suggest that increasing dietary variety may contribute toward improved dietary quality among youth with T1D, despite potentially adverse influences of neophobia and pickiness.

Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes

“…Carruth et al (1998) used food intakes in US toddlers aged 24e26 months old (2-day food record plus a 24-h recall on two occasions) to assess dietary variety and diversity scores: both scores were significantly lower for picky eaters than non-picky eaters. Using 3-day food records in US teenagers (13 years old) with type 1 diabetes, who are at particular risk of poor health outcomes, Quick et al (2014) investigated a nutrient-rich food index and a healthy eating index, used as measures of dietary quality: both were both inversely associated with pickiness, as was dietary variety (measured as the variability in foods chosen from across 20 food groups). Volger et al (2013) used 3-day food records to study diet in 153 picky eating pre-schoolers in China and Hong Kong: they did not include a comparison group of non-picky eaters and so compared their findings with the Hong Kong Food Pyramid recommendations.…”

Young Children with Type 1 Diabetes: Challenges, Research, and Future Directions

“…Dietary quality of young children with T1D is also poorer than their healthy peers, as recent studies indicate that young children with T1D have diets lower in fruits/vegetables and higher in saturated fats, placing them at higher risk for cardiovascular disease [32]. Pickiness and dietary neophobia also impact dietary quality and variety (although not glycemic control directly) in older children with T1D [33]. …”

Adherence in adolescents with Type 1 diabetes: strategies and considerations for assessment in research and practice

“…First, in contrast to conditions requiring a single care behavior (e.g., once- or twice-daily oral medication), the complexity of T1D management recommendations require that adherence to multiple behaviors be considered. There may be distinct facilitators of or barriers to each self-management behavior, and individuals tend to not be uniformly adherent to all behaviors [15]. Indeed, adherence to simple tasks such as pill-taking tends to be higher than more complex tasks [16], such as BGM or insulin calculations, which are central to T1D management.…”