Cross-cultural adaption and validation of the Chinese version of the Child Food Neophobia Scale

Food neophobia scores at 8 Years and associations with nutrition-related behaviors at home in early life: Findings from a New Zealand contemporary birth cohort

Food neophobia (FN) reduces nutritional adequacy and variety which poses a significant concern for children's health and well-being We described the FN scores among 8-year-olds and examined its associations with nutrition-related behaviors at 45 months within the Growing Up in New Zealand cohort (n = 4621). FN was estimated using the Food Neophobia Scale (FNS). Mean FNS scores between variable categories were compared using t-tests for independent samples and ANOVA. Associations between FNS scores at 8 years and nutrition-related behaviors at 45-months were examined using multivariate linear regression. The mean (standard deviation) FN score was 46.2 (15.2) with statistically significant differences by sex (boys = 47.6 (15.7), girls = 43.8 (14.2), p=<0.001). For all children, in models adjusted by breastfeeding duration and sociodemographic characteristics: children who sometimes and never/almost never ate the same foods as their parents, scored, on average, 5.8 and 11 points higher in the FNS (versus those who did always/almost always); children who occasionally/never found mealtimes enjoyable scored on average 3.6 points lower in the FNS (versus mostly/quite often); children who always/almost always had the television on during mealtimes scored on average 2.7 higher in the FNS (versus never/almost never). In comparison to children who mostly/quite often had time to talk to others during mealtimes, those who never/occasionally did it scored on average higher points in the FNS overall (1.46 points higher) and within girls (1.73 points higher). These findings support the eating behavior statements in the National Children's Food and Nutrition Guidelines, which emphasize early exposure to food variety, limiting mealtime distractions, and acknowledge that parental role modeling shapes children's nutrition-related behaviors. Early adoption of preventative interventions for reducing FN in early and middle childhood are needed.

Olfactory performance and odor liking are negatively associated with food neophobia in children aged between 3 and 9 years

BACKGROUND

Child food neophobia, i.e., rejection or avoidance of novel foods at a young age, is a prevalent nutrition problem that affects the quality of children's diet and impedes the development of healthy food preferences. Sensory sensitivity can relate to the degree of food neophobia, but previous studies rarely focused on the olfactory component of this problem in children.

OBJECTIVE

We aimed to thoroughly examine the relationship between various aspects of olfactory sensitivity and food neophobia in children.

METHODS

246 children aged between three and nine years took part in a food neophobia assessment as well as in a comprehensive, psychophysical olfactory testing.

RESULTS

We found that certain smell perception aspects such as lower odor liking, poorer odor identification ability as well as lower sensitivity to an unknown non-food odor all significantly predicted higher food neophobia in children. Among individual characteristics of either a child or a caregiver, only the child's age significantly and positively predicted food neophobia. The exploratory model looking into the role of family environment factors predicting self-reported food neophobia in children revealed that food neophobia was associated with lower control given to a child in this child's feeding process, as well as with a more frequent use of food as a reward in feeding.

CONCLUSIONS

We suggest that suppressed olfactory perception and performance can play a unique role in child nutritional difficulties. The study inspires further considerations of olfaction-engaging interventions to counteract food-neophobia in children.

The Impact of Caregiver Pressure to Eat on Food Neophobia in Children with Autism Spectrum Disorder: A Cross-Sectional Study

(1) Background: With autistic children's high pervasiveness of eating problems and inappropriate feeding behaviors by their caregivers, this study wanted to inspect the connection between caregivers' pressure to eat and food neophobia in these children. (2) Methods: Cross-sectional overview of 160 guardians of kids aged 2 to 7 years. After one-on-one questioning by the researcher, the collected information on the socio-demographic characteristics of the children with autism, caregiver feeding behavior, and new food neophobia (FN) scores was entered into the Questionnaire Star system. (3) Results: The mean FN score was 25.56 ± 6.46. The caregiver's pressure to eat positively related to children's FN (β = 0.164 95% CI, 0.078, 2.163). In these children, we found a negative correlation between FN score and the frequency of vegetable intake (p ≤ 0.001), fruit intake (p ≤ 0.05), aquatic product intake (p ≤ 0.05), and dietary diversity score (p ≤ 0.01), and positively correlated with the frequency of snack intake (p ≤ 0.05). (4) Conclusions: Caregiver pressure to eat was positively associated with high levels of FN in Chinese kids with ASD, which in turn negatively impacted dietary quality. To improve eating habits, caregivers should reconsider their feeding strategies and avoid using forceful methods to ease food neophobia in these children.

Neophobia, sensory experience and child's schemata contribute to food choices

PURPOSE

The aim of the present review is to analyze dynamic interactions between nutrigenomics, environmental cues, and parental influence, which can all lead to children's neophobic reactions and its persistence in time.

METHODS

We reviewed studies available on electronic databases, conducted on children aged from birth to 18 years. We also considered official websites of Italian Institutions, providing advice on healthy eating during infancy.

RESULTS

Modern day societies are faced with an eating paradox, which has severe and ever-growing implications for health. In face of a wider availability of healthy foods, individuals instead often choose processed foods high in fat, salt and sugar content. Economic reasons surely influence consumers' access to foods. However, there is mounting evidence that food choices depend on the interplay between social learning and genetic predispositions (e.g., individual eating traits and food schemata). Neophobia, the behavioral avoidance of new foods, represents an interesting trait, which can significantly influence children's food refusal. Early sensory experiences and negative cognitive schemata, in the context of primary caregiver-child interactions, importantly contribute to the priming of children's food rejection.

CONCLUSIONS

As neophobia strongly affects consumption of healthy foods, it will be relevant to rule definitively out its role in the genesis of maladaptive food choices and weight status in longitudinal studies tracking to adulthood and, in meanwhile, implement early in life effective social learning strategies, to reduce long-term effects of neophobia on dietary patterns and weight status.

LEVEL OF EVIDENCE

Level II, controlled trials without randomization.

Instruments to Evaluate Food Neophobia in Children: An Integrative Review with a Systematic Approach

Food neophobia (FN), a frequent disorder in childhood, profoundly impacts the quality of a diet, restricting the intake of nutrients to maintain proper nutrition. Therefore, using the appropriate tools to assess FN in children to promote healthy eating habits is essential. The study aimed to develop an integrative review with a systematic approach to identify the instruments to measure FN in children and analyze their differences. The included studies (n = 17) were more concentrated in Europe, demonstrating the possible lack of dissemination of the topic at a global level. Among the 18 tools, 6 were represented by adaptations of the Food Neophobia Scale (FNS) and the Children's Food Neophobia Scale (CFNS), and one was the CFNS itself, demonstrating the relevance of these pioneering tools. The need to meet mainly cultural and cognitive criteria led to the creation of other instruments (n = 11). A diversity of approaches concerning the respondents, age range, items, scales, and validation methods was revealed. Modifications to the tools in some nations highlighted their adaptability and effectiveness in addressing regional variations. The instruments can contribute to additional research to help us better understand the prevalence of FN in children, resulting in their health and well-being.

Parental food neophobia, feeding practices, and preschooler's food neophobia: A cross-sectional study in China

This study explores the relationship between parental food neophobia, feeding practices, and preschoolers' food neophobia in China.

METHODS

A cross-sectional study was conducted among 1616 pairs of preschoolers and their parents. Electronic questionnaires were conducted to collect information about social and demographic characteristics, scores of food neophobia among both children and their parents, parents' feeding patterns and children's dietary quality.

RESULTS

Children's average food neophobia score was 23.72 ± 4.45. There was a positive correlation between parental food neophobia score (β: 0.154; 95%CI: 0.113, 0.195), pressure to eat (β: 0.694; 95%CI: 0.423, 0.964), postpartum breastfeeding initiation (β: 0.010; 95%CI: 0.002, 0.018), and children's score of food neophobia. However, parental modeling (β: -0.470; 95%CI: -0.732, -0.207) and the frequency of children eating with their families at home (β: -0.407; 95%CI: -0.707, -0.108) were negatively associated with children's food neophobia scores. The consumption frequencies of vegetables(P < 0.001), fruits(P < 0.001), domestic animals and poultry(P < 0.01), aquatic products(P < 0.05), beans and their products(P < 0.01), eggs(P < 0.05) and nuts(P < 0.05) and children's dietary diversity score (P < 0.001) are negatively associated with children' food neophobia score. While the consumption frequencies of fast food(P < 0.001), sweets(P < 0.01) and puffed/fried food(P < 0.001) were positively associated with children's food neophobia.

CONCLUSION

Chinese preschoolers' food neophobia needs more attention because children with high food neophobia tend to have lower dietary quality. Children whose parents have high-level food neophobia should be the focus of early prevention. Earlier postpartum breastfeeding, more use of parental modelling, less pressure to eat and higher frequency of children eating with families are helpful to reduce the incidence of children's food neophobia.

The Chinese version of the child food neophobia scale and its reliability and validity in preschool children

OBJECTIVE

To translate the English version Child Food Neophobia Scale (CFNS) into the Chinese version and test its reliability and validity in preschool children.

METHODS

To create the Chinese version of the CFNS, it was translated, back-translated, and cross-culturally adapted. The use of the Chinese version of CFNS by 575 parents of preschool children in two kindergartens in Yangzhou City was investigated using cluster sampling to assess the reliability and validity of the scale.

RESULTS

The Chinese version of CFNS has nine items in total. The scale-level average content validity index (S-CVI/Ave) is 0.983. Exploratory factor analysis (EFA) extracted 2 common factors, and the cumulative variance contribution rate was 49.437%. Confirmatory factor analysis (CFA) showed that the 2-factor model was well fitted. The Cronbach'α coefficient of the scale was 0.759, the Cronbach'α coefficients of the two factors were 0.735 and 0.713, the split-half reliability was 0.788, and the test-retest reliability was 0.756.

CONCLUSION

The Chinese version of the Child Food Neophobia Scale has good reliability and validity in preschool children and can be used as an assessment tool for food neophobia in preschool children in China.

PRACTICE IMPLICATIONS

This study has gone through a rigorous translation process, and the CFNS may support future exploration of food neophobia in preschool children. Food allergy factors in the results may be the next step in the research, and several studies are still needed to understand the relationship between food allergy and food neophobia.

Food Neophobia in Children with Autistic Spectrum Disorder (ASD): A Nationwide Study in Brazil

Food neophobia (FN) is common among children with autistic spectrum disorder (ASD), potentially impairing their health and diet quality. This study aimed to investigate and classify the prevalence of FN among 4-to-11-year-old Brazilian children with ASD. This descriptive cross-sectional study was performed by applying online a validated instrument to identify FN in Brazilian children with ASD through their caregivers' responses for a national prevalence of FN in this group. The final sample included 593 children with ASD, 80.1% of boys, with a mean age of 6.72 ± 2.31 years, and 83% having only ASD. Almost 75% (n = 436) of the children with ASD had high food neophobia scores. The fruit neophobia domain had the lowest prevalence of high neophobia (63.7%). No significant difference in FN (total, fruit, and vegetable domains) was found, considering gender and age. There was no statistical difference in FN (all domains) by the number of residents in the same household, income, or the caregivers' educational level. FN did not decrease in older children with ASD. FN is a more complex problem, requiring a multidisciplinary trained team to face the problem.

Screen Time and Its Association with Vegetables, Fruits, Snacks and Sugary Sweetened Beverages Intake among Chinese Preschool Children in Changsha, Hunan Province: A Cross-Sectional Study

(1) Introduction: Screen time may influence preschoolers’ food consumption. However, there is limited evidence regarding preschoolers, especially in China. The aim of this cross-sectional study was to investigate the association between screen time and the consumption of vegetables, fruits, snacks, and sugar sweetened beverages (SSBs). (2) Methods: Participants (1567 caregivers) were recruited from six kindergartens in Hunan, China. Caregivers completed the questionnaire, which included the food frequency questionnaire (FFQ) and questions regarding their children’s daily screen time. (3) Results: The mean screen time of preschoolers was 1.36 ± 1.26 h, and the proportion of children who spent more than one hour on screens was 54.3% in the overall sample. Children with longer screen time consumed vegetables and fruits less frequently, while having a higher consumption of snacks and SSBs. After adjustment of sociodemographic confounders, children’s eating behaviors and parental feeding practices, the association of screen time with vegetables and SSBs still remained significant. (4) Conclusions: Screen time exposure needs to be monitored in preschool children, which was negatively associated with their consumption of vegetables and fruits, whereas it was positively associated with snacks and SSBs. Future research should focus more on the impact of screen time on children’s unhealthy behaviors and dietary patterns.

A methodological study on the combination of qualitative and quantitative methods in cognitive interviewing for cross-cultural adaptation

Aim

The aim of this study is to explore the use of the Questionnaire Appraisal System with a combination of qualitative and quantitative methods in cognitive interviewing for cross‐cultural adaptation.

Design

This is a descriptive methodological study.

Methods

Using the Mandarin version of the Post‐Stroke Checklist as an example, cognitive interviews were conducted with 27 stroke survivors in Guangzhou between November 2020 and February 2021. The Questionnaire Appraisal System was applied as a codebook in focus group discussions to perform quantitative data collections and quantitative content analysis.

Results

Thirty‐eight problems were proposed in focus group discussions and identified all but four of the 30 questions that emerged in the cognitive interviews. A new item was added to the Questionnaire Appraisal System for better categorization. Four categories and six subcategories of problems in the checklist were revealed.

Food neophobia in Lebanese children: scale validation and correlates

OBJECTIVE

To validate the Food Neophobia Scale (FNS) and determine factors associated with the presence of food neophobia (FN) in a sample of Lebanese children.

DESIGN

Cross-sectional study conducted between July and December 2019.

SETTING

All Lebanese governorates.

PARTICIPANTS

Parents of Lebanese children aged 2 to 10 years.

RESULTS

Out of 850 questionnaires, 194 were excluded. The mean age of children was 5·34 ± 2·20 years (50·8 % females); 238 (36·4 %) had low neophobia scores (≤37), whereas 219 (33·5 %) and 197 (30·1 %) had, respectively, moderate (between 38 and 41) and severe neophobia scores (≥42). All items of the FNS were extracted except item 8 and yielded a two-factor solution with Eigenvalues > 1 (variance explained = 51·64 %; Kaiser-Meyer-Olkin (KMO) test = 0·746; Bartlett's sphericity test P < 0·001; αCronbach = 0·739). Children who refused initially to eat vegetables (β = 5·51), fish (β = 4·57), fruits (β = 4·75) or eggs (β = 2·99) and higher parents' instrumental feeding scores (β = 0·3) were significantly associated with higher neophobia scores, whereas higher parents' encouragement scores (β = -0·21) were significantly associated with lower neophobia scores in children.

CONCLUSION

FN is common in children. Neophobic children tend to have lower variety in their diets. One of the ways to lower the levels of neophobia is the use of encouragement by the parents. In contrast, offering a reward to children for them to eat a certain food was associated with more signs of avoidance. More studies should be conducted to evaluate awareness levels concerning FN.

Instrument to Identify Food Neophobia in Brazilian Children by Their Caregivers

This study aimed to develop a specific instrument to evaluate food neophobia focused on Brazilian children and to perform the content validation and internal semantic consistency and reproducibility evaluation of the instrument. Three steps were necessary to conduct the study: (i) development of the instrument, (ii) internal validation (content validation and semantic evaluation) of the food neophobia instrument using 22 experts in the first round and 20 of them in the second round, (iii) evaluation of the internal consistency and reproducibility of the instrument with the children’s caregivers, using the test–retest (where the same caregiver—n = 22—answered twice, with 24 h interval) and comparing responses between two caregivers (n = 44) of the same children (n = 22). We developed an instrument in Brazilian–Portuguese to evaluate children’s food neophobia based on the caregivers’ perceptions with 25 items divided into three domains (neophobia in general, neophobia for fruits and neophobia for vegetables). Our results indicated that the instrument has excellent internal consistency (>0.9) and reproducibility (>0.9) when answered by the caregiver who knows the child’s eating habits, indicating reliability to be applied in Brazil. In addition, when the two caregivers answered the instrument, we found a good reproducibility (>0.6), confirming the possibility to be answered by one of the caregivers. Further studies are necessary to complete external validation with a representative sample of the target group in Brazil, showing nationwide the profile of the population. The potential of a neophobia study would contribute to the implementation of effective strategies and guidelines to support parents and health professionals, especially those involved in health and nutrition, to identify traces of food neophobia or neophobic behavior. By accurately measuring food neophobia in children, families can prevent nutritional deficiencies throughout adolescence and adulthood, improving eating habits. Children usually have neophobias similar to the ones presented by their parents—and when early detected, these neophobias can be addressed.