Instrument to Identify Food Neophobia in Brazilian Children by Their Caregivers

Food Neophobia in Children: A Case Study in Federal District/Brazil

A reluctance to eat and/or avoidance of novel foods is characterized as food neophobia (FN). FN restricts the diet to familiar foods when, in fact, it should be much more varied. FN can be a barrier to healthy foods, affecting the quality of diet, and impairing children's growth and development. Therefore, according to their caregivers' perceptions, this study aimed to evaluate FN in children from Federal District/Brazil. The Brazilian Children's Food Neophobia Questionnaire (BCFNeo), a specific instrument developed and validated in Brazil, was answered by caregivers of children aged 4 to 11 y/o. Sampling occurred through snowball recruitment, being convenient and non-probabilistic. The Health Sciences Ethics Committee approved the study. The analysis evaluated FN in total (BCFNeoTot) and in the following domains: general (FNgen), for fruits (FNfru), and for vegetables (FNveg). FN scores were compared between sex and child's age and categorized according to three ordinal levels. FN levels were compared using the Mann-Whitney U test. The Friedman test, followed by the Wilcoxon test with Bonferroni correction, was performed to analyze differences in FN according to the environment. Of the caregivers' answers for their children, 595 answers were included, because 19 were out of age. The prevalence of high FN was 42.9%. The domain with the highest prevalence of high FN was vegetables (48.6%). Children aged 8 to 11 y/o had a higher mean FN in two domains (FNgen p = 0.047 and FNveg p = 0.038) when compared to children aged 4 to 7 y/o. Boys were more neophobic in all domains (FNgen p = 0.017; FNfru p = 0.010; FNveg p = 0.013; BCFNeoTot p = 0.008), and FN tends not to decrease with age. The results showed that the children of the FD are more neophobic than Brazilian children in general, highlighting the importance of additional studies in FN determinants in this population and nutritional education interventions to reduce FN among FD 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.

Construction and validation of a scale to measure consumers knowledge of food processing and acceptance of processed food

Negative impressions related to food processing can compromise consumer acceptance. Thus, the aim of this study was to validate a tool to assess consumer knowledge and acceptance of food processing. Semantic evaluation was performed with a lay public (n=13). Experts with experience in the area (n=9) participated in the content validation and semantic evaluation, using the Delphi Technique. Overall, there was strong agreement between the judges (Gwet's AC2 = 0.96 [clarity] and 0.81 [relevance]), with Fleiss Kappa equivalent to 0.78, indicating almost perfect agreement. After these phases, the instrument that totaled 37 items approved (W > 0.8) was applied for validation among Brazilian consumers (n = 200). An exploratory factor analysis offered a six-factor solution. The Kaiser-Meyer-Olkin (KMO) index found was 0.90. The Bartlett Sphericity Test was statistically significant (p<0.001). The final instrument contained 34 items. The calculated Cronbach's Alpha was 0.92, indicating an excellent reliability. The developed Consumers Knowledge of Food Processing and Acceptance of Processed Food (CKAFPAPF) was consistently validated and has proven to be a tool that can help identify information asymmetries, allowing the development of strategies that help consumers to have the correct information to make their food choices more consciously.

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.

Food Neophobia among Brazilian Children: Prevalence and Questionnaire Score Development

This study aims to create and validate a score to classify food neophobia among Brazilian children (from the ages of 4 to 11 years) and investigate the prevalence of food neophobia. This descriptive cross-sectional population-based study is conducted following three steps: (i) the application of an instrument to identify food neophobia in Brazilian children by their caregivers; (ii) the instrument’s score definition; and (iii) the evaluation and characterization of the national prevalence of food neophobia among Brazilian children. The scores were categorized into three levels, based on the tertial approximation: low, moderate, and high. The study had 1112 participants, and the prevalence of high food neophobia was observed in 33.4% of Brazilian children. The prevalence of food neophobia allowed us to identify this behavior in Brazilian children and better understand the population. Boys were significantly more neophobic than girls. The general neophobia score and domains did not significantly differ between Brazilian regions and age groups. It is worrying that food neophobia did not decrease with advancing age. The score for the complete instrument with 25 items, or the 3 domains, makes its use practical. It can be used to assess neophobia with more caution, evaluate the most neophobic children, and enable more targeted professional interventions to promote healthier and sustainable eating habits.