Food Neophobia among Brazilian Children: Prevalence and Questionnaire Score Development

Regular Family Meals Associated with Nutritional Status, Food Consumption, and Sedentary and Eating Behaviors of Brazilian Schoolchildren and Their Caregivers

The influence of family meals on nutrition and health for families has been understudied, especially in low- and middle-income countries. We aimed to analyze associations between regular family meals and body mass index (BMI), food consumption, eating, and sedentary behaviors among Brazilian schoolchildren and their caregivers. A cross-sectional study was conducted with 1887 Brazilian schoolchildren aged 6-11 years and their caregivers. Caregivers provided sociodemographic data, their child's weight and height, and the frequency of family meals. Schoolchildren provided data on gender and silhouette scale. Both provided their food consumption, eating, and sedentary behavior data. Associations between regular family meals and BMI, ultra-processed food consumption, and dietary diversity were assessed through multivariate logistic regression models. Correlations of regular family meals with eating and sedentary behaviors were assessed using Pearson chi-square. Regular family meals were frequent (86.6%), and they were associated with less unhealthy BMI in caregivers (AOR: 0.74; 95%CI: 0.5-0.9), as well as higher dietary diversity in caregivers (AOR: 1.66; 95%CI: 1.0-2.7) and in schoolchildren (AOR: 1.78; 95%CI: 1.4-2.3). The coexistence of high dietary diversity and both low ultra-processed food consumption (AOR: 1.45; 95%CI: 1.0-2.1) and healthy BMI (AOR: 1.41; 95%CI: 1.0-1.9) in children was associated with regular family meals. Regular family meals were correlated with healthy eating behaviors in child-caregiver dyads (p < 0.002) and with sedentary behavior in caregivers (p = 0.019). Our findings underscore regular family meals as a protective factor against malnutrition among Brazilian families.

Dietary Challenges in Children with Gluten-Related Disorders: A Study on Food Neophobia

BACKGROUND/OBJECTIVES

Food neophobia (FN) in childhood is characterized by resistance to new foods, potentially impairing health and diet quality and impacting physical and mental development. Adequate nutrition in early childhood is crucial to preventing future problems. FN demands special attention, especially in cases of gluten-related disorders (GRD), due to the risks associated with restrictive diets and food allergies. The objective of this study was to investigate and classify the prevalence of FN among Brazilian children aged 4 to 11 years with GRD.

METHODS

For this cross-sectional study, a questionnaire validated in Portuguese, with 25 items, assessed FN in three domains: general FN, FN of fruits, and FN of vegetables. Data were collected via Google Forms.

RESULTS

Of 209 children with GRD, the majority were female, 83.7% were diagnosed with celiac conditions, 81.3% followed a diet, and 43.1% had moderate total food neophobia. Brazilian children with GRD have a moderate prevalence of food neophobia. General and vegetable neophobia predominate, while fruit FN is lower. Girls exhibit greater neophobia towards vegetables.

CONCLUSIONS

Neophobia does not vary with age, suggesting the persistence of the behavior and potential nutritional challenges in adult life. Differentiated attention to this population is essential to minimize long-term impacts.

Food Neophobia in Children Aged 1-6 Years-Between Disorder and Autonomy: Assessment of Food Preferences and Eating Patterns

Food neophobia, defined as fear or aversion to eating new or unfamiliar foods, is a significant challenge, especially in the context of preschool children. In the scientific literature, this phenomenon is often described as a natural developmental stage, but its severity and impact on preferences and eating patterns still raise many questions. The purpose of the present study was to assess the prevalence of food neophobia in children aged 1 to 6 years and to analyze its relationship with eating habits, preferences, and eating patterns. The study was conducted using a proprietary questionnaire and validated research tools such as the Child Feeding Scale (MCH-FS) and Food Neophobia Scale (FNS). The study included 345 children, of whom 59.1% were observed to be at significant risk for food neophobia. The results of the study suggest that food neophobia is not a common phenomenon in children aged 1-2 years but becomes more pronounced later in childhood. Another important finding was that food neophobia shows a stronger association with established eating patterns than with individual taste preferences. Considering these results, this phenomenon should be considered not only as a natural part of child development, but also as a potential indicator of eating disorders that may require intervention. These findings underscore the need for further research that could deepen the understanding of the mechanisms governing food neophobia and its long-term consequences for child health.

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.

Inflammatory index score in children: its relationship with neophobia, dietary quality and anthropometric measurements

The aim of this study was to examine the correlation between the Diet Inflammatory Index (DII) scores and dietary quality in children, which was measured by the Mediterranean Diet Quality Index (KIDMED), also neophobia scores and anthropometric measurements. This study was conducted in primary schools in Famagusta, Cyprus. A total of 300 children (150 girls, 150 boys) in the 3rd, 4th and 5th grade were included in the study. The frequency of food consumption was measured to calculate the DII scores. Moreover, neophobia and KIDMED scores were obtained. The KIDMED score is a popular tool that is mostly used as a practical scale to assess adherence to the Mediterranean diet among children. Additionally, anthropometric measurements (body weight, height, waist circumference, neck circumference) were collected. Finally, DII scores were compared with KIDMED scores, neophobia scores, and anthropometric measurements. Anthropometric measurements and body mass index (BMI) values were found to be significantly different (p < 0.05) based on the DII scores. Children with DII scores in the 1st quartile had significantly different anthropometric measurements compared to those who had scores in the 2nd, 3rd, and 4th quartiles (p < 0.05). The DII scores of normal-weight children were higher than those of obese children. A significant negative correlation was observed between KIDMED scores and DII scores of the children (p < 0.05). Furthermore, a significant positive correlation was observed between neophobia scores and DII scores (p < 0.05). Additionally, DII scores were correlated with dietary quality and anthropometric measurements (p < 0.05). The MD enhances the anti-inflammatory properties of the diet; it has clearly demonstrated positive effects on diet quality and anthropometric measurements. Furthermore, the MD is suggested to reduce the risk of chronic diseases as a result of improving DII scores at an early age.

Adherence to Mediterranean Diet and Food Neophobia Occurrence in Children: A Study Carried out in Italy

Food Neophobia (FN), defined as the reluctance to eat new or unfamiliar foods, mainly concerns fruit, vegetables, and legumes, typical of the Mediterranean Diet (MD). Considering these premises, this study aimed to clarify the relationship between FN and AMD in a sample of Italian children and their association with some socio-demographic factors and children's nutritional status. A sample of 288 children aged 3-11 years participated in an assessment carried out with a questionnaire evaluating FN and AMD, respectively, with the Child Food Neophobia Scale (CFNS) and the KIDMED test. Most of the sample showed an intermediate (67.3%) or high level of FN (18.1%), with high rates among 6-11-year-old children (63.9%) and especially in those who were the only child (50%). The AMD was mostly low (29.5%) or medium (54.8%) and reached lower levels among higher neophobic children (51.9%; p value < 0.05). The present results confirm the study hypothesis that FN is a driver of MD abandonment and shows the positive effects on children's eating habits and siblings. Finally, this study proves the relevance of adopting effective feeding strategies against FN to avoid its maintenance in adulthood and the detrimental effects on future overall health and well-being.

Translation of the Satter's Division of Responsibility in Feeding Questionnaire into Brazilian Portuguese: A Cross-Sectional Study

This cross-sectional study aimed to translate and perform a psychometric analysis (evaluation of reproducibility and internal consistency) of the sDOR.2-6y™ into Brazilian Portuguese. The translation and back-translation followed the protocol required by the NEEDs Center, and the approved version was called "sDOR.2-6y™-Português-Brasil". The approved version was submitted to a test-retest round to verify its reproducibility through the Intraclass Correlation Coefficient (ICC). A pilot study was performed to assess the internal consistency of the instrument. The reproducibility analysis (n = 23) showed a total ICC of 0.945. With the data from the pilot study (n = 384), the internal consistency evaluation was analyzed through Cronbach's alpha coefficient, and the instrument obtained an overall Cronbach's alpha of 0.301. The translation of the sDOR.2-6y™ into Brazilian Portuguese is the first and only tool available for the Brazilian population to exclusively assess the division of responsibility in feeding, which is essential to the academic community, health professionals, and research on child feeding. Therefore, this instrument in Brazilian Portuguese will allow future research on the division of responsibility in feeding among those responsible for children in Brazil.

Division of Responsibility in Child Feeding and Eating Competence among Brazilian Caregivers

This cross-sectional study aimed to assess Brazilian child caregivers' eating competence (EC) and their adherence to the division of responsibility (sDOR) in child feeding. The research had national coverage in all Brazilian regions. The sample comprised 549 caregivers of Brazilian children (24 up to 72 months) recruited by social media (snowball method). Data on sDOR and EC were collected using the sDOR.2-6y^TM Portuguese-Brazil (sDOR.2-6y-BR) and ecSI2.0^TMBR, both instruments validated to the Brazilian population. The scores of the sDOR.2-6y-BR were described in terms of means, standard deviations (SD), medians, and interquartile range. Student's t-test and analysis of variance (ANOVA) followed by Tukey's post hoc tests were used to compare the scores of sDOR.2-6y-BR and ecSI2.0^TMBR with interest variables. The association between the sDOR.2-6y-BR and ecSI2.0^TMBR scores was verified by Pearson's correlation coefficient. Most of the participants were female (n = 88.7%), 37.8 ± 5.1 y/o, had a high schooling level (70.31%), and high monthly income (more than 15 minimum wages-MW) (31.69%). The children for whom the participants were responsible were mostly girls (53.19%), with an average age of 3.6 ± 1.3 y/o. The instrument presented good responsiveness (floor and ceiling effects = 0%). Cronbach's Alpha = 0.268. There was no statistical difference in sDOR.2-6y-BR scores between caregiver's gender, age, level of education, number of people living in the household, or by gender or age of the child. Caregivers who reported (n = 100) that their children had some medical diagnosis (e.g., food allergy, autism, or Down syndrome) had lower sDOR adherence scores than caregivers who indicated their children had no medical diagnosis (p = 0.031). There was no statistical difference in ecSI2.0^TMBR scores between the categories of caregiver's gender, age, occupancy, and child's gender and age. Caregivers with income higher than 10 MW, living in houses with more than 3 people, and with graduate schooling showed higher EC scores. Caregivers considered competent eaters by ecSI2.0^TMBR scores differed only for educational level, which was more frequent among graduate participants. The total EC score was positively associated with total and mealtime structure (D1), how food is available to the child (D3), and the parent gives respect to the child's autonomy in eating (D4) sDOR.2-6y^TM domains. There was a negative association with the what is available to the child (D2) sDOR.2-6y^TM domain. In general, the sDOR.2-6y-BR had a positive association with the ecSI2.0^TMBR in all domains and total, with a low but significant correlation. This study enables the investigation of the division of responsibility in feeding and EC of a sample of caregivers of children in Brazil. This is the first study to apply the translated and validated version of the sDOR.2-6y-BR and showed good results, where competent eaters' caregivers adhere more to the principles of sDOR.

The impact of COVID-19 pandemic on food habits and neophobia in children in the framework of the family context and parents' behaviors: A study in an Italian central region

Objective

This paper aims to evaluate whether changes in lifestyle and eating habits resulting from the Covid-19 emergency have influenced the post-pandemic level of food neophobia and in children living in an Italian central region.

Methods

A sample of 99 children took part in a retrospective assessment carried out with a self-administrated questionnaire. Pre and post-pandemic evaluation of eating habits, physical activity, and lifestyle indicators was carried out. Food neophobia was evaluated following the Child Food Neophobia Scale (CFNS). Descriptive statistics were produced. A contingency analysis was performed to check associations between variables.

Results

For a large part of the sample (97%) the selective food refusal did not change during the pandemic period. About 70% of participants did not change their eating habits, with some subgroups reporting an increase in the consumption of fruits (22.2%), vegetables (19.2%), and legumes (21.2%). Relevantly the impact of the pandemic on the sedentary attitude passed from 25.3 to 70.7%. Neophobia was not associated with ponderal status (p-value 0.5). However, in normal-weight children, a high prevalence of intermediate-level neophobia (78.4%) was found. 39.4% of the studied children were involved in meal preparation during social isolation, with an increase in the proportion of children that shared all meals with their family (32.3% vs. 78.8%). Non-coercive parent behaviors in reaction to food refusal were associated with low levels of neophobia (p-value < 0.05).

Discussion

In this sample, for the effect of parents' attitudes, the pandemic positively affected children's food habits and, consequently, the level of neophobia after the social restrictions. The main implication of the study is the importance of capitalizing on the period of restrictions in order to involve children in meal sharing and food preparation.

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.