The association of food rejection behaviours in preschool children with compliance to the Mediterranean diet and their quality of life: a cross-sectional analysis

Food refusal behaviours in preschool children can significantly impact their nutritional status and overall quality of life. This study investigated the relationship between food refusal behaviours, compliance with the Mediterranean diet and quality of life in preschool children. Conducted as a cross-sectional study, it included 400 children aged 4–6 years and their parents. The Child Food Rejection Scale measured food refusal behaviours, The Children’s Mediterranean Diet Quality Scale (KIDMED) assessed compliance with the Mediterranean Diet and the Children Quality of Life-Questionnaire (Kiddy-KINDL) scale evaluated quality of life. The mean age of the children was 4·80 (SD 0·71) years. According to age-based BMI-Z scores, 71·0 % were normal, 15·5 % underweight, 9·0 % slightly overweight and 4·5 % obese. Parents’ average age was 34·65 (SD 5·35) years; 96·8 % were married, 88·8 % had a nuclear family structure, 58·0 % were university graduates and 69·8 % rated their income level as moderate. Girls had higher food refusal scores than boys (P < 0·05). Children who frequently fell ill also scored higher in food refusal (P < 0·05). Food refusal decreased with higher family income, larger family size and older parental age (P < 0·05). Parental nutrition education significantly reduced food refusal scores (P < 0·05). Higher KIDMED scores were associated with lower food refusal (P < 0·01), and children with low Kiddy-KINDL scores exhibited higher food refusal behaviours (P < 0·01). A positive correlation was found between KIDMED and Kiddy-KINDL scores (P < 0·01). No significant associations were detected between BMI Z scores and food rejection and its subscales. The findings suggest that compliance with the Mediterranean diet reduces food refusal behaviours in preschool children and increases quality of life, while low quality of life is associated with increased food refusal behaviours.