Picky Eaters Improved Diet Quality in a Randomized Behavioral Intervention Trial in Youth with Type 1 Diabetes

Background Children who are picky eaters typically demonstrate persistent food refusal and poor diet quality and may be resistant to intervention. Objective This study tested whether pickiness moderated the effect of a nutrition intervention on diet quality in youth with type 1 diabetes, hypothesizing that the intervention effect would be smaller among picky relative to nonpicky eaters. Design The study was an 18-month randomized clinical trial. Participants Youth age 8.0 to 16.9 years (n = 136) with type 1 diabetes duration >= 1 year, receiving care at an outpatient diabetes center in Boston, MA, and a parent, participated from 2010 to 2013. Intervention The intervention integrated motivational interviewing, active learning, and applied problem solving to increase whole plant food intake. Main outcome measures Whole plant food density (WPFD, cup/oz equivalents per 1,000 kcal target food groups), Healthy Eating Index-2005 (HEI2005, measures conformance to US dietary guidelines), and dietary variety were calculated from 3-day food records completed at six different times. Parents completed the pickiness subscale of the Child Feeding Questionnaire. Statistical analyses performed Mean WPFD and HEI2005 were estimated using the population ratio method; standard errors were computed using jackknife variance-covariance estimation. Overall P value comparing groups across visits was derived using the x(2) test. Results Baseline diet quality was lower in picky than in nonpicky eaters. No intervention effect on pickiness or dietary variety was seen. In stratified analyses, the intervention effect on diet quality was significant for picky eaters only (WPFD P = 0.0003; HEI2005 P = 0.04). Among picky eaters, diet quality in the treatment group improved, whereas diet quality in the control group remained low. Diet quality of nonpicky eaters in the intervention group changed to a lesser degree. Conclusions The intervention resulted in increased diet quality in picky eaters, whereas no intervention effect was seen in nonpicky eaters. Findings suggest that diet quality of picky eaters can be improved without changing their underlying pickiness.