Child’s Acceptance and Readiness to Adhere to a Low-Sugar Diet: Evidence From a Guided Grocery Shopping Pilot for Latinx Adolescents With Non-Alcoholic Fatty Liver Disease

Abstract

Objectives High sugar intake has been implicated in hepatic steatosis and metabolic dysfunction. A previous clinical trial among adolescents with non-alcoholic liver disease (NAFLD) demonstrated that replacing household meals and snacks with similar no- or lower-sugar alternatives for 8 weeks resulted in a reduction in sugar intake and hepatic steatosis. This pilot study aimed to assess the feasibility and acceptability of a guided grocery shopping (GGS) intervention, as an alternative to food replacement, to reduce sugar intake among Latino children with NAFLD. Methods After removing foods high in added sugar (>5g of sugars per serving) from the households of nine adolescents with previously diagnosed NAFLD, parent/child dyads were provided dietitian-led personalized nutrition education sessions and assistance with selecting and purchasing weekly groceries low in free sugars (added sugars + those in fruit juice) for the household for four weeks. Children's readiness-to-change was measured at baseline (month 0), upon conclusion of the intervention (month 1), and at long-term follow-up (month 6) using a Likert scale survey based on the Transtheoretical Model, and semi-structured in-depth interview with code-based thematic analysis were used to assess parents and children's perceptions of the intervention. Results Readiness-to-change of participating children (n = 5; age 8 to 15 y) shifted from Contemplation (considering to take actions at a foreseeable future) at baseline to Action (recently achieved behavior change) at both months 1 and 6. A key theme that emerged from the interviews (n = 6, 11 interviews) was the importance of promoting nutrition literacy, particularly by utilizing the nutrition facts label to help identify foods high in free sugars. Changes in the food environment through food removal and low-sugar groceries were also considered acceptable and helpful intervention strategies. Conclusions Dietitian-guided grocery shopping with nutrition counseling following removal of sugary foods from the household was found to be an acceptable intervention strategy to promote a low-sugar diet among adolescents with known NAFLD. Funding Sources The pilot trial was funded by the Center for Cystic Fibrosis and Airways Disease Research of Emory University and Children's Healthcare of Atlanta.