Parent healthful eating attitudes and motivation are prospectively associated with dietary quality among youth with type 1 diabetes

Abstract

A family-based behavioral nutrition intervention grounded in Social Cognitive and Self-Determination Theories showed an increased intake of whole plant foods. This study examined 1) whether the intervention changed parent diet-related attitudes/beliefs, 2) whether these attitudes/beliefs were associated with youth diet quality, and 3) the moderating roles of youth age and parent nutritional knowledge. Youth with type 1 diabetes and their parents (n = 136, mean ± SD youth age = 12.6 ± 2.8 years) participated in an 18-month trial targeting intake of whole plant foods. Parents reported attitudes/beliefs (self-efficacy, outcome expectations, perceived barriers, autonomous and controlled motivation) for providing healthy food to their families, and type 1 diabetes-specific nutrition knowledge at 6, 12, and 18 months. Whole Plant Food Density (WPFD; cup or ounce equivalents per 1000 kcal of whole grains, fruit, vegetables, legumes, nuts and seeds) was calculated from 3-day youth food records. Linear mixed models estimated the intervention effect on parent attitudes/beliefs, associations of parent attitudes/beliefs with youth WPFD and the moderating roles of parent nutrition knowledge and youth age. There was no effect of the intervention on parent attitudes/beliefs. Across groups, higher parent self-efficacy and autonomous motivation were positively associated with youth WPF. Parent perceived barriers and negative outcome expectations were inversely associated with youth WPFD, especially when parents had higher nutrition knowledge. Youth age did not modify any associations. Parent diet-related attitudes/beliefs were associated with youth diet quality, highlighting the importance of parent psychosocial factors across this age range. Despite a positive effect on youth diet, the intervention did not affect parent attitudes/beliefs, suggesting it worked through a different mechanism.

Influence of Parental Healthy-Eating Attitudes and Nutritional Knowledge on Nutritional Adequacy and Diet Quality among Preschoolers: The SENDO Project

“…Although considerable discussion has focused on the influence of parental nutrition knowledge, less research has focused on the effects of parenting attitudes on their offspring’s food consumption, nutritional habits, and diet quality. Our findings agree with a recently published randomized controlled trial of a family-based behavioral nutrition intervention [20] in children with type 1 diabetes that concluded that parents’ diet-related attitudes and beliefs were linked to their children’s diet quality, remarking on the essential role of parental psychosocial factors.…”

Effectiveness of medical nutrition therapy in adolescents with type 1 diabetes: a systematic review

“…Diet quality resemblance at final study: HEI (β (SE) = 0.29 (0.11), p = 0.009) of the intervention group WPFD (β (SE) = 0.33 (0.09), p < 0.001) of the intervention group Nansel et al [ 29 ] N = 66 intervention N = 70 control 8–16 years Behavioral nutrition intervention to increase whole plant foods HEI-2005 WPFD Pickiness subscale of the Child Feeding Questionnaire The intervention effect on diet quality was positive for picky eaters only (WPFD p < 0.001; HEI p = 0.04). Eisenberg-Colman et al [ 30 ] N = 42 intervention N = 48 control 8–16 years Behavioral nutrition intervention to increase whole plant foods Adherence to diabetes management tasks Disordered eating behaviors (DEB) DEPS-R Intervention on DEB: β (SE) = 0.00 (0.00), p = 0.84 DEPS-R vs. diabetes management: β (SE) = −0.20 (0.09), p = 0.03 Eisenberg et al [ 31 ] N = 66 intervention N = 70 control 8–16 years Behavioral nutrition intervention to increase whole plant foods Dietary intake Whole Plant Food Density (WPFD) Self-Efficacy for Healthy Eating Outcome Expectations for Healthy Eating Barriers to Healthy Eating Treatment Self-Regulation Parent Nutrition Knowledge Parent self-efficacy vs. WPFD ( β = 0,21, p = 0.02) Autonomous motivation vs. WPFD ( β = 0.17, p = 0.002) Nutrition knowledge vs. WPFD ( β = 0.01, p = 0.03) Barriers to Healthy Eating vs. WPFD ( β = −0.19, p = 0.02) Negative Outcomes Expectation vs. WPFD ( β = −0.20, p = 0.008) Parent positive outcome expectations vs. WPFD ( β = 0.07, p = 0.45) Controlled motivation vs. WPFD ( β = −0.03, p = 0.56) Gilbertson et al [ 27 ] N = 38 CHOx group N = 51 low-GI group 8–13 years Comparison between the CHOx with low-GI Macronutrient intake Carbohydrate food sources Carbohydrate distribution of meals and snacks Energy intake (MJ/day): CHOx group vs. low-GI group (mean (SD) = 9.1 (1.7) vs. 9.3 (1.4), respectively). Protein (%): CHOx group vs. low-GI ...…”

“…In terms of DSMES, a post-hoc analyses of a RCT performed to assess the relationship between parent attitudes and youth diet quality, described no effect of the intervention on parent attitudes or beliefs [ 30 ]; however, a higher parent self-efficacy and autonomous motivation were positively associated with those youth with a higher adherence to a WPFD diet. Furthermore, a secondary data analysis from this RCT found that a behavioral intervention to improve dietary quality did not increase disordered eating behaviors in adolescents [ 29 ]; nevertheless, a greater adherence to diabetes self-management was associated with lower diabetes eating problems in adolescents with type 1 diabetes [ 29 ].…”

“…In terms of DSMES, only two post-hoc analyses from a RCT addressed this issue [ 29 , 30 ]. The authors found that a higher adherence to a WPFD diet was associated with a higher parent self-efficacy and motivation [ 30 ].…”

I Should but I Can't: Controlled Motivation and Self-Efficacy Are Related to Disordered Eating Behaviors in Adolescents With Type 1 Diabetes

“…Previously, we observed that autonomous motivation was associated with healthful eating in this sample, while controlled motivation was not (34). Taken together, findings indicate differential roles of autonomous and controlled motivation in healthful eating versus DEB.…”