Parents' nutrition knowledge, perceived barriers and enablers, and healthy-eating attitudes associated with children's adherence to the Mediterranean Diet: the DELICIOUS project

Sabrina Castellano¹Wen Rui Choo²Alice Rosi³TANIA MARIA ABRIL MERA⁴Francesca Scazzina³Francesca Giampieri^5,6,7Evelyn Frias-Toral^8,9Osama Abdelkarim¹⁰Mohamed Aly¹⁰Achraf Ammar^11,12Juancho Pons¹³Laura Vázquez-Araújo^14,15Fernando Maniega Legarda^16,17,6Lorenzo Monasta¹⁸Alesssandro Scuderi¹⁹Nunzia Decembrino²⁰Ana Mata²¹Adrián Chacón²¹Pablo Busó²¹Giuseppe Grosso^22,23*

• ¹Department of Educational Sciences, University of Catania, Catania, Italy
• ²Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
• ³Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy
• ⁴School of Medicine, Universidad Católica de Santiago de Guayaquil, Av. Pdte. Carlos Julio Arosemena Tola, Guayaquil, Ecuador
• ⁵Department of Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
• ⁶Research Group on Food, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, Santander, Spain
• ⁷International Joint Research Laboratory of Intelligent Agriculture and Agri-Products Processing, Jiangsu University, Zhenjiang, China
• ⁸School of Medicine, Universidad Espíritu Santo, Samborondón, Ecuador
• ⁹Division of Research, Texas State University, 601 University Dr, San Marcos, United States
• ¹⁰Faculty of Physical Education, Assiut University, Assiut, Egypt
• ¹¹Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany
• ¹²Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
• ¹³Editorial Luis Vives (EDELVIVES), Carretera de Madrid, Zaragoza, Spain
• ¹⁴BCC Innovation, Technology Center in Gastronomy, Basque Culinary Center, Donostia-San Sebastián, Spain
• ¹⁵Basque Culinary Center, Faculty of Gastronomic Sciences, Mondragon Unibertsitatea, Donostia-San Sebastián, Spain
• ¹⁶Universidade Internacional do Cuanza, Cuito, Angola
• ¹⁷Universidad de La Romana, La Romana, Dominican Republic
• ¹⁸Institute for Maternal and Child Health – IRCCS Burlo Garofolo, Trieste, Italy
• ¹⁹Department of Agriculture, Food and Environment, University of Catania, Catania, Italy
• ²⁰Neonatal Intensive Care Unit, University Hospital "Policlinico-San Marco" Catania, Integrated Department for Maternal and Child's Health Protection, Catania, Italy
• ²¹Technological Institute for children's products & leisure AIJU, Alicante, Spain
• ²²Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
• ²³Center for Human Nutrition and Mediterranean Foods (NUTREA), University of Catania, Catania, Italy

Objective: Children's dietary choices are influenced by several factors, including parents' modeling. The relation between parents' psychosocial factors and their children's level of adherence to the Mediterranean diet were explored. Methods: Food literacy, perceived barriers and enablers, and healthy-eating attitude following the Capability, Opportunity and Motivation (COM-B) model for behavioral change were evaluated in 2,011 participants in the DELICIOUS (UnDErstanding consumer food choices & promotion of healthy and sustainable Mediterranean Diet and LIfestyle in Children and adolescents through behavIOUral change actionS) project. Adherence to the Mediterranean diet was assessed through the KIDMED questionnaire. Beta coefficients and standard errors (SEs) were calculated through linear regression analyses. Results: Post-adjustment for potential confounding factors, results showed significant positive correlation between children's adherence to the Mediterranean diet and parental food literacy [β (SE) = 0.180 (0.011)], perceived barriers and enablers [β (SE) = 0.135 (0.009)], and healthy-eating attitudes (divided into five constructs) [β (SE) = 0.069 (0.030), β (SE) = 0.037 (0.029), β (SE) = 0.162 (0.017), β (SE) = 0.147 (0.010), β (SE) = 0.158 (0.011)]. Individual dietary components of the Mediterranean diet were also associated with various psychosocial factors. Conclusion: These results confirm the importance of parental food literacy, perceived enablers and barriers to healthy-eating, health-eating attitude in their children's adherence to the Mediterranean diet.