(PTFS04-05-24) Compliance and Readiness to a Low Free Sugar Diet Among Latino Families: Lessons Learned From an Ongoing Pediatric NAFLD Prevention Trial

Objectives: To evaluate compliance and readiness to change of families who participated in a dietitian led, family-focused multi-component intervention over 9 months to reduce sugar intake in Latino school-age children.

Methods: Hispanic families with children aged 6-9 years were enrolled in a randomized controlled trial for non-alcoholic fatty liver disease prevention (ClinicalTrials.gov, NCT05292352). The intervention promotes a low free sugar diet through study purchased food replacements (FR) of high sugar foods with low or no-sugar alternatives throughout month 1 and guided grocery shopping (GGS) sessions at months 3, 6, and 9. Families who completed a readiness-to-change questionnaire (RCQ) at baseline and up to 6 compliance assessments (3 during FR, 3 during GGS) were included in this analysis (N=36). Compliance was measured using a 5-level Likert scale and qualitative feedback was collected to describe challenges and behavior change goals. A 12-item RCQ was adapted from validated tools to measure parental readiness (confidence, perceived importance, commitment to act) on a Likert scale of agreement, and Transtheoretical Model stages using a scale of 0 (not ready) to 10 (very ready).

Results: During FR, 15.7% of families found it easy to comply to a low free sugar diet, 23.1% difficult, and 61.1% neutral. During GGS, 17.5% found compliance easy, 16.5% difficult, and 75% neutral. Key challenges cited by parents included family communication issues with children, child’s resistance to healthy choices, and inconsistent dietary practices within the household. Main goals cited were holistic family involvement, food planning, and fostering positive relationships with food for long-term lifestyle changes. At baseline, caregivers expressed high confidence (81.5% agreement), perceived importance (44.4%), and commitment (88.9%) to reducing sugar intake. Caregivers were generally in the Contemplation stage to limit sugar drinks (median; IQR = 5; 5-8) and 100% fruit juices (5;5-5.5) for their children.

Conclusions: Assessing compliance is crucial to effectively promote diet changes. While Latino caregivers showed high readiness to reduce their child’s free sugar intake, they faced challenges in compliance largely due to family dynamics and child’s acceptance.

Funding Sources: National Institute of Nursing Research at the National Institutes of Health