Parental Feeding Practices, Child Eating Behaviours, and Their Association with Metabolic Control in Children with Type 1 Diabetes: A Systematic Review.

BACKGROUND/

objectivesFamily-related factors are central to type 1 diabetes (T1D) management during childhood and adolescence. This systematic review aimed to synthesise the available evidence on the associations between parental feeding practices, child eating and mealtime behaviours, and glycaemic, nutritional and other diabetes-related outcomes in children and adolescents with T1D.

methodsThis systematic review was conducted and reported in accordance with the PRISMA 2020 statement and prospectively registered in PROSPERO (CRD420261291514). PubMed/MEDLINE, Scopus, and Web of Science were searched without publication date restrictions. Observational studies including children and adolescents aged 0-18 years with T1D and examining parental feeding practices or child eating/mealtime behaviours in relation to diabetes-related outcomes were eligible. Family mealtime functioning was considered as a secondary construct when examined within otherwise eligible feeding- or mealtime-focused studies. Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale. Owing to substantial heterogeneity in study populations, constructs, assessment instruments and outcomes, findings were synthesised narratively.

resultsEleven reports representing nine unique studies were included. Most studies were cross-sectional and involved predominantly preschool and younger school-aged children, with limited representation of adolescents. Associations between feeding and mealtime-related factors and diabetes-related outcomes varied across studies and constructs. Greater child mealtime problems and specific disruptive mealtime behaviours were associated with higher HbA1c or less favourable glucose-related measures in some analyses, while aspects of family mealtime functioning were associated with dietary adherence or glucose measurements outside the target range. Parental feeding practices, including restriction and pressure to eat, showed inconsistent or null associations with glycaemic outcomes. Associations were also reported with diet quality, carbohydrate intake and mealtime behaviours, although effect direction and magnitude varied, and null findings were common. Evidence from continuous glucose monitoring-derived outcomes was limited.

conclusionsParental feeding practices and child mealtime behaviours may be associated with glycaemic, dietary and behavioural outcomes in paediatric T1D, while family mealtime functioning emerged as a relevant secondary contextual construct. However, the available evidence is heterogeneous and predominantly cross-sectional. These constructs should not be considered interchangeable dimensions of parental control, and current evidence does not establish directionality or causality, nor demonstrate that modifying feeding or mealtime practices improves glycaemic outcomes. Further longitudinal and intervention studies using clearly defined constructs, developmentally diverse samples, and objective glycaemic measures are needed.