Systematic review of interventions for dietary adherence in pediatric disease management.

Objective: Though diet is important in the management of many pediatric chronic medical conditions, the last comprehensive review of interventions targeting dietary adherence was published over 20 years ago. This systematic review provides an update on efficacy and existing gaps for dietary adherence interventions in pediatric disease management.

Method: We searched PubMed, MEDLINE, Embase, CENTRAL, PsychINFO, Web of Science, and Scopus up to July 1, 2023 for randomized controlled or clinical trials of interventions that targeted dietary adherence in youth 0-18 years old with a chronic medical condition (not obesity), included nutrition education and behavioral/psychological support, and reported dietary adherence outcomes. We identified manuscripts (N = 15) that spanned four broad diet types (healthy, carbohydrate-modified, elimination, single-nutrient modified), 10 pediatric chronic medical conditions, and 1,110 participants. Primary (dietary adherence) and secondary (disease metrics) outcome findings are organized by diet type; other descriptive information is collapsed across trials.

Results: Overall, interventions yielded moderate-high adherence for most diet types. Interventions used similar approaches for nutrition education (e.g., meal plans) and behavioral support (e.g., goal setting, monitoring, feedback). Risk of bias was assessed using the Quality Criteria Checklist for Primary Research (Academy of Nutrition and Dietetics Evidence Analysis Process) revealing bias may be present in five trials.

Conclusions: Interventions targeting dietary adherence remain sparse. Research is needed to examine adherence in all pediatric chronic conditions where diet is a component of disease management and to identify factors impacting dietary adherence and best practices for intervening on dietary adherence. This protocol is registered on April 5, 2024 at the Open Source Framework: https://doi.org/10.17605/OSF.IO/46YNF.