Food refusal behaviors in preschool children can significantly impact their nutritional status and overall quality of life. This study investigated the relationship between food refusal behaviors, compliance with the Mediterranean Diet, and quality of life in preschool children. Conducted as a cross-sectional study, it included 400 children aged 4–6 and their parents. The Child Food Rejection Scale measured food refusal behaviors, KIDMED assessed compliance with the Mediterranean Diet, and the Kiddy-KINDL scale evaluated quality of life. The mean age of the children was 4.80±0.71 years. According to age-based Body Mass Index-Z scores, 71.0% were normal, 15.5% underweight, 9.0% slightly overweight, and 4.5% obese. Parents’ average age was 34.65±5.35 years; 96.8% were married, 88.8% had a nuclear family structure, 58.0% were university graduates, and 69.8% rated their income level as moderate. Girls had higher food refusal scores than boys(p<0.05). Children who frequently fell ill also scored higher in food refusal(p<0.05). Food refusal decreased with higher family income, larger family size, and older parental age(p<0.05). Parental nutrition education significantly reduced food refusal scores(p<0.05). Higher KIDMED scores were associated with lower food refusal(p<0.01), and children with low Kiddy-KINDL scores exhibited higher food refusal behaviors(p<0.01). A positive correlation was found between KIDMED and Kiddy-KINDL scores(p<0.01). No significant associations were detected between BMI Z scores and food rejection and its subscales. The findings suggest that compliance with the Mediterranean Diet reduces food refusal behaviors in preschool children and increases quality of life, while low quality of life is associated with increased food refusal behaviors.

Omnivores have the advantage of a variety of food options but face a challenge in identifying foods that are safe to eat. Not surprisingly, therefore, children show a relative aversion to new foods (neophobia) and a relative preference for familiar, bland, sweet foods. While this may in the past have promoted survival, in the modern food environment it could have an adverse effect on dietary quality. This review examines the evidence for genetic and environmental factors underlying individual differences in children's food preferences and neophobia. Twin studies indicate that neophobia is a strongly heritable characteristic, while specific food preferences show some genetic influence and are also influenced by the family environment. The advantage of the malleability of human food preferences is that dislike of a food can be reduced or even reversed by a combination of modelling and taste exposure. The need for effective guidance for parents who may be seeking to improve the range or nutritional value of foods accepted by their children is highlighted.