Food refusal behaviours in preschool children can significantly impact their nutritional status and overall quality of life. This study investigated the relationship between food refusal behaviours, 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 years and their parents. The Child Food Rejection Scale measured food refusal behaviours, The Children’s Mediterranean Diet Quality Scale (KIDMED) assessed compliance with the Mediterranean Diet and the Children Quality of Life-Questionnaire (Kiddy-KINDL) scale evaluated quality of life. The mean age of the children was 4·80 (sd 0·71) years. According to age-based BMI-Z scores, 71·0 % were normal, 15·5 % underweight, 9·0 % slightly overweight and 4·5 % obese. Parents’ average age was 34·65 (sd 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 behaviours (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 behaviours in preschool children and increases quality of life, while low quality of life is associated with increased food refusal behaviours.

The incidence of food refusal associated with illness is reviewed, not illness by illness, but according to those factors that affect the ability to eat; normal learning about eating, aversive learning about eating, regulation of appetite, children's cognitions about foods, and parental anxiety about intake. Diseases affecting the major organs are likely to generate food refusal based on at least one of these factors, if not all of them. However, some minor disease processes can also have a major impact on food acceptance. Child temperament also affects food acceptance and may interact with the disease process to produce food refusal.