Symptom burden, psychosocial distress and palliative care needs in heart failure - A cross-sectional explorative pilot study.

BACKGROUND: Beyond guideline-directed treatments aimed at improving cardiac function and prognosis in heart failure (HF), patient-reported outcomes have gained attention. PURPOSE: Using a cross-sectional approach, we assessed symptom burden, psychosocial distress, and potential palliative care (PC) needs in patients with advanced stages of HF. METHODS: At a large tertiary care center, we enrolled HF patients in an exploratory pilot study. Symptom burden and psychosocial distress were assessed using the MIDOS (Minimal Documentation System for Patients in PC) questionnaire and the Distress Thermometer (DT), respectively. The 4-item Patient Health Questionnaire (PHQ-4) was used to screen for anxiety and depression. To assess PC needs, physicians used the "Palliative Care Screening Tool for HF Patients". RESULTS: We included 259 patients, of whom 137 (53%) were enrolled at the Heart Failure Unit (HFU), and 122 (47%) at the outpatient clinic (OC). Mean age was 63 years, 72% were male. New York Heart Association class III or IV symptoms were present in 56%. With a mean 5-year survival 64% (HFU) vs. 69% (OC) calculated by the Seattle Heart Failure Model, estimated prognosis was comparatively good. Symptom burden (MIDOS score 8.0 vs. 5.4, max. 30 points, p < 0.001) and level of distress (DT score 6.0 vs. 4.8, max. 10 points, p < 0.001) were higher in hospitalised patients. Clinically relevant distress was detected in the majority of patients (HFU 76% vs. OC 57%, p = 0.001), and more than one third exhibited at least mild symptoms of depression or anxiety. Screening for PC needs revealed 82% of in- and 52% of outpatients fulfil criteria for specialized palliative support. CONCLUSION: Despite a good prognosis, we found multiple undetected and unaddressed needs in an advanced HF cohort. This study's tools and screening results may help to early explore these needs, to further improve integrated HF care.

Factors associated with change and stability in adherence to muscle-strengthening guidelines among young Australian adults: A longitudinal study.

OBJECTIVES: The 2014 Australian Physical Activity and Sedentary Behaviour Guidelines (Adults) recommend muscle-strengthening activities ≥2 days/week. This study aimed to identify factors associated with 5-year change and stability in adherence to these guidelines. DESIGN: Two adult follow-ups of the Childhood Determinants of Adult Health (CDAH) Study. Participants (n = 1510) were 26-36 years (CDAH-1, 2004-06) and 31-41 years (CDAH-2, 2009-11). METHODS: Information on muscle-strengthening activities, sociodemographics, health, physical activity and sedentary behaviour was collected. Participants reporting muscle-strengthening activities ≥2 days/week 'met guidelines', with change and stability categorised as 'persistent adherence', 'increasing adherence', 'decreasing adherence' and 'persistent non-adherence'. Differences in sociodemographic, health and behavioural factors were analysed using log multinomial regression. RESULTS: Between 15-21% of women (CDAH-1: 14.5%, 95% confidence interval = 12.5-16.9; CDAH-2: 20.7%, 95% confidence interval = 18.3-23.4) and ~21% of men (CDAH-1: 22.2%, 95% confidence interval = 19.0-26.0; CDAH-2: 21.0%, 95% confidence interval = 17.8-24.7) met muscle-strengthening guidelines, but only 8.5% (95% confidence interval = 7.2-10.1) of participants were persistently adherent. Remaining in or moving from a major city, CDAH-1 weight status, cumulative self-rated health and vigorous physical activity were positively associated with persistent adherence (relative risk range = 1.51-3.92), while female gender, becoming partnered and having children at any timepoint were negatively associated with persistent adherence (relative risk range = 0.38-0.58). CONCLUSIONS: Adherence - particularly persistent adherence - to muscle-strengthening guidelines in this sample was low. Gender, marital status, weight status, BMI, self-rated health, urban-rural status, parental status, physical activity and sedentary behaviour were associated with adherence, and should be considered in intervention development to maximise effectiveness.

Youth diet quality and hazard of mood disorder in adolescence and adulthood among an Australian cohort.

BACKGROUND: Prospective studies on youth diet and mood disorders outcomes are limited. We examined if youth diet quality was associated with mood disorder onset over a 25-year follow-up period. METHODS: In 1985, Australian participants (aged 10-15 years) completed a 24-hour food record. A validated 100-point Dietary Guidelines Index (DGI) assessed diet quality. In 2009-11, 1005 participants (aged 33-41 years) completed the lifetime Composite International Diagnostic Interview for age of first DSM-IV defined mood disorder (depression or dysthymia). Cox proportional hazards regression estimated hazard of mood disorder during the 25-year follow-up according to baseline DGI score. Sensitivity analyses censored the study at 5, 10, and 15 years after baseline and used log binomial regression to estimate relative risk (RR). Covariates included baseline negative affect, BMI, academic performance, smoking, breakfast eating, physical activity, and socioeconomic status. RESULTS: The mean(SD) youth DGI score was 45.0(11.5). A 10-point higher DGI was not associated with hazard of mood disorder onset over the 25-year follow-up (Hazard Ratio (HR):1.00; 95% Confidence Interval (CI):0.89-1.13). The only indication that higher DGI might be associated with lower risk of mood disorder was within the first 5 years after baseline and this was not statistically significant (RR=0.85; 95% CI:0.60-1.18). LIMITATIONS: Loss-to-follow-up. A single 24-hour food record may not represent usual diet. CONCLUSION: Youth diet did not predict mood disorders in adulthood. The suggestions of a lower risk of mood disorder during late adolescence highlights that further prospective studies are needed.

An eating pattern characterised by skipped or delayed breakfast is associated with mood disorders among an Australian adult cohort.

BACKGROUND: Meal timing may influence food choices, neurobiology and psychological states. Our exploratory study examined if time-of-day eating patterns were associated with mood disorders among adults. METHODS: During 2004-2006 (age 26-36 years) and 2009-2011 (follow-up, age 31-41 years), N = 1304 participants reported 24-h food and beverage intake. Time-of-day eating patterns were derived by principal components analysis. At follow-up, the Composite International Diagnostic Interview measured lifetime mood disorder. Log binomial and adjacent categories log-link regression were used to examine bidirectional associations between eating patterns and mood disorder. Covariates included sex, age, marital status, social support, education, work schedule, body mass index and smoking. RESULTS: Three patterns were derived at each time-point: Grazing (intake spread across the day), Traditional (highest intakes reflected breakfast, lunch and dinner), and Late (skipped/delayed breakfast with higher evening intakes). Compared to those in the lowest third of the respective pattern at baseline and follow-up, during the 5-year follow-up, those in the highest third of the Late pattern at both time-points had a higher prevalence of mood disorder [prevalence ratio (PR) = 2.04; 95% confidence interval (CI) 1.20-3.48], and those in the highest third of the Traditional pattern at both time-points had a lower prevalence of first onset mood disorder (PR = 0.31; 95% CI 0.11-0.87). Participants who experienced a mood disorder during follow-up had a 1.07 higher relative risk of being in a higher Late pattern score category at follow-up than those without mood disorder (95% CI 1.00-1.14). CONCLUSIONS: Non-traditional eating patterns, particularly skipped or delayed breakfast, may be associated with mood disorders.

Dilated cardiomyopathy: from epidemiologic to genetic phenotypes: A translational review of current literature.

Dilated cardiomyopathy (DCM) is characterized by left ventricular dilatation and, consecutively, contractile dysfunction. The causes of DCM are heterogeneous. DCM often results from myocarditis, exposure to alcohol, drugs or other toxins and metabolic or endocrine disturbances. In about 35% of patients, genetic mutations can be identified that usually involve genes responsible for cytoskeletal, sarcomere and nuclear envelope proteins. Due to its heterogeneity, a detailed diagnostic work-up is necessary to identify the specific underlying cause and exclude other conditions with phenotype overlap. Patients with DCM show typical systolic heart failure symptoms, but, with progress of the disease, diastolic dysfunction is present as well. Depending on the underlying pathology, DCM patients also become apparent through arrhythmias, thromboembolic events or cardiogenic shock. Disease progression and prognosis are mostly driven by disease severity and reverse remodelling within the heart. The worst prognosis is seen in patients with lowest ejection fractions or severe diastolic dysfunction, leading to terminal heart failure with subsequent need for left ventricular assist device implantation or heart transplantation. Guideline-based heart failure medication and device therapy reduces the frequency of heart failure hospitalizations and improves survival.

Biomarkers for heart failure: small molecules with high clinical relevance.

Heart failure (HF) is a rising epidemic due to the ageing population and progress in all areas of medicine. Thus, research efforts are made to ensure a timely diagnosis, to improve prognosis and treatment of the disease and to facilitate risk prediction at the population level. Because of their noninvasive determination with mostly high sensitivity and accuracy, circulating blood biomarkers are becoming increasingly important for daily clinical practice. Natriuretic peptides, especially B-type natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (Nt-proBNP) and midregional pro-atrial natriuretic peptide (MR-proANP) and cardiac troponins are established blood biomarkers in HF diagnosis and prognosis of HF-related outcomes. Inflammatory molecules as C-reactive protein (CRP) may have added value in anti-inflammatory therapy guidance. Next-generation biomarkers including soluble source of tumorigenicity 2 (sST2), growth differentiation factor-15 (GDF-15), galectin-3 (Gal-3) and diverse microribonucleic acids (miRNAs) may have additional benefit in assessment of cardiac remodeling or differentiation of HF subtypes. Multimarker approaches containing different combinations of established and novel biomarkers might improve HF risk prediction at the population level once they are used on top of clinical variables.

The Association of Type 2 Diabetes Mellitus with Cerebral Gray Matter Volume Is Independent of Retinal Vascular Architecture and Retinopathy.

It is uncertain whether small vessel disease underlies the relationship between Type 2 Diabetes Mellitus (T2DM) and brain atrophy. We aimed to study whether retinal vascular architecture, as a proxy for cerebral small vessel disease, may modify or mediate the associations of T2DM with brain volumes. In this cross-sectional study using Magnetic Resonance Imaging (MRI) scans and retinal photographs in 451 people with and without T2DM, we measured brain volumes, geometric measures of retinal vascular architecture, clinical retinopathy, and MRI cerebrovascular lesions. There were 270 people with (mean age 67.3 years) and 181 without T2DM (mean age 72.9 years). T2DM was associated with lower gray matter volume (p = 0.008). T2DM was associated with greater arteriolar diameter (p = 0.03) and optimality ratio (p = 0.04), but these associations were attenuated by adjustments for age and sex. Only optimality ratio was associated with lower gray matter volume (p = 0.03). The inclusion of retinal measures in regression models did not attenuate the association of T2DM with gray matter volume. The association of T2DM with lower gray matter volume was independent of retinal vascular architecture and clinical retinopathy. Retinal vascular measures or retinopathy may not be sufficiently sensitive to confirm a microvascular basis for T2DM-related brain atrophy.

Childhood fitness reduces the long-term cardiometabolic risks associated with childhood obesity.

OBJECTIVE: The objective of this study was to examine whether childhood cardiorespiratory fitness attenuates or modifies the long-term cardiometabolic risks associated with childhood obesity. DESIGN AND METHODS: The study consisted of a 20-year follow-up of 1792 adults who participated in the 1985 Australian Schools Health and Fitness Survey when they were 7-15 years of age. Baseline measures included a 1.6-km run to assess cardiorespiratory fitness and waist circumference to assess abdominal adiposity. At follow-up, participants attended study clinics where indicators of Metabolic Syndrome (MetS) (waist circumference, blood pressure, fasting blood glucose and lipids) were measured and cardiorespiratory fitness was reassessed using a submaximal graded exercise test. RESULTS: Both high waist circumference and low cardiorespiratory fitness in childhood were significant independent predictors of MetS in early adulthood. The mutually adjusted relative risk of adult MetS was 3.00 (95% confidence interval: 1.85-4.89) for children in the highest (vs lowest) third of waist circumference and 0.64 (95% confidence interval: 0.43-0.96) for children with high (vs low) cardiorespiratory fitness. No significant interaction between waist circumference and fitness was observed, with higher levels of childhood fitness associated with lower risks of adult MetS among those with either low or high childhood waist circumference values. Participants who had both high waist circumference and low cardiorespiratory fitness in childhood were 8.5 times more likely to have MetS in adulthood than those who had low waist circumference and high cardiorespiratory fitness in childhood. Regardless of childhood obesity status, participants with low childhood fitness who increased their relative fitness by adulthood had a substantially lower prevalence of MetS than those who remained low fit. CONCLUSIONS: Childhood waist circumference and cardiorespiratory fitness are both strongly associated with cardiometabolic health in later life. Higher levels of cardiorespiratory fitness substantially reduce the risk of adult MetS, even among those with abdominal obesity in childhood.

Does youth adiposity, or change in adiposity from youth to adulthood, predict metabolically healthy obesity in adulthood?

BACKGROUND: Individuals with metabolically healthy obesity (MHO) do not have the metabolic complications usually associated with obesity. OBJECTIVE: To examine whether youth adiposity, or change in adiposity from youth to adulthood, predicts MHO 20 years later. METHODS: A national sample of 2410 Australian participants had height, weight and waist circumference (WC) measured in 1985 (7-15 years old) and 2004-2006 (26-36 years old). A fasting blood sample was taken in 2004-2006. MHO was defined as body mass index (BMI) ≥30 kg m(-2) , normal fasting glucose (<5.6 mmol L(-1) ), triglycerides (<1.695 mmol L(-1) ), high-density lipoprotein-cholesterol (>1.036 mmol L(-1) men, > 1.295 mmol L(-1) women), blood pressure (<130/85 mmHg) and no medication for these conditions. Relative risks (RR) were calculated using log binomial regression and expressed per unit of youth BMI (or WC) z-score or change in BMI (or WC) z-score from youth to adulthood, adjusted for sex and youth age. RESULTS: In total 323 individuals were obese at follow-up, 79 (24.5%) were MHO. Adult MHO was not associated with youth BMI (RR: 1.00, 95%CI: 0.85-1.19) or WC (RR: 0.93, 95%CI: 0.79-1.11). Individuals were less likely to be MHO if they had larger increases in BMI (BMI RR: 0.74, 95%CI: 0.57-0.97) or WC (RR: 0.70, 95%CI: 0.55-0.90) from youth to adulthood. CONCLUSIONS: Change in adiposity from youth to adulthood predicted adult MHO better than youth adiposity alone.

Longitudinal investigation of adenovirus 36 seropositivity and human obesity: the Cardiovascular Risk in Young Finns Study.

BACKGROUND/OBJECTIVES: Adenovirus-36 (Adv-36) infection is associated with exaggerated adipogenesis in cell culture and the development of obesity in animal models and humans, but a causal relationship remains unproven. Our objective was to determine whether serological evidence of Adv-36 infection in childhood and/or adulthood is associated with adult obesity. SUBJECTS/METHODS: Paired plasma concentrations of Adv-36 antibodies were measured by a novel enzyme-linked immunosorbent assay in a subgroup (n=449) of the Cardiovascular Risk in Young Finns Study in childhood (mean age 11.9 years) and adulthood (mean age 41.3 years). The study group included (1) individuals who had maintained normal-weight status (2) those who became obese adults from a normal-weight status in childhood and (3) those that were overweight/obese as a child and obese as an adult. RESULTS: Mean (s.d.) time between baseline and follow-up was 29.4 (3.2) years (range 21-31 years). A total of 24.4% of individuals who were normal weight throughout life were seropositive for Adv-36 during child and/or adulthood as compared with 32.3% of those who became obese adults (P=0.11). Those who became obese in adulthood were more likely to be Adv-36 seropositive as adults compared with those who maintained normal weight (21.3% vs. 11.6%, P=0.02). This difference was mediated by a decline in Adv-36 seropositivity between child and adulthood in those maintaining normal weight. No differences were observed in body mass index across the life course, nor in waist circumference in adult life, between those who were Adv-36 seronegative or seropositive at any age. CONCLUSIONS: Individuals who gained weight across the life course were more likely to be Adv-36 seropositive in adult life than those who did not gain weight. However, analysis of change in weight status in relation to Adv-36 positivity did not support a causal role for Adv-36 in the development of obesity.

The role of pharmacotherapy in the prevention and treatment of paediatric metabolic syndrome--Implications for long-term health: part of a series on Pediatric Pharmacology, guest edited by Gianvincenzo Zuccotti, Emilio Clementi, and Massimo Molteni.

The metabolic syndrome (MetS) is defined as a clustering of risk factors predisposing to the future development of cardiovascular disease and Type 2 diabetes mellitus (T2DM). Its clinical relevance, above and beyond recognition and treatment of each of the component parts, is still hotly debated--especially within paediatric medicine. Prevention and treatment strategies for adult MetS focus on weight management, as obesity and insulin resistance are known to be at the central axis of the definition, alongside pharmacotherapy of integrally linked conditions such as hypertension and dyslipidaemia. In children and adolescents, however, opportunities for pharmacotherapy are currently limited and interventions aimed at weight management remain the sole treatment paradigm in the majority of cases. This is primarily due to a lack of long-term data relating to the degree of cardiovascular disease and T2DM risk from paediatric MetS, as well as concerns relating to safety and side effect profiles of currently available pharmacotherapies in those who are still growing and developing. Coupled with continuing concern about the recently recognised adverse effects of past and proposed anti-obesity drugs, this indicates that a new era of pharmacotherapy for paediatric MetS is unlikely to be imminent. In fact, the overall paucity of effective current interventions for paediatric MetS is concerning, especially given the fact that approximately 25-33% of all obese paediatric patients likely harbour the condition. It is therefore essential at the present time to concentrate efforts on properly testing the safety and efficacy of currently available products in well-constructed randomised controlled trials in obese adolescents. However, not all obese children and adolescents appear equally at-risk of long-term, weight-related morbidity and a change in emphasis is possibly warranted--one that moves away from simple weight reduction for all and more to a model of reducing long-term risk of cardiovascular disease and T2DM in those at greatest metabolic risk.

Predictive associations between alternative measures of childhood adiposity and adult cardio-metabolic health.

OBJECTIVE: To estimate associations between alternative measures of childhood adiposity and indicators of cardio-metabolic health in adulthood, both unadjusted and adjusted for changes in adiposity from childhood to adulthood. DESIGN AND METHODS: The study consisted of a 20-year follow-up of 2188 adults who had participated in the 1985 Australian Schools Health and Fitness Survey when they were between 7 and 15 years of age. Baseline and follow-up measures of body composition included height and weight, waist and hip circumferences and skinfold thicknesses at four sites. At follow-up, participants attended study clinics where component indicators of the metabolic syndrome (MetS) (waist circumference, blood pressure, fasting blood glucose and lipids) were measured. RESULTS: Waist circumference and skinfold measures were the strongest predictors of subsequent MetS (2009 Joint Scientific Statement definition) in early adulthood. For example, relative risks (RRs) for children in the highest (vs lowest) quarter of waist circumference were 4.8 (95% confidence interval (CI): 2.5-9.2) for males and 5.8 (95% CI: 2.4-14.2) for females. After adjusting for change in waist circumference from childhood to adulthood, each 10 cm increase in childhood waist circumference was associated with an approximate twofold increase in risk for adult MetS (RR = 2.1 (95% CI: 1.7-2.7) among males and RR = 2.3 (95% CI: 1.6-3.4) among females). CONCLUSION: Elevated waist circumference and skinfold thickness measures in childhood appear to be the strongest predictors of subsequent MetS in early adulthood. The increased risk associated with higher waist circumference in childhood appears to be independent of changes in waist circumference from childhood to adulthood.

Effect of organic pig production systems on performance and meat quality.

The present study was carried out to establish knowledge of consequence for setting up guidelines of importance for production of competitive organic pork of high quality. Performance and meat quality characteristics were compared between three organic pig production systems based on indoor housing with access to an outdoor area and a Danish conventional indoor system including 100% concentrate during the finishing feeding stage. The three organic systems used the following three feeding regimes: 100% organic concentrate according to Danish recommendations, 70% organic concentrate (restricted) plus ad libitum organic barley/pea silage and 70% organic concentrate (restricted) plus ad libitum organic clover grass silage, respectively. With exception of a slightly lower daily gain in organic pigs fed 100% concentrate, no significant difference was found in performance and meat quality characteristics compared with results obtained in the conventional system. In contrast and independent of roughage used, organic pigs raised on 70% concentrate had a significant reduction in daily gain (P<0.001) compared with pigs raised on 100% concentrate, despite the fact that no difference in feed conversion rate was seen between the tested production systems. However, the percentage of leanness increased significantly in meat from organic pigs raised on 70% concentrate plus roughage compared with meat from pigs given 100% concentrate. This was reflected in higher yield (weight) of lean cuts and lower yield of cuts with high fat content from pigs fed 70% concentrate plus roughage. In general, organic feeding resulted in a significantly higher content of polyunsaturated fatty acids in the back fat (1.8%), which increased further when restricted feeding plus roughage (4%) was used. Restricted concentrate feeding gave rise to a decrease in tenderness compared with pork from pigs fed 100% concentrate.

Consumer and sensory investigations in relation to physical/chemical aspects of cooked pork in Scandinavia.

The present study addresses sensory quality and liking for pork (eight samples) varying in quality due to adrenaline injection resulting in elevated ultimate pH post-slaughter (24h), meat ageing, cooking temperature and warmed-over flavour (WOF) among consumers (n=288) in Scandinavia. The consumers preferred meat with higher pH (pH(24h)=6.0), cooked to the lowest temperature (65 °C versus 80 °C). Consumers least preferred samples with WOF described as metallic, acidic and off-flavour by a trained panel. "Elevated pH(24h) meat" cooked to 65 °C resulted in a more sweet and tender meat. Juiciness, tenderness and the absence of off-flavour were the most important characteristics for consumers' liking of pork. Consumption frequency and liking of pork were positively related. The consumers that were most satisfied with pork quality reported highest consumption frequency. Elderly people and males expressed the highest liking score and consumption frequency, respectively.

An international study on the importance of androstenone and skatole for boar taint: I. Presentation of the programme and measurement of boar taint compounds with different analytical procedures.

An international study, involving 11 participants in 7 European countries, was conducted to provide scientific evidence for an objective measurement of boar taint in entire male pigs and its possible variation between countries. The specific objectives were to determine the respective contributions of androstenone and skatole to boar taint and their possible variations according to production systems and consumer populations. Over 4000 entire male pigs and 200 gilts were raised and slaughtered in 6 countries. Meat samples were taken from the loin and backfat samples were used for the rapid measurement of androstenone and skatole. A sub-population of 377 entire males and 42 gilts was then selected in such a way as to represent all combinations of skatole and androstenone levels. Androstenone and skatole levels in the selected samples were checked, using established reference methods. Meat samples from the selected animals were used for sensory evaluation by trained panels and for consumer surveys in 7 European countries. The present paper gives a general presentation of the programme and reports the main characteristics of the samples. Three companion papers present the results of the evaluation by trained sensory panels [Dijksterhuis, G., Engel, B., Walstra, P., Font i Furnols, M., Agerhem, H., Fisher, K., Oliver, M. A., Claudi-Magnussen, C., Siret, F., Béague, M. P., Homer, D. B., & Bonneau, M. (2000). An international study on the importance of androstenone and skatole for boar taint: II. Sensory evaluation by trained panels in seven European countries. Meat Science54, 261-269], the results of the consumer surveys [Matthews, K. R., Homer, D. B., Punter, P., Béague, M. P., Gispert, M., Kemspter, A. J., Agerhem, H., Claudi-Magnussen, C., Fischer, K., Siret, F., Leask, H., Font i Furnols, M., & Bonneau, M. (2000). An international study on the importance of androstenone and skatole for boar taint: III. Consumer survey in seven European countries. Meat Science, 54, 271-283] and the main conclusions and recommendations [Bonneau, M., Walstra, P., Claudi-Magnussen, C., Kempster, A. J., Tornberg, E., Fischer, K., Diestre, A., Siret, F., Chevillon, P., Claus, R., Dijksterhuis, G., Punter, P., Matthews, K. R., Agerhem, H., Béague, M. P., Oliver, M. A., Gispert, M., Weiler, U., von Seth, G., Leask, H., Font i Furnols, M., Homer, D. B., & Cook, G. L. (2000). An international study on the importance of androstenone and skatole for boar taint: IV. Simulation studies on consumer dissatisfaction with entire male pork and the effect of sorting out carcasses on the slaughter line, main conclusions and recommendations. Meat Science, 54, 285-295]. Seasonal effects and differences between countries in skatole and androstenone levels are presented elsewhere [Walstra, P., Claudi-Magnussen, C., Chevillon, P., von-Seth, G., Diestre, A., Matthews, K. R., Homer, D. B., & Bonneau, M. (in press). An international study on the importance of androstenone and skatole for boar taint: Levels of androstenone and skatole according to country and season. Livestock Production Science]. A supplementary paper considers the effects of human sensitivity to androstenone and skatole on the consumer acceptance of entire male pork [Weiler, U., Font i Furnols, M., Fischer, K., Kemmer, H., Oliver, M. A., Gispert, M., Dobrowolski, A., & Claus, R. (in press). Influence of differences in sensitivity of Spanish and German consumers to perceive androstenone on the acceptance of boar meat differing in skatole and androstenone concentrations. Meat Science]. A study of possible other compounds contributing to boar taint was also carried out within this programme.

An international study on the importance of androstenone and skatole for boar taint: II. Sensory evaluation by trained panels in seven European countries.

The aim of the present study (part of an EU AIR programme on boar taint) was to make objective the perception of boar taint in entire male pork, and to relate the perception to skatole and androstenone levels. Trained analytical sensory panels in seven European countries assessed pig meat with known levels of androstenone and skatole. The panels performed a sensory profiling using the attributes pig, urine, manure/stable, naphthalene/mothballs, rancid, sweet, sweat and abnormal, both for odour and flavour in separate sessions. It turned out to be difficult to harmonise sensory methodology for seven sensory panels throughout the EU, especially with respect to the exact level of training the panellists received. Sensory panels in general were able to differentiate between the two compounds and between different levels of the compounds, though substantial differences between the panels in the different countries existed. Androstenone was found to relate mostly to the urine attribute, while skatole related mostly to manure and, to a lesser extent, to naphthalene.

An international study on the importance of androstenone and skatole for boar taint: III. Consumer survey in seven European countries.

There has long been debate over the relative importance for consumer acceptability of androstenone and skatole. The objective of this study was to investigate consumer reaction to pig meat of varying levels of androstenone and skatole in seven member states of the European Union. Over 4000 entire male pigs (and 233 gilts as a control) were produced in six European countries, and a sub-sample of 420 were selected to represent a range of androstenone and skatole levels. Loin samples from these pigs were distributed to the seven participating countries. Samples were prepared and cooked according to standardised procedures in each of the countries and presented to pork consumers. Each consumer rated samples from five pigs for liking of flavour and liking of odour. Although there were significant differences between country panels in their liking of meat from entire males generally, there was a greater degree of dislike as both androstenone and skatole increased. This reaction was stronger for skatole than androstenone and consumers reacted more negatively in terms of odour than flavour.

An international study on the importance of androstenone and skatole for boar taint: IV. Simulation studies on consumer dissatisfaction with entire male pork and the effect of sorting carcasses on the slaughter line, main conclusions and recommendations.

An international study has been conducted in order to determine the respective contributions of androstenone and skatole to boar taint and their possible variations according to production systems and consumer populations. The presentation of the study and the main results concerning skatole and androstenone levels and data from sensory evaluation or consumer surveys are reported in companion papers. The present paper summarises the main conclusions of the study and gives tentative recommendations. A simulation study was conducted, based on the skatole and androstenone levels currently observed in European populations of entire male pigs and on the results of the consumer surveys. The first part of the simulation study demonstrated that, overall, 6.5% (odour) and 3.0% (flavour) more consumers were dissatisfied with entire male than with gilt pork. The differences were, however, very variable according to countries. Consumer dissatisfaction for the odour of entire male pork was mostly associated with high skatole levels, while androstenone had little influence on it. On the other hand, androstenone and skatole had similar contributions to the level of dissatisfaction for flavour. From the present study it is not possible to determine clear cut-off levels for androstenone/skatole. The regression equations presented in [Matthews, K. R., Homer, D. B., Punter, P., Béague, M. P., Gispert, M., Siret, F., Leask, H., Fonti i Furnols, M., & Bonneau, M. (2000). An international study on the importance of androstenone, skatole for boar taint: III. Consumer survey in seven European countries. Meat Science, 54, 271-283] provide a basis for decision making. However, due to methodological limitations, the results may underestimate consumer reaction to entire male pork. The second part of the simulation study demonstrated that sorting carcasses on the basis of androstenone/skatole would reduce, but not eliminate, differences in consumer dissatisfaction between entire male and gilt pork. For odour, taking androstenone into account did not improve the efficiency obtained from sorting using skatole only. For flavour, sorting using both compounds was more efficient than sorting using skatole only. Sorting out 15% of the entire males, on the basis of skatole only, would result in a difference in the proportion of dissatisfied consumers of 4.2% (odour) or 2.0% (flavour) between entire male and gilt pork. The results of the last part of the simulation study demonstrated that decreasing skatole in entire male pig populations, to levels as low as 0.10 ppm, would still result in a difference in the proportion of dissatisfied consumers of 3.2% (odour) or 1.6% (flavour). To reduce this difference further, the levels of both compounds would have to be reduced still further. The lowest difference that can be achieved is 2.3% (odour) or 0.4% (flavour). The conclusions of the present study may differ according to whether immediate commercial applications or long-term goals are considered. On the basis of the skatole and androstenone levels currently observed in entire male pig populations, sorting out procedures based on skatole is the easiest way to rapidly achieve a significant decrease in consumer dissatisfaction with entire male pork. In most countries, however, this will not be sufficient to obtain the same level of acceptability as with gilts. In the long term, a sharp reduction in both skatole and androstenone would have to be achieved in entire male pig populations to obtain low differences in acceptability between entire male and gilt pork.