The Assessment of Eating Pleasure among Older Adults: Development and Preliminary Validation of the Anticipatory and Consummatory Eating Pleasure (ACEPS).

OBJECTIVE: Maintaining eating pleasure as long as possible is one of the determinants that contributes to and encourages good nutrition in the ageing population. Our study aimed to translate, adapt to the context of food and validate the Temporal Experience of Pleasure Scale (which distinguishes anticipatory and consummatory experiences of pleasure) in a food dependent older French population. DESIGN: Prospective validation study. SETTING: 199 participants dependent for their meals, over 65 years old and living at home. MEASUREMENTS: A pool of 16 self-reported items constituted the initial version of the anticipatory and consummatory eating pleasure scale (ACEPS). Demographic data, nutritional status, appetite and depressive mood were also assessed. RESULTS: The exploratory factorial analysis and also the confirmatory factor analysis highlighted a two-factor model: anticipatory eating pleasure (four items) and consummatory eating pleasure (four items). The ACEPS showed good internal consistency. A higher score on the ACEPS positively correlated with appetite. Consummatory eating pleasure positively correlated with nutritional status and negatively correlated with depressive moods. The oldest-old and also those receiving a meals-on-wheels service had lower scores for anticipatory pleasure (r=-.14, p<.03). CONCLUSION: To our knowledge, the ACEPS is the first comprehensive measure of eating pleasure distinguishing anticipatory and consummatory pleasure. This short measure, easily applicable on older people with vulnerability, allows early identification and intervention preventing malnutrition and decline in health. Specifically, encouraging anticipatory eating pleasure may be a first step to improving food intake among older adults.

Relevance and Feasibility of a Personalized Dietary Intervention in Older People with Meals-On-Wheels: A Randomized Controlled Pilot Trial.

Objective: The present study aimed at assessing the feasibility and the effectiveness of a personalized dietary intervention in a meals-on-wheels service through a randomized controlled pilot trial. Design: Sixty recipients of home-delivered meals (75% of women; 70-97 years old) were recruited and randomly assigned to a control and an experimental group and followed over a period of 4 months. In the experimental group, the nutritional status (Mini-Nutritional Assessment - MNA questionnaire), the food intake and the food preferences were measured for each participant. Based on this screening, participants were provided with dietary guidance and follow-up. Those at risk of malnutrition were proposed enriched home-delivered meals. Enrichment was set up considering food preferences of the participants. Results: Looking at the whole sample at baseline, 80% (n=48/60) were at risk of malnutrition. Furthermore, 55% (n=33/60) ate less than 2/3 of their calorie and/or protein recommended allowances. In the experimental group, the intervention led to an increase of protein intakes and to a lower extent of calorie intake. In the control group, no significant changes were observed. Conclusion: To conclude, this study suggests that providing dietary guidance and adding nutrient-dense food to meals while considering food preferences is feasible and may help older beneficiaries of meals-on-wheels to increase calorie and protein intake and improve their nutritional status. However, there is a need to develop products or recipes to enrich the meals of the elderly more efficiently to achieve the recommended allowance.

Potentially modifiable determinants of malnutrition in older adults: A systematic review.

BACKGROUND & AIMS: Malnutrition in older adults results in significant personal, social, and economic burden. To combat this complex, multifactorial issue, evidence-based knowledge is needed on the modifiable determinants of malnutrition. Systematic reviews of prospective studies are lacking in this area; therefore, the aim of this systematic review was to investigate the modifiable determinants of malnutrition in older adults. METHODS: A systematic approach was taken to conduct this review. Eight databases were searched. Prospective cohort studies with participants of a mean age of 65 years or over were included. Studies were required to measure at least one determinant at baseline and malnutrition as outcome at follow-up. Study quality was assessed using a modified version of the Quality in Prognosis Studies (QUIPS) tool. Pooling of data in a meta-analysis was not possible therefore the findings of each study were synthesized narratively. A descriptive synthesis of studies was used to present results due the heterogeneity of population source and setting, definitions of determinants and outcomes. Consistency of findings was assessed using the schema: strong evidence, moderate evidence, low evidence, and conflicting evidence. RESULTS: Twenty-three studies were included in the final review. Thirty potentially modifiable determinants across seven domains (oral, psychosocial, medication and care, health, physical function, lifestyle, eating) were included. The majority of studies had a high risk of bias and were of a low quality. There is moderate evidence that hospitalisation, eating dependency, poor self-perceived health, poor physical function and poor appetite are determinants of malnutrition. Moderate evidence suggests that chewing difficulties, mouth pain, gum issues co-morbidity, visual and hearing impairments, smoking status, alcohol consumption and physical activity levels, complaints about taste of food and specific nutrient intake are not determinants of malnutrition. There is low evidence that loss of interest in life, access to meals and wheels, and modified texture diets are determinants of malnutrition. Furthermore, there is low evidence that psychological distress, anxiety, loneliness, access to transport and wellbeing, hunger and thirst are not determinants of malnutrition. There appears to be conflicting evidence that dental status, swallowing, cognitive function, depression, residential status, medication intake and/or polypharmacy, constipation, periodontal disease are determinants of malnutrition. CONCLUSION: There are multiple potentially modifiable determinants of malnutrition however strong robust evidence is lacking for the majority of determinants. Better prospective cohort studies are required. With an increasingly ageing population, targeting modifiable factors will be crucial to the effective treatment and prevention of malnutrition.

Association between Salivary Hypofunction and Food Consumption in the Elderlies. A Systematic Literature Review.

OBJECTIVES: This systematic literature review aims to summarize the existing scientific evidence about the association between a reduced salivary function and food consumption in elderly people. METHODS: A validated search strategy in two databases (PubMed and ISI Web of Knowledge) was carried out and retrieved papers together with their reference lists were screened by two independent reviewers. The quality of the included studies was critically appraised via the Quality Assessment Criteria for Evaluating Primary Research Papers. RESULTS: From the originally identified studies (n=391), only 15 articles (all cross-sectional studies) met the pre-fixed inclusion/exclusion criteria. The methodological quality of the included studies was in general good, although only 3 from 15 obtained the maximum score. The control of confounding factors was the quality variable more poorly rated in the selected studies. Salivary hypofunction was associated with a decrease of the objective chewing and swallowing abilities and taste perception. Moreover, most of the selected studies showed a relationship between salivary hypofunction and food consumption (in terms of appetite loss, unbalanced dietary intake and malnutrition), although no causality could be established. CONCLUSIONS: This study highlights the fact that salivary hypofunction definition and measurements are different across the studies. Therefore, future research efforts should focus on establishing a gold standard to define and identify salivary hypofunction throughout life and on performing longitudinal studies controlling for confounding factors to establish causality.

Impact of a non-attentively perceived odour on subsequent food choices.

Current research in psychology suggests that unconscious processes influence a significant proportion of choices and decisions. To study the impact of a non-attentively perceived odour on food choices, we used a priming paradigm. We had previously shown that non-attentively perceived fruity odours could impact food choice intentions (on a menu card), guiding participants toward items containing more fruit and/or vegetables. The present study was designed to extend these findings, in a real-life consumption setting. One hundred and fifteen participants took part in this study, and were assigned randomly to either a control or a scented condition. On arrival in the laboratory, they were seated in a waiting room. For the scented condition, they were unobtrusively exposed to a pear odour, while under the control condition the waiting room was non-odorised. Following this waiting period, all participants moved into a non-odorised test room where they were asked to choose, from dishes served buffet-style, the starter, main course and dessert that they would actually eat for lunch. The results showed that participants subjected to the scented condition chose to consume the 'fruity' dessert (compote) more frequently than those who had waited under the control condition, who chose more frequently the dessert without fruit (brownie). In line with the findings of our previous study, these results confirm the idea of priming effects 'specific to the food cue'. To conclude, a non-attentively perceived fruity odour was shown to influence actual food choices, guiding individuals towards more fruity desserts. The involvement of implicit processes in food choices should be taken into account in guidelines and strategies designed to promote healthy eating.

Food memory and its relation with age and liking: an incidental learning experiment with children, young and elderly people.

The present study compared incidental learning and food memory in children, young adults and elderly people for three sensory modalities (taste, texture and aroma). The relation of gender and liker-status (i.e. how much we like a product) with food memory was also investigated. Participants received a complete meal including a custard dessert used as target under incidental learning conditions. 24h later, participants were confronted with a series of samples consisting of the target and slightly modified versions of the target (distractors) and were unexpectedly asked to perform an "absolute memory" ("Did you eat this sample yesterday?") and a "relative memory" test ("Is the present sample less/equal/more pleasant than the one you ate yesterday?"). Participants also performed a hedonic and a discrimination test. Memory for the custard was poor and did not depend on age, but it was related to gender, and to how much participants liked the product. Females and high-likers outperformed males and low-likers in the absolute memory task, but they were not better in discriminating the products on both the hedonic and the perceptual dimension. Results also showed that, contrary to common belief, not all sensory aspects that can be discriminated in perception and in liking, are equally well remembered.

Semantic, typicality and odor representation: a cross-cultural study.

This study investigated odor-category organization in three cultures by evaluating (i) the relationship between linguistic and perceptual categorization and (ii) the existence of an internal structure of odor categories. In the first experiment, three groups of 30 participants from American, French and Vietnamese cultures performed a sorting task. The first group sorted 40 odorants on the basis of odor similarity, the second group sorted 40 odor names on the basis of name similarity and the last group sorted 40 odor names on the basis of imagined odor similarity. Results showed that odor categorization was based on perceptual or conceptual similarity and was in part independent of word and imagined categorizations. In the second experiment, another group of 30 participants from each culture rated the typicality of the odorants for 11 odor categories. Results showed that some odorants were rated as more typical than others. Moreover, the typicality gradient predicted the odor space obtained in the odor sorting task in a consensual way among the three cultures. These results suggest that, as for other categories, odor categories are based on perceptual similarities rather than on semantic cues. Moreover odor-category structure might have a core representation which might be common to different cultures with boundaries which might be more culturally dependent.