Exploring within-meal variety to promote appeal of home-cooked meals in older adults.

Undernutrition is highly prevalent in older adults and poses a major threat to physical and mental wellbeing. To foster healthy eating (and healthy aging), strategies are needed to improve dietary quality of older adults. In this study, the feasibility of increasing food variety in home-cooked meals is explored as strategy to promote meat and vegetable consumption in community dwelling older adults. Adults aged 50 years or older (N = 253) evaluated pictures of traditional Dutch dinner meals with more or less variety in the vegetable or meat component in an online questionnaire. Specifically, four different variety 'levels' were presented: (1) no variety, (2) meat variety, (3) vegetable variety, and (4) variety in both meat and vegetables (mixed). Participants indicated for each meal picture how much they would like the meal, whether it represented an ideal portion size, and whether they would be able and willing to prepare the meal. We expected that with increasing variety, liking and ideal portion size would increase, while ability and willingness to prepare the meals would decrease. Results showed that the meals with meat variety and mixed variety were liked less than meals with vegetable variety or no variety. Participants were all highly willing to prepare the meals, but they were less willing to prepare the meals with meat variety and mixed variety compared to the meals with vegetable variety and no variety. All meals were evaluated as being too large, but the meals with vegetable variety and mixed variety were evaluated as more oversized than the meals without variety and with meat variety. These results suggest that encouraging older adults to include variety in home-cooked meals might be more challenging than anticipated.

A longitudinal evaluation of smell and taste function in children with cancer during and after treatment with chemotherapy.

Smell and taste changes are bothersome treatment symptoms interfering with food intake. It remains unclear how and when children with cancer experience such changes during chemotherapy, and if the symptoms resolve after treatment. In this longitudinal study, we measured smell and taste function of 94 childhood cancer patients treated for hematological, solid, or brain malignancies. Smell and taste function were assessed using commercial Sniffin' Sticks and Taste Strips, respectively. For both tests, normative values were used to identify the presence of smell and taste abnormalities. Self-reported chemosensory and appetite changes were assessed using a questionnaire. Measurements were taken approximately 6 weeks (T0), 3 months (T1), 6 months after starting chemotherapy (T2), and 3 months after termination of chemotherapy or maintenance phase for children with acute lymphoblastic leukemia (ALL) (T3). We found that smell and taste scores did not change during active treatment (T0-2). However, approximately 20% of the patients suffered from decreased taste function according to normative values, particularly children with lymphoma or solid tumors. Changes in smell were predominantly characterized as increased rather than decreased. Self-reported changes were much more common than objectively measured, with smell changes ranging from 26 to 53% and taste changes up to 80% during treatment. After active treatment, odor threshold scores decreased in children with ALL during maintenance phase, whereas total taste scores increased in all children at T3. In summary, objectively measured smell and taste function remained stable during active treatment, while at the individual level a fairly large number of children suffered from chemosensory distortions which comprised either increased or decreased sensitivity. Individual dietary advice and coping strategies are warranted to prevent detrimental effects on food intake in children with cancer.

Promoting vegetable acceptance in toddlers using a contingency management program: A cluster randomised trial.

Children learn to accept novel foods by repeated exposure to these foods. In the current study, we investigated in toddlers whether a contingency management program (The Vegetable Box), comprising repeated vegetable taste exposure with contingent non-food rewards, is particularly potent at increasing recognition of and willingness to try vegetables. A total of 598 children (1-4 years old) recruited at 26 different day-care centres in the Netherlands took part. The day-care centres were randomly assigned to one of three conditions ('exposure/reward', 'exposure/no reward', or 'no exposure/no reward'). At the start and directly after the 3-month intervention period, all children were asked to identify various vegetables (recognition test; max score = 14) and whether they would like to taste and consume 1 or 2 bite-size pieces of tomato, cucumber, carrot, bell pepper, radish, and cauliflower (willingness to try test). Data were analysed with linear mixed-effects regression analyses (for recognition and willingness to try separately) with condition and time as independent variables, and adjusting for day-care centre clustering. Vegetable recognition significantly increased in both the 'exposure/reward' and the 'exposure/no reward' group, relative to the 'no exposure/no reward' control group. The willingness to try vegetables only increased significantly in the 'exposure/reward' group. Offering vegetables to children at day-care centres significantly increased toddlers' ability to identify various vegetables, but rewards contingent upon tasting vegetables appear particularly effective to also increase children's willingness to try (i.e., taste and consume) different vegetables. This result corroborates and strengthens previous findings demonstrating the efficacy of similar reward-based programs.

Child-reported vegetable neophobia is associated with risk avoidance for distaste in children aged 4-15 years.

Children who are food neophobic and/or picky eaters often refuse intake of especially fruits and vegetables, thereby narrowing their dietary variety and impairing the quality of their food intake. In this preregistered study, we investigated whether picky eating and food neophobia are related to bitter taste sensitivity (PROP taster status) and risk avoidance for distaste. A total of 367 children (201 girls; M age = 8.7 years, range: 4-15 years) participated in the study. They completed the vegetable neophobia subscale of the fruit and vegetable neophobia instrument (FVNI). A caregiver completed the child food rejection scale (CFRS), a parent-report measure of food neophobia and picky eating. Children's bitter taste sensitivity was measured with a PROP (6-n-propylthiouracil) taste strip, and the children completed a modified Children's Gambling Task (Candy Gambling Game) to measure risk avoidance for distaste. In this task, children could select cards from a risky deck (chance of winning two tasty cherry-flavoured jelly beans, but also the risk of getting a distasteful soap-flavoured jelly bean) or a safe deck (chance of winning one tasty jelly bean or no jelly bean). The results show that picky eating and food neophobia (either parent- or self-reported) are not related to PROP taster status. However, children who self-reported higher levels of vegetable neophobia showed less risky choice behaviour in the Candy Gambling Game, although this relationship was not found with parent-reported food neophobia. We conclude that risk avoidance for distaste, but not taste function, is associated with children's self-reported food rejection tendencies. To broaden the food repertoire of children high in food neophobia, it might be useful to reduce the perceived risk of distaste, when introducing a novel food or meal.

Child characteristic correlates of food rejection in preschool children: A narrative review.

Dietary habits formed in early childhood are key for establishing a healthy diet later in life. Picky eating and food neophobia - the two main forms of food rejection in young children - form an important barricade to establishing such healthy habits. Understanding these types of food rejection is thus essential for promoting healthy eating behaviour in both children and adults. To this end, the present narrative review aims to provide an overview of food rejection research in preschool-aged children, focusing on recent advances in the cognitive literature. Specifically, we evaluate the link between children's cognitive development, chemosensory perception and affective evaluation of food, food knowledge, decision-making strategies, anxiety and disgust sensitivity, and food rejection behaviour. Longitudinal and experimental studies are necessary to establish how the relationships between food rejection and cognitive processes develop over time and to determine their causal directions.

Fake meat or meat with benefits? How Dutch consumers perceive health and nutritional value of plant-based meat alternatives.

Animal agriculture has a large impact on the environment. Hence, there is an increasing demand for meat alternatives - more sustainably produced plant-based products that replace meat as meal component. Demands for meat alternatives also seem to be fuelled by consumers' belief that meat alternatives are healthier than meat products. In an online questionnaire study, we examined whether consumers indeed perceived meat alternatives to be healthier, to what degree consumers adequately estimated the nutritional value of meat (alternatives), and whether a nutrition claim could misguide consumers. In a panel of 120 Dutch consumers, it was found that meat alternatives were generally perceived as being healthier than meat products. According to supermarket data, meat alternatives contained less protein and saturated fat, higher levels of fibre and salt compared to meat. Consumers were found to overestimate the protein content of meat alternatives relative to meat products, especially when meat alternatives carry a 'high in protein' claim. The current beliefs about the healthiness and nutritional content of meat and meat alternatives are precarious and a fair, transparent, and understandable environment should be created for the conscious consumer.

Taste function in children: normative values and associated factors.

BACKGROUND: Although less frequent than in adults, taste loss also occurs in childhood. "Taste Strips" are frequently used for diagnosing taste dysfunction; however, normative values are lacking for children. In this study, we will create normative values for the "Taste Strips" in children. METHODS: This cross-sectional study included 609 children aged 6-15 years. "Taste Strips" were used to determine sweet, sour, salty, and bitter taste scores by a non-forced procedure. The 10th percentile was used to distinguish normal taste function from a reduced sense of taste. Multivariable generalized linear models (GLM) were estimated to study the effect of age (group), sex, and 6-n-propylthiouracil (PROP) status on taste function. RESULTS: Taste function changed with age, allowing for a distinction of three age groups: (I) 6-7 years, (II) 8-9 years, and (III) 10-15 years. Normative values were created for the age groups and boys and girls separately. Additionally, GLM showed a significant effect of (1) age (group) on sweet, salty, bitter, and total taste scores; (2) sex on sweet, sour, and total taste scores; and (3) PROP status on total taste scores. CONCLUSIONS: This study provided normative values for the "Taste Strips" in children, highlighting age- and sex-related differences. IMPACT: Taste dysfunction can be harmful and impacts quality of life, a topic that became increasingly important since the COVID-19 pandemic. Although taste dysfunction is thought to be rare in childhood, the detrimental impact of such dysfunction might be large, as children's eating habits are strongly influenced by input from the chemical senses. Measuring taste function may elucidate the relationship between taste dysfunction and disease, fostering the development of more appropriate supportive strategies. However, adequate tools are lacking for children. Normative values of the "Taste Strips" are now available for children, which bolster the clinical utility of this test.

Does labelling a food as 'light' vs. 'filling' influence intake and sensory-specific satiation?

Although several studies have investigated the influence of nutrition labelling on food intake, the effect of labels indicating a food's satiating power on food intake and sensory-specific satiation (SSS) is poorly understood. We investigated whether providing information about the satiating power of a meal affects intake and SSS. Participants (19 men and 18 women) consumed the same test meal of pasta salad ad libitum on two occasions, once described as 'light' and once as 'filling'. SSS was determined as the change in liking of the flavor and desire to eat the test meal before and after consumption, compared to seven uneaten foods. As hypothesized, intake increased by a mean (±SD) of 31 ± 59 g and 42 ± 81 kcal when the meal was labelled 'light' as opposed to 'filling' (p < 0.01). After eating, ratings for both liking and desire to eat decreased significantly more for the test meal than for the uneaten control foods (p < 0.001), demonstrating SSS. These relative changes in liking and desire to eat did not differ between the label conditions, despite differences in intake. Furthermore, accounting for amount consumed, the magnitude of SSS did not differ between the label conditions, which suggests that it did not explain the effect of the labels on intake. This study shows that labels indicating the satiating power of a meal can affect intake, warranting caution in the use of such labels on products intended to reduce intake.

Taste Dysfunction in Children-A Clinical Perspective and Review of Assessment Methods.

Taste dysfunction has been associated with aging and is therefore thought to be less common in children. However, children can face medical conditions influencing their taste function. Measuring and understanding taste dysfunction in children may foster the development of treatments/interventions mitigating the detrimental effects of taste dysfunction on children's appetite and quality of life. But measuring loss of taste function requires adequate tools. This review was conducted to 1) provide an overview of etiologies (i.e., disease and iatrogenic) associated with taste dysfunction in a pediatric population; 2) to investigate which tools (psychophysical tests and questionnaires) are available to assess taste function in children; and 3) to identify what tools can be and are actually used in clinical practice. It is concluded that only a minority of available tools to assess taste function in children are readily suitable for a pediatric clinical setting. Considering the profound impact of taste dysfunction in the pediatric setting, developing, and implementing a standard taste test that is sensitive, simple, and practical to use with children is pertinent.

Smell and taste function in childhood cancer patients: a feasibility study.

PURPOSE: Chemotherapy can affect smell and taste function. This has never been investigated in childhood cancer patients during chemotherapy. The objective of this study was to determine whether psychophysical smell and taste tests are suitable for children with cancer. Taste and smell function, fungiform papillae density, and eating behavior were measured before (T1) and after (T2) a cycle of chemotherapy and compared with healthy controls. METHODS: Thirty-one childhood cancer patients treated for a hematological, solid, or brain malignancy (median age 12 years, 16 girls), and 24 healthy controls (median age: 11 years, 10 girls) participated. Smell function was measured using Sniffin' Sticks, including a threshold, discrimination, and identification test. Taste Strips were used to determine recognition thresholds for sweet, sour, salty, and bitter taste. Papillae density was investigated by counting the fungiform papillae of the anterior tongue. Eating behavior was assessed using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS). RESULTS: Smell and taste function could be investigated in more than 90% of the patients, while fungiform papillae density could be determined in 61% of the patients. A significant difference in smell threshold was found between patients and controls (p = 0.001), showing lower thresholds in patients. In patients, sweet taste (p < 0.001), bitter taste (p = 0.028), and total taste function (p = 0.004) were significantly different after a cycle of chemotherapy, with higher scores at T2. CONCLUSION: The assessment of smell, taste, and fungiform papillae density is feasible in children with cancer. Results of the current study suggest that smell and taste sensitivity increased in children with cancer.

Sensory-specific satiety, the variety effect and physical context: Does change of context during a meal enhance food intake?

Food variety has been shown to increase food intake, and sensory-specific satiety (a relative decrease in pleasantness of a food as it is consumed) has been proposed as the mechanism through which variety increases consumption. The aim of this study was to investigate whether variation of eating context can add to experienced meal variety and hence increase consumption even further. A total of 128 participants were assigned to one of four conditions in which they first ate a specific food item (ad libitum) until satiated, after which they consumed a second course ad libitum of either the same or a different food in either the same context or in a different context. We hypothesized that, compared to eating the same food in the same context during the second course, introducing a different food item or changing the context for the second course increases consumption (of the second course), and changing both food and context enhances food intake to a greater degree than only changing the food or changing the context. Results indicated that food variety (introducing a different food) significantly increased consumption in the second course, but that a context switch did not enhance consumption. These results suggest that there is little reason to believe that sensory-specific satiety is context specific.

Taste the texture. The relation between subjective tactile sensitivity, mouthfeel and picky eating in young adults.

Selective or picky eating can be an obstacle for a varied diet. One reason why people reject certain foods is because they do not like the texture. Several studies show that in children tactile sensitivity is related to pickiness in eating. Children who do not like the feel of sand or of slimy substances with their hands also reject more kinds of food, presumably because the children are more sensitive to the mouthfeel of several food textures. There is however hardly any research on the role of tactile sensitivity in adult food acceptance. Two important questions therefore are: Is tactile sensitivity related to picky eating in adults and if so, does mouthfeel mediate the relation between tactile sensitivity and pickiness? In the current study, picky eating, subjective tactile sensitivity, and evaluation of mouthfeel were measured in 87 undergraduate students. It appeared that the three measures are moderately related, with mouthfeel mediating the relation between subjective tactile sensitivity and pickiness in eating. These results show that in adults too, tactile sensitivity plays a role in the acceptance of a larger variety of foods. This means that when aiming to change or improve dietary quality of adults, acceptance of food texture should be taken into account.

Appetitive conditioning to specific times of day.

Human laboratory studies have shown that eating desires are easily learned through classical conditioning: after a few pairings of an initially neutral stimulus (e.g., a box) with the intake of palatable food (e.g., chocolate), the stimulus elicits increased eating expectancies and eating desires (acquisition). After repeated non-reinforced presentations of the chocolate-associated stimulus, eating expectancies and desires decrease again (extinction). It is commonly assumed that eating desires in daily life are acquired and extinguished in a similar manner, but to date, this has not been empirically tested. In two studies, we examined whether the repeated consumption of chocolate at a specific time of day elicits increased eating expectancies and eating desires over a period of 5 days (study 1) or 15 days (study 2), and relative to a time of day not paired with chocolate intake. Further, it was tested whether acquired responding diminishes again during extinction (study 1). Ecological momentary assessment was used to carry out the studies in daily life. Results showed that eating expectancies were acquired in both studies. Only in study 2, eating desires were also successfully learned. It is concluded that eating expectancies and eating desires can be conditioned to ecologically valid cues and under real-life circumstances. This highlights the importance of associative learning processes in the experience of eating desires in daily life.

Violation of eating expectancies does not reduce conditioned desires for chocolate.

Although eating desires can be easily learned, their extinction appears more difficult. The present two-session study aimed to investigate the role of eating expectancies in the short and longer-term extinction of eating desires. In addition, the relationship between eating desires and conditioned evaluations was examined to test whether they might share a similar mechanism. It was hypothesized that the short-term extinction of eating desires would be more successful after the disconfirmation of eating expectancies (instructed extinction or IE), while resulting in worse longer-term extinction because omission of the food reward during extinction is not surprising. In contrast to the hypotheses, it was found that IE had no effect on the short-term and longer-term extinction of eating desires. Eating desires correlated with conditioned evaluations only to some extent. It is concluded that eating expectancies do not mediate the short-term extinction of conditioned eating desires. In addition, their longer-term extinction does not appear to be facilitated by a greater violation of eating expectancies. This suggests that it might not be necessary to focus on expectancy violation in cue exposure therapy to reduce eating desires.

Feel your food. The influence of tactile sensitivity on picky eating in children.

Children who are very picky in eating frequently refuse the intake of foods. This rejection is not only based on the evaluation of taste, but also on tactile qualities of foods. It matters whether food is crispy or slimy, consistent, or with bits and pips. It is hypothesised that children who are more sensitive to touch and dislike the feel of various tactile stimuli in general, are also more dismissive of tactile stimulation in their mouth and therefore more selective in their eating. In the present study, 44 children between the ages of 4 and 10 were asked to feel different tactile stimuli with their hands and to taste different foods. Results showed a significant positive correlation between the evaluations of the two modalities, especially for the younger subjects. This suggests that tactile sensitivity might play a role in the acceptance of food. Future research could explore if training children to tolerate more tactile stimuli would also increase their appreciation of a wider variety of foods.

Eating and inflicting pain out of boredom.

In the present study it was investigated whether boredom promotes eating and if so, whether this effect likely reflects an increased drive for rewarding stimulation (positive reinforcement) or more plainly the drive to escape boredom (negative reinforcement). In the latter case, the valence of the stimulation should not matter and people might even be willing to look for negative stimulation, for instance to hurt oneself, just to escape boredom. In two parallel experiments, it was tested whether induced boredom promotes the consumption of chocolate (Experiment 1) and whether participants likewise are more inclined to self-administer electrocutaneous stimuli (Experiment 2). In both experiments, a total of 30 participants attended two separate sessions watching a documentary for 1 h (neutral condition) and a monotonous repetition of a single clip from the same documentary for 1 h (boring condition), in balanced order. During Experiment 1, participants had free access to M&Ms and during Experiment 2 participants could freely self-administer brief electrical shocks. It was found that participants ate more M&Ms when bored but also that they more readily self-administered electrical shocks when bored. It is concluded that eating when bored is not driven by an increased desire for satisfying incentive stimulation, but mainly by the drive to escape monotony.

Sensory-specific satiation with a pinched nose and eyes closed: testing the sensory modality specificity of satiation.

Sensory-specific satiation refers to the decrease in pleasantness derived from a consumed food relative to other unconsumed foods. In the current study, it was investigated to what extent sensory-specific satiation is modality specific. To this end, 80 female participants ate a preferred snack until full while wearing (or not wearing) a blindfold and/or a nose clip. Impaired vision should impede satiation for the appearance of the consumed test snack. Obstructing olfaction should undermine satiation for the smell of the test snack. Indeed, when vision was obstructed, hedonic ratings of specifically snack appearance did not decrease as much. When olfaction was blocked, the hedonic ratings for the flavor of the test snack did not show as much of a reduction. It is concluded that, to a degree, sensory-specific satiation is indeed modality specific.

How partial reinforcement of food cues affects the extinction and reacquisition of appetitive responses. A new model for dieting success?

Animals and humans can easily learn to associate an initially neutral cue with food intake through classical conditioning, but extinction of learned appetitive responses can be more difficult. Intermittent or partial reinforcement of food cues causes especially persistent behaviour in animals: after exposure to such learning schedules, the decline in responding that occurs during extinction is slow. After extinction, increases in responding with renewed reinforcement of food cues (reacquisition) might be less rapid after acquisition with partial reinforcement. In humans, it may be that the eating behaviour of some individuals resembles partial reinforcement schedules to a greater extent, possibly affecting dieting success by interacting with extinction and reacquisition. Furthermore, impulsivity has been associated with less successful dieting, and this association might be explained by impulsivity affecting the learning and extinction of appetitive responses. In the present two studies, the effects of different reinforcement schedules and impulsivity on the acquisition, extinction, and reacquisition of appetitive responses were investigated in a conditioning paradigm involving food rewards in healthy humans. Overall, the results indicate both partial reinforcement schedules and, possibly, impulsivity to be associated with worse extinction performance. A new model of dieting success is proposed: learning histories and, perhaps, certain personality traits (impulsivity) can interfere with the extinction and reacquisition of appetitive responses to food cues and they may be causally related to unsuccessful dieting.

Factors affecting public acceptance of healthy lifestyle nudges.

In two online vignette studies, we investigated the effects of healthy lifestyle nudging and pricing interventions in two different contexts: a supermarket (Study 1) and a train station (Study 2). In Study 1 (N = 318) participants were randomly assigned to evaluate one of eight interventions described in a vignette and designed to either encourage healthier food choices or discourage unhealthy food choices in a supermarket setting. Two interventions comprised a small financial incentive to either encourage a healthy food choice or discourage an unhealthy food choice, but the other six interventions were nudges conceived to specifically impact agency, self-constitution or freedom of choice (three different aspects of autonomy). Relative to these nudges, the financial incentive interventions were not found to be less acceptable or more patronising. Overall, the encouragement of healthy food choices was rated as more acceptable and less patronising. The same pattern of results was found in Study 2 (N = 314). We conclude that interventions threatening specific aspects of one's autonomy do not necessarily affect its acceptance. However, the behavioural focus does affect intervention acceptance, that is, interventions focused on encouraging healthy choices are considered more acceptable than interventions that discourage the unhealthy option.

Impulsivity makes more susceptible to overeating after contextual appetitive conditioning.

Animals can learn that specific contexts are associated with important biological events such as food intake through classical conditioning. Very few studies suggest this is also possible in humans and contextual appetitive conditioning might even be a main determinant of habitual overeating in vulnerable humans. A Virtual Reality laboratory was used to test whether humans show conditioned responding (increased food desires and expectations, increased salivation and increased food intake) to a specific context after repeated pairings of this context with intake. It was also examined whether the personality trait impulsivity strengthens this contextual appetitive conditioning. Conditioned context-induced reactivity was indeed demonstrated and impulsivity predicted increased intake in only the intake-associated context. It is concluded that humans easily learn desires to eat in intake-related environments. The data also suggest that in particular more impulsive people are vulnerable for conditioned context-induced overeating. This relatively easy learning of associations between specific contexts and intake might stimulate habitual overeating and contribute to increased obesity prevalence.