Comparing body composition between the sweet-liking phenotypes: experimental data, systematic review and individual participant data meta-analysis.

BACKGROUND: Legislation aimed at reducing sugar intake assumes that sweet-liking drives overconsumption. However, evidence that a greater liking for sweet taste is associated with unhealthier body size is mixed and complicated by relatively small samples, an overreliance on body mass index (BMI) and lack of classification using sweet-liking phenotypes. METHODS: We first examined body size data in two larger samples with sweet-liking phenotyping: extreme sweet-likers, moderate sweet-likers and sweet-dislikers. Adults (18-34yrs), attended a two-session lab-based experiment involving phenotyping for sweet-liking status and a bioelectrical impedance body composition measurement (Experiment One: N = 200; Experiment Two: N = 314). Secondly, we conducted an individual participant data (IPD) meta-analysis: systematic searches across four databases identified 5736 potential articles. Of these, 53 papers met our search criteria: a taste assessment that measured liking using sucrose (>13.7% w/v), which allowed sweet-liking phenotyping and included either BMI, body fat percentage (BF%), fat-free mass (FFM) or waist-circumference. RESULTS: A significant effect of sweet-liking phenotype on FFM was found in both Experiment One and Two, with extreme sweet-likers having significantly higher FFM than sweet-dislikers. In Experiment One, sweet-dislikers had a significantly higher BF% than extreme sweet-likers and moderate sweet-likers. However, as these data are from one research group in a young, predominantly westernised population, and the results did not perfectly replicate, we conducted the IPD meta-analyses to further clarify the findings. Robust one-stage IPD meta-analyses of 15 studies controlling for sex revealed no significant differences in BF% (n = 1836) or waist-circumference (n = 706). For BMI (n = 2368), moderate sweet-likers had slightly lower BMI than extreme sweet-likers, who had the highest overall BMI. Most interestingly, for FFM (n = 768), moderate sweet-likers and sweet-dislikers showed significantly lower FFM than extreme sweet-likers. CONCLUSION: The higher BMI often seen in sweet-likers may be due to a larger FFM and questions the simple model where sweet liking alone is a risk factor for obesity.

Female sweet-likers have enhanced cross-modal interoceptive abilities.

There are well known phenotypic differences in sweet-liking across individuals, but it remains unknown whether these are related to broader underlying differences in interoceptive abilities (abilities to sense the internal state of the body). Here, healthy women (N = 64) classified as sweet likers (SLs) or sweet dislikers (SDs) completed a bimodal interoception protocol. A heartbeat tracking and a heartbeat discrimination task determined cardiac interoception; both were accompanied by confidence ratings. A water load task, where participants consumed water to satiation and then to maximum fullness was used to assess gastric interoceptive abilities. Motivational state, psychometric characteristics and eating behaviour were also assessed. SLs performed significantly better than SDs on both heartbeat tasks, independently of impulsivity, anxiety, depression, and alexithymia. No differences in metacognitive awareness and subjective interoceptive measures were found. With gastric interoception, SLs were more sensitive to stomach distention, and they ingested less water than SDs to reach satiety when accounting for stomach capacity. SLs also scored higher on mindful and intuitive eating scales and on emotional eating particularly in response to negative stimuli; emotional overeating was fully mediated via interoceptive performance. Overall, our data suggest the SL phenotype may reflect enhanced responsiveness to internal cues more broadly.

Increased physical activity combined with more eating occasions is beneficial against dyslipidemias in children. The Healthy Growth Study.

PURPOSE: To identify lifestyle patterns associated with blood lipid levels in children. METHODS: A representative sample of 2,043 schoolchildren (9-13 years) participated in a cross-sectional epidemiologic study conducted in 77 primary schools in four large regions in Greece. Dietary intakes, breakfast patterns and eating frequency, physical activity levels, sleep duration, anthropometric and physical examination data, biochemical indices and socioeconomic information (collected from parents) were assessed in all children. Principal component analysis was used to identify the lifestyle patterns. RESULTS: A lifestyle pattern of more screen time, shorter sleep duration and higher sugar-sweetened beverage consumption was inversely associated with HDL cholesterol (ß = -0.077; P < 0.001) and positively associated with total/HDL cholesterol ratio (ß = 0.049; P = 0.025). Furthermore, a lifestyle pattern of more eating occasions and higher moderate-to-vigorous physical activity (MVPA) levels was inversely associated with total cholesterol (ß = -0.064; P = 0.006), LDL (low-density lipoprotein) cholesterol (ß = -0.065; P = 0.004) and total/HDL (high-density lipoprotein) cholesterol ratio (ß = -0.043; P = 0.049) in multivariate models. Finally, children with MVPA levels and eating frequency higher than that corresponding to the second quartile of this lifestyle pattern (i.e., > 44.8 min of MVPA per day and > 4.7 meals per day) were 29.7, 32.6 and 43.1 % less likely of having abnormal levels of total cholesterol, LDL and total/HDL cholesterol ratio, respectively, according to the National Cholesterol Education Program (NCEP) cutoff points. CONCLUSIONS: A lifestyle pattern of more than approximately 45 min of MVPA and 5 eating occasions per day was significantly associated with reduced likelihood of dyslipidemias in schoolchildren (9-13 years).

Under-identification of cancer outpatients at risk of malnutrition: are we making the most of anthropometric data?

In oncological outpatient settings, patients often require nutritional support after they have developed malnutrition. A delayed dietetic referral can lead to increased difficulties in providing therapies and surgery, and to poorer patient outcomes. The audit described in this article aimed to assess the frequency and completeness of patient record documentation of anthropometric measurements in a day treatment unit (DTU) in a single cancer centre in the UK. The underlying goal was to improve anthropometry monitoring procedures to ensure that documentation is sufficient to indicate weight loss and, hence, allow timely referrals for nutrition support. The results show that, for over 80% of patients, it was not possible to identify a weight trend between the latest two treatments received at the hospital. The audit findings highlight the need to improve malnutrition monitoring and to ensure patient records contain updated and accurate anthropometric measurements in order to facilitate medical staff to recognise early malnutrition risk and refer for appropriate nutritional support when needed.

Accuracy and correlates of visual and verbal instruments assessing maternal perceptions of children's weight status: the Healthy Growth Study.

OBJECTIVE: To examine the accuracy of maternal ability to classify their children's weight status correctly using a verbal and a visual classification instrument and to detect significant correlates of maternal misperceptions. DESIGN: Cross-sectional study. SETTING: Primary schools in four counties from north, west, central and south Greece. SUBJECTS: A representative sample of 1858 primary-school children aged 9-13 years was examined. Two different instruments to assess maternal perceptions of their children's weight status, i.e. a verbal and a visual one, were used. RESULTS: Verbal and visual maternal underestimation rates of children's weight status were 15·0 % and 41·3 %, respectively. The frequency of underestimation was much higher among overweight and obese children for both instruments. The highest underestimation rates of 87·9 % and 82·1 % in overweight and obese boys, respectively, were obtained with the visual instrument. Multiple logistic regression modelling revealed that the likelihood of both verbal and visual maternal underestimation of their children's weight status was significantly higher for overweight mothers and for those with a lower educational level. Furthermore, children's male gender and a nanny or someone other than the mother as the child's primary caregiver were found to increase the odds of visual and verbal maternal underestimation of children's weight status, respectively. CONCLUSIONS: The present study showed that the verbal instrument used to assess maternal perceptions of their children's weight status was more accurate compared with the visual one. However, both instruments showed that a considerable number of overweight and obese boys had their weight status underestimated by their mothers. Educating mothers to classify their children's weight status correctly might be a key factor for the implementation of successful childhood obesity prevention initiatives.

Understanding sweet-liking phenotypes and their implications for obesity: Narrative review and future directions.

Building on a series of recent studies that challenge the universality of sweet liking, here we review the evidence for multiple sweet-liking phenotypes which strongly suggest, humans fall into three hedonic response patterns: extreme sweet likers (ESL), where liking increases with sweetness, moderate sweet likers (MSL), who like moderate but not intense sweetness, and sweet dislikers (SD), who show increasing aversion as sweetness increases. This review contrasts how these phenotypes differ in body size and composition, dietary intake and behavioural measures to test the widely held view that sweet liking may be a key driver of obesity. Apart from increased consumption of sugar-sweetened beverages in ESL, we found no clear evidence that sweet liking was associated with obesity and actually found some evidence that SD, rather than ESL, may have slightly higher body fat. We conclude that ESL may have heightened awareness of internal appetite cues that could protect against overconsumption and increased sensitivity to wider reward. We note many gaps in knowledge and the need for future studies to contrast these phenotypes in terms of genetics, neural processing of reward and broader measures of behaviour. There is also the need for more extensive longitudinal studies to determine the extent to which these phenotypes are modified by exposure to sweet stimuli in the context of the obesogenic environment.

Effects of Sweet-Liking on Body Composition Depend on Age and Lifestyle: A Challenge to the Simple Sweet-Liking-Obesity Hypothesis.

Taste hedonics drive food choices, and food choices affect weight maintenance. Despite this, the idea that hyper-palatability of sweet foods is linked to obesity development has been controversial for decades. Here, we investigate whether interpersonal differences in sweet-liking are related to body composition. Healthy adults aged 18-34 years from the UK (n = 148) and the US (n = 126) completed laboratory-based sensory tests (sucrose taste tests) and anthropometric measures (body mass index; BMI, body fat; fat-free mass; FFM, waist/hips circumferences). Habitual beverage intake and lifestyle and behavioural characteristics were also assessed. Using hierarchical cluster analysis, we classified participants into three phenotypes: sweet liker (SL), sweet disliker (SD), and inverted-U (liking for moderate sweetness). Being a SD was linked to higher body fat among those younger than 21 years old, while in the older group, SLs had the highest BMI and FFM; age groups reflected different levels of exposure to the obesogenic environment. FFM emerged as a better predictor of sweet-liking than BMI and body fat. In the older group, sweetened beverage intake partially explained the phenotype-anthropometry associations. Collectively, our findings implicate underlying energy needs as an explanation for the variation in sweet-liking; the moderating roles of age and obesogenic environment require additional consideration.

Quantifying Sweet Taste Liker Phenotypes: Time for Some Consistency in the Classification Criteria.

Taste hedonics is a well-documented driver of food consumption. The role of sweetness in directing ingestive behavior is largely rooted in biology. One can then intuit that individual differences in sweet-liking may constitute an indicator of variations in the susceptibility to diet-related health outcomes. Despite half a century of research on sweet-liking, the best method to identify the distinct responses to sweet taste is still debated. To help resolve this issue, liking and intensity ratings for eight sucrose solutions ranging from 0 to 1 M were collected from 148 young adults (29% men). Hierarchical cluster analysis (HCA) revealed three response patterns: a sweet-liker (SL) phenotype characterized by a rise in liking as concentration increased, an inverted U-shaped phenotype with maximum liking at 0.25 M, and a sweet-disliker (SD) phenotype characterized by a decline in liking as a function of concentration. Based on sensitivity and specificity analyses, present data suggest the clearest discrimination between phenotypes is seen with 1.0 M sucrose, where a liking rating between -15 and +15 on a -50/+50 scale reliably distinguished individuals with an inverted U-shaped response from the SLs and the SDs. If the efficacy of this approach is confirmed in other populations, the discrimination criteria identified here can serve as the basis for a standard method for classifying sweet taste liker phenotypes in adults.