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.

A road from health care classifications and coding systems to biomedical ontology: the CEN categorial structure for terminologies of human anatomy: Catanat.

There is an increasing need for updated and harmonised health care classifications and coding systems to allow international comparisons and cooperation for instance for population based WHO indicators, Electronic Health Record safety, trans border migration of population, case mix and procedure payment. It is not feasible to propose a standardisation of the linguistic expressiveness of different health care professionals and of the citizens. Natural language expressions show inconsistencies and ambiguities as assessed by biomedical ontology driven tools. In order to build a road towards standardisation the European Standard Body CEN has stated that it was not possible to convince the different European member states using different national languages to agree on a reference clinical terminology as Snomed-CT or to standardise a detailed language independent biomedical ontology. It has developed since 1990 an approach named categorial structure as a step standardising only the terminologies model structure. The categorial structure for terminologies of human anatomy currently in the phase of final approval is presented as a methodology for bridging between classifications and coding systems and biomedical ontology on the way to semantic interoperability between different languages, legacies and goals.

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.

The foundational model of anatomy: a template for the symbolic representation of multi-scale physiological functions.

We describe the foundational model of anatomy (FMA), reference ontology for the discipline of human anatomy. Using the semantic structure of the FMA as knowledge representation template, we propose a physiology reference ontology (PRO) as a corresponding ontology for "functional bioinformatics". We envision the PRO as a source vocabulary for building symbolic representations of human physiological states and actions that may ultimately be extensible to other species. We describe the evolving architecture of the PRO, in terms of simple examples based on the anatomical concepts encoded in the FMA.

Profile of on-line anatomy information resources: design and instructional implications.

This study is based on a review of 40 on-line anatomy web resources compiled from sites selected from our own searches as well as sites reviewed and published by an external group (Voiglio et al., 1999, Surg. Radiol. Anat. 21:65-68; Frasca et al., 2000, Surg. Radiol. Anat. 22:107-110). The purpose of our survey was to propose criteria by which anatomy educators could judge the characteristics of the currently available web-based resources for incorporation into the courses they teach. Each site was reviewed and scored based on a survey matrix that included four main categories: 1). site background information, 2). content components, 3). interactivity features, and 4). user interface design components. The average score of the reviewed sites was 3.3 of the total possible score of 10, indicating the limited use of computer-based design features by the majority of sites. We found, however, a number of programs in each of the survey categories that could serve as prototypes for designing future on-line anatomy resources. From the survey we conclude that various design features are less important than the comprehensiveness, depth, and logical organization of content. We suggest that the content should be sufficient for supporting explicitly defined educational objectives, which should target specific end-user populations. The majority of anatomy programs currently accessible on-line fall short of these requirements. There is a need for a coordinated and synergistic effort to generate a comprehensive anatomical information resource that is of sufficient quality and depth to support higher levels of learning beyond the memorization of structure names. Such a resource is a prerequisite for meaningful on-line anatomy education.

Imaging and the Human Brain Project: a review.

OBJECTIVES: Survey current work primarily funded by the US Human Brain Project (HBP) that involves substantial use of images. Organize this work around a framework based on the physical organization of the body. METHODS: Pointers to individual research efforts were obtained through the HBP home page as well as personal contracts from HBP annual meetings. References from these sources were followed to find closely related work. The individual research efforts were then studied and characterized. RESULTS: The subject of the review is the intersection of neuroinformatics (information about the brain), imaging informatics (information about images), and structural informatics (information about the physical structure of the body). Of the 30 funded projects currently listed on the HBP web site, at least 22 make heavy use of images. These projects are described in terms of broad categories of structural imaging, functional imaging, and image-based brain information systems. CONCLUSIONS: Understanding the most complex entity known (the brain) gives rise to many interesting and difficult problems in informatics and computer science. Although much progress has been made by HBP and other neuroinformatics researchers, a great many problems remain that will require substantial informatics research efforts. Thus, the HPB can and should be seen as an excellent driving application area for biomedical informatics research.

The Virtual Anatomy Lab: a hands-on anatomy learning environment.

This paper introduces the Virtual Anatomy Lab software platform for coordinating on-line gross anatomy learning sessions over time.

Terminologia anatomica: considered from the perspective of next-generation knowledge sources.

This report examines the semantic structure of Terminologia Anatomica, taking one page as an example. The focus of analysis is the meaning imparted to an anatomical term by virtue of its location within the structured list. Terminologia's structure, expressed through hierarchies of headings, varied typographical styles, indentations, and an alphanumeric code, implies specific relationships among the terms embedded in the list. Together, terms and relationships can potentially capture essential elements of anatomical knowledge. The analysis focuses on these knowledge elements and evaluates the consistency and logic in their representation. Most critical of these elements are class inclusion and part-whole relationships. Since these are implied, rather than explicitly modeled, by Terminologia, the use of the term list is limited to those who have some knowledge of anatomy; computer programs are excluded from navigating through the terminology. Assuring consistency in the explicit representation of anatomical relationships would facilitate adoption of Terminologia as the anatomical standard by the various controlled medical terminology (CMT) projects. These projects are motivated by the need to computerize the patient record, and their aim is to generate machine-understandable representations of biomedical concepts, including anatomy. Because of the lack of a consistent and explicit representation of anatomy, each of these CMTs has generated its own anatomy model. None of these models is compatible with any other, yet each is consistent with textbook descriptions of anatomy. The analysis of the semantic structure of Terminologia Anatomica leads to some suggestions for enhancing the term list in ways that would facilitate its adoption as the standard for anatomical knowledge representation in biomedical informatics.

Enabling clinicians, researchers, and educators to build custom web-based biomedical information systems.

We describe an open-source toolkit that enables clinicians, researchers, and educators to build their own web-based biomedical information systems. The Web Interfacing Repository Manager (Wirm) is a high-level application server aimed at medical professionals, allowing them to create individually tailored systems for managing their multimedia data and knowledge. We provide an overview of the features of Wirm, explaining how they meet the requirements for supporting biomedical information management, and describe four applications that are currently being developed with Wirm: MyPACS, a teaching file authoring system for radiologists, Fathom, an experiment management system for natural language processing, the Digital Anatomist Repository, an image archiving tool for medical schools, and Ontolog, a browser for medical vocabularies.

Foundational model of neuroanatomy: implications for the Human Brain Project.

In order to meet the need for a controlled terminology in neuroinformatics, we have integrated the extensive terminology of NeuroNames into the Foundational Model of anatomy. We illustrate the application of foundational principles for the establishment of an inheritance hierarchy, which accommodates anatomical attributes of neuroanatomical concepts and provides the foundation to which other information may be linked.

The role of definitions in biomedical concept representation.

The Foundational Model (FM) of anatomy, developed as an anatomical enhancement of UMLS, classifies anatomical entities in a structural context. Explicit definitions have played a critical role in the establishment of FM classes. Essential structural properties that distinguish a group of anatomical entities serve as the differentiate for defining classes. These, as well as other structural attributes, are introduced as template slots in Protégé, a frame-based knowledge acquisition system, and are inherited by descendants of the class. A set of desiderata has evolved during the instantiation of the FM for formulating definitions. We contend that 1. these desiderata generalize to non-anatomical domains and 2. satisfying them in constituent vocabularies of UMLS would enhance the quality of information retrievable through UMLS.

Influence of the Digital Anatomist Foundational Model on traditional representations of anatomical concepts.

A principled and logical representation of the structure of the human body has led to conflicts with traditional representations of the same knowledge by anatomy textbooks. The examples which illustrate resolution of these conflicts suggest that stricter requirements must be met for semantic consistency, expressivity and specificity by knowledge sources intended to support inference than by textbooks and term lists. These next-generation resources should influence traditional concept representation, rather than be constrained by convention.

Conceptualization of anatomical spatial entities in the Digital Anatomist Foundational Model.

Anatomical spatial concepts are indispensable in educational and clinical discourse, yet a system for representing these concepts has not been proposed. Guided by explicit principles and definitions of the Digital Anatomist Foundational Model, we developed an ontology of spaces, surfaces, lines and points that are associated with anatomical structures. Ontologies for Anatomical Structure and Anatomical Spatial Entity were instantiated for the thorax, abdomen, pelvis and perineum. Representing the concepts in--part of--hierarchies as well, provided formative evaluation of the classification. We invite empirical evaluation of the Foundational Model through its use for educational and clinical applications.