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.

Development of a new in-home testing method to assess infant food liking.

The objective of this study was to develop a new elaborate method to evaluate infants' liking of foods that could be applied at home and to compare the results of this elaborate method with those of a basic method. Mothers of infants aged 4 to 7 (n = 44) and 12-15 months (n = 46) participated in this study. For the basic method, mothers were asked to assess their infant's global liking at the end of a meal. Then, for the elaborate method, mothers received detailed instructions on how to feed their infant, how infants might express like/dislike and when to stop the meal. During the first nine spoons, they were asked to report the presence/absence of positive and negative behaviours after each spoon, and the infant's initial liking was reported after each triplet of spoons. They also assessed their infant's global liking at the end of the meal. Both methods were applied using three commercial familiar baby foods adapted to each age range. In 4-7-month-olds, the elaborate method showed a significant difference across products for liking, whereas the basic method did not show any difference. In 12-15-month-olds, the elaborate method showed more differences across products for liking than the basic method. In both age groups, negative behaviours, despite being less frequently reported, provided better liking discrimination than positive behaviours. In conclusion, the elaborate method produced better product liking discrimination than the basic method by focusing maternal attention on infants' eating behaviours since the first spoons.

Impact of olfactory and auditory priming on the attraction to foods with high energy density.

\]\Recent research suggests that non-attentively perceived stimuli may significantly influence consumers' food choices. The main objective of the present study was to determine whether an olfactory prime (a sweet-fatty odour) and a semantic auditory prime (a nutritional prevention message), both presented incidentally, either alone or in combination can influence subsequent food choices. The experiment included 147 participants who were assigned to four different conditions: a control condition, a scented condition, an auditory condition or an auditory-scented condition. All participants remained in the waiting room during15 min while they performed a 'lure' task. For the scented condition, the participants were unobtrusively exposed to a 'pain au chocolat' odour. Those in the auditory condition were exposed to an audiotape including radio podcasts and a nutritional message. A third group of participants was exposed to both olfactory and auditory stimuli simultaneously. In the control condition, no stimulation was given. 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 the participants primed with the odour of 'pain au chocolat' tended to choose more desserts with high energy density (i.e., a waffle) than the participants in the control condition (p = 0.06). Unexpectedly, the participants primed with the nutritional auditory message chose to consume more desserts with high energy density than the participants in the control condition (p = 0.03). In the last condition (odour and nutritional message), they chose to consume more desserts with high energy density than the participants in the control condition (p = 0.01), and the data reveal an additive effect of the two primes.

Impact of adiposity, age, sex and maternal feeding practices on eating in the absence of hunger and caloric compensation in preschool children.

BACKGROUND/OBJECTIVES: Between the ages of 3 and 5 years, children may become less responsive to internal cues of satiation and more responsive to external cues, which may induce overeating and lead to weight gain. This study aimed to compare eating in the absence of hunger (EAH) and caloric compensation in 3- to 6-year-old children, and to relate the measurements with children's adiposity, age, sex and maternal feeding practices. METHODS: According to a within-subject three sequential condition design, food intake in children (n=236) was measured at lunch during three sessions, once a week. The same meal (565 kcal) was offered at each session. The first session (control) was only composed of the meal. Thirty minutes before the second meal, children were offered an energy preload (137 kcal; caloric compensation condition). Ten minutes after the third meal, children were exposed to a post-meal snack (430 kcal; EAH condition). Individual caloric compensation score (COMPX) and EAH score were calculated. Maternal characteristics were measured by questionnaire. Child anthropometrics were measured by a medical doctor. RESULTS: On average, children compensated 52±4% of the energy preload and ate 24±1% of the energy provided by their meal in the absence of hunger. COMPX and EAH score were not correlated and did not vary with children's adiposity or age. EAH score was higher in boys (P=0.006). Maternal use of food as reward was associated with higher EAH score (P=0.01) but greater COMPX (P=0.005). CONCLUSIONS: As early as the age of 3 years children did not fully compensate the energy brought by a snack and ate in the absence of hunger. Parents should be advised to avoid these situations where overeating may occur and to limit the use of food as reward.

Impact of information and in-home sensory exposure on liking and willingness to pay: The beginning of Fairtrade labeled coffee in France.

This study was conducted to assess how the Fairtrade label interacts with the perception of intrinsic product characteristics on liking and purchase decisions and to estimate the evolution of this interaction after exposure to coffees and/or exposure to ethical information. In the first session, 119 consumers gave liking scores for 2 regular and 2 Fairtrade coffees under a blind tasting condition. Then, they were asked to indicate the maximum price they would pay for each product in 2 auctions taking place under different information conditions. In the first auction, participants saw the packaging but did not taste the coffee; in the second auction, they could both taste the coffee and see the packaging. After the first session, the consumers were randomly split into 4 groups, and these groups were exposed for one month to different conditions before returning to the lab for exactly the same measurements as in the first session. The first of the 4 groups was not exposed to sensory characteristics or ethical information. Each consumer of the second group was only exposed to sensory characteristics of the coffees (one packet of his/her least liked regular and ethical coffees delivered in blind packaging for home consumption). The third group was exposed to sensory characteristics and ethical information (the same as the second group but using the original coffee packaging showing fair trade information). The final group was only exposed to ethical information. Results showed that the hedonic scores of the least liked ethical and regular products increased from sessions 1 to 2, but not significantly more when consumers were exposed to these products between the sessions. However, while consumers offered lower prices for ethical products at the first session, those who were exposed to ethical information increased their willingness to pay for ethical products. This effect became statistically significant when consumers could taste the products before making their bid. The effect of exposure to ethical information was also transferred to the willingness to pay for the ethical product to which the consumers were not exposed. This study highlights the interest of a design, which makes it possible to assess the impact over time of sensory and external information on the willingness to pay.

Liking the odour, liking the food. Toddlers' liking of strongly flavoured foods correlates with liking of their odour.

Olfaction plays a significant role in the sensing of foods. However, little information is available at any age on the relationship between the hedonic responses to given food odours and the effective liking and disliking of foods bearing these same odours. The present study aimed to assess the relationships between food odour liking and liking of the corresponding foods. This study relied on a longitudinal design involving 235 toddlers who were assessed for both their observed liking of a set of food odours and their parent-reported liking of foods at 12 and 22 months. To assess odour liking, eight odorants representing pleasant and unpleasant foods were presented in bottles along with neutral stimuli. The participants' behaviour towards the odorized and control bottles was measured in terms of mouthing, a behaviour considered to reflect attraction. For each odorant, odour-liking scores were calculated relative to the control. The participants' food liking was rated by the parents at the periods 12-15 and 21-24 months. Positive correlations were found between the odour-liking scores for some of the odours and the liking of the associated foods. These correlations concerned foods with strong, unpleasant flavours at 12 months only, suggesting that the olfactory system acts as an 'alarm' system during this period of food transition. At 22 months, no significant correlations were found, except a marginal one for green vegetables. Whatever the age, no significant correlations were found for pleasant odours. Thus, some correlations were found between the observed odour liking for food-related odours and the liking for the corresponding foods. However, these relationships are subject to developmental fluctuations depending on the hedonic nature of the odorants and the age when infants are tested.

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.

[To which tastes are infants exposed during the first year of life?]. / A quelles saveurs les nourrissons sont-ils exposés dans la première année de vie ?

Food consumption in young children is guided by their food preferences, which are partly determined by their attraction to the different tastes (sweet, salty, sour, bitter, and umami tastes). Early food experiences might modulate this attraction. Yet, no study has previously described the tastes of infant foods during the first year of life. This is the objective of the present study. The diet of 76 infants was recorded by their parents 1 week per month during the first year of life. This record provided an inventory of 2902 foods a priori different from a sensory point of view. The taste intensity of these foods was estimated. For each infant, each month, and each taste, a variable of exposure to the taste was calculated. Foods consumed by infants from 1 to 12 months of age generally had low or relatively moderate taste intensity. During the milk-feeding period, infants were mainly exposed to sweet taste; this exposure increased during the first year. Beginning with weaning, the exposure to sour taste rose sharply without becoming as high as the exposure to sweet taste, the exposures to salty and umami tastes rose modestly, and the exposure to bitter taste rose slightly, then stagnated. Consequently, the proportion of bitter taste was reduced to approximately half the other tastes between the age of 7 and 12 months. Taking these observations into account would be helpful in establishing feeding recommendations for the pediatric population.

Development of olfactory ability in children: sensitivity and identification.

This study assessed the influence of school level and gender on odor sensitivity and identification, and the role of verbal capacity on odor identification in children (4-12 years) by using a revised version of an olfactory test designed for adults [Rouby et al. (1997). Connaissance et reconnaissance d'une série olfactive chez l'enfant préscolaire. Enfance, 1, 152-171]. We found that odor sensitivity and identification scores increased with school level, and that identification performance was better in girls than in boys. However, when we controlled verbal ability, the gender differences disappeared and the school level differences remained. This result indicates that the effect of gender on identification was probably due to the greater verbal ability of girls rather than to their greater olfactory ability per se. In addition, we found that general verbal ability is independent of olfactory fluency and that their influence on olfactory perception is different. Thus, this study illuminates the role of cognitive/verbal factors in the development of odor perception and knowledge.

Odour and taste sensitivity is associated with body weight and extent of misreporting of body weight.

BACKGROUND: Sensory factors are important determinants of appetite and food choices but little is known about the relationship between body weight and sensory capabilities. OBJECTIVE: To investigate the relationship between measured body weights, misreporting of body weight and sensory capabilities. DESIGN: In a cross-sectional sensory study, body weight was assessed by measured and self-reported body weight in healthy men (n=130) and women (n=181). Sensory capabilities were assessed as odour detection and identification, and detection for salty, sweet, sour and bitter taste. RESULTS: Odour detection, odour identification and taste perception scores were lower in subjects with a BMI >or=28 kg/m(2) than in subjects with a BMI <28 kg/m(2) in the age group <65 years whereas in subjects >or=65 years scores were higher in subjects with a BMI >or=28 kg/m(2) than in subjects with a BMI <28 kg/m(2) (BMI*age group: P=0.015, 0.053 and 0.015, respectively). Independent of age, scores were highest in under reporters of body weight (P=0.008, 0.001 and 0.017). Differences in taste perception could be attributed to sour (P=0.015) and bitter (P=0.026) perception, but not to salty or sweet perception. CONCLUSION: Relationship between sensory capabilities and body mass is age dependent. Compared to overweight subjects, the sensory capabilities of normal weight individuals appear to be higher (<65 years) and lower (>or=65 years). At any age, however, subjects who under reported their body weight show higher sensory capabilities.

[Gustatory perceptions in children]. / Les perceptions gustatives chez l'enfant.

As soon as the end of gestation, the gustatory system is stimulated by the taste-active compounds carried by the amniotic fluid and its maturation continues until mid-childhood. Facial expressions and relative ingestion methods show that the newborn can discriminate the various taste qualities (bitter, salty, sour, sweet and umami). The range of individual responses is wide. Neonatal reactions to sweet and umami are generally considered to express pleasure. The bitter and sour stimulations lead to hedonically negative reactions. The response to salt taste is less characteristic. Overall, the attraction towards sweet and the rejection of bitter and sour tastes become more pronounced during childhood but tend to decrease in adult life. The early attraction to sweetness is reinforced by exposure to sweet stimulations. With age, the response to salt evolves towards attraction which intensity is dependent on the context and on postnatal exposures to salt. The link between gustatory sensitivity to sweet, salty and sour stimuli and food preferences is far from being clear; the sensitivity to bitter taste better explains the rejection of bitter foods, such as vegetables for instance. The development of gustatory perceptions partly depends upon experience. A better knowledge of the role of experience could help to improve the orientation and the efficacy of nutritionally-oriented food education strategies.

Measurements of consumer attitudes and their influence on food choice and acceptability (AIR-CAT).

A changing European food market demands insight into consumer attitudes and their influence on food choice and acceptability. This multidisciplinary area needs to bring together scientists from all regions of Europe and with very different scientific backgrounds. The primary objectives of this concerted action have been: to establish a base with state of the art methods for measurements of consumer attitudes; to review and test existing methods in practical applications in collaboration with European food industries; to perform comparative studies between laboratories on food products, where attitudes play different roles for consumer behaviour in the community countries, such as transgenic foods, irradiated foods, foods with different additives, declarations and process technologies, foods with different origin declarations, ecological foods and foods with strong health connotations (such as high-fat foods). The members of the action have published more than 130 publications related to aspects of how consumer attitudes can be measured and how food choice behaviour is related to acceptability, during the last four years. Studies have been conducted in relation to methodological aspects as well as particular studies related to specific food items and regions for food production. The paper will give a brief selection of relevant results from experiments reported through the action. During 2001 a textbook called "Food, People and Society, in a European Perspective", will be published. The book was initiated during the action and is later supported with additional authors. Altogether 29 chapters will cover the whole spectrum of topics from consumer food choice and acceptability to market perspectives and risk analysis.

Odor intensity evaluation in gas chromatography-olfactometry by finger span method.

This paper describes the potential of evaluating odor intensities in a gas chromatographic effluent by cross-modality matching with the finger span (GC-O-FSCM). A simple prototype is described that allows the precise measurement and acquisition of the distance between the thumb and another finger during the analysis. The stimulation of panelists at the sniffing port with ethyl butyrate shows a log-log relation between peak height values obtained from finger span and stimulus concentrations. It also shows that all panelists are able to perform this task but with different precision, which is used to select them. A triplicate evaluation by GC-O-FSCM of the intensity of flavor constituents in synthetic solutions shows that a four-member panel is perfectly able to determine most of the characteristics of the solutions and to create a finger span multidimensional space highly correlated with the theoretical intensity space.

Effects of panel experience on olfactory memory performance: influence of stimuli familiarity and labeling ability of subjects.

This work attempted to define the impact of panel experience on olfactory memory performance by comparing scores in an odor recognition task obtained from a highly trained descriptive panel (17 subjects) and a naive one (33 subjects with no experience in sensory analysis). During the inspection phase, 16 odorants were presented monadically to subjects for familiarity rating and a written description. The recognition session was planned 7 days later with 32 odorants (including the 16 of the target set). Subjects also described the odor of the stimuli. The memory performance of each panel was estimated by the mean value of individual d' (index of detectability). Training of the descriptive panel did not enhance the olfactory memory ability, which strengthened the well-established idea that odor memory is closely linked to personal experience of the subject with the stimuli. However, odor recognition performances were improved by a precise and consistent answer at the encoding task: for both groups, subjects performed better when stimuli were precisely labeled and consistently used. Trained subjects were more accurate when describing than naive ones, whatever the degree of familiarity. Panel experience allowed trained subjects to verbalize their perception especially accurately when stimuli were familiar.

Consumer expectations and perceptions of meat and meat product quality.

This paper presents the determinants of perceived quality viewed by different authors. Then, it sets the factors of quality from purchase to consumption and some mechanisms of change over time. After this general presentation, the distinctive features of food and the particular place of meat and meat products among foods are underlined. Important credence and experience attributes as well as quality cues for meat and meat products are then presented through results from previous works. Finally, the advantages but also the limitations of present methodologies used in quality research are presented and some orientations for future research are suggested.

Influence of label and location of testing on acceptability of cream cheese varying in fat content.

The acceptability of low-, medium- and high-fat versions of a cream cheese to consumers was measured in different conditions by rating overall distance from ideal. The influence of label (unlabelled vs. commercial package) differed according to the cream cheese fat-level habits of the assessors and to the fat level of the product. In labelled testing, high-fat cream cheese was more highly accepted by high- and medium-fat users and low-fat cream cheese seemed to be further from ideal for high-fat users. The location of testing (home vs. laboratory) affected the rating of only the high-fat product: consumers are more severe on it at home than in the laboratory.