Combination of flavor enhancement and chemosensory education improves nutritional status in older cancer patients.

BACKGROUND: Abnormalities in taste and smell functioning occur with elevated frequency in both older adults and patients with cancer. With the predicted increase in both of these populations in the coming decades, it is imperative to evaluate potential interventions that are designed to help older cancer patients compensate for the additive burden of this disease and its treatment on age-related taste and smell losses. OBJECTIVE: The purpose of the current study was to determine if providing instruction and products for flavor enhancement of foods to elderly cancer patients in addition to nutritional information would improve their nutritional status, and, by extension, functional and immune status as well as quality of life. DESIGN: One hundred and seven subjects enrolled in the study. Fifty-four subjects were in the experimental group that received flavor enhancement plus nutritional information; fifty-three control subjects received only nutritional information. Subjects were evaluated 1 month, 3 months, and 8 months after beginning chemotherapy. At every session, subjects completed taste and smell assessments as well as questionnaires related to nutritional status, activities of daily living, and quality of life. Blood samples were also obtained to determine immune parameters. RESULTS: At the eight-month time point, experimental subjects had better scores on the mini nutritional assessment (MNA) and the physical function assessment of the quality of life questionnaire. Also at eight months, self-reported taste and smell perception for experimental subjects was better than that of controls as well as better than at earlier time points. Tests that assessed quantity and quality of food intake, as well as a number of immune parameters declined over time and did not differ significantly between groups. CONCLUSION: The combination of flavor enhancement, chemosensory education, and nutritional information for elderly cancer patients improved their nutritional assessment on the MNA and physical function over time. On the whole, experimental subjects perceived themselves to be better functioning at eight months than did their control counterparts.

Taste, smell and neuropsychological performance of individuals at familial risk for Alzheimer's disease.

The purpose of the study was to determine whether there are chemosensory and neuropsychological changes that predate the onset of Alzheimer's disease in individuals at enhanced risk of developing the condition. To study this question, a unique sample of individuals (n = 33) was studied who were genetically at-risk for AD by virtue of documented multigenerational evidence of the disease (so-called multiplex families). The performance of at-risk individuals was evaluated on various smell, taste, and neuropsychological measures at baseline and 18 months later. Their performance was compared to a control group (n = 32) that was matched in age, gender, education, and race. At baseline the at-risk group performed worse than the control group on the chemosensory measures of phenethyl alcohol smell detection, smell memory, and taste memory, and on a memory measure involving recall of narrative information (Logical Memory I from the Wechsler Memory Scale- Revised). Across both sessions, the at-risk group had lower smell memory scores than the control group. At-risk status was not significantly associated with APOE status. The results of this and other studies suggest that individuals who are genetically at risk for developing AD may perform more poorly on memory and smell measures compared to those not at risk. This effect may be separate from one known genetic risk factor of AD, APOE, and supports that multiple genes are likely responsible for the disease and its associated memory and other neurocognitive symptoms.

Taste and smell perception affect appetite and immunity in the elderly.

The losses in taste and smell that occur with advancing age can lead to poor appetite, inappropriate food choices, as well as decreased energy consumption. Decreased energy consumption can be associated with impaired protein and micronutrient status and may induce subclinical deficiencies that directly impact function. Most nutritional interventions in the elderly do not compensate for taste and smell losses and complaints. For example, cancer is a medical condition in which conventional nutritional interventions (that do not compensate for taste and smell losses) are ineffective. Evidence is now emerging that suggests compensation for taste and smell losses with flavor-enhanced food can improve palatability and/or intake, increase salivary flow and immunity, reduce chemosensory complaints in both healthy and sick elderly, and lessen the need for table salt.

Elevated and sustained desire for sweet taste in african-americans: a potential factor in the development of obesity.

Oral habituation is a relatively long-lasting decrease in oral responsiveness that results from the repeated presentation of a single stimulus. The purpose of this study was to evaluate the degree of habituation to sweet-tasting foods and to determine whether there are differences in the rate of habituation between African Americans and European Americans. These two groups were compared because the prevalence of obesity and obesity-related disorders such as diabetes and hypertension is significantly higher among African Americans than among European Americans. Nine different commercial foods and beverages that differed in sweetness intensity and caloric density served as stimuli. Subjects tasted and rated each food once per minute for a 30-min period on scales related to desire for another taste of the same sample and desire for a different taste. The stimuli and portion size for each of the 30 samples were two candy bars (Ultra Slim-Fast Cocoa Almond Crunch Bar, 1/16 of a bar; Natural Nectar Peanut Butter Granola Bar, 1/16 of a bar), three beverages (Nestea Lemon Flavored Instant Tea with NutraSweet, 5 mL; Welch's Grape Juice, 5 mL; Pink Swimmingo Kool-Aid, 5 mL), two gelatin desserts (Cherry Flavored Jell-O Gelatin, 5 g; Cherry Flavored Jell-O Gelatin with NutraSweet, 5 g), one enteral nutrition drink (Vanilla Ensure Plus, 5 mL), and one pudding (Ultra Slim-Fast Chocolate Pudding, 5 g). Subjects consumed the entire portion of each sample. Habituation occurred for seven of the nine foods as judged by a decrease in the desire for another taste of the same food. The degree of habituation for European Americans and African Americans was similar except for the sweetest food (Cherry Flavored Jell-O Gelatin with NutraSweet), for which African Americans showed no habituation. The degree of habituation in both groups was unrelated to caloric density. Overall, young African Americans had a significantly greater desire for another taste of the same food than did young European Americans for seven of the nine foods, and this desire was strongly correlated with the sweetness intensity for young African Americans but not for young European Americans. Furthermore, young African Americans had a greater desire than young European Americans for a different taste for seven of nine foods. The greater desire for intense sweet tastes may be a factor in the elevated incidence of obesity and diabetes in African Americans. In addition, young African Americans had greater perceived stress in this study than did young European Americans. If African Americans use sweet taste to compensate for feelings of stress, this compensation may also contribute to weight gain.

Effect of antimicrobial and anti-inflammatory medications on the sense of taste.

Elderly individuals and HIV-infected patients have a disproportionate number of taste complaints relative to the general population, and these taste alterations are correlated with the use of medications. Clinical reports of taste disorders have been associated with many drugs, including antimicrobial and anti-inflammatory medications. The purpose of this study was to quantify the taste effects of 6 nonsteroidal anti-inflammatory drugs (NSAIDS) and 13 antimicrobial drugs. The six NSAIDS were: diclofenac sodium salt, fenoprofen calcium salt, ibuprofen, ketoprofen, nabumetone, and sulindac. The 13 antimicrobials were: acyclovir, ampicillin, atovaquone, dapsone, enoxacin, ethambutol, lomefloxacin HCl, ofloxacin, pentamidine isethionate, pyrimethamine, sulfamethoxazole, tetracycline HCl, and trimethoprim. These 19 medications were applied topically to the tongues of unmedicated young and elderly volunteers as well as unmedicated HIV-infected patients to measure the direct effect of the drug on taste receptors. Topical application of drugs to the apical tongue surface was used to mimic the situation in which the drug is secreted into the saliva. The main finding was that the taste qualities of these drugs were perceived as predominantly bitter, metallic, and/or sour, although several did not have a taste. Elderly subjects had higher thresholds than young subjects for one-third of the drugs that were tested. Thresholds for HIV-infected patients were statistically equivalent to young controls; however, HIV-infected patients rated the drugs as more intense at four times above the detection threshold than young subjects. Most of these drugs when applied directly to the tongue also modified the taste intensity of other tastants (e.g., NaCl, citric acid).

Synergism among ternary mixtures of fourteen sweeteners.

The purpose of the present study was to determine the degree of synergism of sweet taste among ternary mixtures of 14 sweeteners. A trained panel evaluated ternary mixtures of 14 sweeteners varying in chemical structure and type. The ternary mixtures that were tested were limited to those in which the compounds comprising the mixture were synergistic in binary combinations, according to an earlier study. All sweeteners in the ternary mixtures were isointense with 2% sucrose, according to a previously developed formulae. Each self-mixture was also tested (e.g. 2% sucrose + 2% sucrose + 2% sucrose). The triad with the highest mean sweetness intensity rating was alitame-neohesperidin dihydrochalcone-rebaudioside-A (10.8). This represents an increase of 99.4% when compared with the average of the self-mixtures. While this is greater than the maximum of 74% increase found for binary mixtures, more dyadic combinations of sweeteners tested previously exhibited synergism than ternary combinations tested here. However, most ternary mixtures were synergistic (significantly greater than the average of the three self-mixtures) to some degree.

Effect of temperature, pH, and ions on sweet taste.

The purpose of this experiment was to determine the effects of temperature (50 degrees C and 6 degrees C), pH (pH 3.0, 4.0, 5.0, 6. 0, and 7.0) and the addition of monovalent and divalent cations (5 mM Na(+), 5 mM K(+), and 5 mM Ca(2)+ ) on the sweetness intensity ratings of sweeteners ranging widely in chemical structure. A trained panel provided intensity evaluations for prototypical tastes (sweet, bitter, sour, and salty) as well as aromatic and mouth-feel attributes. The following sweeteners were included in this experiment: three sugars (fructose, glucose, sucrose), three terpenoid glycosides (monoammonium glycyrrhizinate, rebaudioside-A, stevioside), two polyhydric alcohols (mannitol, sorbitol), two dipeptide derivatives (alitame, aspartame), two N-sulfonylamides (acesulfame-K, sodium saccharin), one sulfamate (sodium cyclamate), one protein (thaumatin), one dihydrochalcone (neohesperidin dihydrochalcone), and one chlorodeoxysugar (sucralose). Two to five levels of each sweetener reflecting a range of sweetness intensities were tested, using formulae developed by DuBois et al. The main finding from this three-part study was that temperature, pH, and ions had little effect on perceived sweetness intensity. Even when significant differences were found in the temperature study, the effects were very small.

Taste effects of lingual application of cardiovascular medications.

Medications used to treat cardiovascular diseases such as congestive heart failure, high blood pressure, and arrhythmia, are prescribed extensively in Western countries. However, taste complaints are common side effects of many of these cardiovascular medications. Although clinical observations are helpful in determining potential taste problems from a medication, experimental studies are necessary to obtain quantitative data on taste. In the studies performed here, nine cardiovascular medications (labetalol HCl, captopril, diltiazem HCl, enalapril maleate, hydrochlorothiazide, propranolol HCl, mexiletine HCl, procainamide HCl, and propafenone HCl) were applied to the tongue in human volunteers to measure the direct effect of these drugs on taste receptors. The medications were applied topically to the tongue surface of both young and elderly subjects to mimic the situation in which the drug is secreted into the saliva. Detection thresholds ranged from 0.048 mM (propafenone) to 0.438 mM (procainamide). The detection thresholds of healthy elderly subjects did not significantly differ from young controls. The compounds tested had a predominantly bitter taste with other qualities as well. In addition, topical application of the medications to the tongue affected the taste of one or more taste stimuli, with medications differing in the pattern of taste effects exhibited. The mechanism of taste effects is not fully known, but the results of this study suggest one route may be due to medications' effect on peripheral taste receptors.

Selective inhibition of sweetness by the sodium salt of +/-2-(4-methoxyphenoxy)propanoic acid.

The purpose of this study was to determine the degree to which the sodium salt of +/-2-(4-methoxyphenoxy)propanoic acid (Na-PMP) reduced sweet intensity ratings of 15 sweeteners in mixtures. Na-PMP has been approved for use in confectionary/frostings, soft candy and snack products in the USA at concentrations up to 150 p.p.m. A trained panel evaluated the effect of Na-PMP on the intensity of the following 15 sweeteners: three sugars (fructose, glucose, sucrose), three terpenoid glycosides (monoammonium glycyrrhizinate, rebaudioside-A, stevioside), two dipeptide derivatives (alitame, aspartame), two N-sulfonylamides (acesulfame-K, sodium saccharin), two polyhydric alcohols (mannitol, sorbitol), 1 dihydrochalcone (neohesperidin dihydrochalcone), one protein (thaumatin) and one sulfamate (sodium cyclamate). Sweeteners were tested at concentrations isosweet with 2.5, 5, 7.5 and 10% sucrose in mixtures with two levels of Na-PMP: 250 and 500 p.p.m. In addition, the 15 sweeteners were tested either immediately or 30 s after a pre-rinse with 500 p.p.m. Na-PMP. In mixtures, Na-PMP at both the 250 and 500 p.p.m. levels significantly blocked sweetness intensity for 12 of the 15 sweeteners. However, when Na-PMP was mixed with three of the 15 sweeteners (monoammonium glycyrrhizinate, neohesperidin dihydrochalcone and thaumatin), there was little reduction in sweetness intensity. Pre-rinsing with Na-PMP both inhibited and enhanced sweetness with the greatest enhancements found for monoammonium glycyrrhizinate, neohesperidin dihydrochalcone and thaumatin, which were not suppressed by Na-PMP in mixtures. The mixture data suggest that Na-PMP is a selective competitive inhibitor of sweet taste. The finding that pre-treatment can produce enhancement may be due to sensitization of sweetener receptors by Na-PMP.

Alterations of chemosensory function in end-stage liver disease.

Taste and smell dysfunction has been documented in patients with both acute and chronic liver disease. The purpose of this study was to determine if chemosensory function is improved after restoration of hepatic function with liver transplantation. Nine subjects (seven women and two men) with end-stage liver disease participated in the study. Taste and smell detection and recognition thresholds were determined before and after transplantation. A significant improvement in detection of the taste of sodium chloride and the odor of phenethyl alcohol was found after transplantation. These findings may have clinical significance in food choices and nutritional status of these patients.

Effect of psychotropic drugs on taste responses in young and elderly persons.

The taste of six psychotropic drugs (amitriptyline HCl, clomipramine HCl, desipramine HCl, imipramine HCl, doxepin HCl, and trifluoperazine HCl) can be detected at concentrations of 0.1 mM or less in both young and elderly individuals. At concentrations 4 times higher than the detection thresholds, these drugs have bitter as well as other unpleasant taste properties. Oral exposure to these drugs not only induces a taste from the drug itself but also alters taste perception of other compounds such as NaCl and sucrose. These results indicate that both hypogeusia and dysgeusia may be induced by psychotropic medications.

Taste and smell losses in HIV infected patients.

Human immunodeficiency virus (HIV-1) associated wasting is an increasingly common clinical manifestation of AIDS. The pathogenesis of wasting is multifactorial and includes reduced caloric intake as a major contributing mechanism. The perceptions of taste and smell play an important role in stimulating caloric intake and in optimizing nutrient absorption through cephalic phase reflexes. The purpose of this study was to evaluate the degree of losses in taste and smell function that occur in subjects infected with HIV. Taste and smell function was evaluated in 40 HIV infected individuals and 40 healthy control subjects matched for age, sex, race, smoking behavior, and number of years of education. Chemosensory tests administered to subjects included taste and smell detection thresholds, taste and smell memory tests, taste and smell discrimination tests, and taste and smell identification tasks. Significant differences were observed between experimental and control subjects in glutamic acid taste detection threshold (p < 0.001), quinine hydrochloride taste detection threshold (p < 0.001), menthol smell detection threshold (p < 0.001) and in the taste identification task (p = 0.006). Overall the results suggest abnormalities in the peripheral and central nervous systems, and subjective distortion of taste and smell. A significant correlation was not established between CDC classification of HIV infection and taste and smell function, although trends were observed suggesting worsening function with progression of HIV disease. These results document significant taste and smell losses in HIV infected subjects which may be of clinical significance in the development or progression of HIV associated wasting.

The effect of pleasant odors and hormone status on mood of women at midlife.

The effect of odors on the mood of 56 women ranging in age from 45 to 60 years was determined using the POMS (Profile of Mood States). The 56 subjects were divided into four groups of 14 subjects each on the basis of hormonal status. Group 1 consisted of 14 women who were still menstruating; group 2 consisted of 14 women who were no longer menstruating and taking estrogen; group 3 consisted of 14 women who were no longer menstruating and taking estrogen and progesterone; and, group 4 consisted of 14 women who were no longer menstruating and taking no hormone replacement. Use of pleasant odors significantly improved scores on tension, depression, and confusion factors. In addition, women using estrogen replacement with or without progesterone had better mood scores than those who did not, which is consistent with previous studies.

The effect of environmental odors emanating from commercial swine operations on the mood of nearby residents.

The effect of environmental odors emanating from large-scale hog operations on the mood of nearby residents was determined using the POMS (Profile of Mood States). The scores for six POMS factors and the TMD (total mood disturbance score) for 44 experimental subjects were compared to those of 44 control subjects who were matched according to gender, race, age, and years of education. The results indicated a significant difference between control and experimental subjects for all six POMS factors and the TMD. Persons living near the intensive swine operations who experienced the odors reported significantly more tension, more depression, more anger, less vigor, more fatigue, and more confusion than control subjects as measured by the POMS. Persons exposed to the odors also had more total mood disturbance than controls as determined by their ratings on the POMS. Both innate physiological responses and learned responses may play a role in the impairment of mood found here.

Investigation of synergism in binary mixtures of sweeteners.

The purpose of the present study was to determine the presence and degree of synergism among all binary mixtures of 14 sweeteners varying in chemical structure. A trained panel evaluated binary combinations of the following sweeteners: three sugars (fructose, glucose, sucrose), two polyhydric alcohols (mannitol, sorbitol), two diterpenoid glycosides (rebaudioside-A, stevioside), two dipeptide derivatives (alitame, aspartame), one sulfamate (sodium cyclamate), one protein (thaumatin), two N-sulfonyl amides (acesulfame-K, sodium saccharin), and one dihydrochalcone (neohesperidin dihydrochalcone). Each sweetener was tested at three concentrations that were isosweet with 3%, 5%, and 7% sucrose. Two methods of analysis were performed to determine synergistic effects. In Method I, an ANOVA was performed for each intensity level to determine if the mean sweetness intensity ratings of each binary mixture were equal to nominal sweetness (i.e., additivity) or not equal to nominal sweetness (i.e., synergism or suppression). In Method II, an additional ANOVA was performed to determine if the sweetness intensity ratings of any given mixture were equal to or greater than the average of the sweetness ratings of the two pure components in that blend.

Taste perception of monosodium glutamate (MSG) in foods in young and elderly subjects.

The purpose of this study was to determine the concentrations at which young and elderly subjects were able to detect and recognize monosodium glutamate (MSG) and MSG with 0.5 mM inosine-5'-monophosphate (IMP) in various food media including meats, vegetables, and soups. The most preferred concentration levels of MSG and MSG (with IMP) in the foods were also determined. Detection thresholds for MSG (with IMP) in foods were elevated in elderly subjects compared with young subjects. The detection thresholds for elderly subjects for MSG with IMP in foods were an average of 2.8 times higher than the same detection thresholds for young subjects. The variability among subjects in the ability to detect MSG (with or without IMP) in every food was far greater than the variability found previously in water solutions, especially for young subjects. Adding 0.5 mM IMP to the MSG did not significantly affect detection thresholds in foods. However, preference scores of both young and elderly subjects were significantly higher for the MSG with IMP condition than the MSG alone condition for some foods. Optimally preferred concentration levels of MSG in foods tended to be lower than the level at which MSG is detected or recognized in the food but above the detection threshold for MSG in water. The mechanism by which MSG can be preferred at a subthreshold concentration in foods is not fully understood. One possibility is that MSG synthesizes with food chemicals and forms a new taste quality.

Adaptation of sweeteners in water and in tannic acid solutions.

Repeated exposure to a tastant often leads to a decrease in magnitude of the perceived intensity; this phenomenon is termed adaptation. The purpose of this study was to determine the degree of adaptation of the sweet response for a variety of sweeteners in water and in the presence of two levels of tannic acid. Sweetness intensity ratings were given by a trained panel for 14 sweeteners: three sugars (fructose, glucose, sucrose), two polyhydric alcohols (mannitol, sorbitol), two terpenoid glycosides (rebaudioside-A, stevioside), two dipeptide derivatives (alitame, aspartame), one sulfamate (sodium cyclamate), one protein (thaumatin), two N-sulfonyl amides (acesulfame-K, sodium saccharin), and one dihydrochalcone (neohesperidin dihydrochalcone). Panelists were given four isointense concentrations of each sweetener by itself and in the presence of two concentrations of tannic acid. Each sweetener concentration was tasted and rated four consecutive times with a 30 s interval between each taste and a 2 min interval between each concentration. Within a taste session, a series of concentrations of a given sweetener was presented in ascending order of magnitude. Adaptation was calculated as the decrease in intensity from the first to the fourth sample. The greatest adaptation in water solutions was found for acesulfame-K, Na saccharin, rebaudioside-A, and stevioside. This was followed by the dipeptide sweeteners, alitame and aspartame. The least adaptation occurred with the sugars, polyhydric alcohols, and neohesperidin dihydrochalcone. Adaptation was greater in tannic acid solutions than in water for six sweeteners. Adaptation of sweet taste may result from the desensitization of sweetener receptors analogous to the homologous desensitization found in the beta adrenergic system.

The effect of sweeteners on bitter taste in young and elderly subjects.

The purpose of this study was to quantify the degree of reduction in perceived bitterness by sweeteners at both threshold and suprathreshold concentrations of bitter compounds. Detection and recognition thresholds were determined for six bitter compounds (caffeine, denatonium benzoate, magnesium chloride, quinine hydrochloride, sucrose octaacetate, and urea) in the absence and presence of several suprathreshold concentrations of five sweeteners. The sweeteners were: sucrose, aspartame, sodium saccharin, mannitol, and sorbitol. Polycose was also tested along with the sweeteners. The degree to which bitter thresholds were affected by the addition of sweeteners was dependent on the chemical classification of the sweeteners and their concentrations. In general, the natural sweeteners, sucrose, mannitol, and sorbitol, were more effective than the noncaloric sweeteners, aspartame and sodium saccharin, in elevating the detection and recognition thresholds of the bitter compounds. A sweetness intensity approximating that of 6% sucrose (0.175 M sucrose) or greater was required to elevate thresholds. For elderly subjects, sweeteners did not significantly elevate thresholds for denatonium benzoate and sucrose octaacetate. The degree to which sorbitol and sucrose can decrease the perceived bitterness intensity of suprathreshold concentrations of the six bitter compounds was also determined. The concentrations of sweeteners and bitter compounds were selected to be of moderate to high subjective intensity. The levels of sweeteners used in the mixtures were: sucrose (none, 0.946 M, and 2.13 M) and sorbitol (none, 2.1 M, and 3.68 M). Both sweeteners significantly reduced the bitterness ratings of almost every concentration of the six bitter compounds. The greatest reductions in bitterness were 87.0% for 0.192 microM denatonium benzoate mixed with 2.13 M sucrose and 84.7% for 1.8 M urea mixed with 3.68 M sorbitol.

Halothane and morphine-nitrous oxide anesthesia in patients undergoing coronary artery bypass operation. Patterns of intraoperative ischemia.

To examine whether the hemodynamic responses to halothane or morphine-nitrous oxide anesthesia produce different patterns of myocardial ischemia in patients undergoing myocardial revascularization, we studied 26 patients anesthetized with nitrous oxide (50%) and either halothane (0.2% to 1.0% end-tidal concentration) or morphine (2 mg/kg, given intravenously). We measured systemic and coronary hemodynamics and took blood samples to measure blood gases, oxygen content, and lactate and norepinephrine concentrations. Systemic blood pressure, rate-pressure produce, systemic vascular resistance, cardiac output, and stroke work were elevated following sternotomy in patients anesthetized with morphine, whereas halothane obtunded these hemodynamic responses to surgical stress. Intraoperative myocardial ischemia occurred in both patient groups. Ten of 14 patients receiving halothane and eight of 12 receiving morphine had at least one episode of either ST-segment depression or myocardial lactate production. The difference between these groups was not statistically significant. Only patients anesthetized with morphine had a significantly elevated rate-pressure product when ischemia occurred. In this selected series of patients subjected to myocardial revascularization, two sustained a myocardial infarction and four died in the postoperative period. The incidence of these and other indices of postoperative morbidity was not related to choice of primary anesthetic and did not differ between the patients who sustained ischemia and those who did not.