The influence of food sensory properties on eating behaviours in children with Down syndrome.

Developing new food products for children is challenging, particularly in vulnerable groups including children with Down syndrome (DS). Focusing on children with DS, the aim of this study was to study the influence of parent liking on acceptance of food products by children with DS and demonstrate the influence of food sensory properties on indicators of food acceptance, food rejection, and challenging eating behaviours. Children (ages 1158 months) with DS (n = 111) participated in a home use test evaluating snack products with varying sensory properties as profiled by a trained sensory panel. Parents recorded their children's reactions to each food product; trained coders coded videos for eating behaviours. To understand the influence of each sensory modality on eating behaviour, ordered probit regression models were run. Results found a significant correlation between the parent liking and overall child disposition to the food (p < 0.05). From the regression analysis, the inclusion of all food sensory properties, including texture, flavour, taste, product shape and size, improved the percentage of variance explained in child mealtime behaviours and overall disposition over the base model (containing no sensory modalities), with texture having the largest influence. Overstuffing the mouth, a challenging eating behaviour, was most influenced by product texture (children ≥ 30 months), and product texture and size (children < 30 months). In both age groups, coughing/choking/gagging was most influenced by food texture and was associated with a product that was grainy and angular (sharp corners). In both age groups, product acceptance was associated with a product that was dissolvable, crispy, and savoury while rejection was associated with a dense, gummy and fruity product. These results suggest that a dissolvable, crispy texture, with a cheesy or buttery flavour are the sensory properties important in a desirable flavoured commercial snack product for children with DS; however, overall disposition must be balanced against mouth overstuffing.

Eating behaviors in children with Down syndrome: Results of a home-use test.

Children with Down syndrome (DS) display a disproportionate number of health challenges, including feeding and swallowing difficulties and food texture sensitivities. To start addressing food texture challenges early in life, the aim of this research was to understand mealtime behaviors and identify preferred food textures of children with DS. Children (aged 11 to 58 months) with DS (n = 111) and without (typically developing, TD; n = 107) participated in a home use test evaluating snack products of varying textures. Parents recorded their children's reactions to each food product; a panel of trained coders coded videos for mealtime behaviors. Children were also identified as food texture sensitive (TS) or non-texture sensitive (NTS). Results showed that age, TS, the presence of a DS diagnosis and the TS*DS interaction influenced the child's behaviors to the food products. Children with DS were more likely to increase distance from the food, mouth/suck on the food, and less likely to chew/much on the food compared to children TD. Children with DS also ate significantly less than typically developing children. Similar mealtime behaviors were observed between the children with TD/<30 months of age and children with DS regardless of age (p < .05). While children with DS/TS had a higher disposition for the dissolvable texture, along with products that were salty and cheesy, children with DS/NTS had a greater tolerance for more textures in general, including crunchy and grainy. Overall, this research identified mealtime behaviors in children with DS, determined overall disposition of children with DS to foods of differences sensory properties, and demonstrated the influence of TS on a child's disposition to a food. This research will be extended to develop acceptable and innovative food products for children with DS/TS.

Assessing patients' preferences for treatments for angina using a modified repertory grid method.

A current popular theme in medicine concerns whether and how patients should be involved in treatment choice. Assuming patient involvement is desirable, how should one go about eliciting preferences? A variety of quantitative and qualitative methods exist that may be used for this purpose, one of which is the repertory grid method. This method involves eliciting constructs (reasons) for preferences through comparing sets of three options. This method allows the structured elicitation of the reasons behind individual preferences, but also, when used with generalised procrustes analysis (GPA), allows aggregation of individual data to reveal general preference patterns. In this study the repertory grid method was used to examine patient preferences for angina treatments with the goal of, first, gaining some understanding of general patterns of patient preference, and second, examining the likely utility of the technique in this setting. A sample of 21 patients with mild and stable angina from two general practices in Norfolk, UK was interviewed using the repertory grid method to elicit the constructs underlying their preferences amongst seven angina treatments (including 'no treatment'). Individualised questionnaires were then produced and sent to the patients for self-completion, which required rating the extent to which each construct was relevant for each treatment (scored on visual analogue rating scales). Analysis of the ratings, using GPA, showed that the constructs clustered around two dimensions: 'some treatment' versus 'no treatment', and drug treatment versus surgical treatment. While some treatment was generally preferred to no treatment, individuals varied in preference for drug treatments or surgical treatments. Although the latter were generally perceived as 'effective' they were also perceived, for example, as 'invasive', 'frightening', related to 'negative experiences', and being more appropriate for when symptoms are severe ('proportionate'). We consider the implications of these results for involving patients in choosing amongst treatments.