Taste function in children: normative values and associated factors.

BACKGROUND: Although less frequent than in adults, taste loss also occurs in childhood. "Taste Strips" are frequently used for diagnosing taste dysfunction; however, normative values are lacking for children. In this study, we will create normative values for the "Taste Strips" in children. METHODS: This cross-sectional study included 609 children aged 6-15 years. "Taste Strips" were used to determine sweet, sour, salty, and bitter taste scores by a non-forced procedure. The 10th percentile was used to distinguish normal taste function from a reduced sense of taste. Multivariable generalized linear models (GLM) were estimated to study the effect of age (group), sex, and 6-n-propylthiouracil (PROP) status on taste function. RESULTS: Taste function changed with age, allowing for a distinction of three age groups: (I) 6-7 years, (II) 8-9 years, and (III) 10-15 years. Normative values were created for the age groups and boys and girls separately. Additionally, GLM showed a significant effect of (1) age (group) on sweet, salty, bitter, and total taste scores; (2) sex on sweet, sour, and total taste scores; and (3) PROP status on total taste scores. CONCLUSIONS: This study provided normative values for the "Taste Strips" in children, highlighting age- and sex-related differences. IMPACT: Taste dysfunction can be harmful and impacts quality of life, a topic that became increasingly important since the COVID-19 pandemic. Although taste dysfunction is thought to be rare in childhood, the detrimental impact of such dysfunction might be large, as children's eating habits are strongly influenced by input from the chemical senses. Measuring taste function may elucidate the relationship between taste dysfunction and disease, fostering the development of more appropriate supportive strategies. However, adequate tools are lacking for children. Normative values of the "Taste Strips" are now available for children, which bolster the clinical utility of this test.

Body composition of patients with neuroblastoma using computed tomography.

BACKGROUND: Computed tomography (CT) is often used to investigate muscle and fat mass in adult patients with cancer. However, this method has rarely been used in the pediatric cancer population. The present retrospective study aimed to investigate changes in body composition using CT during treatment in children with neuroblastoma. PROCEDURE: CT images of 29 patients with high-risk neuroblastoma were retrospectively analyzed at diagnosis and longitudinally during treatment. The cross-sectional area of skeletal muscle, intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) and skeletal muscle density at the level of the third lumbar vertebra were examined. To correct for height, cross-sectional areas were divided by height in meters squared. A linear mixed model was estimated to investigate changes in body composition over time. RESULTS: A small increase in skeletal muscle (p = .029), skeletal muscle density (p = .002), and IMAT (p < .001) was found. Furthermore, a rapid increase in VAT (p < .001) and SAT (p = .001) was seen early during treatment with the highest volumes after six cycles of chemotherapy. CONCLUSIONS: CT scans obtained during standard care provide insight into the direction and timing of changes in skeletal muscle and different types of adipose tissue in childhood cancer patients. Future research is needed regarding the consequences of the rapid increase of VAT and SAT early during treatment.

Taste Dysfunction in Children-A Clinical Perspective and Review of Assessment Methods.

Taste dysfunction has been associated with aging and is therefore thought to be less common in children. However, children can face medical conditions influencing their taste function. Measuring and understanding taste dysfunction in children may foster the development of treatments/interventions mitigating the detrimental effects of taste dysfunction on children's appetite and quality of life. But measuring loss of taste function requires adequate tools. This review was conducted to 1) provide an overview of etiologies (i.e., disease and iatrogenic) associated with taste dysfunction in a pediatric population; 2) to investigate which tools (psychophysical tests and questionnaires) are available to assess taste function in children; and 3) to identify what tools can be and are actually used in clinical practice. It is concluded that only a minority of available tools to assess taste function in children are readily suitable for a pediatric clinical setting. Considering the profound impact of taste dysfunction in the pediatric setting, developing, and implementing a standard taste test that is sensitive, simple, and practical to use with children is pertinent.

Smell and taste function in childhood cancer patients: a feasibility study.

PURPOSE: Chemotherapy can affect smell and taste function. This has never been investigated in childhood cancer patients during chemotherapy. The objective of this study was to determine whether psychophysical smell and taste tests are suitable for children with cancer. Taste and smell function, fungiform papillae density, and eating behavior were measured before (T1) and after (T2) a cycle of chemotherapy and compared with healthy controls. METHODS: Thirty-one childhood cancer patients treated for a hematological, solid, or brain malignancy (median age 12 years, 16 girls), and 24 healthy controls (median age: 11 years, 10 girls) participated. Smell function was measured using Sniffin' Sticks, including a threshold, discrimination, and identification test. Taste Strips were used to determine recognition thresholds for sweet, sour, salty, and bitter taste. Papillae density was investigated by counting the fungiform papillae of the anterior tongue. Eating behavior was assessed using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS). RESULTS: Smell and taste function could be investigated in more than 90% of the patients, while fungiform papillae density could be determined in 61% of the patients. A significant difference in smell threshold was found between patients and controls (p = 0.001), showing lower thresholds in patients. In patients, sweet taste (p < 0.001), bitter taste (p = 0.028), and total taste function (p = 0.004) were significantly different after a cycle of chemotherapy, with higher scores at T2. CONCLUSION: The assessment of smell, taste, and fungiform papillae density is feasible in children with cancer. Results of the current study suggest that smell and taste sensitivity increased in children with cancer.

Eating and feeding problems in children with cancer: Prevalence, related factors, and consequences.

BACKGROUND & AIMS: During treatment for cancer, children experience many side effects such as lack of appetite, nausea, and vomiting. As a result, ensuring adequate intake puts pressure on both the child and the parent. This study aims to determine the prevalence, causes and consequences of eating and feeding problems in children treated for cancer. METHODS: Parents of 85 children with cancer completed the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and symptoms, BMI, energy intake, feeding style, and parental distress were measured at 0, 3, 6 and 12 months after diagnosis. RESULTS: Parent-reports revealed that almost a quarter of the children experienced eating disorder: 15.7% experienced problems related to diminished intake and 8.6% related to excessive intake. Prevalence of feeding disorders related to parents' behavior was 21.1%. In children <8 years prevalence of eating and feeding disorders was significantly higher: 31% and 36% for child and parent behavior respectively. Younger age, poor pre-illness eating behavior, increase in symptoms and a demanding feeding style were associated with more eating problems. Excessive eating resulted in higher energy intake, however, no association was found between eating problems and nutritional status. Food refusal resulted in more parental distress. CONCLUSIONS: Especially younger children with cancer are at risk for eating and feeding problems. In addition, poor pre-illness eating behavior, symptoms and a demanding feeding style aggravate eating problems. Therefore, interventions should focus at diminishing side effects of treatment and instructing parents to be less demanding regarding their child's eating behavior.

Metallic Taste in Cancer Patients Treated with Systemic Therapy: A Questionnaire-based Study.

A metallic taste is reported by cancer patients as a side effect of systemic therapy. Despite the high prevalence, this taste alteration has received limited attention. The present study investigated: 1) the prevalence of metallic taste in cancer patients treated with systemic therapy; 2) possible predictors of metallic taste; and 3) characteristics of metallic taste. A heterogeneous population of 127 cancer patients, who had received systemic treatment in the past year or were still on treatment, completed a questionnaire developed for this study. Fifty-eight of 127 (46%) patients reported taste changes in the preceding week. Of these patients, 20 (34%) reported a metallic taste. Patients treated with chemotherapy, concomitant radiotherapy, as well as targeted therapy reported metallic taste. Women experienced metallic taste more often than men. Patients experiencing a metallic taste also reported more frequently that they were bothered by sour food and that everything tasted bitter. The experience of metallic taste was highly variable among patients. In conclusion, metallic taste is a frequently experienced taste alteration by cancer patients. Patients treated with chemotherapy, concomitant radiotherapy, and targeted therapy are all at risk for this taste alteration. However, not all patients reported this alteration as bothersome.

Changes in taste and smell function, dietary intake, food preference, and body composition in testicular cancer patients treated with cisplatin-based chemotherapy.

BACKGROUND & AIMS: Taste and smell changes due to chemotherapy may contribute to the high prevalence of overweight in testicular cancer patients (TCPs). This study investigates the taste and smell function, dietary intake, food preference, and body composition in TCPs before, during, and up to 1 year after cisplatin-based chemotherapy. METHODS: Twenty-one consecutive TCPs participated. At baseline TCPs were compared to healthy controls (N = 48). Taste strips and 'Sniffin' Sticks' were used to determine psychophysical taste and smell function. Subjective taste, smell, appetite, and hunger were assessed using a questionnaire. Dietary intake was analyzed using a food frequency questionnaire. Food preference was assessed using food pictures varying in taste (sweet/savoury) and fat or protein content. A Dual-Energy X-ray Absorptiometry (DEXA) scan was performed to measure whole body composition. RESULTS: Compared to controls, TCPs had a lower smell threshold (P = 0.045) and lower preference for high fat sweet foods at baseline (P = 0.024). Over time, intra-individual psychophysical taste and smell function was highly variable. The salty taste threshold increased at completion of chemotherapy compared to baseline (P = 0.006). A transient decrease of subjective taste, appetite, and hunger feelings was observed per chemotherapy cycle. The percentage of fat mass increased during chemotherapy compared to baseline, while the lean mass and bone density decreased (P < 0.05). CONCLUSIONS: Coping strategies regarding subjective taste impairment should especially be provided during the first week of each chemotherapy cycle. Since the body composition of TCPs already had changed at completion of chemotherapy, intervention strategies to limit the impact of cardiovascular risk factors should probably start during treatment.

Taste and smell function in testicular cancer survivors treated with cisplatin-based chemotherapy in relation to dietary intake, food preference, and body composition.

BACKGROUND: Chemotherapy can affect taste and smell function. This may contribute to the high prevalence of overweight and metabolic syndrome in testicular cancer survivors (TCS). Aims of the study were to evaluate taste and smell function and possible consequences for dietary intake, food preference, and body composition in TCS treated with cisplatin-based chemotherapy. METHODS: Fifty TCS, 1-7 years post-chemotherapy, and 50 age-matched healthy men participated. Taste and smell function were measured using taste strips and 'Sniffin' Sticks', respectively. Dietary intake was investigated using a food frequency questionnaire. Food preference was assessed using food pictures varying in taste (sweet/savoury) and fat or protein content. Dual-Energy X-ray Absorptiometry was performed to measure body composition. Presence of metabolic syndrome and hypogonadism were assessed. RESULTS: TCS had a lower total taste function, a higher bitter taste threshold, higher Body Mass Index (BMI), and more (abdominal) fat than controls (p < 0.05). No differences in smell function and dietary intake were found. Testosterone level was an important determinant of body composition in TCS (p = 0.016). CONCLUSION: Although taste function was impaired in TCS, this was not related to a different dietary intake compared to controls. Lower testosterone levels were associated with a higher BMI, fat mass, and abdominal fat distribution in TCS.

The palatability of oral nutritional supplements: before, during, and after chemotherapy.

PURPOSE: Oral nutritional supplements (ONS) are commonly prescribed to malnourished patients to improve their nutritional status. Taste and smell changes in patients with cancer can affect the palatability of ONS. The present study investigated: (1) the palatability of six ONS in testicular cancer patients before, during the first two cycles, and after chemotherapy; (2) the relation between the palatability and taste and smell function; (3) the metallic taste of these ONS. METHODS: Twenty-one testicular cancer patients undergoing first-line cisplatin-based chemotherapy participated. Two milk-based (vanilla; strawberry), two juice-based (apple; orange), and two yoghurt-based (vanilla-lemon; peach-orange) ONS were tested. A questionnaire was used to assess the palatability of ONS and to which extent the attribute 'metallic' was applicable. Taste and smell function were measured using taste strips and 'Sniffin' Sticks', respectively. RESULTS: The palatability of ONS was highly variable among patients. The milk-based strawberry ONS was preferred most before, during, and after chemotherapy. The liking of the milk-based vanilla ONS tended to decrease over time (p = 0.053), whereas the liking of the other ONS remained stable. A higher smell threshold and a lower sour taste threshold were correlated to a decreased liking of the milk-based vanilla ONS. The two juice-based ONS tended to taste more metallic during than before chemotherapy. CONCLUSION: Health care professionals and patients should be aware that the palatability of ONS can change over time. Regular structured contact between health care professionals and patients regarding the choice of ONS seems warranted.

Protein intake in relation to risk of hypertension and microalbuminuria in patients with type 1 diabetes: the EURODIAB Prospective Complications Study.

BACKGROUND: A beneficial association between dietary protein intake (especially from plant sources) with incident hypertension, being strongly correlated to microalbuminuria, has been suggested in healthy populations. Evidence from diabetic populations, in which the prevalence of these diseases is high, is lacking. We examined the associations of total, animal and plant protein intake with incident hypertension (n = 1319) and microalbuminuria (n = 1045) in patients from 16 European countries with type 1 diabetes from the clinic-based EURODIAB Prospective Complications study. METHODS: Odds ratios (OR) with 95% confidence intervals (CI) for incident hypertension after 7 years of follow-up were calculated in tertiles of protein intake (energy%) with adjustments for age, sex, diabetes duration, HbA1c, BMI, physical activity, smoking, alcohol, total energy, total fat and carbohydrate intake. RESULTS: After adjustment for potential confounders, total, animal and plant protein intakes were not related to incident hypertension (298 cases). OR's (95% CI) across increasing tertiles of total protein were 1.00 (ref), 0.86 (0.60-1.25) and 0.91 (0.59-1.43). Furthermore, no relation was observed with incident microalbuminuria (135 cases), with ORs (95% CI) across increasing tertiles of total protein being 1.00 (ref), 0.88 (0.53-1.48) and 1.08 (0.57-2.04). CONCLUSION: Results from our study did not provide evidence that a protein intake commonly consumed by European patients with type 1 diabetes is associated with incident hypertension or microalbuminuria. Prospective studies with more detailed information on dietary intake (including mineral intake) are needed to confirm these findings, and to investigate the impact on vascular and renal complications of a long-term very high protein intake in patients with type 1 diabetes.