Dietary experience and sweet taste preference in human infants

Public health policies to encourage healthy eating habits: recent perspectives

There is an urgent need to address unhealthy dietary patterns at the population level. Poor diet and physical inactivity are key drivers of the obesity pandemic, and they are among the leading causes of preventable death and disability in nearly every country in the world. As countries grapple with the growing obesity prevalence, many innovative policy options to reduce overeating and improve diet quality remain largely unexplored. We describe recent trends in eating habits and consequences for public health, vulnerabilities to unhealthy eating, and the role for public health policies. We reviewed recent public health policies to promote healthier diet patterns, including mandates, restrictions, economic incentives, marketing limits, information provision, and environmental defaults.

Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking

Despite isolated areas of improvement, no country to date has reversed its obesity epidemic. Governments, together with a broad range of stakeholders, need to act urgently to decrease the prevalence of obesity. In this Series paper, we review several regulatory and non-regulatory actions taken around the world to address obesity and discuss some of the reasons for the scarce and fitful progress. Additionally, we preview the papers in this Lancet Series, which each identify high-priority actions on key obesity issues and challenge some of the entrenched dichotomies that dominate the thinking about obesity and its solutions. Although obesity is acknowledged as a complex issue, many debates about its causes and solutions are centred around overly simple dichotomies that present seemingly competing perspectives. Examples of such dichotomies explored in this Series include personal versus collective responsibilities for actions, supply versus demand-type explanations for consumption of unhealthy food, government regulation versus industry self-regulation, top-down versus bottom-up drivers for change, treatment versus prevention priorities, and a focus on undernutrition versus overnutrition. We also explore the dichotomy of individual versus environmental drivers of obesity and conclude that people bear some personal responsibility for their health, but environmental factors can readily support or undermine the ability of people to act in their own self-interest. We propose a reframing of obesity that emphasises the reciprocal nature of the interaction between the environment and the individual. Today's food environments exploit people's biological, psychological, social, and economic vulnerabilities, making it easier for them to eat unhealthy foods. This reinforces preferences and demands for foods of poor nutritional quality, furthering the unhealthy food environments. Regulatory actions from governments and increased efforts from industry and civil society will be necessary to break these vicious cycles.

An exploratory trial of parental advice for increasing vegetable acceptance in infancy

Research suggests that repeatedly offering infants a variety of vegetables during weaning increases vegetable intake and liking. The effect may extend to novel foods. The present study aimed to investigate the impact of advising parents to introduce a variety of single vegetables as first foods on infants' subsequent acceptance of a novel vegetable. Mothers of 4- to 6-month-old infants in the UK, Greece and Portugal were randomised to either an intervention group (n 75), who received guidance on introducing five vegetables (one per d) as first foods repeated over 15 d, or a control group (n 71) who received country-specific ‘usual care’. Infant's consumption (g) and liking (maternal and researcher rated) of an unfamiliar vegetable were assessed 1 month post-intervention. Primary analyses were conducted for the full sample with secondary analyses conducted separately by country. No significant effect of the intervention was found for vegetable intake in the three countries combined. However, sub-group analyses showed that UK intervention infants consumed significantly more novel vegetable than control infants (32·8 (sd 23·6) v. 16·5 (sd 12·1) g; P =0·003). UK mothers and researchers rated infants' vegetable liking higher in the intervention than in control condition. In Portugal and Greece, there was no significant intervention effect on infants' vegetable intake or liking. The differing outcome between countries possibly reflects cultural variations in existing weaning practices. However, the UK results suggest in countries where vegetables are not common first foods, advice on introducing a variety of vegetables early in weaning may be beneficial for increasing vegetable acceptance.

Impacts of in utero and early infant taste experiences on later taste acceptance: a systematic review

BACKGROUND

Dietary behavior exerts a critical influence on health and is the outcome of a broad range of interacting factors, including food and taste acceptance. These may be programmed in utero and during early infancy.

OBJECTIVE

We examined the hypothesis that fetuses and infants exposed to sweet, salty, sour, bitter, umami, or specific tastes show greater acceptance of that same taste later in life.

METHODS

We conducted a systematic review of the literature, using comprehensive searches and following established procedures for screening, data extraction, and quality appraisal. We used harvest plots to synthesize the evidence graphically.

RESULTS

Twenty studies comprising 38 subgroups that differed by taste, age, medium, and duration of exposure were included. Exposure to bitter and specific tastes increased the acceptance of these tastes. Studies on sweet and salty tastes showed equivocal results. Studies on sour tastes were sparse.

CONCLUSION

Our systematic review clearly shows programming of the acceptance of bitter and specific tastes. For other tastes the results were either equivocal or confined to a few number of studies that precluded us from drawing conclusions. Further research should examine the association of salty and sour taste exposures on later preferences of these tastes. Long-term studies and randomized clinical trials on each type of taste are needed.

Nutritional challenges and opportunities during the weaning period and in young childhood

The early years of life are a period of very rapid growth and development. In this critical phase, food preferences are formed which carry over into childhood and beyond and foundations are laid for a healthy adult life. Excess energy, imbalances in macronutrient quality, and nutritional deficiencies may form inappropriate nutritional signals, leading to metabolic disturbances and affecting the obesity risk. For instance, the intake of protein and sugar-sweetened beverages in young children has been associated with an increased risk of overweight and obesity. In reality, scientific reports have shown that the dietary intakes of vegetables, α-linolenic acid, docosahexaenoic acid, iron, vitamin D, and iodine are low and the intakes of protein, saturated fatty acids, and added sugar are high in young children living in Europe. A focus on improving feeding habits and approaches to support more balanced nutritional intakes early in life may have significant public health benefits.

Opportunities to reduce children's excessive consumption of calories from beverages

OBJECTIVE

To describe children's consumption of sugar-sweetened beverages (SSBs) and 100% fruit juice (FJ), and identify factors that may reduce excessive consumption.

DESIGN

A total of 830 parents of young children completed a 36-item questionnaire at the pediatricians' office.

RESULTS

Children consumed soda (62.2%), other SSBs (61.6%), and FJ (88.2%): 26.9% exceeded the American Academy of Pediatrics' recommended daily FJ intake. 157 (18.9%) children consumed excessive calories (>200 kcal/d) from beverages (median = 292.2 kcal/d, range 203.8-2177.0 kcal/d). Risk factors for excessive calorie consumption from beverages were exceeding recommendations for FJ (odds ratio [OR] = 119.7, 95% confidence interval [CI] = 52.2-274.7), being 7 to 12 years old (OR = 4.3, 95%CI = 1.9-9.9), and having Medicaid insurance (OR = 2.6, 95%CI = 1.1-6.0). Parents would likely reduce beverage consumption if recommended by the physician (65.6%).

CONCLUSIONS

About 1 in 5 children consumes excessive calories from soda, other SSBs and FJ, with FJ the major contributor.

A qualitative study of the factors that influence mothers when choosing drinks for their young children

Background

The consumption of sweetened beverages is a known common risk factor for the development of obesity and dental caries in children and children consume sweet drinks frequently and in large volumes from an early age. The aim of this study was to examine factors that influence mothers when choosing drinks for their children.

Method

Semi-structured interviews (n = 32) were conducted with a purposive sample of mothers of young children from Victoria’s Barwon South Western Region (selected from a larger cohort study to include families consuming different types of water, and different socioeconomic status and size). Inductive thematic analysis was conducted on transcribed interviews.

Results

Several themes emerged as influencing child drink choice. Child age: Water was the main beverage for the youngest child however it was seen as more acceptable to give older children sweetened beverages. Child preference and temperament: influencing when and if sweet drinks were given; Family influences such as grandparents increased children’s consumption of sweet drinks, often providing children drinks such as fruit juice and soft drinks regardless of maternal disapproval. The Setting: children were more likely to be offered sweetened drinks either as a reward or treat for good behaviour or when out shopping, out for dinner or at parties.

Conclusions

Limiting intake of sweet drinks is considered an important step for child general and oral health. However, the choice of drinks for children has influences from social, environmental and behavioural domains, indicating that a multi-strategy approach is required to bring about this change.

Salivary protein profiles are linked to bitter taste acceptance in infants

Based on recent studies in adult subjects, saliva composition is increasingly considered as a physiological factor contributing to taste sensitivity or acceptance. In order to evaluate a possible link between salivary protein composition and taste acceptance in infants, 73 infants participated longitudinally in taste acceptance tests and donated saliva at the age at 3 and 6 months. Intake ratios, reflecting acceptance of a taste solution relative to water were calculated for the five basic tastes. Salivary proteins were separated by one-dimensional electrophoresis and bands were semi-quantified by image analysis. Partial least square (PLS) regression analyses were performed for each taste at both ages to explain intake ratios by band intensities. Bitterness acceptance in the younger infants was unique in the sense that salivary protein profiles could partly predict bitter taste acceptance. At that age, infants were on average indifferent to the 0.18-M urea solution, but great variability in acceptance was observed. The six bands considered as the best predictors for bitterness acceptance were identified by MALDI-TOF mass spectrometry. Higher abundance of bands containing secretory component, zinc-α-2-glycoprotein and carbonic anhydrase 6 was associated to a lower bitterness acceptance, while higher abundance of bands containing lactoperoxidase, prolactin-inducible protein and S-type cystatins was associated to a higher bitterness acceptance. In a second stage, S-type cystatin abundance was measured by Western blotting in order to tentatively confirm this particular finding in an independent group of 22 infants. Although not reaching statistical significance, probably due to a relatively small sample size, it was again observed that cystatin abundance was higher in infants accepting more readily the bitter solution over water.

CONCLUSION

saliva protein composition may contribute to bitter taste acceptance in the younger infants.

Learning to eat: birth to age 2 y

During the first 2 y of life, development is rapid and includes dramatic changes in eating behavior. Individual patterns of food preferences and eating behaviors emerge and differ depending on the foods offered and on the contexts of feeding during this early period of dietary transition. In this review, we discuss evidence on ways in which early learning influences food preferences and eating behavior, which, in turn, shape differences in dietary patterns, growth, and health. Although the evidence reviewed indicates that this early period of transition provides opportunities to influence children's developing intake patterns, there is no consistent, evidence-based guidance for caregivers who are feeding infants and toddlers; the current Dietary Guidelines are intended to apply to Americans over the age of 2 y. At present, the evidence base with regard to how and what children learn about food and eating behavior during these first years is limited. Before developing guidance for parents and caregivers, more scholarship and research is necessary to understand how infants and toddlers develop the food preferences and self-regulatory processes necessary to promote healthy growth, particularly in today's environment. By the time they reach 2 y of age, children have essentially completed the transition to "table foods" and are consuming diets similar to those of other family members. This article discusses parenting and feeding approaches that may facilitate or impede the development of self-regulation of intake and the acceptance of a variety of foods and flavors necessary for a healthy diet. We review the limited evidence on how traditional feeding practices, familiarization, associative learning, and observational learning affect the development of eating behavior in the context of the current food environment. Areas for future research that could inform the development of anticipatory guidance for parents and caregivers responsible for the care and feeding of young children are identified.

Ontogeny of taste preferences: basic biology and implications for health

Health initiatives address childhood obesity in part by encouraging good nutrition early in life. This review highlights the science that shows that children naturally prefer higher levels of sweet and salty tastes and reject lower levels of bitter tastes than do adults. Thus, their basic biology does not predispose them to favor the recommended low-sugar, low-sodium, vegetable-rich diets and makes them especially vulnerable to our current food environment of foods high in salt and refined sugars. The good news is that sensory experiences, beginning early in life, can shape preferences. Mothers who consume diets rich in healthy foods can get children off to a good start because flavors are transmitted from the maternal diet to amniotic fluid and mother's milk, and breastfed infants are more accepting of these flavors. In contrast, infants fed formula learn to prefer its unique flavor profile and may have more difficulty initially accepting flavors not found in formula, such as those of fruit and vegetables. Regardless of early feeding mode, infants can learn through repeated exposure and dietary variety if caregivers focus on the child's willingness to consume a food and not just the facial expressions made during feeding. In addition, providing complementary foods low in salt and sugars may help protect the developing child from excess intake later in life. Early-life experiences with healthy tastes and flavors may go a long way toward promoting healthy eating, which could have a significant impact in addressing the many chronic illnesses associated with poor food choice.

Early influences on the development of food preferences

The ability to perceive flavors begins in utero with the development and early functioning of the gustatory and olfactory systems. Because both amniotic fluid and breast milk contain molecules derived from the mother's diet, learning about flavors in foods begins in the womb and during early infancy. This early experience serves as the foundation for the continuing development of food preferences across the lifespan, and is shaped by the interplay of biological, social, and environmental factors. Shortly after birth, young infants show characteristic taste preferences: sweet and umami elicit positive responses; bitter and sour elicit negative responses. These taste preferences may reflect a biological drive towards foods that are calorie- and protein-dense and an aversion to foods that are poisonous or toxic. Early likes and dislikes are influenced by these innate preferences, but are also modifiable. Repeated exposure to novel or disliked foods that occurs in a positive, supportive environment may promote the acceptance of and eventually a preference for those foods. Alternatively, children who are pressured to eat certain foods may show decreased preference for those foods later on. With increasing age, the influence of a number of factors, such as peers and food availability, continue to mold food preferences and eating behaviors.

Family and infant characteristics associated with timing of core and non-core food introduction in early childhood

Objective

To identify family and infant characteristics associated with timing of introduction of two food types: core foods (nutrient-dense) and non-core foods (nutrient-poor) in a population-based sample of mothers and infants.

Method

Participants were 1861 mothers and infants from the Gemini twin birth cohort (one child per family). Family and infant characteristics were assessed when the infants were around 8 months old. Timing of introducing core and non-core foods was assessed at 8 and 15 months. As the distributions of timing were skewed, three similar-sized groups were created for each food type: earlier (core: 1–4 months; non-core: 3–8 months), average (core: 5 months; non-core: 9–10 months), and later introduction (core: 6–12 months; non-core: 11–18 months). Ordinal logistic regression was used to examine predictors of core and non-core food introduction, with bootstrapping to test for differences between the core and non-core models.

Results

Younger maternal age, lower education level, and higher maternal BMI were associated with earlier core and non-core food introduction. Not breastfeeding for at least 3 months and higher birth weight were specifically associated with earlier introduction of core foods. Having older children was specifically associated with earlier introduction of non-core foods.

Conclusion

There are similarities and differences in the characteristics associated with earlier introduction of core and non-core foods. Successful interventions may require a combination of approaches to target both food types.

Why don't they like that? And can I do anything about it? The nature and correlates of parents' attributions and self-efficacy beliefs about preschool children's food preferences

Children's food preferences influence their food intakes, which then have important effects on their health status. Presently little is understood about the aetiology of children's food preferences within families. Parental beliefs are important in many domains of socialisation although their role in the development of children's food preferences has seldom been investigated. Parents of 2-5 year old children participated in semi-structured qualitative interviews, which were analysed with content analysis. The parents either had children with healthy food preferences (i.e. closely aligned with dietary guidelines) (N=20), unhealthy food preferences (i.e. not closely aligned with dietary guidelines) (N=18), or high levels of food neophobia (N=19). Parents described their beliefs about why children like and dislike foods (their attributions) and their ability to influence children's food preferences (their self-efficacy). Children's food preferences were attributed to (a) the influence of children's characteristics (e.g. food neophobia level and personality), (b) sensory attributes of foods (e.g. texture and appearance), and (c) socialisation experiences (e.g. peer modelling and parental feeding behaviours). Results provide preliminary evidence of differences in parents' attributions and self-efficacy beliefs in the feeding domain and highlight the need for greater understanding of the ways in which parents' beliefs affect children's food preferences.

Does diet-beverage intake affect dietary consumption patterns? Results from the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial

BACKGROUND

Little is understood about the effect of increased consumption of low-calorie sweeteners in diet beverages on dietary patterns and energy intake.

OBJECTIVE

We investigated whether energy intakes and dietary patterns were different in subjects who were randomly assigned to substitute caloric beverages with either water or diet beverages (DBs).

DESIGN

Participants from the Choose Healthy Options Consciously Everyday randomized clinical trial (a 6-mo, 3-arm study) were included in the analysis [water groups: n = 106 (94% women); DB group: n = 104 (82% women)]. For energy, macronutrient, and food and beverage intakes, we investigated the main effects of time, treatment, and the treatment-by-time interaction by using mixed models.

RESULTS

Overall, the macronutrient composition changed in both groups without significant differences between groups over time. Both groups reduced absolute intakes of total daily energy, carbohydrates, fat, protein, saturated fat, total sugar, added sugar, and other carbohydrates. The DB group decreased energy from all beverages more than the water group did only at month 3 (P-group-by-time < 0.05). Although the water group had a greater reduction in grain intake at month 3 and a greater increase in fruit and vegetable intake at month 6 (P-group-by-time < 0.05), the DB group had a greater reduction in dessert intake than the water group did at month 6 (P-group-by-time < 0.05).

CONCLUSIONS

Participants in both intervention groups showed positive changes in energy intakes and dietary patterns. The DB group showed decreases in most caloric beverages and specifically reduced more desserts than the water group did. Our study does not provide evidence to suggest that a short-term consumption of DBs, compared with water, increases preferences for sweet foods and beverages. This trial was registered at clinicaltrials.gov as NCT01017783.

Trends in dietary intake among US 2- to 6-year-old children, 1989-2008

BACKGROUND

Between 1989 and 2008, obesity increased markedly in children of all ages. We examined changes in the diets of children ages 2 to 6 years in the United States between 1989 and 2008. Our study provides new insight into diet changes that might have contributed to the sharp rise in obesity during this period.

OBJECTIVE

Our aim was to describe changes in diet among 2- to 6-year-old children from 1989 to 2008 related to sharp rises in obesity during this period.

PARTICIPANTS

This analysis included 10,647 children ages 2 to 6 years from the following five nationally representative surveys of dietary intake in the United States: Continuing Survey of Food Intake in Individuals 1989-1991 and 1994-1998 and the What We Eat In America, National Health and Nutrition Examination Surveys 2003-2004, 2005-2006, and 2007-2008. Diet data were categorized into groupings using the University of North Carolina-Chapel Hill approach.

STATISTICAL ANALYSES

Analyses were carried out using a single 24-hour dietary recall with appropriate survey weighting. T tests were used to compare means across survey years, with P<0.05 considered significant.

RESULTS

During the 20-year period, there were increases in per capita intake of savory snacks (+51 kcal; P<0.01), pizza/calzones (+32 kcal; P<0.01), sweet snacks and candy (+25 kcal; P<0.01), mixed Mexican dishes (+22 kcal; P<0.01), and fruit juice (+18 kcal; P<0.01), and total daily energy intake increased by 109 kcal (from 1,475 to 1,584 kcal) (P<0.05). Fruit intake increased marginally (+24 kcal; P<0.01). Six of the 10 greatest absolute changes in per capita intake between sequential survey years occurred between Continuing Survey of Food Intake in Individuals 1994-1998 and National Health and Nutrition Examination Surveys 2003-2004 (P<0.05).

CONCLUSIONS

Foods high in added sugars and solid fats, such as savory snacks, pizza/calzones, mixed Mexican dishes, sweet snacks and candy, and fruit juice, predominated the top changes in per capita consumption between 1989 and 2008.

Taking the bitter with the sweet: relationship of supertasting and sweet preference with metabolic syndrome and dietary intake

Results examining the effects of tasting profile on dietary intake and health outcomes have varied. This study examined the interaction of sweet liker (SL) and supertaster (ST) (bitter taste test through phenylthiocarbamide [PTC]) status with incidence of metabolic syndrome. Participants (n = 196) as part of baseline testing in a behavioral weight loss study completed measures assessing SL and ST status, metabolic syndrome, and dietary intake. SLs were more likely to be African American. More women than men were STs. There was a significant interaction between ST and SL status as associated with metabolic syndrome, after adjustment for demographic characteristics. This interaction was also significantly associated with fiber and caloric beverage intake. Post hoc analyses showed that participants who were only an ST or SL appeared to have a decreased risk of having metabolic syndrome compared with those who have a combination or are neither taster groups (P = 0.047) and that SL + ST consumed less fiber than SL + non-ST (P = 0.04). Assessing genetic differences in taster preferences may be a useful strategy in the development of more tailored approaches to dietary interventions to prevent and treat metabolic syndrome.

PRACTICAL APPLICATION

Tasting profile, such as sweet liking (SL) or supertaster (ST), may be influenced by genetics, and therefore in turn, may influence dietary intake. The present study found an interaction between ST and SL status with incidence of metabolic syndrome and fiber and caloric beverage intake. Testing people for these tasting profiles may assist with tailoring dietary recommendations, particularly around fiber and caloric beverage intake, and provide a way to modify metabolic syndrome risk.

Television viewing associated with adverse dietary outcomes in children ages 2-6

The aim of this paper was to systematically review the evidence for the association between television viewing and diet in children ages 2-6. Data sources included PubMed, PsycINFO, EMBASE, ERIC, SportDISCUS, Sociological Abstracts, Web of Science and hand searches of reference lists of relevant articles. Twelve studies were reviewed in which the relationship between television viewing and diet was assessed in children between the ages of 2 and 6. All but one study reported significant relationship between television viewing time and adverse dietary outcomes. Parent-reported television viewing time was used to assay child television viewing in all included studies. Food frequency survey was the most frequent method of dietary assessment, and parent served as proxies for children in all studies. Lower fruit and/or vegetable intake was the most frequently reported dietary outcome, followed by increased energy intake with increased television viewing. The majority of studies reported adverse dietary outcomes with as little as 1 h of daily television exposure. While these results are consistent with recommendations from child health advocates to limit television viewing in young children, they also suggest that further efforts to limit television viewing in young children may be needed to aid in obesity prevention.

Early life opportunities for prevention of diabetes in low and middle income countries

BACKGROUND

The global burden of diabetes and other non-communicable diseases is rising dramatically worldwide and is causing a double poor health burden in low- and middle-income countries. Early life influences play an important part in this scenario because maternal lifestyle and conditions such as gestational diabetes and obesity affect the risk of diabetes in the next generation. This indicates important periods during the lifecourse when interventions could have powerful affects in reducing incidence of non-communicable diseases. However, interventions to promote diet and lifestyle in prospective parents before conception have not received sufficient attention, especially in low- and middle-income countries undergoing socio-economic transition.

DISCUSSION

Interventions to produce weight loss in adults or to reduce weight gain in pregnancy have had limited success and might be too late to produce the largest effects on the health of the child and his/her later risk of non-communicable diseases. A very important factor in the prevention of the developmental component of diabetes risk is the physiological state in which the parents enter pregnancy. We argue that the most promising strategy to improve prospective parents' body composition and lifestyle is the promotion of health literacy in adolescents. Multiple but integrated forms of community-based interventions that focus on nutrition, physical activity, family planning, breastfeeding and infant feeding practices are needed. They need to address the wider social economic context in which adolescents live and to be linked with existing public health programmes in sexual and reproductive health and maternal and child health initiatives.

SUMMARY

Interventions aimed at ensuring a healthy body composition, diet and lifestyle before pregnancy offer a most effective solution in many settings, especially in low- and middle-income countries undergoing socio-economic transition. Preparing a mother, her partner and her future child for "the 1000 days", whether from planned or unplanned conception would break the cycle of risk and demonstrate benefit in the shortest possible time. Such interventions will be particularly important in adolescents and young women in disadvantaged groups and can improve the physiological status of the fetus as well as reduce the prevalence of pregnancy conditions such as gestational diabetes mellitus which both predispose to non-communicables diseases in both the mother and her child. Pre-conception interventions require equipping prospective parents with the necessary knowledge and skills to make healthy lifestyle choices for themselves and their children. Addressing the promotion of such health literacy in parents-to-be in low- and middle-income countries requires a wider social perspective. It requires a range of multisectoral agencies to work together and could be linked to the issues of women's empowerment, to reproductive health, to communicable disease prevention and to the Millennium Development Goals 4 and 5.

Use of caloric and noncaloric sweeteners in US consumer packaged foods, 2005-2009

Our understanding of the use of caloric and noncaloric sweeteners in the US food supply is limited. This study uses full ingredient list and Nutrition Facts label data from Gladson Nutrition Database and nationally representative purchases of consumer packaged foods from Nielsen Homescan in 2005 through 2009 to understand the use of caloric sweeteners (including fruit juice concentrate) and noncaloric sweeteners in consumer packaged foods. Of the 85,451 uniquely formulated foods purchased during 2005 through 2009, 75% contain sweeteners (68% with caloric sweetener only, 1% with noncaloric sweetener only, 6% with both caloric and noncaloric sweeteners). Caloric sweetener are in >95% of cakes/cookies/pies, granola/protein/energy bars, ready-to-eat cereals, sweet snacks, and sugar-sweetened beverages. Noncaloric sweetener are in >33% of yogurts and sport/energy drinks, 42% of waters (plain or flavored), and most dietetic sweetened beverages. Across unique products, corn syrup is the most commonly listed sweetener, followed by sorghum, cane sugar, high-fructose corn syrup, and fruit juice concentrate. Also, 77% of all calories purchased in the United States in 2005-2009 contained caloric sweeteners and 3% contained noncaloric sweeteners, and 73% of the volume of foods purchased contained caloric sweetener and 15% contained noncaloric sweetener. Trends during this period suggest a shift toward the purchase of noncaloric sweetener-containing products. Our study poses a challenge toward monitoring sweetener consumption in the United States by discussing the need and options available to improve measures of caloric sweetener and noncaloric sweetener and additional requirements on Nutrition Facts labels on consumer packaged foods.

Reproducibility of the measurement of sweet taste preferences

Developing interventions to prevent and treat obesity are medical and public health imperatives. Taste is a major determinant of food intake and reliable methods to measure taste preferences need to be established. This study aimed to establish the short-term reproducibility of sweet taste preference measurements using 5-level sucrose concentrations in healthy adult volunteers. We defined sweet taste preference as the geometric mean of the preferred sucrose concentration determined from two series of two-alternative, forced-choice staircase procedures administered 10min apart on a single day. We repeated the same procedures at a second visit 3-7days later. Twenty-six adults (13 men and 13 women, age 33.2±12.2years) completed the measurements. The median number of pairs presented for each series was three (25th and 75th percentiles: 3, 4). The intraclass correlation coefficients between the measurements was 0.82 (95% confidence interval [CI]: 0.63-0.92) within a few days. This study showed high short-term reproducibility of a simple, 5-level procedure for measuring sweet taste preferences. This method may be useful for assessing sweet taste preferences and the risks resulting from those preferences.

Breast-feeding duration: influence on taste acceptance over the first year of life

Early feeding experiences, e.g. related to milk feeding, can affect later food and taste preferences. However, consequences of breast-feeding on taste acceptance are under-investigated. The objective of the present study was to examine the impact of exclusive breast-feeding duration (DEB) on taste acceptance at 6 and 12 months in the same infants (n122). Mothers recorded the DEB. Acceptance of solutions of each of the five basic tastes relative to water was evaluated in the laboratory at 6 and 12 months by the ingestion ratio (IR). Kendall correlations were calculated between the DEB and the IR. Only 16 % completed at least 6 months of exclusive breast-feeding; 79 % had begun complementary feeding by 6 months. At 6 months, infants preferred sweet, salty and umami solutions over water and were indifferent to sour and bitter solutions. The longer an infant was breast-fed, the more s/he accepted the umami solution at 6 months. At 12 months, infants preferred sweet and salty solutions over water and were indifferent to sour, bitter and umami solutions. The relationship between the DEB and acceptance of the umami solution was not observed at 12 months. No relationship was observed between the DEB and sweet, salty, sour and bitter taste acceptance at 6 or 12 months. The association between the DEB and umami taste acceptance at 6 months may relate to the higher glutamate content of human milk compared with formula milk. Beyond the acknowledged metabolic benefits of breast-feeding, this suggests that prolonged breast-feeding could also be associated with an impact on sensory preference at the beginning of complementary feeding.

Sweetness and food preference

Human desire for sweet taste spans all ages, races, and cultures. Throughout evolution, sweetness has had a role in human nutrition, helping to orient feeding behavior toward foods providing both energy and essential nutrients. Infants and young children in particular base many of their food choices on familiarity and sweet taste. The low cost and ready availability of energy-containing sweeteners in the food supply has led to concerns that the rising consumption of added sugars is the driving force behind the obesity epidemic. Low-calorie sweeteners are one option for maintaining sweet taste while reducing the energy content of children's diets. However, their use has led to further concerns that dissociating sweetness from energy may disrupt the balance between taste response, appetite, and consumption patterns, especially during development. Further studies, preferably based on longitudinal cohorts, are needed to clarify the developmental trajectory of taste responses to low-calorie sweeteners and their potential impact on the diet quality of children and youth.

The role and requirements of digestible dietary carbohydrates in infants and toddlers

Digestible carbohydrates are one of the main sources of dietary energy in infancy and childhood and are essential for growth and development. The aim of this narrative review is to outline the intakes of digestible carbohydrates and their role in health and disease, including the development of food preferences, as well the consequences of excess carbohydrate. Key experts in these fields provided up-to-date reviews of the literature. A search of available information on dietary intakes of children below the age of 4 years was conducted from 1985 up to 2010. Articles and reports including information about sugars and/or starch intakes were selected. A number of factors limit the ability to obtain an overall picture of carbohydrate intakes and food sources in this age group. These include small numbers of intake studies, differing approaches to analysing carbohydrate, a variety of terms used to describe sugars intakes and a dearth of information about starch intakes. Data suggest that sweet taste is preferred in infancy and later food choices. There are few established adverse consequences of high intakes of digestible carbohydrate for young children. The greatest evidence is for dental caries, although this is influenced by high intake frequency and poor oral hygiene. Evidence for detrimental effects on nutrient dilution, obesity, diabetes or cognition is limited. In infants, minimum carbohydrate (mainly lactose) intake should be 40% of total energy, gradually increasing to 55% energy by the age of 2 years.

Maternal dietary counseling reduces consumption of energy-dense foods among infants: a randomized controlled trial

OBJECTIVE

To evaluate the impact of a dietary counseling in reducing the intake of energy-dense foods by infants.

DESIGN

A randomized controlled trial.

SETTING AND PARTICIPANTS

São Leopoldo, Brazil. Mothers and infants of a low-income-group population were randomized into intervention (n = 163) and received dietary counseling during 10 home visits, or control (n = 234) groups.

MAIN OUTCOMES MEASURES

Child consumption of sugar-dense (SD) and lipid-dense (LD) foods at 12 to 16 months.

ANALYSIS

The effect of the intervention was expressed by relative risks and 95% confidence intervals. Poisson regression analysis was used to determine the association between exclusive breastfeeding and the energy-dense foods intake.

RESULTS

A smaller proportion of infants from the intervention group consumed candy, soft drinks, honey, cookies, chocolate, and salty snacks. In the intervention group, there was a reduction of 40% and 50% in the proportion of infants who consumed LD and SD foods, respectively. Being breastfed up to 6 months reduced the risk for consumption of LD and SD foods by 58% and 67%, respectively.

CONCLUSIONS AND IMPLICATIONS

Dietary counseling to mothers may be effective in reducing the consumption of energy-dense foods among infants, and it is helpful in improving early dietary habits.

From the tongue to the gut

The physiology of human taste experienced an unprecedented expansion of knowledge brought forward by modern genetics and molecular biology. In the last 10 years, the cellular organization of taste receptors from taste buds distributed in the various papillae of the tongue and the soft palate was enlightened. This molecular revolution rapidly expanded over and above the tongue because several papers reporting the presence of taste receptors in nongustatory tissues (eg, gut, brain) appeared. Hence, the issue of perception of food molecules is no longer confined to the field of nutrition and food preferences, but is rapidly expanding to gastrointestinal (GI) function and, possibly, to gut dysfunction. In children, functional GI diseases are strictly correlated to food preference and food aversion and up to now, the tools to address these kinds of problems were basic nutritional requirements, familial good sense, and a lot of patience: blunt tools to face extremely common and disturbing complaints. The fact that taste receptors are expressed down the whole of the intestinal tract is of particular interest because of their possible role in digestive behavior and absorption of nutrients; therefore, recent and future discoveries in this field will make possible the fine-tuning of new, sharper tools to treat children with functional GI diseases.

Genetics of sweet taste preferences

Sweet taste is a powerful factor influencing food acceptance. There is considerable variation in sweet taste perception and preferences within and among species. Although learning and homeostatic mechanisms contribute to this variation in sweet taste, much of it is genetically determined. Recent studies have shown that variation in the T1R genes contributes to within- and between-species differences in sweet taste. In addition, our ongoing studies using the mouse model demonstrate that a significant portion of variation in sweetener preferences depends on genes that are not involved in peripheral taste processing. These genes are likely involved in central mechanisms of sweet taste processing, reward and/or motivation. Genetic variation in sweet taste not only influences food choice and intake, but is also associated with proclivity to drink alcohol. Both peripheral and central mechanisms of sweet taste underlie correlation between sweet-liking and alcohol consumption in animal models and humans. All these data illustrate complex genetics of sweet taste preferences and its impact on human nutrition and health. Identification of genes responsible for within- and between-species variation in sweet taste can provide tools to better control food acceptance in humans and other animals.

Innate and learned preferences for sweet taste during childhood

PURPOSE OF REVIEW

In nature, carbohydrates are a source of energy often equated with sweetness, the detection of which is associated with powerful hedonic appeal. Intakes of processed carbohydrates in the form of added sugars and sugar-sweetened beverages have risen consistently among all age groups over the last two decades. In this review, we describe the biological underpinnings that drive the consumption of sweet-tasting foods among pediatric populations.

RECENT FINDINGS

Scientific literature suggests that children's liking for all that is sweet is not solely a product of modern-day technology and advertising but reflects their basic biology. In fact, heightened preference for sweet-tasting foods and beverages during childhood is universal and evident among infants and children around the world. The liking for sweet tastes during development may have ensured the acceptance of sweet-tasting foods, such as mother's milk and fruits. Moreover, recent research suggests that liking for sweets may be further promoted by the pain-reducing properties of sugars.

SUMMARY

An examination of the basic biology of sweet taste during childhood provides insight, as well as new perspectives, for how to modify children's preferences for and intakes of sweet foods to improve their diet quality.

How emotions expressed by adults' faces affect the desire to eat liked and disliked foods in children compared to adults

The aim of this study was to determine whether or not pleasure, neutrality, and disgust expressed by eaters in photographs could affect the desire to eat food products to a greater extent in children than in adults. Children of 5 and 8 years of age, as well as adults, were presented with photographs of liked and disliked foods. These foods were presented either alone or with an eater who expressed three different emotions: pleasure, neutrality, or disgust. Results showed that, compared with food presented alone, food presented with a pleasant face increased the desire to eat disliked foods, particularly in children, and increased the desire to eat liked foods only in the 5-year-old children. In contrast, with a disgusted face, the desire to eat the liked foods decreased in all participants, although to a greater extent in children, while it had no effect on the desire to eat the disliked foods. Finally, food presented with a neutral face also increased and decreased the desire to eat disliked and liked foods, respectively, and in each case more for the 5-year-olds than for the older participants. In sum, the facial expressions of others influence the desire to eat liked and disliked foods and, to a greater extent, in younger children.

Individual and job-related variation in infant feeding practices among working mothers

OBJECTIVE

To document working mothers' infant feeding practices and delineate factors that may shape infant feeding.

METHODS

Cross-sectional data were obtained from a community sample of working women with 8-month old infants (n=199).

RESULTS

Nearly all working mothers used commercially prepared foods like infant cereals, fruits, and vegetables. Approximately one-fifth fed infants french fries, sweetened beverages, and sweetened desserts. Unhealthy infant feeding was elevated among unmarried mothers, those with less education, and those with a nonstandard work schedule.

CONCLUSIONS

Working mothers use commercially prepared foods for infant feeding. Socially disadvantaged working mothers' infant feeding may pose health and developmental risks.

Developmental changes in the acceptance of the five basic tastes in the first year of life

Taste is a major determinant of children's food preferences, but its development is incompletely known. Thus, exploring infants' acceptance of basic tastes is necessary. The first objective was to evaluate the acceptance of tastes and their developmental changes over the first year. The second objective was to compare acceptance across tastes. The third objective was to evaluate global taste reactivity (within-subject variability of acceptance across tastes). Acceptance of sweet, salty, bitter, sour and umami tastes was assessed in three groups of forty-five 3-, 6- and 12-month-old infants using observations based on ingestion and liking scored by the experimenter. For each taste, four bottles were presented (water, tastant, tastant, water). Acceptance of each taste relative to water was defined using proportional variables based on ingestion or liking. Acceptance over the first year only evolved for sweet taste (marginal decrease) and salty taste (clear increase). At each age, sweet and salty tastes were the most preferred tastes. Reactions to umami were neutral. Sour and bitter tastes were the least accepted ones but rejected only when considering liking data. Ingestion and liking were complementary to assess taste acceptance. However, congruency between these measures rose during the first year. Moreover, with increasing age, reactions were more and more contrasted across tastes. Finally, during the first year, inter-individual variability increased for all tastes except salty taste. By enhancing knowledge of the development of taste acceptance the present study contributes to understand better food behaviour in infancy, the foundation of food behaviour in adulthood.

A marker of growth differs between adolescents with high vs. low sugar preference

Sweet preference is higher in childhood than adulthood but the mechanism for this developmental shift is not known. The objective of this study was to assess perceptual, physiological and eating habit differences between children preferring solutions high in sugar (high preference) and children preferring solutions low in sugar (low preference). We tested 143 children (11- to 15-years old) using sip and spit methodology to assess their hedonic profile, detection threshold, and perceived intensity of sucrose. Their plasma concentration of several hormones, a biomarker of bone-growth, body size, puberty stage, and dietary habits were measured. Eighty-eight children were classified as high preference and 53 were classified as low preference based on their hedonic ratings to a series of sucrose solutions. A marker of bone growth measured in urine and plasma leptin adjusted for body weight were significantly lower in the low preference group. Children with high and low preference patterns did not differ in sensory aspects of sucrose perception, nor did they differ in age, body mass index percentile, or dietary restraint. The change in sugar preference from high to low during adolescence appears to be associated with the cessation of growth.

Consumption of fruit, vegetables, sweets and soft drinks are associated with psychological dimensions of eating behaviour in parents and their 12-year-old children

Objective

We investigated associations between consumption of fruits, vegetables, sweets and soft drinks and the psychological dimensions of eating in parents and their children. The role of the parent’s characteristics for their children’s food intake was also explored.

Design

Food intake patterns were assessed by self-reported consumption of the respective foods. Eating behaviour was measured by the Dutch Eating Behaviour Questionnaire and self-esteem by Harter self-perception scale. The participants were 1441 families (mother, father and their 12-year-old child), and additionally 354 mothers and thirty fathers.

Results

Among parents, reported intake of fruit and vegetables were associated with restrained eating, higher self-esteem, and higher education and age. Intake of sweets was related to more external and less restrained eating, and for mothers also emotional eating. Parent’s intake of soft drink was foremost related to a younger age, and also weakly associated with psychological characteristics. The food intake of parents was more important for the children’s food intake than any other characteristics. However, children’s intake of sweets showed clear-cut positive associations with external eating.

Conclusions

Psychological dimensions of eating behaviour are associated with patterns of food intake, in particular for consumption of sweets, and are most prominent in the parents. The children’s food intake mirrored their parents’ intake. Being sensitive to external food cues may increase unhealthy food consumption in our society, whereas more restrained eating may indicate proneness or intention to healthier food choices among parents. Emotional eating may imply a proneness to consume sweets for comfort, in particular among mothers.

Food consumption, eating behaviour and self-esteem among singlev. married and cohabiting mothers and their 12-year-old children

Objective

Being a single mother may have implications for health behaviours that can also affect the child. More information about the food intakes and body weights in singlev. married/cohabiting mothers and in their children is needed. Psychological dimensions of eating behaviour and self-esteem are also of relevance to explore for single mothers and their children.

Design

Food style patterns were assessed by self-reported consumption of fruits, vegetables, sweets and soft drinks. Eating behaviour was measured by the Dutch Eating Behaviour Questionnaire and self-esteem by the Harter self-perception scale. The participants were 1781 mothers and their 12-year-old children, of whom 278 mothers (16 %) were single.

Results

Single mothers had lower intake of fruits and vegetables and lower self-worth compared to the married and cohabiting mothers, controlling for age, education and BMI. Although single mothers did not have a higher BMI, their daughters were heavier than girls from complete families. Daughters to single mothers furthermore had a higher intake of soft drinks, higher levels of restrained eating and lower self-worth. No such difference was found for the boys.

Conclusions

A lower sense of self-worth and lower intake of fruit and vegetables in single mothers could be seen in the context of the social disadvantages and less social support. Girls may be more inclined to be affected by family status than the boys, seen in a more unfortunate psychological pattern and a higher body weight. Boy’s health behaviours may be more unaffected by living in single families.

Biobehavior of the human love of salt

We are beginning to understand why humans ingest so much salt. Here we address three issues: The first is whether our salt appetite is similar to that in animals, which we understand well. Our analysis suggests that this is doubtful, because of important differences between human and animal love of salt. The second issue then becomes how our predilection for salt is determined, for which we have a partial description, resting on development, conditioning, habit, and dietary culture. The last issue is the source of individual variation in salt avidity. We have partial answers to that too in the effects of perinatal sodium loss, sodium loss teaching us to seek salt, and gender. Other possibilities are suggested. From animal sodium appetite we humans may retain the lifelong enhancement of salt intake due to perinatal sodium loss, and a predisposition to learn the benefits of salt when in dire need. Nevertheless, human salt intake does not fit the biological model of a regulated sodium appetite. Indeed this archetypal 'wisdom of the body' fails us in all that has to do with behavioral regulation of this most basic need.

Physiological regulation through learnt control of appetites by contingencies among signals from external and internal environments

As reviewed by [Cooper, S. J. (2008). From Claude Bernard to Walter Cannon: emergence of the concept of homeostasis. Appetite 51, 419-27.] Claude Bernard's idea of stabilisation of bodily states, as realised in Walter B. Cannon's conception of homeostasis, took mathematical form during the 1940s in the principle that externally originating disturbance of a physiological parameter can feed an informative signal around the brain to trigger counteractive processes--a corrective mechanism known as negative feedback, in practice reliant on feedforward. Three decades later, enough was known of the physiology and psychology of eating and drinking for calculations to show how experimentally demonstrated mechanisms of feedforward that had been learnt from negative feedback combine to regulate exchanges of water and energy between the body and the surroundings. Subsequent systemic physiology, molecular neuroscience and experimental psychology, however, have been traduced by a misconception that learnt controls of intake are 'non-homeostatic', the myth of biological 'set points' and an historic failure to address evidence for the ingestion-adapting information-processing mechanisms on which an operationally integrative theory of eating and drinking relies.

The effect of frequency of consumption of artificial sweeteners on sweetness liking by women

Research into sweetness perception and preference thus far has demonstrated that sweetness preference is related not to the total sugar consumed by an individual but the amount of refined sugar ingested. Research has yet to be conducted, however, to determine whether a diet high in artificial sweeteners contributes to sweetness liking and preference with the same result as a diet high in sugar. The purpose of this research was to determine if such a relationship exists with regard to diets high in artificially sweetened beverages. Seventy-one female participants were recruited and screened for sweetener consumption in beverages. Sixty-four of these individuals were selected for sensory testing. All participants evaluated orange juice samples (ranging from 0% added sucrose to 20% added sucrose) for liking of sweetness using a 9-point hedonic scale. Based on screening survey data, participants were categorized according to sweetener consumption group (artificial sweetener consumers and natural sweetener consumers) and by overall sweetened beverage intake (low or high, regardless of sweetener type normally consumed). Sensory data were analyzed to compare sweetness liking in each of these groups. Significant differences in liking were observed, with individuals in the high sweetened beverage intake group preferring sweeter orange juice than those in the low-intake group. Categorization by sweetener type resulted in no significant differences between the groups, indicating that regardless of the type of sweetener consumed in a beverage, liking of sweetness will be influenced in the same manner.

Genetic and environmental determinants of children's food preferences

Omnivores have the advantage of a variety of food options but face a challenge in identifying foods that are safe to eat. Not surprisingly, therefore, children show a relative aversion to new foods (neophobia) and a relative preference for familiar, bland, sweet foods. While this may in the past have promoted survival, in the modern food environment it could have an adverse effect on dietary quality. This review examines the evidence for genetic and environmental factors underlying individual differences in children's food preferences and neophobia. Twin studies indicate that neophobia is a strongly heritable characteristic, while specific food preferences show some genetic influence and are also influenced by the family environment. The advantage of the malleability of human food preferences is that dislike of a food can be reduced or even reversed by a combination of modelling and taste exposure. The need for effective guidance for parents who may be seeking to improve the range or nutritional value of foods accepted by their children is highlighted.