Taste assessment in normal weight and overweight individuals with co-occurring Binge Eating Disorder

Uses of the NIH Toolbox® in Clinical Samples: A Scoping Review

Background and Objectives

The NIH Toolbox® for the Assessment of Neurologic and Behavioral Function is a compilation of computerized measures designed to assess sensory, motor, emotional, and cognitive functioning of individuals across the life span. The NIH Toolbox was initially developed for use with the general population and was not originally validated in clinical populations. The objective of this scoping review was to assess the extent to which the NIH Toolbox has been used with clinical populations.

Methods

Guided by the Joanna Briggs Methods Manual for Scoping Reviews, records were identified through searches of PubMed MEDLINE, PsycINFO, ClinicalTrials.gov, EMBASE, and ProQuest Dissertations and Theses Global (2008-2020). Database searches yielded 5,693 unique titles of original research that used at least one NIH Toolbox assessment in a sample characterized by any clinical diagnosis. Two reviewers screened titles, abstracts, and full texts for inclusion in duplicate. Conflicts at each stage of the review process were resolved by a group discussion.

Results

Ultimately, 281 publication records were included in this scoping review (nJournal Articles = 104, nConference Abstracts = 84, nClinical Trial Registrations = 86, and nTheses/Dissertations = 7). The NIH Toolbox Cognition Battery was by far the most used of the 4 batteries in the measurement system (nCognition = 225, nEmotion = 49, nMotor = 29, and nSensation = 16). The most represented clinical category was neurologic disorders (n = 111), followed by psychological disorders (n = 39) and cancer (n = 31). Most (96.8%) of the journal articles and conference abstracts reporting the use of NIH Toolbox measures with clinical samples were published in 2015 or later. As of May 2021, these records had been cited a total of nearly 1,000 times.

Discussion

The NIH Toolbox measures have been widely used among individuals with various clinical conditions across the life span. Our results lay the groundwork to support the feasibility and utility of administering the NIH Toolbox measures in research conducted with clinical populations and further suggest that these measures may be of value for implementation in fast-paced clinical settings as part of routine practice.

Psychophysical chemosensory dysfunction in eating disorders: a qualitative systematic review

PURPOSE

Patients with chemosensory dysfunction experience significant quality of life disruptions, including reduced enjoyment of eating. While chemosensory dysfunction has been associated with eating disorders, the relationship is poorly understood. This systematic review aims to characterize psychophysical gustation and olfaction in patients with eating disorders.

METHODS

Systematic review of investigations assessing psychophysical chemosensory function in patients with organic eating disorders.

RESULTS

26 studies were included. Five studies assessed both chemosenses, while 12 and 9 assessed exclusively gustation or olfaction, respectively. In total, 779 patients were included [72.4% anorexia nervosa (AN), 26.7% bulimia nervosa (BN), 0.8% combined AN/BN]. Patients with eating disorders experienced rates of hypogeusia up to 87% in AN and 84.6% in BN. There was evidence for alterations in psychophysical olfaction, but orientation of trends were less clear. Chemosensory dysfunction was more evident in AN patients. Treatment correlated with improved chemosensory function.

CONCLUSIONS

Despite heterogeneity in study methodology and results, this review demonstrates that patients with eating disorders experience some degree of chemosensory dysfunction, particularly in gustation. This symptomatology overlaps with those experienced by patients with other causes of chemosensory impairment. These findings suggest potential broad psychosocial, dietary, and mental health implications in patient populations experiencing chemosensory dysfunction.

LEVEL OF EVIDENCE

Level II.

A Systematic Review of Taste Differences Among People With Eating Disorders

BACKGROUND

Eating disorders are a significant cause of morbidity and mortality. The etiology and maintenance of eating-disorder symptoms are not well understood. Evidence suggests that there may be gustatory alterations in patients with eating disorders.

OBJECTIVE

This article systematically reviews research assessing gustatory differences in patients with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).

METHOD

A systematic review was performed, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, examining taste and eating disorders. We reviewed electronic databases and identified 1,490 peer-reviewed English-language studies. Of these, 49 met inclusion criteria.

RESULTS

Studies employed psychophysical measures (n = 27), self-reported questionnaires (n = 5), and neuroimaging techniques (i.e., electroencephalography, functional magnetic resonance imaging; n = 17). Psychophysical studies showed that individuals with BN, in general, had greater preference for sweetness than healthy controls, and those with AN had a greater aversion for fat than controls. In neuroimaging studies, findings suggested that predictable administration of sweet-taste stimuli was associated with reduced activation in taste-reward regions of the brain among individuals with AN (e.g., insula, ventral, and dorsal striatum) but increased activation in BN and BED.

DISCUSSION

To our knowledge, this systematic review is the first to synthesize literature on taste differences in AN, BN, and BED. The inconsistency and variability in methods used across studies increased difficulties in comparing studies and disease processes. Further studies with well-defined population parameters are warranted to better understand how taste varies in patients with eating disorders.

Sweet taste preference in binge-eating disorder: A preliminary investigation

Research suggests that individuals with high liking for sweets are at increased risk for binge eating, which has been minimally investigated in individuals with binge-eating disorder (BED). Forty-one adults (85% female, 83% white) with binge eating concerns completed a sweet taste test and measures of eating disorder behaviors and food cravings. A subset of participants with BED completed an oral glucose tolerance test (OGTT; N=21) and a 24-hour dietary recall (N=26). Regression models were used to compare highest sweet preferers (HSP [N=18]) to other sweet preferers (OSP [N=23]) and were used to assess associations between sweet taste preference and outcome variables. Effect sizes (ηp²) for differences between HSP and OSP ranged from small (≤0.01) to large (≥0.24); group differences were statistically nonsignificant except for 24-hour caloric intake (ηp²=0.16, p=0.04), protein intake (ηp²=0.16, p=0.04), and insulin sensitivity index (ηp²=0.24, p=0.04), which were higher in HSP, and postprandial insulin, which was smaller in HSP (ηp²=0.27, p=0.03). Continuous analyses replicated postprandial insulin response. Compared with OSP, HSP reported numerically higher binge-eating frequency (ηp²=0.04), over-eating frequency (ηp²=0.06), and carbohydrate intake (ηp²=0.14), and they exhibited numerically smaller postprandial glucose AUC (ηp²=0.16). Sweet taste preference may have implications for glucose regulation, binge-eating frequency, and nutrient intake in BED.

Processing of visual food cues during bitter taste perception in female patients with binge-eating symptoms: A cross-modal ERP study

OBJECTIVE

In healthy individuals, the perception of an intense bitter taste decreased the reward value of visual food cues, as reflected by the reduction of a specific event-related brain potential (ERP), frontal late positivity. The current cross-modal ERP study investigated responses of female patients with binge-eating symptoms (BES) to this type of visual-gustatory stimulation.

METHODS

Women with BES (n=36) and female control participants (n=38) viewed food images after they rinsed their mouth with either bitter wormwood tea or water.

RESULTS

Relative to controls, the patients showed elevated late positivity (LPP: 400-700ms) to the food images in the bitter condition. The LPP source was located in the medial prefrontal cortex. Both groups did not differ in the ratings for the fluids (intensity, bitterness, disgust).

CONCLUSIONS

This ERP study showed that a bitter taste did not decrease late positivity to visual food cues (reflecting food reward) in women with BES.

SIGNIFICANCE

The atypical bitter responding might be a biological marker of this condition and possibly contributes to overeating. Future studies should additionally record food intake behavior to further investigate this mechanism.