Hunger, taste, and normative cues in predictions about food intake

The Impact of Modifiable Preoral Factors on Swallowing and Nutritional Outcomes in Healthy Adults: A Scoping Review

PURPOSE

Swallowing has previously been characterized as consisting of four phases; however, it has become apparent that these four phases are not truly discrete and may be influenced by factors occurring prior to bolus entrance into the oral cavity (i.e., preoral factors). Still, the relationship between these factors and swallowing remains poorly understood. The aim of this review was to synthesize and characterize the literature pertaining to the influence of preoral factors on swallowing and nutritional outcomes in healthy individuals.

METHOD

We performed a scoping review, searching the databases of PubMed, CINAHL, Cochrane, and Scopus. Search terms included those related to swallowing, experience of preoral factors, and exclusionary terminology to reduce animal and pediatric literature. Our initial search revealed 5,560 unique articles, of which 153 met our inclusionary criteria and were accepted into the review.

RESULTS

Of the accepted articles, 78% were focused exclusively on nutritional outcomes, 17% were focused on both swallowing and nutritional outcomes, and 5% were focused on solely swallowing outcomes. Of the preoral factors examined, 99% were exteroceptive in nature (17% olfactory, 44% visual, 21% auditory, 7% tactile, 11% other), while 1% were proprioceptive in nature.

CONCLUSIONS

This review supports the influence of preoral factors on swallowing and nutritional outcomes. However, there is a large emphasis on the visual modality and on nutritional outcomes. Nearly none of the literature found in this review directly measured swallowing safety, efficiency, or physiology. Future work will benefit from a larger focus on proprioceptive preoral factors as they relate to swallowing outcomes.

Evaluating eating behavior traits of virtual targets: Attitudes and empathy

There are many common stereotypes related to food consumption and eating behaviors that are considered indicative of one's personal character. Negative evaluations of an individual based on their eating behaviors may lead to stigmatization and other harmful psychosocial outcomes. Using vignette scenarios, we examined 582 participants' attitudes towards two target characters who exhibited bitter food dislike and high reward-based eating drive respectively. In open-ended text responses, participants were more likely to respond negatively and use stigmatizing language when describing the character with high reward-based eating drive versus the character with bitter food dislike. In addition, empathic responses depended on whether participants believed they, themselves, exhibited reward-based eating drive. Participants tended to be more empathetic and more positive towards the target who shared their own reward-based eating behaviors. Interestingly, the same was not true for those who shared bitter food distaste. These results suggest that eating behaviors that are perceived as more controllable and unusual may be more negatively perceived. Targeted education or support to reduce negative attitudes about such traits may be beneficial.

Development and validation of an online tool to assess perceived portion size norms of discretionary foods

BACKGROUND

Perceived portion size norms (typical perception of how much of a given food individuals choose to eat at a single occasion) may have shifted towards larger sizes due to the ubiquity of large serving sizes. However, there is a lack of validated tools to assess such norms for energy-dense and nutrient-poor discretionary foods. This study aimed to develop and validate an online tool to examine the perceived portion size norms of discretionary foods.

METHODS

An online image-series tool of 15 commonly consumed discretionary foods was developed, with eight successive portion size options included for each food. Using a randomised-crossover design, adult consumers (18-65 years) completed the validation study in a laboratory session (April-May 2022) by reporting their perceived portion size norms for each food twice, once based on food images on a computer and another time based on equivalent real food portion size options at food stations in the laboratory. Agreement between methods for each test food was examined using cross-classification and intra-class correlation (ICC).

RESULTS

A sample of 114 subjects were recruited (mean age 24.8 years). Cross-classification indicated >90% of selections were matched in the same or adjacent portion size option. ICC was 0.85 across all foods, demonstrating a good level of agreement.

CONCLUSION

This novel online image-series tool developed to examine perceived portion size norms of discretionary foods showed good agreement with equivalent real food portion size options and may be valuable to investigate perceived portion size norms of common discretionary foods in future studies.

Altruistic behaviour decreases agent's unhealthy food intake: Based on the self-determination theory model of vitality

This study explored whether altruistic behaviour would decrease agent's unhealthy food intake, and whether vitality and state self-control would sequentially mediate this effect based on the Self-Determination Theory Model of Vitality. It included 1019 college students in total across three studies. Study 1 was a laboratory experiment. By framing a physical task as a helping behaviour or a neutral experimental task, we examined whether these framed tasks impacted participants' subsequent unhealthy food intake levels. Study 2 was an online investigation measuring the relationship between donation (vs. no donation) behaviour and participant's estimated unhealthy food intake level. Study 3 was an online experiment with a mediation test. By random assignment of conducting a donation behaviour versus a neutral task, we examined whether these behaviours affected participants' vitality, state self-control, and estimated unhealthy food intake levels. In addition, we tested a sequential mediation model with vitality and state self-control as the mediators. Both unhealthy and healthy foods were included in Study 2 and 3. Results showed that altruistic behaviour could decrease agent's unhealthy (but not healthy) food intake, and this effect was sequentially mediated by vitality and state self-control. The findings highlight that altruistic acts may buffer agents against unhealthy eating behaviour.

Awareness of Social Influences on Eating Is Dependent on Familiarity With Imagined Dining Partners and Type of Eating Occasion

When eating with strangers, people tend to eat less than they would when eating alone (social inhibition of eating), whereas they tend to eat more with family and friends (social facilitation of eating). To assess awareness of the social inhibition and facilitation of eating we conducted two online studies (Study 1:N = 481; Study 2:N = 485). In Study 1, participants imagined a dining scenario and indicated whether they would eat the same, more, or less when eating with someone who was more or less familiar to them (friend; family member; acquaintance; stranger) compared with when eating alone. Results from Study 1 indicated that participants imagined eating special meals with friends/family and so, in Study 2, another group of participants made the same predictions as for Study 1, but they did so for special and regular meals. In Study 1, a significant majority of participants said that they would "eat less" with a stranger/acquaintance. A similar proportion of participants said that they would "eat the same" or "eat more" when with a friend/family member and significantly fewer participants said that they would "eat less" with a friend/family member. In Study 2, the majority of participants said that they would "eat less" with a stranger across both special and regular meals. For meals with an acquaintance, the majority of participants reported that they would "eat the same" during regular meals, while for special meals, equal numbers said that they would "eat the same" as would "eat less." The majority of participants indicated that they would "eat more" during a special meal with a friend/family member. However, for regular meals with a friend/family member, a significant majority of participants said that they would "eat the same." Hence, participants acknowledge the social inhibition of intake and the social facilitation of eating at special meals, but they are either unwilling or unable to acknowledge that they would eat more with a friend/family member at a regular meal compared with eating alone. Raising awareness that eating with friends/family is associated with greater intake at regular meals may be helpful for individuals who are trying to manage their intake.

The role of nurse staffing in the performance of function-preserving processes during acute hospitalization: A cross-sectional study

BACKGROUND

Performance of function-preserving hospitalization processes related to patient mobility, use of continence aids and food intake is significantly associated with outcomes in older adults. Nurses are the front-line personnel responsible for promoting performance of such processes. The degree to which nurse staffing is related to this performance is unclear.

OBJECTIVE

To identify nurse-staffing characteristics and nursing-related care needs associated with older patients' mobility, continence care and food intake during acute hospitalization.

DESIGN

Cross-sectional study using survey data from the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR) cohort study combined with day-level administrative nurse staffing data and clinical day-level aggregated data for all patients hospitalized during the HoPE-FOR study period.

SETTING

Internal medicine units in two medical centers in Israel.

PARTICIPANTS

Eight hundred seventy-three older adults.

METHODS

Mobility, continence care and food intake were assessed within 2 days of admission using validated questionnaires. Nurse-to-patient ratios and nursing-skill mix (i.e. registered nurses (RNs), nurse aides, nurses with advanced clinical training and RNs with an academic degree) were assessed using administrative data. Decision trees were developed for mobility, continence care and food intake, applying classification and regression-tree analysis.

RESULTS

The mobility decision tree identified three characteristics subdividing patients into six nodes: pre-admission functioning, pre-admission activity level and percentage of nurses with advanced training. The percentage of nurses with advanced training classified low-functioning patients into those walking in corridors versus walking or sitting only inside the room. The continence-care classification decision tree identified two characteristics that subdivided the patients into four nodes: pre-admission functioning and bladder control. Nurse-to-patient-ratio variables and patients' nursing-related care needs did not contribute to this classification. The food-intake decision tree identified four characteristics-pre-admission functioning, gender, percentage of nurses with advanced training and percentage of nurse aides-subdividing patients into eight nodes. Low-functioning patients exposed to a higher percentage of nurses with advanced training had food-intake scores 14% higher than patients exposed to a lower percentage of nurses with advanced training. Independent men exposed to a higher percentage of nurse aides had a 14% higher habitual daily in-hospital food-intake score than independent men exposed to a lower percentage of nurse aides.

CONCLUSIONS

A higher percentage of nurses with post-graduate education is associated with better performance of mobility and food intake of hospitalized older adults. To maintain the potential benefits of highly trained staff, education levels should be considered in scheduling and assignment decision-making processes in internal medicine units. Tweetable abstract: A higher percentage of nurses with post-graduate education is associated with better mobility and food intake of hospitalized older adults.

Portion size normality and additional within-meal food intake: two crossover laboratory experiments

Reducing food portion size could reduce energy intake. However, it is unclear at what point consumers respond to reductions by increasing intake of other foods. We predicted that a change in served portion size would only result in significant additional eating within the same meal if the resulting portion size was no longer visually perceived as 'normal'. Participants in two crossover experiments (Study 1: n 45; Study 2: n 37; adults, 51 % female) were served different-sized lunchtime portions on three occasions that were perceived by a previous sample of participants as 'large-normal', 'small-normal' and 'smaller than normal', respectively. Participants were able to serve themselves additional helpings of the same food (Study 1) or dessert items (Study 2). In Study 1 there was a small but significant increase in additional intake when participants were served the 'smaller than normal' compared with the 'small-normal' portion (m difference = 161 kJ, P = 0·002, d = 0·35), but there was no significant difference between the 'small-normal' and 'large-normal' conditions (m difference = 88 kJ, P = 0·08, d = 0·24). A similar pattern was observed in Study 2 (m difference = 149 kJ, P = 0·06, d = 0·18; m difference = 83 kJ, P = 0·26, d = 0·10). However, smaller portion sizes were each associated with a significant reduction in total meal intake. The findings provide preliminary evidence that reductions that result in portions appearing 'normal' in size may limit additional eating, but confirmatory research is needed.