The excess salt appetite of humans is not due to sodium loss in adulthood

Sex Differences in Salt Appetite: Perspectives from Animal Models and Human Studies

Salt ingestion by animals and humans has been noted from prehistory. The search for salt is largely driven by a physiological need for sodium. There is a large body of literature on sodium intake in laboratory rats, but the vast majority of this work has used male rats. The limited work conducted in both male and female rats, however, reveals sex differences in sodium intake. Importantly, while humans ingest salt every day, with every meal and with many foods, we do not know how many of these findings from rodent studies can be generalized to men and women. This review provides a synthesis of the literature that examines sex differences in sodium intake and highlights open questions. Sodium serves many important physiological functions and is inextricably linked to the maintenance of body fluid homeostasis. Indeed, from a motivated behavior perspective, the drive to consume sodium has largely been studied in conjunction with the study of thirst. This review will describe the neuroendocrine controls of fluid balance, mechanisms underlying sex differences, sex differences in sodium intake, changes in sodium intake during pregnancy, and the possible neuronal mechanisms underlying these differences in behavior. Having reviewed the mechanisms that can only be studied in animal experiments, we address sex differences in human dietary sodium intake in reproduction, and with age.

The impact of 16-h heat exposure on appetite and food reward in adults

Heat exposure is thought to reduce energy intake (EI) but studies are sparse and results not always concordant. The aim of this study was to examine whether a 16-h exposure to 32 °C leads to reduced EI compared to a control session (22 °C) and whether modifications in appetite sensations or food reward are implied. Sixteen healthy, lean, and active participants (9 women and 7 men, 25 ± 5 yo, body mass index: 22.0 ± 2.4 kg.m^-2) were passively exposed to two different thermal temperatures from 4:00 pm to 8:00 am under controlled conditions. Hunger and thirst scores were regularly assessed using visual analogue scales. A fixed dinner meal (3670 ± 255 kJ) was consumed at 7:30 pm and an ad libitum breakfast buffet (20 foods/drinks varying in temperature, fat, and carbohydrate content) at 7:30 am. Components of reward (explicit liking [EL] and implicit wanting [EI]) for fat and sweet properties of food were assessed before each meal using the Leeds Food Preference Questionnaire (LFPQ). Ad libitum EI at breakfast did not differ between sessions (2319 ± 1108 vs 2329 ± 1141 kJ, in 22 and 32 °C sessions, respectively; p = 0.955). While thirst scores were higher in the 32 than the 22 °C session (p < 0.001), hunger scores did not differ (p = 0.580). EL and IW for high fat foods relative to low fat foods were decreased in 32 compared to 22 °C before dinner and breakfast (p < 0.001 for all). Although EI and hunger were not affected by a 16-h exposure to heat, modifications in food reward suggested a reduction in the preference of high-fat foods. Future research should investigate whether reduced EI in response to heat exposure is due to spontaneous selection of low-fat foods rather than altered appetite sensations.

Exertional sodium loss does not increase immediate salt appetite or dietary sodium intake in athletes

We tested whether salt preference increases immediately after exertion-induced Na⁺ loss in sweat, and whether this may generalise to an increase in habitual dietary Na⁺ intake. For the first aim, trained athletes (n = 20) exercised in 2 ambient temperatures and sweat Na⁺ loss related to immediate salt preference assessed by taste, intake and psychophysical tests. For the second aim, we compared dietary and urinary Na⁺, and salt preference, seasoning and hedonics in the athletes and sedentary men (n = 20). No relationship was found between sodium loss during exercise and immediate preference for salt or psychophysical responses, and no differences in comparison to sedentary men. However, athlete diet had fewer foods (29.4 ± 1.5 vs 37.8 ± 1.9, p < 0.001), less seasoning (19 vs 32. p = 0.011) and more athletes reported dietary limitations (31 vs 11, p < 0.05), although nutrient content did not differ. Together these might suggest athlete adherence to a healthy diet at the expense of variety and flavour and a dissociation between dietary reports and intake. Athletes, more than controls, liked foods rich in energy and K⁺ suggesting compensatory-driven hedonics, although overall their intake did not differ. The findings are consistent with the absence of a salt appetite responding to Na⁺ loss in humans, and specifically that trained athletes do not increase their preference for salt in immediate response to exertion-induced Na⁺ loss and are not at risk for increased dietary Na⁺ compared to sedentary men.

Salt need needs investigation

Expensive and extensive studies on the epidemiology of excessive Na intake and its pathology have been conducted over four decades. The resultant consensus that dietary Na is toxic, as well as the contention that it is less so, ignores the root cause of the attractiveness of salted food. The extant hypotheses are that most Na is infiltrated into our bodies via heavily salted industrialised food without our knowledge and that mere exposure early in life determines lifelong intake. However, these hypotheses are poorly evidenced and are meagre explanations for the comparable salt intake of people worldwide despite their markedly different diets. The love of salt begins at birth for some, vacillates in infancy, climaxes during adolescent growth, settles into separate patterns for men and women in adulthood and, with age, fades for some and persists for others. Salt adds flavour to food. It sustains and protects humans in exertion, may modulate their mood and contributes to their ailments. It may have as yet unknown benefits that may promote its delectability, and it generates controversy. An understanding of the predilection for salt should allow a more evidence-based and effective reduction of the health risks associated with Na surfeit and deficiency. The purpose of this brief review is to show the need for research into the determinants of salt intake by summarising the little we know.

Acculturation of immigrant diet, basic taste responses and sodium appetite

In young new Ethiopian immigrants (EI, about 0·5 years since immigration; n 20), veteran Ethiopian immigrant students (ES, about 13 years since immigration; n 30) and native Israeli students (NS; n 82), dietary macronutrients and electrolytes, and responses to basic tastes were compared in a cross-sectional design. From EI, to ES, to NS, dietary energy, protein, fat, and Na⁺ increase, whereas carbohydrates, K⁺ and Ca²⁺ do not differ. Corrected for energy intake, only Na⁺ increases. EI consume less dietary Na⁺, like foods with less Na⁺ content, salt their food less, yet show a greater hedonic response to salt taste. In contrast, preference for sweet does not differ. Taste psychophysics, 6-n-propylthiouracil (PROP) responses and lingual fungiform papillae density differ by group (and sex), but do not relate to dietary intake. Together, these changes could reflect dietary acculturation, increasing overall intake, Na⁺ in particular, accompanied by decreasing taste sensitivity, and changes in sensory perception and preference in these Ethiopian immigrants. The fact that immigrants find salt more hedonic, yet eat less of it, could suggest increased sensitivity to its taste, and might suggest restoring sensitivity to reduce Na⁺ intake for all. Similar alterations in taste sensory responses might be obtained in other forms of dietary flux. Understanding dietary acculturation can focus efforts (e.g. on Na⁺), to anticipate the disease burden of diets of affluence among immigrants. Yet, these immigrants’ nutrition is healthier in its low fat and Na⁺, suggesting that nutritional advice should focus on preservation, as well as prevention. Our study adds Ethiopian nutritional acculturation to that of the varied immigrant groups around the world.

Perceived 6-n-Propylthiouracil (PROP) Bitterness Is Associated with Dietary Sodium Intake in Female Japanese College Students

Despite the negative health consequences of a high sodium consumption, humans consume well above the recommended levels. This study examines whether or not the dietary intake of sodium was affected by individual variation of the perceived bitterness of 6-n-propylthiouracil (PROP), and examines the relationship between the perceived bitterness of PROP and the preferred NaCl concentration of broth. Female students (20-22 y old) were recruited from the university community. Genotypes of A49P and I296V polymorphism of the TAS2R38 bitter taste receptor were determined for each subject. Samples containing NaCl, PROP or broth in 5-mL portions were evaluated by sensory testing. The participants completed a food record for each diet. Our results indicate that the individuals perceiving PROP to be more bitter had consumed a greater amount of dietary sodium. In contrast, there was no significant positive correlation between an individual's perceived saltiness and the dietary sodium intake. Those who perceived PROP to be more bitter preferred a broth containing a higher concentration of NaCl. All of these correlations were apparent even after those subjects with TAS2R38 AI/AI homozygotes (PROP non-taster) had been excluded. In conclusion, the results of this study suggest that a factor affecting the bitter rating of PROP other than the AI/AI homozygotes of TAS2R38 contributes to the variation in sodium intake and the preference for salty food.

Salt appetite is not increased in summer heat

We tested the hypothesis that salt appetite increases in summer heat due to increased sodium loss due to increased drinking and perspiration. A test battery in the same sample of healthy young people tested in summer and winter revealed no seasonal differences in salt appetite (or fluid intake) despite a 10 °C rise in mean environmental temperature. Unexpectedly, sweet preference is reduced in summer.

Determinants of water and sodium intake and output

Physiological regulation of sodium and water intake and output is required for the maintenance of homeostasis. The behavioral and neuroendocrine mechanisms that govern fluid and salt balance are highly interdependent, with acute and chronic alterations in renal output tightly balanced by appropriate changes in thirst and, to a lesser extent in humans, sodium appetite. In healthy individuals, these tightly coupled mechanisms maintain extracellular fluid volume and body tonicity within a narrow homeostatic range by initiating ingestive behaviors and the release of hormones necessary to conserve water and sodium within the body. In this review, the factors that determine output of sodium and fluid and those that determine "normal" input (i.e., matched to output) are addressed. For output, individual variability accompanied by dysregulation of homeostatic mechanisms may contribute to acute and/or chronic disease. To illustrate that point, the specific condition of salt-sensitive hypertension is discussed. For input, physical characteristics, physiological phenotypes, genetic and developmental influences, and cultural and environmental factors combine to result in a wide range of individual variability that, in humans, is compensated for by alterations in excretion.

Does salt increase thirst?

Our diet is believed to be overly rich in sodium, and it is commonly believed that sodium intake increases drinking. Hence the concern of a possible contribution of dietary sodium to beverage intake which in turn may contribute to obesity and ill health. Here we examine whether voluntary, acute intake of a sodium load, as occurs in routine eating and snacking, increases thirst and drinking. We find that after ingesting 3.5 or 4.4 g NaCl (men) and 1.9 or 3.7 g (women) on nuts during 15 minutes, there is no increase in thirst or drinking of freely available water in the following 2 h compared with eating similar amounts of sugared or unflavored nuts. This suggests that routine ingestion of boluses of salt (~30-40% of daily intake for men, ~ 20-40% for women) does not increase drinking. Methodological concerns such as about nuts as vehicle for sodium suggest further research to establish the generalizability of this unexpected result.

Salt appetite in the elderly

The present study investigated whether salt appetite in the elderly is impaired similar to thirst because of the commonality of their physiological substrates and whether alterations in salt appetite are related to mood. Elderly (65–85 years, n 30) and middle-aged (45–58 years, n 30) men and women were compared in two test sessions. Thirst, psychophysical ratings of taste solutions, dietary Na and energy intakes, seasoning with salt and sugar, number of salty and sweet snacks consumed, preferred amounts of salt in soup and sugar in tea, and an overall measure of salt appetite and its relationship with mood, nocturia and sleep were measured. Elderly participants were found to be less thirsty and respond less to thirst. In contrast, no impairment of salt appetite was found in them, and although they had a reduced dietary Na intake, it dissipated when corrected for their reduced dietary energy intake. Diet composition and Na intake were found to be similar in middle-aged and elderly participants, despite the lesser intake in elderly participants. There were no age-related differences in the intensity of taste or hedonic profile of Na, in salting habits, in tests of salting soup, or number of salty snacks consumed. No relationship of any measure of salt appetite with mood measured by the Positive and Negative Affect Schedule, frequency of nocturia, or sleep duration was observed. The age-related impairment of the physiology of mineralofluid regulation, while compromising thirst and fluid intake, spares salt appetite, suggesting that salt appetite in humans is not regulated physiologically. Intact salt appetite in the elderly might be utilised judiciously to prevent hyponatraemia, increase thirst and improve appetite.

Changes in taste preference after colorectal surgery: A longitudinal study

BACKGROUND & AIMS

Nutrition is a key component of surgical enhanced recovery programmes. However, alterations in food preferences are often reported as reasons for patients not eating in the early postoperative period. We hypothesised that taste preferences are altered in the early postoperative period and this dysgeusia affects patients' food choices during this critical time.

METHODS

This is a longitudinal study looking at taste preferences of patients recovering from surgery. Patients undergoing colonic resections were recruited. Using visual analogue scales participants completed a questionnaire, taste tests and preference scoring of food images for the 6 groups of taste (bitter, salty, savoury, sour, spicy and sweet) preoperatively and on postoperative days 1-3. Patients were also offered snacks postoperatively, which represented foods from the six groups and consumption was measured. Differences from baseline were assessed using the Friedman's and Wilcoxon tests.

RESULTS

31 patients were studied. In the immediate postoperative period participants reported deterioration in their sense of taste (p ≤ 0.001), increased nausea (p < 0.001) and hunger (p = 0.03). Sweet, savoury and spicy tastes were the most popular during the perioperative period. However, only palatability for salty taste increased (p = 0.001) following surgery. The highest rated images were for savoury food with only the ratings for salty food increasing after surgery (p < 0.05). These findings concurred with the sweet, savoury and salty snacks being the most consumed foods in the postoperative period. Bitter, sour and spicy foods were the least frequently consumed.

DISCUSSION

This is the first study to investigate postsurgical patients' food preferences. A consistent change in all the individual tastes with the exception of salty in the postoperative period was observed. The most desirable tastes were for savoury and sweet, reflecting patients' preoperative preferences. An improved understanding of taste may improve the resumption of eating after colonic surgery.

Intact sensory function in anorexia nervosa

BACKGROUND

In anorexia nervosa (AN), taste and smell are believed to be anhedonic, hunger and pain are muted, and body-image distortion obscures wasting, which together facilitate self-starvation. However, the emphasis on these deficits may be biased because other sensory systems have been sparsely investigated.

OBJECTIVES

Objectives of the study were to clarify whether these dysfunctions are specific or part of a pattern of sensory-perceptual deficits in AN patients and to test the gustatory senses dissociated from ingestion to clarify whether any deficit is sensory or affective.

DESIGN

In 15 adolescent, first-episode, hospitalized, restrictive AN patients and 15 matched healthy controls who responded to gustatory stimuli (intensity and hedonics of 5 basic tastes and tastes and odors of foods and nonfoods), size estimation (manual and oral judgment of size and shape, kinesthesia, and body size and esthetics), cold pain, and auditory and visual processing were compared.

RESULTS

AN patients did not differ on most tests, were better at odor recognition, were less successful in central auditory processing and oral assessment of size and shape, and may have been more sensitive to cold. Body-image dissatisfaction in AN patients was not related to dysfunctional size estimation.

CONCLUSIONS

There is no systematic sensory-perceptual deficit in AN patients, and specifically, not in gustatory function. The few differences shown might be due to fear of food-related stimuli or comorbidity.

Higher salt preference in heart failure patients

Heart failure (HF) is a complex syndrome that involves changes in behavioral, neural and endocrine regulatory systems. Dietary salt restriction along with pharmacotherapy is considered an essential component in the effective management of symptomatic HF patients. However, it is well recognized that HF patients typically have great difficulty in restricting sodium intake. We hypothesized that under HF altered activity in systems that normally function to regulate body fluid and cardiovascular homeostasis could produce an increased preference for the taste of salt. Therefore, this study was conducted to evaluate the perceived palatability (defined as salt preference) of food with different concentrations of added salt in compensated chronically medicated HF patients and comparable control subjects. Healthy volunteers (n=25) and medicated, clinically stable HF patients (n=38, NYHA functional class II or III) were interviewed and given an evaluation to assess their preferences for different amounts of saltiness. Three salt concentrations (0.58, 0.82, and 1.16 g/100 g) of bean soup were presented to the subjects. Salt preference for each concentration was quantified using an adjective scale (unpleasant, fair or delicious). Healthy volunteers preferred the soup with medium salt concentration (p=0.042), HF patients disliked the low concentration (p<0.001) and preferred the high concentration of salted bean soup (p<0.001). When compared to healthy volunteers, HF patients demonstrated a significantly greater preference for the soup with a high salt concentration (p=0.038). It is concluded that medicated, compensated patients under chronic treatment for HF have an increased preference for salt.

Low fat loss response after medium-term supervised exercise in obese is associated with exercise-induced increase in food reward

Objective. To examine exercise-induced changes in the reward value of food during medium-term supervised exercise in obese individuals. Subjects/Methods. The study was a 12-week supervised exercise intervention prescribed to expend 500 kcal/day, 5 d/week. 34 sedentary obese males and females were identified as responders (R) or non-responders (NR) to the intervention according to changes in body composition relative to measured energy expended during exercise. Food reward (ratings of liking and wanting, and relative preference by forced choice pairs) for an array of food images was assessed before and after an acute exercise bout. Results. 20 responders and 14 non-responders were identified. R lost 5.2 kg ± 2.4 of total fat mass and NR lost 1.7 kg ± 1.4. After acute exercise, liking for all foods increased in NR compared to no change in R. Furthermore, NR showed an increase in wanting and relative preference for high-fat sweet foods. These differences were independent of 12-weeks regular exercise and weight loss. Conclusion. Individuals who showed an immediate post-exercise increase in liking and increased wanting and preference for high-fat sweet foods displayed a smaller reduction in fat mass with exercise. For some individuals, exercise increases the reward value of food and diminishes the impact of exercise on fat loss.

Explaining variability in sodium intake through oral sensory phenotype, salt sensation and liking

Our sodium-rich food supply compels investigation of how variation in salt sensation influences liking and intake of high-sodium foods. While supertasters (those with heightened propylthiouracil (PROP) bitterness or taste papillae number) report greater saltiness from concentrated salt solutions, the non-taster/supertaster effect on sodium intake is unclear. We assessed taster effects on salt sensation, liking and intake among 87 healthy adults (45 men). PROP bitterness showed stronger associations with perceived saltiness in foods than did papillae number. Supertasters reported: greater saltiness in chips/pretzels and broth at levels comparable to regular-sodium products; greater sensory and/or liking changes to growing sodium concentration in cheeses (where sodium ions mask bitterness) and broths; and less frequently salting foods. PROP effects were attenuated in women. Compared with men, women reported more saltiness from high-sodium foods and greater liking for broth at salt levels comparable to regular-sodium products. Across men and women, Structural Equation Models showed PROP and papillae number independently explained variability in consuming high-sodium foods by impacting salt sensation and/or liking. PROP supertasters reported greater changes in sensation when more salt was added to broth, which then associated with greater changes in broth liking, and finally with more frequent high-sodium food intake. Greater papillae number was associated with less frequent high-sodium food intake via reduced liking for high-fat/high-sodium foods. In summary, variation in sensations from salt was associated with differences in hedonic responses to high-sodium foods and thus sodium intake. Despite adding less salt, PROP supertasters consumed more sodium through food, as salt was more important to preference, both for its salty taste and masking of bitterness.

Salt preference of nursing mothers is associated with earlier cessation of exclusive breastfeeding

Successful breastfeeding is predicated on its initial success. Salt appetite during lactation may be relevant to breastfeeding success because sodium is essential for development of foetus and neonate. Here we examined whether maternal salt preference might facilitate breastfeeding. Nursing mothers (n=327) were categorized as high, medium or low salt preferring, and the relationship to persistence of exclusive breastfeeding during the first 25 days postnatal was evaluated. Contrary to expectation, we find that mothers with low salt preference persisted in breastfeeding beyond day 7 postnatal in comparison to mothers with high salt preference, and mothers with high salt preference had the shortest exclusive breastfeeding duration up to postnatal day 25. Awareness of this among health workers and nursing mothers could contribute to successful breastfeeding.