Understanding sweet-liking phenotypes and their implications for obesity: Narrative review and future directions

Does sweetness exposure drive 'sweet tooth'?

It is widely believed that exposure to sweetened foods and beverages stimulates the liking and desire for sweetness. Here we provide an updated review of the empirical evidence from human research examining whether exposure to sweet foods or beverages influences subsequent general liking for sweetness (‘sweet tooth’), based on the conclusions of existing systematic reviews and more recent research identified from a structured search of literature. Prior reviews have concluded that the evidence for a relationship between sweet taste exposure and measures of sweet taste liking is equivocal, and more recent primary research generally does not support the view that exposure drives increased liking for sweetness, in adults or children. In intervention trials using a range of designs, acute exposure to sweetness usually has the opposite effect (reducing subsequent liking and desire for sweet taste), while sustained exposures have no significant effects or inconsistent effects. Recent longitudinal observational studies in infants and children also report no significant associations between exposures to sweet foods and beverages with measures of sweet taste preferences. Overall, while it is widely assumed that exposure to sweetness stimulates a greater liking and desire for sweetness, this is not borne out by the balance of empirical evidence. While new research may provide a more robust evidence base, there are also a number of methodological, biological and behavioural considerations that may underpin the apparent absence of a positive relationship between sweetness exposure and liking.

Comparing body composition between the sweet-liking phenotypes: experimental data, systematic review and individual participant data meta-analysis

BACKGROUND

Legislation aimed at reducing sugar intake assumes that sweet-liking drives overconsumption. However, evidence that a greater liking for sweet taste is associated with unhealthier body size is mixed and complicated by relatively small samples, an overreliance on body mass index (BMI) and lack of classification using sweet-liking phenotypes.

METHODS

We first examined body size data in two larger samples with sweet-liking phenotyping: extreme sweet-likers, moderate sweet-likers and sweet-dislikers. Adults (18-34yrs), attended a two-session lab-based experiment involving phenotyping for sweet-liking status and a bioelectrical impedance body composition measurement (Experiment One: N = 200; Experiment Two: N = 314). Secondly, we conducted an individual participant data (IPD) meta-analysis: systematic searches across four databases identified 5736 potential articles. Of these, 53 papers met our search criteria: a taste assessment that measured liking using sucrose (>13.7% w/v), which allowed sweet-liking phenotyping and included either BMI, body fat percentage (BF%), fat-free mass (FFM) or waist-circumference.

RESULTS

A significant effect of sweet-liking phenotype on FFM was found in both Experiment One and Two, with extreme sweet-likers having significantly higher FFM than sweet-dislikers. In Experiment One, sweet-dislikers had a significantly higher BF% than extreme sweet-likers and moderate sweet-likers. However, as these data are from one research group in a young, predominantly westernised population, and the results did not perfectly replicate, we conducted the IPD meta-analyses to further clarify the findings. Robust one-stage IPD meta-analyses of 15 studies controlling for sex revealed no significant differences in BF% (n = 1836) or waist-circumference (n = 706). For BMI (n = 2368), moderate sweet-likers had slightly lower BMI than extreme sweet-likers, who had the highest overall BMI. Most interestingly, for FFM (n = 768), moderate sweet-likers and sweet-dislikers showed significantly lower FFM than extreme sweet-likers.

CONCLUSION

The higher BMI often seen in sweet-likers may be due to a larger FFM and questions the simple model where sweet liking alone is a risk factor for obesity.

Sweet and sour sips: No effect of repeated exposure to sweet or sour-tasting sugary drinks on children's sweetness preference and liking

Health agencies advocate reducing children's sweetness exposure to lower sweetness preference or liking to ultimately lower sugar intake. However, the relationship between sweetness exposure, preference, and liking remains unclear. This work investigated the influence of exposure to a sucrose-containing sweet or sour-tasting drink on sweetness preference and liking for sweet and sour products in 4-7-year-old children (n = 65). The children were randomized into three groups with one daily exposure to either the sweet drink, sour drink, or water (control group) for 14 days. Sweetness preference was assessed at baseline (t1), day 15 (t2), and two months after the intervention (t3), using a forced-choice, paired comparison test with five beverages varying in sweetness intensity. Hedonic liking for the intervention drinks, a sweet and sour yogurt, and a sweet and sour candy was evaluated using a 5-point pictorial scale. Linear mixed models revealed a significant increase in sweetness preference from t1 to t3 (F(2) = 7.46, p < 0.001). However, ANCOVA analysis indicated that this effect was not caused by the intervention. Based on linear mixed models, we observed that children's hedonic liking for sweet and sour products remained stable from t1 to t3 and was not influenced by the intervention. These findings suggest that 14 exposures to a sucrose-containing sweet or sour-tasting drink did not affect sweetness preference or liking in 4-7-year-old children.

Sweet liking predicts liking and familiarity of some alcoholic beverages, but not alcohol intake: A population study using a split-sample approach

Sweetness has been proposed to be an important quality in the decision to consume alcohol, and strong preferences for sweet tastes have been associated with alcohol abuse. However, alcohol is characterized by a number of other sensory properties, including astringency and bitterness that may drive preference and consumption. Spinelli et al. (2021) classified individuals into three sweet-sensory liking clusters (High Sweet-Liking, Moderate Sweet-Liking, and Inverted-U) that differed in their sweetness optima and sensory-liking patterns (relationship between liking and sweetness, bitterness and astringency perception in a food model). The current paper replicates the sweet sensory-liking clusters in a new set of participants (n = 1976), and extends the predicted value of these clusters examining their relationship to wine and other types of alcoholic beverages by gender using a split-sample approach on a total of over 3000 adults. The sweet sensory-liking clusters had a predictive relationship for the familiarity and liking of some alcoholic beverages characterized by stronger tastes, but not weekly alcohol intake levels. Thus, although sweet sensory-liking clusters may be associated with the type of beverages and frequency with which a person will drink and enjoy a type of alcoholic beverage, they are poor predictors of the quantity of alcohol that a person ingests over the course of a week.

Regulator of G-Protein Signalling 9: A New Candidate Gene for Sweet Food Liking?

Genetics plays an important role in individual differences in food liking, which influences food choices and health. Sweet food liking is a complex trait and has been associated with increased body mass index (BMI) and related comorbidities. This genome-wide association study (GWAS) aimed to investigate the genetics of sweet food liking using two adult discovery cohorts (n = 1109, n = 373) and an independent replication cohort (n = 1073). In addition, we tested the association of our strongest result on parameters related to behaviour (food adventurousness (FA) and reward dependence (RD) and health status (BMI and blood glucose). The results demonstrate a novel strong association between the Regulator of G-Protein Signalling 9 (RGS9I) gene, strongest single nucleotide polymorphism (SNP) rs58931966 (p-value 7.05 × 10^-9 in the combined sample of discovery and replication), and sweet food liking, with the minor allele (A) being associated with a decreased sweet food liking. We also found that the A allele of the rs58931966 SNP was associated with decreased FA and RD, and increased BMI and blood glucose (p-values < 0.05). Differences were highlighted in sex-specific analysis on BMI and glucose. Our results highlight a novel genetic association with food liking and are indicative of genetic variation influencing the psychological-biological drivers of food preference. If confirmed in other studies, such genetic associations could allow a greater understanding of chronic disease management from both a habitual dietary intake and reward-related perspective.

Study protocol of the sweet tooth study, randomized controlled trial with partial food provision on the effect of low, regular and high dietary sweetness exposure on sweetness preferences in Dutch adults

BACKGROUND

Several health organizations recommend lowering the consumption of sweet-tasting foods. The rationale behind this recommendation is that a lower exposure to sweet foods may reduce preferences for sweet tasting foods, thus lowering sugar and energy intake, and in turn aiding in obesity prevention. However, empirical data supporting this narrative are lacking. In fact, relatively little is known about the contribution of long-term sweet taste exposure on one's sweetness preferences.

METHODS

The primary objective of this randomized controlled trial is to assess the effect of low, regular and high dietary sweetness exposure on preference for sweet foods and beverages, and to compare these effects between intervention groups. One hundred and eighty adults aged 18-65 years with a BMI of 18.5-30.0 kg/m² will be recruited and randomly allocated to either: low dietary sweetness exposure (LSE) (10-15% daily energy from sweet tasting foods), regular dietary sweetness exposure (RSE) (25-30% daily energy from sweet tasting foods), or high dietary sweetness exposure (HSE) (40-45% daily energy from sweet tasting foods), for 6 months, followed by a 4-month follow up. Intervention foods are provided ad libitum, covering approximately 50% of the daily number of food items, to include sugar-sweetened, low-calorie-sweetener-sweetened and non-sweet foods. The primary outcome measure is the difference in change in sweetness preference from baseline to 6 months between intervention groups. Secondary outcomes include: change in sweet taste preferences at different time-points; taste intensity perception; behavioral outcomes: food choice and intake, sweet-liker type, food cravings, dietary taste preferences and dietary taste patterns; anthropometric outcomes: body composition, waist-hip circumference, body weight; and biochemical outcomes: glucose variability and biomarkers related to CVD and diabetes.

DISCUSSION

This study will generate important data on the effect of dietary sweetness exposure on sweetness preferences in terms of effect size and change, duration of change and its impact on food intake, body weight status and associated health outcomes.

TRIAL REGISTRATION

The study protocol has been registered on ClinicalTrials.gov (ID no. NCT04497974, Registered 4 August 2020, https://clinicaltrials.gov/ct2/show/NCT04497974 ) and approved by Wageningen's Medical Ethical Committee (ABR no. NL72134).

The sweet tooth of infancy: Is sweetness exposure related to sweetness liking in infants up to 12 months of age?

Infants become increasingly exposed to sweet-tasting foods in their first year of life. However, it is still unclear whether repeated exposure to sweet taste is linked to infants' sweetness liking during this period. Making use of data from the OPALINE cohort, this study aimed to examine the link between sweetness exposure and sweetness liking during two important periods in early infant feeding: at the start of complementary feeding (3-6 months) and the transition to the family table (10-12 months). Infants' sweetness exposure was assessed using 7-d food records which were completed by mothers every month (n 312), reporting daily consumption rates of formula/breast milk or complementary food and the type of formula milk and/or complementary foods for each feeding occasion. Infants' sweetness liking was studied in the laboratory at 3, 6 and 12 months of age by assessing their response to a lactose-water solution and the amount drunk of this solution compared with plain water. Linear regressions and structural equation model assessed associations between exposure to and liking for sweetness at 6 and 12 months. Neither at 6 (n 182) nor at 12 months (n 197) was sweetness exposure associated with sweetness liking. While sweetness liking at 3 months was unrelated to liking at 6 months, the latter predicted sweetness liking at 12 months. These findings demonstrate no association between sweetness exposure at 3 to 12 months and liking at 6 and 12 months despite a sharp increase in sweetness exposure in that period. However, sweetness liking at 6 and 12 months was positively associated.

Characterizing Individual Differences in Sweet Taste Hedonics: Test Methods, Locations, and Stimuli

Sweetness drives the consumption of added sugars, so understanding how to best measure sweet hedonics is important for developing strategies to lower sugar intake. However, methods to assess hedonic response to sweetness vary, making results across studies difficult to integrate. We compared methods to measure optimal sucrose concentration in 21 healthy adults (1) using paired-comparison preference tracking vs. ratings of liking, (2) with participants in the laboratory vs. at home, and (3) using aqueous solutions vs. vanilla milk. Tests were replicated on separate days to assess test-retest reliability. Test-retest reliability was similar between laboratory and home testing, but tended to be better for vanilla milk and preference tracking. Optimal sucrose concentration was virtually identical between laboratory and home, slightly lower when estimated via preference tracking, and about 50% lower in vanilla milk. However, optimal sucrose concentration correlated strongly between methods, locations, and stimuli. More than 50% of the variability in optimal sucrose concentration could be attributed to consistent differences among individuals, while much less variability was attributable to differences between methods. These results demonstrate convergent validity between methods, support testing at home, and suggest that aqueous solutions can be useful proxies for some commonly consumed beverages for measuring individual differences.

Re-evaluating how sweet-liking and PROP-tasting are related

Past research has identified distinct phenotypic differences in responses to sweet taste, although the origins of these differences remain unclear. One possibility is that these individual differences in sweet-liking are a manifestation of the more widely known differences in sensitivity to the bitter tastant 6-n-propylthiouracil (PROP), which has been related to wider differences in food liking and preference. However, previous studies exploring the relationship between sweet-liking and PROP-tasting have had mixed outcomes. This is possibly due to older studies using a more simplistic dichotic characterisation of sweet likers, whereas recent research suggests three sweet-liking phenotypes (extreme sweet likers, ESL; moderate sweet likers, MSL; and sweet dislikers, SD). To re-assess how sweet-liking and PROP tasting are inter-related, 236 volunteers evaluated their liking for 1.0 M sucrose and the intensity of three concentrations of each NaCl and PROP. Using three different methods for classifying PROP taster status, our analysis confirmed that all three sweet-liking phenotypes were represented in all three PROP taster groups (super-tasters, ST; medium tasters, MT; and non-tasters, NT), but relatively few ESL were classified as ST, or SD as NT. Overall, these data suggest that while PROP tasting and sweet-liking are not causally related, the SD phenotype may partly be explained by a broader tendency for anhedonia.

Alterations in sweet taste function in adults with diabetes mellitus: a systematic review and potential implications

Diet therapy for diabetes involves controlling carbohydrate intake in order to manage blood glucose concentrations. Simple carbohydrates, like sucrose, quickly and potently raise blood glucose when ingested, and are typically perceived as sweet. Sweetness is innately pleasurable and contributes to the positive hedonic evaluation of foods and beverages. There is some evidence to suggest that individuals with diabetes mellitus may be less able to detect sweetness, which could result in increased intake and, thus, more difficulty managing blood glucose. A systematic review that included PubMed, PsycInfo, and Embase databases was conducted. Inclusion criteria included observational studies that investigated the sweet taste function of adults with and without diabetes mellitus (Prospero CRD42021225058). The quality of the final included studies was assessed using the Academy of Nutrition and Dietetics' Evidence Analysis Library Quality Criteria Checklist: Primary Research tool. Eighteen studies that compared sweet taste thresholds, intensity ratings, or hedonic responses in adults both with and without diabetes were included. Differences in sweet taste thresholds, both detection and recognition, indicated that individuals with diabetes were less sensitive than healthy controls. The same findings were observed for intensity ratings. Only two studies examined hedonic responses; results were inconclusive.

Visual cues associated with sweet taste increase short-term eating and grab attention in healthy volunteers

Most studies that examine responses to food cues use images of actual foods as stimuli. Since foods are rewarding in multiple ways, it then becomes difficult to try and partial out the role of the importance of different aspects of food reward. Here we aimed to evaluate the impact of novel visual cues specifically associated with the immediate sensory reward from a liked sweet taste. In the training phase, one visual cue (CSsweet) was associated with the experience of sweet taste (10%sucrose) and a second, control cue (CSneutral) with a neutral taste (artificial saliva) using a disguised training procedure. In Experiment 1, participants (n = 45) were given an ad libitum snack intake test 30 min post-training, either labelled with CSsweet or CSneutral. Total caloric consumption was significantly higher in the CSsweet (650 ± 47 kcal) than CSneutral (477 ± 45 kcal) condition, but ratings of liking for the snacks did not differ significantly between conditions. In Experiment 2, participants (n = 80) exhibited an overall attentional bias (22.1 ± 9.9 ms) for the CSsweet relative to CSneutral cue (assessed using a dot-probe task), however rated liking for the CSsweet did not change significantly after cue-sweet training. Likewise, measures of expected satiety for drinks labelled with CSsweet did not differ significantly from CSneutral. Overall these two experiments provide evidence that associations between neutral visual cues and the experience of a liked sweet taste leads to cue-potentiated eating in the presence of the CSsweet cue. With no evidence that cue-sweet training altered rated liking for the visual cues, and in keeping with extant literature on the dissociation of hedonic and rewarding properties of food rewards, we propose this potentiation effect to reflect increased incentive salience.