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van den Brink M, Havermans RC, Fiocco M, Tissing WJE. A longitudinal evaluation of smell and taste function in children with cancer during and after treatment with chemotherapy. Appetite 2024; 193:107174. [PMID: 38128763 DOI: 10.1016/j.appet.2023.107174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
Smell and taste changes are bothersome treatment symptoms interfering with food intake. It remains unclear how and when children with cancer experience such changes during chemotherapy, and if the symptoms resolve after treatment. In this longitudinal study, we measured smell and taste function of 94 childhood cancer patients treated for hematological, solid, or brain malignancies. Smell and taste function were assessed using commercial Sniffin' Sticks and Taste Strips, respectively. For both tests, normative values were used to identify the presence of smell and taste abnormalities. Self-reported chemosensory and appetite changes were assessed using a questionnaire. Measurements were taken approximately 6 weeks (T0), 3 months (T1), 6 months after starting chemotherapy (T2), and 3 months after termination of chemotherapy or maintenance phase for children with acute lymphoblastic leukemia (ALL) (T3). We found that smell and taste scores did not change during active treatment (T0-2). However, approximately 20% of the patients suffered from decreased taste function according to normative values, particularly children with lymphoma or solid tumors. Changes in smell were predominantly characterized as increased rather than decreased. Self-reported changes were much more common than objectively measured, with smell changes ranging from 26 to 53% and taste changes up to 80% during treatment. After active treatment, odor threshold scores decreased in children with ALL during maintenance phase, whereas total taste scores increased in all children at T3. In summary, objectively measured smell and taste function remained stable during active treatment, while at the individual level a fairly large number of children suffered from chemosensory distortions which comprised either increased or decreased sensitivity. Individual dietary advice and coping strategies are warranted to prevent detrimental effects on food intake in children with cancer.
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Affiliation(s)
- Mirjam van den Brink
- Laboratory of Behavioral Gastronomy, Centre for Healthy Eating and Food Innovation, Maastricht University Campus Venlo, PO Box 8, 5900 AA, Venlo, the Netherlands; Princess Máxima Center for Pediatric Oncology, PO Box 113, 3720 AC, Bilthoven, the Netherlands.
| | - Remco C Havermans
- Laboratory of Behavioral Gastronomy, Centre for Healthy Eating and Food Innovation, Maastricht University Campus Venlo, PO Box 8, 5900 AA, Venlo, the Netherlands
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, PO Box 113, 3720 AC, Bilthoven, the Netherlands; Mathematical Institute, Leiden University, PO Box 9512, 2300 RA, Leiden, the Netherlands; Medical Statistics, Department of Biomedical Data Science, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, PO Box 113, 3720 AC, Bilthoven, the Netherlands; Department of Pediatric Oncology and Hematology, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, the Netherlands
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Ranmal SR, Nhouchi Z, Keeley A, Adler L, Lavarde M, Pensé-Lhéritier AM, Tuleu C. Taste assessment for paediatric drug Development: A comparison of bitterness taste aversion in children versus Naïve and expert young adult assessors. Int J Pharm 2023; 647:123494. [PMID: 37806503 DOI: 10.1016/j.ijpharm.2023.123494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
Medicines for children often taste bitter, presenting a significant challenge to treatment compliance. However, most studies on paediatric drug development rely on adult volunteers for sensory research, and the level of expertise required from these assessors is unclear. This study aimed to address this gap by investigating perceived bitterness aversion to taste strips impregnated with different concentrations of quinine hydrochloride in 439 school-aged children. Expert (n = 26) and naïve (n = 65) young adult assessors evaluated quinine solutions as well as taste strips, for methodological bridging purposes. All assessors differentiated the aversiveness of the taste strips in a dose dependent manner. Younger children aged 4-8 years had difficulty discriminating higher bitter concentrations, whereas pre-adolescents 9-11 years and naive adults showed better discrimination at the top of the scale. Naive assessors showed similar bitter perception as children. However, the results were slightly different between strips and solution in adults. These findings highlight the key role that adult panels can play in paediatric formulation development. Taste strips show promise as a safe and pragmatic tool for sensory pharmaceutical evaluations, though further studies are warranted to establish the relationship between age and hedonic taste perception using compounds with diverse physicochemical and sensory qualities.
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Affiliation(s)
- Sejal R Ranmal
- UCL School of Pharmacy, University College London, 29-39, Brunswick Square, London WC1N 1AX, UK.
| | - Zeineb Nhouchi
- Ecole de Biologie Industrielle - EBI, UPR EBInnov®, 49, Avenue des Genottes CS90009 95895, Cergy-Pontoise, France.
| | - Alexander Keeley
- UCL School of Pharmacy, University College London, 29-39, Brunswick Square, London WC1N 1AX, UK.
| | - Lisa Adler
- Ecole de Biologie Industrielle - EBI, UPR EBInnov®, 49, Avenue des Genottes CS90009 95895, Cergy-Pontoise, France.
| | - Marc Lavarde
- Ecole de Biologie Industrielle - EBI, UPR EBInnov®, 49, Avenue des Genottes CS90009 95895, Cergy-Pontoise, France.
| | - Anne-Marie Pensé-Lhéritier
- Ecole de Biologie Industrielle - EBI, UPR EBInnov®, 49, Avenue des Genottes CS90009 95895, Cergy-Pontoise, France.
| | - Catherine Tuleu
- UCL School of Pharmacy, University College London, 29-39, Brunswick Square, London WC1N 1AX, UK.
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Yoo O, von Ungern-Sternberg BS, Lim LY. Paediatric Medicinal Formulation Development: Utilising Human Taste Panels and Incorporating Their Data into Machine Learning Training. Pharmaceutics 2023; 15:2112. [PMID: 37631326 PMCID: PMC10459634 DOI: 10.3390/pharmaceutics15082112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
This review paper explores the role of human taste panels and artificial neural networks (ANNs) in taste-masking paediatric drug formulations. Given the ethical, practical, and regulatory challenges of employing children, young adults (18-40) can serve as suitable substitutes due to the similarity in their taste sensitivity. Taste panellists need not be experts in sensory evaluation so long as a reference product is used during evaluation; however, they should be screened for bitterness taste detection thresholds. For a more robust evaluation during the developmental phase, considerations of a scoring system and the calculation of an acceptance value may be beneficial in determining the likelihood of recommending a formulation for further development. On the technological front, artificial neural networks (ANNs) can be exploited in taste-masking optimisation of medicinal formulations as they can model complex relationships between variables and enable predictions not possible previously to optimise product profiles. Machine learning classifiers may therefore tackle the challenge of predicting the bitterness intensity of paediatric formulations. While advancements have been made, further work is needed to identify effective taste-masking techniques for specific drug molecules. Continuous refinement of machine learning algorithms, using human panellist acceptability scores, can aid in enhancing paediatric formulation development and overcoming taste-masking challenges.
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Affiliation(s)
- Okhee Yoo
- Pharmacy, School of Allied Health, University of Western Australia, Perth, WA 6009, Australia;
| | - Britta S. von Ungern-Sternberg
- Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, WA 6009, Australia;
- Department of Anaesthesia and Pain Medicine, Perth Children’s Hospital, Perth, WA 6009, Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, WA 6009, Australia
| | - Lee Yong Lim
- Pharmacy, School of Allied Health, University of Western Australia, Perth, WA 6009, Australia;
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Sobek G, Jagielski P. The Number of Fungiform Papillae, Taste Sensitivity and Smell Functions of Children Aged 11–15. Nutrients 2022; 14:nu14132578. [PMID: 35807758 PMCID: PMC9268619 DOI: 10.3390/nu14132578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 02/04/2023] Open
Abstract
Differences in the ability to identify and perceive tastes and smells might influence food consumption and, ultimately, chronic nutrition-related conditions such as overweightness and obesity. This study aimed to investigate the associations between taste sensitivity and odour function, anthropometry, and quantity of fungiform papillae in children at age 11–15. Taste strips (4 base tastes), U-Sniff sticks (12 selected smells), and a filter paper strip impregnated with 6-n-propylthiouracil (PROP) were used. The photographic method was used to estimate the number of fungiform papillae (FP) on the tongue. The results showed that the quantity of FP was not related to anthropometry or gender. The taste test total scores were higher for girls, for whom the median score was 14 (12.0–15.0), than for boys, for whom the median score was 12 (9.0–13.0). Of the children, 13.9% had some difficulty in identifying odours. The Mann–Whitney U test showed that children who were most sensitive to bitter taste had more FP (p = 0.0001). The median score for this group (score = 4) was 34.0 (27.0–37.0). For those who had some problems with correctly assessing all bitter taste strips (score = 0–3), the median score was 24.0 (20.0–31.0). Higher numbers of FP were also observed in tasters, that is, people sensitive to PROP, than in nontasters. Only some measures of the taste function correlated with each other, but not very significantly. We concluded that there are multiple perceptual phases of taste, with no single measure able to entirely represent the sense of taste.
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Affiliation(s)
- Grzegorz Sobek
- Institute of Health Sciences, Medical College of Rzeszów University, 35-959 Rzeszów, Poland
- Correspondence:
| | - Paweł Jagielski
- Department of Nutrition and Drug Research, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-066 Krakow, Poland;
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