Possibilities for Maintaining Appetite in Recovering COVID-19 Patients

Using Cooking Schools to Improve the Pleasure of Food and Cooking in Patients Experiencing Smell Loss

Smell loss affects around 15-20% of the population, with a major effect on the quality of life. The most common complaint is the impairment of the eating experience, with around 90% of patients reporting this issue. A study conducted at a specialised Taste and Smell Clinic investigated if food and cooking can positively affect the enjoyment of food, subjective cooking skills, and quality of life in patients with smell loss. The 49 participants in the study received a 5-week cooking school course that focused on emphasizing the other senses to regain the enjoyment of food. Participants gained more confidence in cooking, and their quality of life improved significantly. Positively evaluated recipes were adjusted based on feedback and published as free e-books in Danish, German, and English. Eating and cooking are multisensory experiences, and the perception of food depends on the complex interaction of senses and surroundings. If the olfactory input is reduced or absent, both the enjoyment and cooking experience can be negatively affected. Therefore, focusing on food and cooking can have a positive impact on patients with smell loss.

Long-term smell loss experiences after COVID-19: A qualitative study

OBJECTIVES

Sudden smell loss is one of the early symptoms of COVID-19. Although it is stated that the loss of smell and taste following COVID-19 improves within a few weeks, there are also cases that do not improve for a long time. The aim of this study is to reveal long-term smell loss experiences after COVID-19.

METHODS

A qualitative approach was adopted. We conducted semistructured interviews with 11 participants who had smell loss for at least 3 months. Interviews were recorded, transcribed and evaluated using a thematic analysis for qualitative data.

RESULTS

Nutrition and appetite, personal hygiene, threats to safety and emotional changes were the main themes created by the authors and were the areas where participant expressions focused. The participants used oral/nasal corticosteroid therapy for smell loss and received short-term olfactory training, but could not find a solution.

CONCLUSIONS

Long-term smell loss problems, which were neglected during the pandemic period, should be carefully evaluated due to their negative effects. Understanding and focusing on the negative effects of loss of smell may contribute to the solution of long-term smell loss problems.

PATIENT AND PUBLIC CONTRIBUTION

Eleven participants who experienced long-term loss of smell following COVID-19 contributed to the study. They enriched the study by describing the effects of their experiences. There was no other participation or contribution from the public to the research.

Measuring Pleasure from Food-Validation of the Food Pleasure Scale by Multiple Techniques and Mixed Methods

The development of scales and questionnaires to assess pleasure perception has gained prominence, particularly for evaluating anhedonia in mental disorders. The Food Pleasure Scale is a comprehensive tool exclusively dedicated to measuring pleasure perception from food and food-related experiences. This study aimed to evaluate the face validity and consistency reliability of the Food Pleasure Scale using a mixed methods approach. Twenty-two participants completed the Food Pleasure Scale questionnaire and participated in in-depth interviews to understand their interpretation of the scale items. The interview data underwent thematic analysis, and the quantitative survey data was compared to the qualitative interview responses. Results indicated a high level of understanding of all items in the Food Pleasure Scale, confirming its face validity and applicability. The mixed methods approach supported the consistency reliability, showing consistency between quantitative measures and participants' explicit and implicit expressions of food pleasure. Furthermore, the study revealed a novel aspect related to food pleasure: the concept of "making an effort". Overall, this study highlights the comprehensibility, validity, and potential of the Food Pleasure Scale in consumer studies. It effectively captures the subjective experience of pleasure derived from food and food-related encounters, making it a valuable tool for further research in this domain.

Altered expression levels of TAS1R2 and TAS1R3 genes among SARS-CoV-2 variants of concerns

BACKGROUND

The most common symptoms of coronavirus infections are fever, cough, shortness of breath, headache, ache of joints, a loss of smell and loss of taste, and etc. Early studies suggested that smell and taste receptors were associated with pathogenic detection and immunity. Thus, we aimed to evaluate the expression profile of gene receptors that are related to taste, smell, and appetite control in COVID-19 patients and their putative correlation with SARS-CoV-19 variants.

METHOD

Gene expression levels of TAS1R2, TAS1R3, TAS2R38, OR51E1, LEPR, GHRL were analyzed in 100 COVID-19 patients and 100 SARS-CoV-2 RT-qPCR negative group.

RESULTS

The expression levels of TAS1R2 and TAS1R3 genes were significantly decreased in COVID-19 patients who were infected with Delta variant. However, the TAS2R38 gene expression level was significantly lower when compared to the control group. The TAS1R2 gene expression was positively correlated with TAS1R3, and TAS2R38 genes (p = 0.001, p = 0.025, respectively).

CONCLUSION

TAS1R2, TAS1R3, and TAS2R38 gene expression levels were decreased in the Delta variant compared to the Omicron BA.1 variant in the studied groups. These results provided a significant clue for the temporary taste loss, especially in patients infected with the Delta variant, which is the most disruptive and symptomatic variant causing hospitalizations, and deaths compared to other variants may be because ACE2 is expressed in the taste buds and high replication of SARS-CoV-2 in the infected gustatory cells in the taste bud generates inflammation and then could eventually destroy the cells. This gustatory cell damage may cause malfunction of the gustatory system.

Clinical characteristics and acute complication of COVID-19 patients with diabetes: a multicenter, retrospective study in Southern China

Aims

This study aims to describe the clinical characteristics, laboratory data and complications of hospitalized COVID-19 patients with type 2 diabetes mellitus (T2DM) since epidemic prevention and control optimization was adjusted in December 2022 in China.

Methods

This retrospective multicenter study included 298 patients with confirmed type 2 diabetes mellitus with or without COVID-19. We collected data from the first wave of the pandemic in The Fifth Affiliated Hospital of Guangzhou Medical University, Loudi Central Hospital and The First People's Hospital of Xiangtan from December 1, 2022 to February 1, 2023. We extracted baseline data, clinical symptoms, acute complications, laboratory findings, treatment and outcome data of each patient from electronic medical records.

Results

For among 298 hospitalized patients with type 2 diabetes, 136 (45.6%) were COVID-19 uninfected, and 162 (54.4%) were COVID-19 infected. We found that the incidence of cough, fatigue, fever, muscle soreness, sore throat, shortness of breath, hyposmia, hypogeusia and polyphagia (all p<0.01) were significantly higher in the exposure group. They showed higher levels of ketone (p=0.04), creatinine (p<0.01), blood potassium (p=0.01) and more diabetic ketoacidosis (p<0.01). Patients with COVID-19 less use of metformin (p<0.01), thiazolidinediones (p<0.01) and SGLT2 (p<0.01) compared with patients without COVID-19.

Conclusion

COVID-19 patients with diabetes showed more severe respiratory and constitutional symptoms and an increased proportion of hyposmia and hypogeusia. Moreover, COVID-19 patients with diabetes have a higher incidence of acute complications, are more prone to worsening renal function, and are more cautious about the use of antidiabetic drugs.

Food-related experiences and behavioral responses among people affected by chemosensory dysfunctions following COVID-19: A scoping review

A category of symptoms that became characteristic early in the first wave of the coronavirus disease 2019 (COVID-19) pandemic was chemosensory dysfunctions (alterations of smell and taste). Such symptoms substantially affect food and eating-cornerstones for both nutrition-related health outcomes and for quality of life. Based on this, this scoping review aimed to map out existing scientific literature on food-related experiences and related behavioral responses among people affected by chemosensory dysfunctions following COVID-19. A librarian-supported search of PsycInfo, PubMed, and Scopus for publications written in English (2020 to April 26, 2022) was conducted. Two authors searched for and screened publications and three others extracted and collated data. These are reported following the Preferred Reporting Items of Systematic reviews and Meta-Analyses extension for Scoping Reviews. Of 1169 hits, 9 publications were included in the review. The results are thematized as "Psychological and social aspects" and "Nutritional aspects," each with the subsections "Experiences" and "Behavioral responses." A great variety of food-related problems, nutritional and mental health effects, and implications for social life are identified. People affected by chemosensory dysfunctions following COVID-19 suffer, as evident both in stories from qualitative studies and in measurements of quality of life. The results impact all professions who are and may come to be involved in treating these patients, such as nurses, physicians, dietitians, and psychologists. With more knowledge about the dysfunctions' manifestation, duration, and impact on everyday life, multiprofessional teams need to collaborate in supporting patients medically, psychosocially, and nutritionally.

Eating Habits and Body Weight Changes Induced by Variation in Smell and Taste in Patients with Previous SARS-CoV-2 Infection

Olfactory and gustatory dysfunction are recognized as common symptoms in patients with COVID-19, with a prevalence ranging, respectively, between 41-61% and 38.2-49%. This review focused on relating the variations in dietary habits with the reduction/loss of smell and/or taste in patients who contracted the COVID-19 infection. Primarily, we reviewed the main pathological mechanisms involved in COVID 19-induced anosmia/dysosmia and ageusia/dysgeusia. Then, we explored and summarized the behavioural changes in food intake and body weight during the COVID-19 pandemic in relation to sensory impairment and the underlying mechanisms. Most studies on this topic argue that the altered chemosensory perception (taste and smell) mainly induces reduced appetite, leading to a faster fullness sensation during the consumption of a meal and, therefore, to a decrease in body weight. On the other hand, a reduced perception of the food's sensory properties may trigger compensatory responses that lead some individuals to increase food intake with a different effect on body weight. Regarding body weight, most studies evaluated malnutrition in patients hospitalized for COVID-19; more studies are warranted to investigate nutritional status specifically in non-hospitalized patients with olfactory and gustatory dysfunctions caused by COVID-19 infection.

A Snapshot of the Experience of Dietitians during the COVID-19 Crisis in Five Arab Countries: Findings from a Regional Cross-Sectional Study

COVID-19's intimidating spread has challenged the resilience of the global health systems, causing shifts in the practices of healthcare workers, including dietitians. The current study aimed to assess the change in dietitians' practices and duties in hospitals/clinics after the commencement of COVID-19 pandemic. This cross-sectional study was conducted in five Arab countries between November 2020 and January 2021. A convenient sample of 903 dietitians filled an online self-administered questionnaire to meet the study aims. Nearly 40.0% of the dietitians experienced a change in their workload and caseload during the pandemic. Besides, 18.7% of the dietitians had been assigned additional tasks in their facilities. Nearly half the dietitians (46.9%) had started giving remote nutrition consultations, associated with a 21% drop in the number of dietitians offering in-person consultations (p = 0.001). Approximately 58.9% of the dietitians provided nutrition care to COVID-19 patients, with 48.4% having access to personal protective equipment. Moreover, 17.0% of dietitians supported COVID-19 patients with enteral and parenteral nutrition. In addition, 45.0% of dietitians reported that managing COVID-19 was challenging given that it was a newly discovered condition.

Food Intake Changes and Their Impact on Quality of Life in Spanish Citizens with and without COVID-19 during Lockdown

The pervasive impact of the COVID-19 pandemic is just beginning to be analyzed. To date, only a handful of these studies have investigated the relationship between an individual’s quality of life (QoL) and their changes in food intake due to the virus (from the associated symptomatology of diagnosis to the universal impact of lockdown on individual lives, regardless of a person’s health status). Therefore, the purpose of this study is to identify changes in food intake resulting from the pandemic and the corresponding impact on QoL in the Spanish population. This study focuses its investigation on the 3-month time period within which lockdown was its most restrictive, March−May 2020. Survey questions ask participants to compare their eating habits, general health status, and QoL during these 3 months to times prior to the pandemic. We conducted an online survey amongst the Spanish population over 18 years old. Three surveys were administered: (1) the adult eating behavior questionnaire (EABQ), (2) EuroQoL-5D-5L, and (3) The determinants lifestyle changes during lockdown period (March to May 2020). A total of 86 participants were included, with a mean age of 34 years. In the analysis of QoL, significant differences were found according to age, sex, and the presence of a COVID-19 diagnosis. Likewise, in the analysis of food intake, significant differences were found by age (greater changes in the 18−29-years-old population) (p< 0.01) and by sex (women p < 0.03), as well as greater changes in those with a diagnosis of COVID-19. Furthermore, both food intake and COVID-19 diagnosis were variables that predicted QoL outcomes. In sum, forced home lockdown can cause changes in food intake, which can predict a lower QoL. It follows that the lockdown situation caused by the worldwide COVID-19 pandemic has affected the food intake and overall QoL of the Spanish population.

Complementary Strategies to Promote Hair Regrowth in Post-COVID-19 Telogen Effluvium

Post-COVID-19 telogen effluvium has been largely reported as a sequela in the post-acute phase of COVID-19, causing major emotional distress among the affected patients. The affected individuals are further exposed to a vast amount of misinformation from the internet and social media and it is important for physicians to be familiar with the phenomenon and provide appropriate counselling to their patients regarding this condition. This article aims to review the evidence-based complementary strategies that can help enhance hair regrowth after post-COVID-19 hair loss, from psychological support and patient education to the importance of optimal nutrition and potential indications and benefits of oral nutritional supplementation, as well as the role of both topical and injectable hair growth stimulators.

Olfactory and gustatory disorders caused by COVID-19: How to regain the pleasure of eating?

Background

Recently, anosmia and ageusia (and their variations) have been reported as frequent symptoms of COVID-19. Olfactory and gustatory stimuli are essential in the perception and pleasure of eating. Disorders in sensory perception may influence appetite and the intake of necessary nutrients when recovering from COVID-19. In this short commentary, taste and smell disorders were reported and correlated for the first time with food science.

Scope and approach

The objective of this short commentary is to report that taste and smell disorders resulted from COVID-19 may impact eating pleasure and nutrition. It also points out important technologies and trends that can be considered and improved in future studies.

Key findings and conclusions

Firmer food textures can stimulate the trigeminal nerve, and more vibrant colors are able to increase the modulation of brain metabolism, stimulating pleasure. Allied to this, encapsulation technology enables the production of new food formulations, producing agonist and antagonist agents to trigger or block specific sensations. Therefore, opportunities and innovations in the food industry are wide and multidisciplinary discussions are needed.

Varied Effects of COVID-19 Chemosensory Loss and Distortion on Appetite: Implications for Understanding Motives for Eating and Drinking

A common symptom of COVID-19 is altered smell and taste. This qualitative study sought to further characterise this altered chemosensory perception and its effects on appetite for food and drink. Eighteen women and two men who had experienced chemosensory loss associated with COVID-19 participated in semi-structured interviews. Thematic analysis of the interview transcripts revealed five major themes. These confirmed that all participants had experienced an altered sense of smell (anosmia, and less frequently parosmia and phantosmia) of variable duration. Loss of taste (ability to detect sweetness, saltiness, etc.) was less common. Participants experienced decreased, no change or increased appetite, with six participants reporting weight loss. Consistent with evidence linking diminished appetite with inflammation, for two participants, decreased appetite preceded anosmia onset. Anosmia reduced enjoyment of food and drink. Compensatory strategies included choosing salty, sweet and ‘spicy’ foods, and increased attention to food texture, and there was evidence that the postingestive rewarding effects of food intake were also important for maintaining appetite. Some participants mentioned increased alcohol intake, in part facilitated by reduced intensity of disliked flavours of alcoholic drinks. The narratives also underlined the value placed on the sociability and structuring of time that daily meals provide. This research adds to the record and analysis of lived experiences of altered chemosensory perception resulting from SARS-CoV-2 infection, and it contributes insights concerning the role of smell and flavour in motivating and rewarding food ingestion.

“Sound” Decisions: The Combined Role of Ambient Noise and Cognitive Regulation on the Neurophysiology of Food Cravings

Our ability to evaluate long-term goals over immediate rewards is manifested in the brain’s decision circuit. Simplistically, it can be divided into a fast, impulsive, reward “system 1” and a slow, deliberate, control “system 2.” In a noisy eating environment, our cognitive resources may get depleted, potentially leading to cognitive overload, emotional arousal, and consequently more rash decisions, such as unhealthy food choices. Here, we investigated the combined impact of cognitive regulation and ambient noise on food cravings through neurophysiological activity. Thirty-seven participants were recruited for an adapted version of the Regulation of Craving (ROC) task. All participants underwent two sessions of the ROC task; once with soft ambient restaurant noise (∼50 dB) and once with loud ambient restaurant noise (∼70 dB), while data from electroencephalography (EEG), electrodermal activity (EDA), and self-reported craving were collected for all palatable food images presented in the task. The results indicated that thinking about future (“later”) consequences vs. immediate (“now”) sensations associated with the food decreased cravings, which were mediated by frontal EEG alpha power. Likewise, “later” trials also increased frontal alpha asymmetry (FAA) —an index for emotional motivation. Furthermore, loud (vs. soft) noise increased alpha, beta, and theta activity, but for theta activity, this was solely occurring during “later” trials. Similarly, EDA signal peak probability was also higher during loud noise. Collectively, our findings suggest that the presence of loud ambient noise in conjunction with prospective thinking can lead to the highest emotional arousal and cognitive load as measured by EDA and EEG, respectively, both of which are important in regulating cravings and decisions. Thus, exploring the combined effects of interoceptive regulation and exteroceptive cues on food-related decision-making could be methodologically advantageous in consumer neuroscience and entail theoretical, commercial, and managerial implications.

The effect of glutamine supplementation on serum levels of some inflammatory factors, oxidative stress, and appetite in COVID-19 patients: a case-control study

Background

Malnutrition is seen in COVID-19 patients, and reducing malnutrition with appropriate therapies may improve these patients' health. This case–control study aimed to assess and compare serum levels of some inflammatory factors, oxidative stress, and appetite in COVID-19 patients with respiratory infections that receive glutamine treatment with a control group.

Methods

In this study, patients who consented to use glutamine were considered as the case group and other patients who did not use glutamine were considered as a control group. Two hundred twenty-two COVID-19 patients (51.2 ± 6.7) using l-Glutamine and 230 COVID-19 patients (51.3 ± 8.2) with similar age, gender, and clinical status, as the control group, were included in the study. For 5 days, the case group consumed 10 g of glutamine supplement three times per day. At the end of the 5 days, blood samples were taken again to test for serum levels of IL1β, tumor necrosis factor-α, malondialdehyde, and total antioxidant capacity, then all data were analyzed.

Results

Serum levels of β-1 interleukin, tumor necrosis factor-α and hs-CRP were significantly reduced with five days of glutamine supplementation (p < 0.05), and patients’ appetite during 5 days of glutamine supplementation compared with the control group had a significant increase (p < 0.05).

Conclusion

Glutamine supplementation in COVID-19 patients with respiratory infection significantly reduces serum levels of interleukin-1 β, hs-CRP, and tumor necrosis factor-α and significantly increases appetite, so glutamine supplementation may be useful for COVID-19 patients in the hospital.

A Conceptual Framework for Multi-Dimensional Measurements of Food Related Pleasure-The Food Pleasure Scale

In modern times, the majority of food intake is believed to be driven by hedonic processes, rather than homeostatic ones. Various factors have been found to influence the hedonic eating experience and thereby influence eating behaviour, and each factor can be regarded a piece that contributes to parts of the total picture of the hedonic response to food. As a result, the literature on the hedonic response to food-related experiences is comprehensive, but at the same time rather fragmented; and importantly, it is not clear how individuals/segments differ in key drivers of their hedonic experience and the extent to which food pleasure is perceived. In this paper, we present a conceptual framework for the development of a scale (self-report questionnaire) to measure the qualitative and quantitative aspects of food-related pleasure, the Food Pleasure Scale. We introduce the concept of (an)hedonia and scales developed in the past for its measurement, identify the spectrum of characteristics influencing food-related pleasure and explain the relevance of developing such a scale. Based on this theoretical framework, a strategy for the development of the Food Pleasure Scale is proposed.

A Detailed Characterisation of Appetite, Sensory Perceptional, and Eating-Behavioural Effects of COVID-19: Self-Reports from the Acute and Post-Acute Phase of Disease

Sensory perception alterations are common in relation to COVID-19 disease, but less is known about the characteristic of the sensory alterations, and how they associate with alterations in appetite and eating behaviour. The current study aims to investigate the acute and long-term effects of COVID-19 disease on (1) the desire for food, hunger, and satiety sensations; (2) smell, taste, and flavour perception; (3) meals and intake of food types; and (4) the frequency of commonly applied strategies to tackle potential changes in appetite and sensory perception. An online survey was conducted among Danish adults (n = 102) who had experienced changes in appetite, sensory perception, and/or food-related pleasure due to COVID-19 disease. Key results include appetite-altering effects at all times during the day when suffering from COVID-19 and often associated with impaired sensory function. Severe sensory perception alterations were found, namely, for the perception of taste, ageusia > hypogeusia > hypergeusia, and for the perception of smell, anosmia > parosmia > hyposmia > hyperosmia. Eating behavioural changes included alteration in quantitative and qualitative aspects of intake. The effects were, in general, more pronounced during the acute phase of disease than during the post-acute phase. The findings illustrate the complexity by which COVID-19 affects human appetite, sensory perception, and eating behaviour, but also point to strategies to cope with these changes.