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Background: The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). Methods: Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. Results: The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. Conclusion: This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.

Problem identification Both chemotherapy and radiation therapy cause considerable symptom burden on patients' oral health, influencing nutritional status and quality of life. The role of the oral and gut microbiome in oral health alterations during cancer therapy is an emerging area of science in symptom management. Literature search PubMed®, CINAHL®, and Scopus® were searched for articles published from January 2000 through July 2020. Data evaluation Articles published in English that were focused on chemotherapy and/or radiation therapy were included in the review. Synthesis Of the 22 identified studies, 12 described oral health symptoms during chemotherapy and radiation therapy for head and neck cancer. Ten studies assessed symptoms during treatment for a variety of solid tumors and blood cancers, with four of these describing microbial interventions for the management of oral mucositis. Interventions varied, but the results supported the benefits of probiotics and synbiotics in reducing mucositis severity. Overall, less diverse oral and gut microbiome environments were associated with increased severity of oral health symptomatology. Implications for practice Additional research is needed to determine how the oral and gut microbiome and microbial interventions may be used to improve oral health management during cancer treatment.

We identified associations between self-reported olfactory dysfunction (OD) and dietary attributes in participants aged ≥40 years (n = 6,356) from the nationally representative 2011–2014 National Health and Nutrition Examination Survey (NHANES). The chemosensory questionnaire and 24-h dietary recalls were administered by trained interviewers. OD was defined as self-report of either smell problems in the last year, worse smell relative to age 25, or perceiving phantom odors. Dietary outcomes included Healthy Eating Index 2015 score (HEI) with adequacy and moderation components (higher scores indicated higher diet quality), dietary diversity, energy density, and intake of major food groups. Survey-weighted linear regression models estimated OD–diet associations, adjusting for socio-demographic, lifestyle, and clinical factors. Adjusted mean difference (95% CI) between those with versus without OD, showed that adults with OD had significantly lower HEI moderation score (−0.67 (−1.22, −0.11)) and diets higher in energy density (0.06 (0.00, 0.11)), and percent energy from saturated fat (0.47 (0.12, 0.81)), total fat (0.96 (0.22, 1.70)), and added sugar (1.00 (0.33, 1.66)). Age and sex-stratified analyses showed that younger females (40–64 years) primarily accounted for the associations with diet quality and total/saturated fat intake. These findings inform dietary screening and recommendations for adults who report OD, including those experiencing transient or persistent smell loss with COVID-19.

Precision nutrition is an emerging concept that aims to develop nutrition recommendations tailored to different people's circumstances and biological characteristics. Responses to dietary change and the resulting health outcomes from consuming different diets may vary significantly between people based on interactions between their genetic backgrounds, physiology, microbiome, underlying health status, behaviors, social influences, and environmental exposures. On 11-12 January 2021, the National Institutes of Health convened a workshop entitled "Precision Nutrition: Research Gaps and Opportunities" to bring together experts to discuss the issues involved in better understanding and addressing precision nutrition. The workshop proceeded in 3 parts: part I covered many aspects of genetics and physiology that mediate the links between nutrient intake and health conditions such as cardiovascular disease, Alzheimer disease, and cancer; part II reviewed potential contributors to interindividual variability in dietary exposures and responses such as baseline nutritional status, circadian rhythm/sleep, environmental exposures, sensory properties of food, stress, inflammation, and the social determinants of health; part III presented the need for systems approaches, with new methods and technologies that can facilitate the study and implementation of precision nutrition, and workforce development needed to create a new generation of researchers. The workshop concluded that much research will be needed before more precise nutrition recommendations can be achieved. This includes better understanding and accounting for variables such as age, sex, ethnicity, medical history, genetics, and social and environmental factors. The advent of new methods and technologies and the availability of considerably more data bring tremendous opportunity. However, the field must proceed with appropriate levels of caution and make sure the factors listed above are all considered, and systems approaches and methods are incorporated. It will be important to develop and train an expanded workforce with the goal of reducing health disparities and improving precision nutritional advice for all Americans.

Objective: This pilot study assessed the effectiveness and acceptability of personalized nutrition intervention for mobile food pantry users. Methods: The 8-week intervention recruited 25 participants in the control (n = 13) and in the treatment (n = 12) groups (60% obese). Personalized nutrition and health reports were generated based on baseline dietary intake and health status. The treatment group received weekly phone counseling and nutrition education, while the control group was only contacted to ensure compliance. The primary outcomes were 8-week changes in weight and diet quality score, assessed by the Healthy Eating Index. Results: The acceptability of the intervention was assessed by the eligibility rate, recruitment rate (62.5%), and drop-out rate (36%). Following the intervention, there was a significant decrease in weight (mean ± standard deviation, −2.3% ± 2.4%) among all participants (p &lt, 0.05). Diet-quality improved (4.54% in treatment vs. 0.18% in control), but was ultimately non-significant (p = 0.284). Conclusions and Implications: A personalized nutrition education intervention in mobile food pantry users may be an acceptable and effective intervention to encourage weight loss through dietary improvements.

BACKGROUND: The popularity of E-cigarettes is due in part to their flavorings. The purpose of this study was to determine the effect on smokers’ sensory perceptions and liking of various e-cigarette flavorings, and the degree to which those perceptions are influenced by nicotine level, sex, and PROP bitter taster phenotype. METHODS: We recruited 132 non-treatment-seeking, daily cigarette smokers. In repeated trials in one laboratory session participants vaped the Joyetech eGo-C e-cigarette with each of the following flavorings (in random order): unflavored, tobacco, cherry, chocolate, and menthol. Participants vaped the e-juice first without nicotine and then with high nicotine (18mg/ml), and provided sensory (bitterness/sourness, irritation, sweetness) and liking ratings. Perceived intensity of 6-n-propylthiouracil (PROP) was used to classify the participants as non-tasters (n=28), medium-tasters (n=74), or supertasters (n=28). Mixed-effects linear models and generalized estimating equations were used to evaluate ratings as a function of flavor interacting with nicotine content, sex and taster phenotype, adjusting for age, race/ethnicity, menthol use, and nicotine dependence. RESULTS: Regardless of nicotine level, cherry (β=1.76, p

We aimed to test the feasibility of an online survey and tailored message program in young women. Recruited from college campuses, women (n = 189) completed an online survey assessing preference for and behaviors toward diet and physical activity as well as theory-based influencers of these behaviors (knowledge/information, motivation, and confidence). Health messages were tailored to the participant’s survey responses and learning style to address misconceptions and motivate or reinforce healthy physical activity and dietary behaviors. Most women reported the survey as relevant (92%) and useful for reflecting on their health (83%), with survey responses variable in level of nutrition and physical activity knowledge, motivation, and confidence. Each woman received four tailored messages—most reported the messages as relevant (80%) and learning new information (60%). Across all messages, nearly half of the participants (~48%) reported willingness to try or maintain healthier behaviors and confidence in their ability. Body size discrepancy and dietary restraint had small effects message responses of information learned, and the motivation and confidence in trying healthier behaviors. In summary, these data support the feasibility of this online tailored message program. The college women found the tailored message program acceptable and useful to motivate healthier behaviors. The findings provide direction for behaviorally focused interventions to improve dietary and physical activity behaviors.

In a secondary analysis, we assessed the ability of dietary and physical activity surveys to explain variability in weight loss within a worksite-adapted Diabetes Prevention Program. The program involved 58 overweight/obese female employees (average age = 46 ± 11 years SD, average body mass index = 34.7 ± 7.0 kg/m2 SD) of four long-term care facilities who survey-reported liking and frequency of dietary and physical activity behaviors. Data were analyzed using a latent variable approach, analysis of covariance, and nested regression analysis to predict percent weight change from baseline to intervention end at week 16 (average loss = 3.0%, range—6% gain to 17% loss), and follow-up at week 28 (average loss = 2.0%, range—8% gain to 16% loss). Using baseline responses, restrained eaters (reporting liking but low intakes of high fat/sweets) achieved greater weight loss at 28 weeks than those reporting high liking/high intake (average loss = 3.5 ± 0.9% versus 1.0 ± 0.8% S.E., respectively). Examining the dietary surveys separately, only improvements in liking for a healthy diet were associated significantly with weight loss (predicting 44% of total variance, p &lt, 0.001). By contrasting liking versus intake changes, women reporting concurrent healthier diet liking and healthier intake lost the most weight (average loss = 5.4 ± 1.1% S.E.), those reporting eating healthier but not healthier diet liking (possible misreporting) gained weight (average gain = 0.3 ± 1.4% S.E.). Change in liking and frequency of physical activity were highly correlated but neither predicted weight loss independently. These pilot data support surveying dietary likes/dislikes as a useful measure to capture dietary behaviors associated with weight loss in worksite-based programs. Comparing dietary likes and intake may identify behaviors consistent (appropriate dietary restraint) or inconsistent (misreporting) with weight loss success.

Obesity prevention involves promoting healthy eating and physical activity across all children. Can we leverage technology to feasibly survey children&rsquo, s health behaviors and deliver theory-based and user-tailored messages for brief clinical encounters? We assessed the acceptability and utility of an online pediatric-adapted liking survey (PALS) and tailored messages among children receiving non-urgent care in a pediatric emergency department (PED). Two hundred and forty-five children (average age = 10 years, racially/ethnically diverse, 34% overweight/obese from measured indices, 25% of families reporting food insecurity) and their parents/caregivers participated. Each reported the child&rsquo, s activity and behaviors using the online PALS and received two to three messages tailored to the responses (aligned with elaboration likelihood and transtheoretical models) to motivate behavioral improvements or reinforce healthy behaviors. Most children and parents (&gt, 90%) agreed the PALS was easy to complete, encouraging thought about their own/child&rsquo, s behaviors. The child&rsquo, s PALS responses appeared reasonable (fair-to-good child&ndash, parent intraclass correlations). Most children and parents (&ge, 75%) reported the tailored messages to be helpful and favorable for improving or maintaining the targeted behavior. Neither message type (motivating/reinforcing) nor favorability responses varied significantly by the child&rsquo, s weight or family&rsquo, s food security status. In summary, children and parents found the PALS with tailored messages acceptable and useful. The message types and responses could help focus brief clinical encounters.

Improving our understanding of what physical activities are enjoyed and the factors that are associated with physical activity liking can promote participation in regular physical activity. We aimed to study physical activity (PA) liking in college women by modelling interactions between body size perception and dietary behaviors on PA liking, and by examining discrepancies between PA liking versus engagement on body size perception and dietary behaviors. Women (n = 251, 74% white) utilized an online survey to report their level of liking for PA types (scored into a PA liking index) and frequency of PA participation. They also reported their perceived body size, level of dietary restraint, and frequency of consuming foods (scored into a diet quality index). In multivariate analyses, a greater perceived body size was directly associated with lower PA liking and indirectly through greater dietary restraint but lower diet quality. Healthiest dietary behaviors were reported by women who both liked and engaged in PA. Women who reported high PA liking but low PA participation reported a higher dietary restraint and lower diet quality. These findings support the empowerment of women across all body sizes to identify physical activities that they enjoy. Health promotion efforts should encourage women to couple physical activity liking and engagement with a healthy level of dietary restraint and consumption of a healthy diet.

Objective Variation in taste perception and exposure to risk factors of taste alterations have been independently linked with elevated adiposity. Using a laboratory database, taste-adiposity associations were modeled and examined for whether taste functioning mediates the association between taste-related risk factors and adiposity. Methods Healthy women (n = 407, 35.5 ± 16.9 y) self-reported histories of risk factors of altered taste functioning (tonsillectomy, multiple ear infections, head trauma) and were assessed for taste functioning (tongue-tip and whole-mouth intensities of quinine and salt) and density of taste papillae. Twenty-four percent had elevated waist circumferences; thirty-nine percent had overweight or obesity. Using structural equation modeling, direct and indirect associations between taste-related risk factors, taste functioning, and adiposity were tested. Results In models with good fit, elevated central adiposity was explained directly by history of risk factors (tonsillectomy, multiple ear infections) and directly by lower taste functioning (lower tongue-tip taste function, lower papillae density). Risk factors of taste alterations were significantly associated with lower taste functioning, with taste mediating the association between head trauma and reduced adiposity. Conclusions This large laboratory-based study supports associations between taste-related risk factors, taste functioning, and adiposity. These findings need to be confirmed with other population-based studies, including the National Health and Nutrition Examination Survey 2013-2014 taste data.

Clinical settings need rapid yet useful methods to screen for diet and activity behaviors for brief interventions and to guide obesity prevention efforts. In an urban pediatric emergency department, these behaviors were screened in children and parents with the 33-item Pediatric-Adapted Liking Survey (PALS) to assess the reliability and validity of a Healthy Behavior Index (HBI) generated from the PALS responses. The PALS was completed by 925 children (average age = 11 &plusmn, 4 years, 55% publicly insured, 37% overweight/obese by Body Mass Index Percentile, BMI-P) and 925 parents. Child&ndash, parent dyads differed most in liking of vegetables, sweets, sweet drinks, and screen time. Across the sample, child and parent HBIs were variable, normally distributed with adequate internal reliability and construct validity, revealing two dimensions (less healthy&mdash, sweet drinks, sweets, sedentary behaviors, healthy&mdash, vegetables, fruits, proteins). The HBI showed criterion validity, detecting healthier indexes in parents vs. children, females vs. males, privately- vs. publicly-health insured, and residence in higher- vs. lower-income communities. Parent&rsquo, s HBI explained some variability in child BMI percentile. Greater liking of sweets/carbohydrates partially mediated the association between low family income and higher BMI percentile. These findings support the utility of PALS as a dietary behavior and activity screener for children and their parents in a clinical setting.

We examined associations of olfactory dysfunction with anthropometric and cardiometabolic measures in a nationally representative sample of US adults. In the 2013-2014 National Health and Nutrition Examination Survey (NHANES), 3,815 participants, 40 years and older, completed a standardized taste and smell protocol, which consisted of an 8-item odor identification test and a chemosensory questionnaire. Measured dysfunction was incorrect identification of ≥3 of 8 odors; self-reported dysfunction was affirmative response to either a recent smell problem, worse ability since age 25, or phantosmia. Survey-weighted linear regression models tested associations of olfactory dysfunction with body mass index (BMI), waist circumference (WC), blood pressure, serum total cholesterol (TC) with fractions, triglycerides, and glucose levels. Models were adjusted for age, race, education, physical activity, self-reported general health condition, smoking history, and income-to-poverty ratio, stratifying by sex and age group (middle-age 40-64 years; older ≥65 years). Relative to normal, measured olfactory dysfunction was associated with lower BMI [β=-1.6 (95% CI: -3.2, -0.01)] in older men. In middle-age women, dysfunction was associated with higher BMI and WC, whether assessed by examination [β's for BMI=3.1 (0.6, 5.5), WC=5.0 (0.3, 9.8)] or self-report [β's for BMI=2.5 (0.6, 4.3), WC=6.1 (2.2, 9.9)]. Measured dysfunction was associated with significantly higher TC [β=12.8 (7.5, 18.1)] and LDL [β=18.1 (9.1, 27.2)] among older men, but significantly lower TC [β=-15.0 (-25.0, -5.7)] and marginally lower LDL [β=-12.0 (-25.0, 1.2)] among older women. Between measured dysfunction and fasting glucose, the association was inverse [β=-7.9 (-13.0, -2.6)] among middle-age men, but positive [β=15.6 (1.5, 29.7)] among older women. No significant associations were observed with blood pressure levels. In conclusion, among US adults ≥40 years, olfactory dysfunction is associated with anthropometric and glucose and lipid levels, with associations varying by sex and age group.

We tested the hypothesis that successful weight loss post-bariatric surgery would be associated with healthier chemosensory function, food likes, and dietary behaviors than either unsuccessful weight loss or pre-surgery morbid obesity. In a case-control design, pre-surgical women with morbid obesity (n = 49) were compared with those 1-year post-surgery (24 Roux-en-Y Bypass, 24 Sleeve Gastrectomy) and defined by excess or percent weight loss as successful/unsuccessful. For self-reported smell/taste perception, more post-surgery than pre-surgery reported improved/distorted perception, especially if weight loss successful. Measured taste function (perceived quinine and NaCl intensity) was lower among weight loss unsuccessful versus pre-surgery patients, yet a genetic variation in taste probe (propylthiouracil bitterness) matched expected frequencies without significant pre/post-surgery difference. Regarding survey-reported liking, higher diet quality was seen in the weight loss successful (independent of surgery type) versus pre-surgical patients, with differences driven by lower sweet and refined carbohydrate liking. The post versus pre-surgical patients had greater restraint but less hunger and disinhibition. Patients reporting both higher diet quality and lower hunger showed greater % weight loss, independent of surgery type. Thus, successful weight loss 1-year post-bariatric surgery was associated with improved or distorted chemosensation and patterns of liking associated with healthier diets, especially if coupled with less hunger.

Interest in nutrient-rich berry juices is growing, but their high polyphenol levels render them sensorily unappealing. Fifty adults, who were assessed for sensory phenotype and dietary behaviors, provided sensory and palatability ratings of juices from ‘Viking’ aronia berries for each of seven harvest weeks. By peak harvest, juice preference increased two-fold, averaging neither like/dislike. This hedonic shift was associated with: increases in juice sugars paralleling increases in perceived sweetness (maximum = weak); reductions in percent acidity paralleling reductions in sourness (minimum = moderate), astringency (minimum = to just above weak) and bitterness (minimum = just below weak). About 25% of adults liked the aronia juice, including adults who also liked an aqueous citric acid solution (average rating = moderately sour) or those who reported adventurous eating behaviors. Bitter taste phenotype, measured by propylthiouracil or quinine bitterness, failed to explain significant variation in juice sensation or preference. We also collected sensory and preference ratings from juice collected at peak harvest blended with sugar and/or sweet olfactory flavoring (10 ppm ethyl butyrate). Increasing juice sweetness by adding 5% sucrose decreased sourness and improved preference from weak dislike to weak like. Adding sweet olfactory flavoring decreased juice sourness without changing preference. Adding sweet flavoring and 3% sucrose resulted in reduction of sourness and improvements in preference ratings comparable to 5% added sucrose. Neither added sugar nor flavoring blocked juice astringency. In summary, these findings suggest that aronia juice, even from berries picked at peak harvest, appealed to only a few adults (sour likers or adventurous eaters). Although enhanced sweetness, with added sugar and sweet olfactory flavoring, improved aronia juice preference, broader sensory approaches are required to blunt astringency for greater consumer appeal.

Chronic cigarette smoking may influence chemosensory function, which in turn, may affect cigarette usage. Because menthol in cigarettes can attenuate nicotine bitterness, choice of menthol/nonmenthol cigarettes may be influenced by ability to perceive bitterness. We examined chemosensory function of chronic smokers, hypothesizing they would show altered function in comparison to non-smokers and by menthol cigarette preference. In laboratory-based measures, chronic smokers (N = 135; 84 menthol smokers) self-reported their chemosensory function and participated in smell (identification task with perceived intensity) and taste (quinine and NaCl intensity on tongue-tip and whole mouth) testing. A taste genetics probe (propylthiouracil (PROP) bitterness) also was assessed. Self-reported and measured chemosensory function were compared with nationally-representative 2013–2014 National Health and Nutrition Examination Survey (NHANES) data generated with similar measures. The taste measures also were compared between smokers and age- and sex-matched non-smokers from a laboratory database. Frequencies of self-reported smell and taste alterations among smokers exceeded NHANES prevalence estimates for non-smokers. The rate of measured smell dysfunction also exceeded NHANES prevalence for hyposmia. Compared to non-smokers, smokers reported elevated tongue-tip and whole mouth intensities from 1 M NaCl, with no significant differences in whole mouth quinine or 0.32 M NaCl. Inconsistent with previous hypotheses, smokers were not more likely to report depressed PROP bitterness than non-smokers. However, as expected, menthol smokers reported greater PROP bitterness than non-menthol smokers. In conclusion, chemosensory alterations were more frequent among chronic smokers, including hyposmia and heightened intensity from NaCl at an oral-irritant concentration. PROP supertasters were most likely to prefer mentholated cigarettes.

Sensations from foods and beverages drive dietary choices, which in turn, affect risk of diet-related diseases. Perception of these sensation varies with environmental and genetic influences. This observational study aimed to examine associations between chemosensory phenotype, diet and cardiovascular disease (CVD) risk. Reportedly healthy women (n = 110, average age 45 ± 9 years) participated in laboratory-based measures of chemosensory phenotype (taste and smell function, propylthiouracil (PROP) bitterness) and CVD risk factors (waist circumference, blood pressure, serum lipids). Diet variables included preference and intake of sweet/high-fat foods, dietary restraint, and diet quality based on reported preference (Healthy Eating Preference Index—HEPI) and intake (Healthy Eating Index—HEI). We found that females who reported high preference yet low consumption of sweet/high-fat foods had the highest dietary restraint and depressed quinine taste function. PROP nontasters were more likely to report lower diet quality; PROP supertasters more likely to consume but not like a healthy diet. Multivariate structural models were fitted to identify predictors of CVD risk factors. Reliable latent taste (quinine taste function, PROP tasting) and smell (odor intensity) variables were identified, with taste explaining more variance in the CVD risk factors. Lower bitter taste perception was associated with elevated risk. In multivariate models, the HEPI completely mediated the taste-adiposity and taste-HDL associations and partially mediated the taste-triglyceride or taste-systolic blood pressure associations. The taste-LDL pathway was significant and direct. The HEI could not replace HEPI in adequate models. However, using a latent diet quality variable with HEPI and HEI, increased the strength of association between diet quality and adiposity or CVD risk factors. In conclusion, bitter taste phenotype was associated with CVD risk factors via diet quality, particularly when assessed by level of food liking/disliking.

Anosmia and hyposmia, the inability or decreased ability to smell, is estimated to afflict 3-20% of the population. Risk of olfactory dysfunction increases with old age and may also result from chronic sinonasal diseases, severe head trauma, and upper respiratory infections, or neurodegenerative diseases. These disorders impair the ability to sense warning odors in foods and the environment, as well as hinder the quality of life related to social interactions, eating, and feelings of well-being. This article reports and extends on a clinical update commencing at the 2016 Association for Chemoreception Sciences annual meeting. Included were reports from: a patient perspective on losing the sense of smell with information on Fifth Sense, a nonprofit advocacy organization for patients with olfactory disorders; an otolaryngologist's review of clinical evaluation, diagnosis, and management/treatment of anosmia; and researchers' review of recent advances in potential anosmia treatments from fundamental science, in animal, cellular, or genetic models. As limited evidence-based treatments exist for anosmia, dissemination of information on anosmia-related health risks is needed. This could include feasible and useful screening measures for olfactory dysfunction, appropriate clinical evaluation, and patient counseling to avoid harm as well as manage health and quality of life with anosmia.

Purpose: Rapid yet useful methods are needed to screen for dietary behaviors in clinical settings. We tested the feasibility and reliability of a pediatric adapted liking survey (PALS) to screen for dietary behaviors and suggest tailored caries and obesity prevention messages. Methods: In an observational study, children admitted to a pediatric emergency department (PED) for nonurgent care were approached to complete the PALS (33 foods, 4 nonfoods including brushing teeth). Measured height/weight were used for body mass index (BMI) percentile determination. Feasibility was assessed by response rate and PALS completion time. Reliability was assessed by internal consistency of food groups and test-retest reliability for PED-home reported PALS. Results: PALS was completed by 144 children (96% of approached) – 54% male (average age = 11 ± 3 years) with diversity in family income (43% publicly insured), race/ethnicity (15% African American, 33% Hispanic, 44% Caucasian) and adiposity (3% underweight, 50% normal, 31% overweight, 17% obese, 8% extremely obese). The average completion time was 3: 52 min, and conceptual food groups had reasonable internal reliability. From 57% (n = 82) with PED-home completion, PALS had a good/excellent test-retest reliability. Relative preferences for sweets versus brushing teeth identified unique groups of children for tailored prevention messages (high sweet/brushing preference, sweets > brushing, brushing > sweets). Females with higher adiposity reported significantly greater preference for sweet/high-fat foods, independently of demographic variables; the relationship was nonsignificant in males and with the other food groups. Conclusion: The PALS appears to be a fast, feasible and reliable dietary screener in a clinical setting to assist in forming tailored diet-related messages for dental caries and obesity prevention.

The TAS1R genes encode heterodimeric receptors that mediate umami (hTAS1R1 + hTAS1R3) and sweet (hTAS1R2 + hTAS1R3) sensations. The question of interest for this study is if TAS1R1 variation associates with differences in overall taste intensity. We leveraged an existing database of adults (n = 92, primarily European American) to test associations between 2 TAS1R1 single nucleotide polymorphisms (SNPs) (intronic rs17492553, C/T and exonic rs34160967, G/A) and intensity of 4 prototypical tastants (NaCl, sucrose, citric acid, and quinine), applied regionally to fungiform and circumvallate loci, and sampled with the whole mouth. Both SNPs were associated with modest shifts in perceived intensities across all taste qualities. Three genotype groups were represented for the intronic SNP-minor allele homozygotes (TT) averaged 40% lower intensities than did CC homozygotes for all regionally applied tastants, as well as whole-mouth NaCl and citric acid. Similar, but less pronounced, intensity differences were seen for the exonic SNP (GG homozygotes reported greater intensities than did the AA/AG group). Our predominantly European American cohort had a low frequency of AA homozygotes, which may have attenuated the SNP-related differences in perceived intensity. These preliminary findings, if replicated, could add TAS1R1 polymorphisms to the repertoire of genotypic and phenotypic markers of heightened taste sensation.

Introduction The present study examined the influence of flavouring on the smoking and vaping behaviour of cigarette smokers asked to adopt e-cigarettes for a period of 6 weeks. Methods Participants were 88 current male and female smokers with no intention to stop smoking, but who agreed to substitute e-cigarettes for their current cigarettes. On intake, participants were administered tests of taste and smell for e-cigarettes flavoured with tobacco, menthol, cherry and chocolate, and were given a refillable e-cigarette of their preferred flavour or a control flavour. Participants completed daily logs of cigarette and e-cigarette use and were followed each week. Results Analyses over days indicated that, during the 6-week e-cigarette period, cigarette smoking rates dropped from an average of about 16 to about 7 cigarettes/day. e-Cigarette flavour had a significant effect such that the largest drop in cigarette smoking occurred among those assigned menthol e-cigarettes, and the smallest drop in smoking occurred among those assigned chocolate and cherry flavours. e-Cigarette vaping rates also differed significantly by flavour assigned, with the highest vaping rates for tobacco- and cherry-flavoured e-cigarettes, and the lowest rates for those assigned to chocolate. Conclusions The findings suggest that adoption of e-cigarettes in smokers may influence smoking rates and that e-cigarette flavourings can moderate this effect. e-Cigarette vaping rates are also influenced by flavourings. These findings may have implications for the utility of e-cigarettes as a nicotine replacement device and for the regulation of flavourings in e-cigarettes for harm reduction.

The U.S. NHANES included chemosensory assessments in the 2011–2014 protocol. We provide an overview of this protocol and 2012 olfactory exam findings. Of the 1818 NHANES participants aged ≥40 years, 1281 (70.5 %) completed the exam; non-participation mostly was due to time constraints. Health technicians administered an 8-item, forced-choice, odor identification task scored as normosmic (6–8 odors identified correctly) versus olfactory dysfunction, including hyposmic (4–5 correct) and anosmic/severe hyposmic (0–3 correct). Interviewers recorded self-reported smell alterations (during past year, since age 25, phantosmia), histories of sinonasal problems, xerostomia, dental extractions, head or facial trauma, and chemosensory-related treatment and changes in quality of life. Olfactory dysfunction was found in 12.4 % (13.3 million adults; 55 % males/45 % females) including 3.2 % anosmic/severe hyposmic (3.4 million; 74 % males/26 % females). Selected age-specific prevalences were 4.2 % (40–49 years), 12.7 % (60–69 years), and 39.4 % (80+ years). Among adults ≥70 years, misidentification rates for warning odors were 20.3 % for smoke and 31.3 % for natural gas. The highest sensitivity (correctly identifying dysfunction) and specificity (correctly identifying normosmia) of self-reported olfactory alteration was among anosmics/severe hyposmics (54.4 % and 78.1 %, respectively). In age- and sex-adjusted logistic regression analysis, risk factors of olfactory dysfunction were racial/ethnic minority, income-to-poverty ratio ≤ 1.1, education

Chronic smokers have a greater risk for altered chemosensation, unhealthy dietary patterns, and excessive adiposity. In an observational study of chronic smokers, we modeled relationships between chemosensation, fat/carbohydrate liking, smoking-associated dietary behaviors, and body mass index (BMI). Also tested in the model was liking for sweet electronic cigarette juice (e-juice). Smokers (n = 135, 37 &plusmn, 11 years) were measured for: Taste genetics (intensity of 6-n-propylthiouracil&mdash, PROP), taste (NaCl and quinine intensities) and olfactory (odor identification) function, liking for cherry e-juice, and weight/height to calculate BMI. Smokers survey-reported their food liking and use of smoking for appetite/weight control. Structural equation models tested direct and indirect relationships between chemosensation, fat/carbohydrate liking, dietary behaviors, and BMI. In good-fitting models, taste intensity was linked to BMI variation through fat/carbohydrate liking (greater PROP intensity&rarr, greater NaCl intensity&rarr, greater food liking&rarr, higher BMI). Olfactory function tended to predict sweet e-juice liking, which, in turn, partially mediated the food liking and BMI association. The path between smoking-associated dietary behaviors and BMI was direct and independent of chemosensation or liking. These findings indicate that taste associates with BMI in chronic smokers through liking of fats/carbohydrates. Future research should determine if vaping sweet e-juice could improve diet quality and adiposity for smokers.

The 25 human bitter receptors and their respective genes (TAS2Rs) contain unusually high levels of allelic variation, which may influence response to bitter compounds in the food supply. Phenotypes based on the perceived bitterness of single bitter compounds were first linked to food preference over 50 years ago. The most studied phenotype is propylthiouracil bitterness, which is mediated primarily by the TAS2R38 gene and possibly others. In a laboratory-based study, we tested for associations between TAS2R variants and sensations, liking, or intake of bitter beverages among healthy adults who were primarily of European ancestry. A haploblock across TAS2R3, TAS2R4, and TAS2R5 explained some variability in the bitterness of espresso coffee. For grapefruit juice, variation at a TAS2R19 single nucleotide polymorphism (SNP) was associated with increased bitterness and decreased liking. An association between a TAS2R16 SNP and alcohol intake was identified, and the putative TAS2R38–alcohol relationship was confirmed, although these polymorphisms did not explain sensory or hedonic responses to sampled scotch whisky. In summary, TAS2R polymorphisms appear to influence the sensations, liking, or intake of common and nutritionally significant beverages. Studying perceptual and behavioral differences in vivo using real foods and beverages may potentially identify polymorphisms related to dietary behavior even in the absence of known ligands.

Dysregulation of the insulin-like growth factor (IGF) system, a common consequence of adiposity-induced insulin resistance, may be a key underlying mechanism linking excess body weight with colon cancer. Evidence has been derived from studies of cancer and polyps. Supporting data about aberrant crypt foci (ACF), putative pre-polyp changes, have been generated only from animal studies to date.We randomly selected 26 patients with sex-specific elevated waist-hip-ratio (WHR) and 26 with normal values from a series of 150 patients seeking routine colonoscopy at the University of Connecticut Health Center. Cross-sectional analyses were performed of ACF number (5,or = 5) in relation to total IGF1, IGF-binding protein-3 (IGFBP3), insulin, body mass index (BMI), WHR and waist circumference (WC). Visualized ACF in the 20 cm of the distal colon were counted using advanced endoscopic imaging.Patients withor = 5 ACF had higher BMI, WHR, and WC compared with patients with5 ACF (p = 0.04, p = 0.03, and p = 0.01, respectively). IGFBP3 was reduced (p = 0.02) and IGF1:IGFBP3 molar ratio was greater (p = 0.03) in patients withor = 5 ACF. We did not observe significant associations between ACF number and insulin or total IGF1.Our study provides the first report in humans of a possible association of ACF prevalence and IGF1 bioavailability as characterized by IGF1:IGFBP3 molar ratio and IGFBP3 level. More research is needed to determine whether this relationship is varied by ACF features (e.g., size, dysplasia, molecular changes), synchronous cancer and polyps, and is modified by colon cancer risk factors.

Important advances in our understanding of how taste, smell and somatosensation contribute to oral sensation are reviewed and the nutritional and health implications associated with variation in oral sensation are discussed.Oral sensation is a central integration of taste (salty, sweet, sour, bitter, umami), retronasal olfaction (i.e. smelling through the mouth), and somatosensation (touch, temperature, pain) by the orbitofrontal cortex. There is normal variation in oral sensation across individuals, ranging from those living in a neon orosensory world to those living in a pastel world. Historically, study of this variation revolved around genetically mediated bitterness of phenylthiocarbamide or propylthiouracil, but now it encompasses additional phenotypes (e.g. fungiform papillae number, bitterness of quinine) and emerging receptor genotypes. Aging and exposure to pathogens interact with genetics to further influence oral sensation. Orosensory variation is associated with differences in preference for high-fat foods, sweets, vegetables, and alcoholic beverages. Emerging data suggest this variation influences intake of these foods/beverages and thus diet-related chronic diseases (cardiovascular diseases, certain cancers, obesity).Oral sensation varies with genetics and gene-environment interactions. As this variation explains some of the differences in what we like/dislike to eat, attempts to reduce disease risk through diet should consider food/beverage preference to promote health and food enjoyment.

Genetic variation in oral sensation presumably influences ingestive behaviors through sensations arising from foods and beverages. Here, we investigated the influence of taste phenotype [6-n-propylthiouracil (PROP) bitterness, fungiform papillae (FP) density] on sweet and creamy sensations from sugar/fat mixtures. Seventy-nine subjects (43 males) reported the sweetness and creaminess of water or milk (skim, whole, heavy cream) varying in sucrose (0-20% w/v) on the general Labeled Magnitude Scale. Sweetness grew with sucrose concentration and when shifting from water to milk mixtures--the growth was greatest for those tasting PROP as most bitter. At higher sucrose levels, increasing fat blunted the PROP-sweet relationship, whereas at lower levels, the relationship was effectively eliminated. Perceived sweetness of the mixture exceeded that predicted from the sum of components at low sucrose concentrations (especially for those tasting PROP most bitter) but fell below predicted at high concentrations, irrespective of fat level. Creaminess increased greatly with fat level and somewhat with sucrose. Those tasting PROP most bitter perceived greater creaminess in the heavy cream across all sucrose levels. Perceived creaminess was somewhat lower than predicted, irrespective of PROP bitterness. The FP density generally showed similar effects as PROP on sweetness and creaminess, (but to a lesser degree) and revealed potential taste-somatosensory interactions in weakly sweet stimuli. These data support that taste phenotype affects the nature of enhancement or suppression of sweetness and creaminess in liquid fat/sugar mixtures. Taste phenotype effects on sweetness and creaminess likely involve differential taste, retronasal olfactory, and somatosensory contributions to these perceptual experiences.

Chemosensory problems challenge health through diminished ability to detect warning odors, consume a healthy diet, and maintain quality of life. We examined the prevalence and associated risk factors of self-reported chemosensory alterations in 3603 community-dwelling adults (aged 40+ years), from the nationally representative, US National Health and Nutrition Examination Survey (NHANES) 2011-2012. In this new NHANES component, technicians surveyed adults in the home about perceived smell and taste problems, distortions, and diminished abilities since age 25 (termed "alterations"), and chemosensory-related health risks and behaviors. The prevalence of self-reported smell alteration was 23%, including phantosmia at 6%; taste was 19%, including dysgeusia at 5%. Prevalence rates increased progressively with age, highest in those aged 80+ years (smell, 32%; taste, 27%). In multivariable logistic regression, controlling for sociodemographics, health behaviors, and chemosensory-related conditions, the strongest independent risk factor for smell alteration was sinonasal symptoms (odds ratio [OR] = 2.06; 95% confidence interval [CI]: 1.63-2.61), followed by heavy drinking, loss of consciousness from head injury, family income ≤110% poverty threshold, and xerostomia. For taste, the strongest risk factor was xerostomia (OR = 2.65; 95% CI: 1.97-3.56), followed by nose/facial injury, lower educational attainment, and fair/poor health. Self-reported chemosensory alterations are prevalent in US adults, supporting increased attention to decreasing their modifiable risks, managing safety/health consequences, and expanding chemosensory screening/testing and treatments.

Intake of vegetables falls short of recommendations to lower risk of chronic diseases. Most research addresses bitterness as a sensory deterrent to consuming vegetables. We examined bitter and sweet sensations from vegetables as mediators of vegetable preference and intake as well as how these tastes vary with markers of genetic variation in taste (3.2 mM 6-n-propylthiouracil bitterness) and taste pathology (1.0 mM quinine bitterness, chorda tympani nerve relative to whole mouth). Seventy-one females and 39 males (18-60 years) reported prototypical tastes from and preference for Brussels sprouts, kale and asparagus as well as servings of vegetables consumed, excluding salad and potatoes. Intensity and hedonic ratings were made with the general Labeled Magnitude Scale. Data were analyzed with multiple linear regression and structural equation modeling. Vegetable sweetness and bitterness were independent predictors of more or less preference for sampled vegetables and vegetable intake, respectively. Those who taste PROP as most bitter also tasted the vegetables as most bitter and least sweet. The spatial pattern of quinine bitterness, suggestive of insult to chorda tympani taste fibers, was associated with less bitterness and sweetness from vegetables. Via structural equation modeling, PROP best explained variability in vegetable preference and intake via vegetable bitterness whereas the quinine marker explained variability in vegetable preference and intake via vegetable bitterness and sweetness. In summary, bitterness and sweetness of sampled vegetables varied by taste genetic and taste function markers, which explained differences in preference for vegetables tasted in the laboratory as well as overall vegetable intake outside the laboratory.

Alcoholic beverages are complex stimuli, giving rise to sensations that promote or inhibit intake. Previous research has shown associations between 6-n-propylthiouracil (PROP) bitterness, one marker of genetic variation in taste, and alcohol behaviors. We tested the PROP bitterness and alcohol intake relationship as mediated by tastes of sampled alcoholic beverages. Forty-nine undergraduates (mean age=22 years) participated. According to the Alcohol Use Disorders Identification Test (AUDIT), only 3 of 49 subjects reported patterns indicating problematic drinking. Participants used the general Labeled Magnitude Scale to rate PROP bitterness and tastes from and preference for Pilsner beer, blended scotch whiskey, instant espresso and unsweetened grapefruit juice. Alcohol intake was reported over a typical week. Regression analysis tested the hypothesis that PROP bitterness influenced alcohol bitterness and sweetness, which in turn predicted alcohol intake. Those who tasted less PROP bitterness tasted all beverages as less bitter and more preferred. Sweetness of scotch was significantly greater in those who tasted PROP as least bitter. For scotch, greater sweetness and less bitterness from sampled scotch were direct predictors of greater alcohol intake. For beer, preference ratings were better predictors of alcohol intake than the bitter or sweet tastes of the sampled beer. These findings support that PROP bitterness predicts both positive and negative tastes from alcoholic beverages and that those tastes may predict alcohol intake. The college environment may attenuate direct effects of PROP bitterness and intake. Here, PROP bitterness does not predict alcohol intake directly, but acts instead through sweet and bitter tastes of alcoholic beverages.

Alcohol produces a range of oral sensations, some of which have been shown to vary with the perceived bitterness of 6-n-propylthiouracil (PROP), one marker for genetic variation in taste. Some studies report that offspring of alcoholics are most likely to be PROP nontasters [Physiol. Behav. 51 (1992) 1261; Physiol. Behav. 64 (1998) 147], yet others report the offspring as more responsive to sodium chloride (NaCl) and citric acid, which appears to contradict the taste genetic hypothesis. We predicted alcohol sensation and intake from measures of taste genetics (PROP bitterness and number of fungiform papilla), NaCl and citric acid intensity, and spatial taste pattern in 40 females and 43 males. Subjects used the general Labeled Magnitude Scale (gLMS) [Chem. Senses 18 (1993) 683; J. Food Qual. Pref. 14 (2002) 125] as an intensity and hedonic scale. Those who tasted PROP as most bitter or had highest numbers of fungiform papilla reported greatest oral burn from an alcohol probe; those who tasted least PROP bitterness consumed alcoholic beverages most frequently. Although higher NaCl and citric acid ratings associated with more frequent consumption of alcoholic beverages, the findings could be explained by lower intensity of tastants on the tongue tip (chorda tympani nerve) relative to whole mouth perception. In multiple regression analyses, PROP bitterness and the spatial pattern of taste perception were independent contributors to the prediction of alcohol intake. In summary, the results support that variation in oral sensation associates with alcohol intake. Those who taste PROP as least bitter and have low chorda tympani relative to whole mouth taste intensity appear to have fewest oral sensory hindrances to the consumption of alcoholic beverages.

Food liking-disliking patterns may strongly influence food choices and health. Here we assess: (1) whether food preference patterns are genetic/environmentally driven; and (2) the relationship between metabolomics profiles and food preference patterns in a large population of twins. 2,107 individuals from TwinsUK completed an online food and lifestyle preference questionnaire. Principle components analysis was undertaken to identify patterns of food liking-disliking. Heritability estimates for each liking pattern were obtained by structural equation modeling. The correlation between blood metabolomics profiles (280 metabolites) and each food liking pattern was assessed in a subset of 1,491 individuals and replicated in an independent subset of monozygotic twin pairs discordant for the liking pattern (65 to 88 pairs). Results from both analyses were meta-analyzed. Four major food-liking patterns were identified (Fruit and Vegetable, Distinctive Tastes, Sweet and High Carbohydrate, and Meat) accounting for 26% of the total variance. All patterns were moderately heritable (Fruit and Vegetable,h2[95% CI]: 0.36 [0.28; 0.44]; Distinctive Tastes: 0.58 [0.52; 0.64]; Sweet and High Carbohydrate: 0.52 [0.45, 0.59] and Meat: 0.44 [0.35; 0.51]), indicating genetic factors influence food liking-disliking. Overall, we identified 14 significant metabolite associations (Bonferronip< 4.5 × 10−5) with Distinctive Tastes (8 metabolites), Sweet and High Carbohydrate (3 metabolites), and Meat (3 metabolites). Food preferences follow patterns based on similar taste and nutrient characteristics and these groupings are strongly determined by genetics. Food preferences that are strongly genetically determined (h2≥ 0.40), such as for meat and distinctive-tasting foods, may influence intakes more substantially, as demonstrated by the metabolomic associations identified here.

The study of genetic variation in taste produces parallels between mice and men. In mice, genetic variation across strains has been documented with psychophysical and anatomical measures as well as with recordings from whole nerves. In humans, the variation has been documented with psychophysical and anatomical measures. Whole-nerve recordings from animals and psychophysical ratings of perceived intensities from human subjects have a similar logical limitation: absolute comparisons across individuals require a standard stimulus that can be assumed equally intense to all. Comparisons across whole-nerve recordings are aided by single-fiber recordings. Comparisons across psychophysical ratings of perceived intensity have been aided by recent advances in methodology; these advances now reveal that the magnitude of genetic variation in human subjects is larger than previously suspected. In females, hormones further contribute to variation in taste. There is evidence that the ability to taste (particularly bitter) cycles with hormones in women of child-bearing age, rises to a maximum early in pregnancy and declines after menopause. Taste affects food preferences, which in turn affect dietary behavior and thus disease risks. Valid assessment of taste variation now permits measurement of the impact of taste variation on health. Advances in psychophysical methodology were essential to understanding genetic variation in taste. In turn, the association of perceived taste intensities with tongue anatomy now provides a new tool for psychophysics. The ability of a psychophysical scale to provide across-subject comparisons can be assessed through its ability to show the fungiform papillae density-taste association.

Taste blindness to phenylthiocarbamide (PTC) and its chemical relative 6-n-propylthiouracil (PROP) was discovered in the 1930s. Family studies showed that those who could not taste PTC/PROP (nontasters) carried two recessive alleles. In recent years, we have classified tasters into two groups: medium (PROP is moderately bitter) and supertasters (PROP is intensely bitter). With our classification, approximately 25% of Americans are nontasters, 50%, medium tasters, and 25%, supertasters. Studies showed that supertasters form a cohesive group. Anatomical studies showed that supertasters have the most fungiform papillae. Psychophysical studies showed that supertasters perceive the most intense bitterness and sweetness from a variety of compounds, the most intense burn from oral irritants, and the most intense tactile sensations from viscous solutions. Oral burn and touch are presumably perceived to be the most intense to supertasters because taste buds in fungiform papillae are innervated by the trigeminal nerve (pain, touch) as well as the chorda tympani nerve (taste). The psychophysical scaling method used was magnitude matching with NaCl as the control modality. With this method, subjects rated the intensities of a series of NaCl and PROP solutions. The assumption that the taste of NaCl did not vary with PROP status allowed comparisons of the bitterness of PROP across subjects. Early magnitude matching studies, using sound as the control, had suggested that this assumption was reasonable. However, recent studies challenged that conclusion. Larger samples with more diverse populations, using sound as the control, showed that the taste of NaCl varied with PROP bitterness; supertasters perceived the strongest taste and nontasters, the weakest. Thus our earlier conclusions were conservative because differences between nontasters, medium tasters, and supertasters were concealed by using NaCl as a standard. Using magnitude matching with sound as the standard, or using the Green scale, which employs intensity labels, we found that the differences between PROP groups are larger. Note that the association between PROP status and salt taste is interesting in itself, since variability in salt taste may have important nutritional consequences.

UNLABELLED We examined taste intensity and preference in 46 pregnant and 41 healthy female controls enrolled in the Yale Pregnancy Study (J. Rodin, PI). Pregnant females were tested non-pregnant (non-pg) and during the first, second and third trimesters; controls, at corresponding time intervals. Subjects rated intensity of and preference for a three-member concentration series of NaCl, sucrose, citric acid (CA), and quinine hydrochloride (QHCl) on a labeled line ('nothing' at the left, 'extremely' at 80%). Variance differences between groups were tested with the F distribution (p < 0.05). Controls had significantly greater variance among overall intensity ratings than pregnant females, most pronounced for QHCl. Controls did not have highest variance among overall hedonic ratings, but did have highest variance for sweet and QHCl ratings. Within pregnancy analyses were tested with the Friedman two-way ANOVA. Significant intensity changes occurred for moderate NaCl and QHCL concentrations (p < 0.005). For NaCl, intensity fell from non-pg and first trimester to second and third trimesters. For QHCl, intensity rose from non-pg to first trimester, and fell from first to second and third trimesters. In the hedonic ratings, significant changes occurred for top concentrations of NaCl (p < 0.05) and 0.001 M CA (p < 0.001), and moderate QHCl (p < 0.005). NaCl preference rose from non-pg to third trimester. Preference for CA fell from non-pg to first trimester and then rose from first to second and third trimesters. QHCl became less disliked from non-pg and first trimester to third trimester. SUMMARY taste intensity and hedonic variance in controls may associate with menstrual hormone fluctuations. Pregnant women were aligned in pregnancy stage which may explain the lower variance. Taste intensity and hedonic changes across pregnancy could serve to support healthy pregnancy outcomes: increases in bitter intensity in first trimester to protect against ingesting poisons; changes in NaCl, sour and bitter preference later in pregnancy to support ingesting a varied diet.

Family studies using thresholds showed that PROP (6-n-propylthiouracil) tasting is produced by a dominant allele, T. Nontasters have two recessive alleles and tasters have one or two dominant alleles. The bitterness of suprathreshold PROP and anatomical criteria subdivide tasters into medium and supertasters. Supertasters may be TT tasters, but this has yet to be demonstrated. Supertasters preceive the greatest bitterness and sweetness from many stimuli as well as the greatest oral burn from alcohol and capsaicin. Women are more likely than men to be supertasters. Otitis media and head trauma can alter taste and thus PROP classifications, complicating studies on PROP genetics. Some subjects with a history of otitis media show taste reductions, but others show enhanced tastes and appear to have more taste buds per fungiform papilla. Subjects with head trauma show reduced tastes on some oral loci, but there is evidence that severe reductions on the front of the tongue ameliorate reductions at the circumvallate papillae on the back of the tongue by a release of inhibition mechanism.

Dietary assessment in children is difficult, suggesting a need to develop more objective biomarkers of intake. Resonance Raman spectroscopy (RRS) is a non-invasive, validated method of measuring carotenoid status in skin as a biomarker of fruit/vegetable intake. The purpose of this study was to examine the feasibility of using RRS in preschool children, to describe inter-individual variability in skin carotenoid status and to identify factors associated with the biomarker in this population. We conducted a cross-sectional study of 381 economically disadvantaged preschoolers in urban centers in Connecticut (USA). In all, 85.5% were black non-Hispanic or Hispanic/Latino, and 14.1% were obese and 16.9% were overweight by age- and sex-specific body mass index (BMI) percentiles. Children had their skin carotenoid status assessed by RRS in the palm of the hand. Fruit/vegetable consumption was assessed by a brief parent/guardian-completed food frequency screener and a liking survey. We observed inter-individual variation in RRS values that was nearly normally distributed. In multiple regression analysis, higher carotenoid status, measured by RRS, was positively associated with fruit/vegetable consumption (P=0.02) and fruit/vegetable preference (P

Taste worlds of humans vary because of taste blindness to phenylthiocarbamide (PTC) and its chemical relative, 6-n-propylthiouracil (PROP). We review early PTC studies and apply modern statistical analyses to show that a higher frequency of women tasted PTC crystals, and were tasters (threshold classification). In our laboratory, scaling of PROP bitterness led to the identification of a subset of tasters (supertasters) who rate PROP as intensely bitter. Supertasters also perceive stronger tastes from a variety of bitter and sweet substances, and perceive more burn from oral irritants (alcohol and capsaicin). The density of taste receptors on the anterior tongue (fungiform papillae, taste buds) correlate significantly with perceived bitterness of PROP and support the supertaster concept. Psychophysical data from studies in our laboratory also show a sex effect; women are supertasters more frequently. The anatomical data also support the sex difference; women have more fungiform papillae and more taste buds. Future investigations of PTC/PROP tasting and food behaviors should include scaling to identify supertasters and separate sex effects.

Chronic exposure to otitis media (OM) has been linked to risk of overweight/obesity. Here we tested if dietary behaviors explained some of the OM-adiposity relationship among 485 racially-diverse, low-income preschoolers (253 girls, mean age=45±7 months) enrolled in government-supported urban preschool programs. From measured weight/height, 4% were underweight, 17% were overweight and 13% were obese. OM exposure according to parent report varied across nearly equal quartiles-low (never, once) to high (3-5 times, 6+ times) exposure categories. Boys were more likely to be in the high exposure categories. Parents rated their child's liking/disliking of foods (high-fat/added sugar, fruits/juice, vegetables) and non-food activities. In analysis of covariance (ANCOVA), mean liking for vegetables and fruits/juice fell as OM exposure increased, with significant differences between lowest and highest exposure categories (p.05). Food neophobic versus non-neophobic preschoolers also liked vegetables and fruits less (p.001). In a two-way ANCOVA, main effects of OM and food neophobia independently predicted vegetable and fruit liking; preschoolers with more OM exposure and neophobia had the lowest liking. Although ANCOVA failed to reveal OM effects on mean liking for fat/sugar foods, the relative ranking of liking for these foods differed by OM category. Fat/sugar foods were ranked as most preferred for the high OM children, particularly the boys, surpassing the ranking of pleasurable non-food items. Conversely, low OM children ranked pleasurable non-food items and fruits/juice as more pleasurable than high OM children. BMI percentile varied with OM exposure, but not neophobia: preschoolers with the greatest exposure averaged the highest percentiles. In multiple regression analyses, liking for vegetables or fruits failed to associate significantly with BMI percentile. There was a small but significant association between greater fat/sugar liking and higher BMI percentile. Overall these findings confirm associations between high OM exposure and elevated adiposity in preschoolers. They also suggest this relationship is explained through lower affinity for vegetables and fruits and greater affinity for fat/sugar foods.

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.

Genetics, environmental exposures, and aging interact to produce variations in the perception or liking of taste, olfaction, and somatosensory sensations (i.e., chemosensation). Chemosensory variation can affect disease risk by influencing what people like and choose to eat from abundant supplies of desirable high-fat, sweet, and salty foods and alcoholic beverages at the expense of less-available or less-liked vegetables. We contend that assessing dietary preference via liking-disliking surveys holds promise for linking chemosensation with dietary intake and health outcomes in population-based studies. Typical intake measures (e.g., frequency surveys, dietary records) are difficult to complete and interpret. Because of memory issues and dietary restraint, individuals under- or overreport intakes, leading to inaccurate conclusions about diet-disease relationships. Surveying food and beverage liking is a time-efficient, simple task that minimizes the cognitive limitations of intake measures. In the present study, women in a worksite health risk appraisal completed brief food frequency and liking surveys and reported their height and weight, and blood pressure was measured. While liking and intake measures for high-fat and high-fiber foods were correlated, only liking was associated with disease risk. In multiple regression models, women reporting greater liking for high-fat foods and less liking for spicy foods had greater adiposity and/or blood pressure, controlling for age. These data, along with previous laboratory and community-based studies, support that reported liking of high-fat foods explains variability in adiposity and adiposity-related outcomes. Hedonic measures appear to capture habitual intake of foods and beverages, are easy to implement in the field, and thus may increase understanding of how chemosensory variation modifies disease risk.

Polymorphisms in the TAS2R38 gene provide insight to phenotypes long associated 6-n-propylthiouracil (PROP) and phenylthiocarbamide bitterness. We tested relationships between TAS2R38 genotype, taste phenotype, and fungiform papillae (FP) number in 139 females and 59 males (age range 21–60 years), primarily of European ancestry. DNA was analyzed for 3 polymorphic sites, identifying common (alanine–valine–isoleucine [AVI/AVI], heterozygotes, proline–alanine–valine [PAV/PAV]) and rare (proline–valine–isoleucine, alanine–alanine–valine, AAI) forms. Individuals with PROP threshold >0.15 mM were almost exclusively AVI/AVI; those with threshold

Psychophysical comparisons seem to show that obese individuals experience normal sweet and fat sensations, they like sweetness the same or less, but like fat more than the non-obese do. These psychophysical comparisons have been made using scales (visual analogue or category) that assume intensity labels (e.g.extremely) which denote the same absolute perceived intensity to all. In reality, the perceived intensities denoted by labels vary because they depend on experiences with the substances to be judged. This variation makes comparisons invalid. Valid comparisons can be made by asking the subjects to rate their sensory/hedonic experiences in contexts that are not related to the specific experiences of interest. Using this methodology, we present the evidence that the sensory and hedonic properties of sweet and fat vary with body mass index. The obese live in different orosensory and orohedonic worlds than do the non-obese; the obese experience reduced sweetness, which probably intensifies fat sensations, and the obese like both sweet and fat more than the non-obese do. Genetic variation as well as taste pathology contribute to these results. These psychophysical advances will impact experimental as well as clinical studies of obesity and other eating disorders.

Objective Nutrition components of health risk appraisals (HRAs) aim to rapidly and accurately assess dietary behaviors that increase disease risk. Because cognitive research suggests that recalling food likes/dislikes may be simpler and more accurate than recalling intake, we tested whether a preference measure was predictive of cardiovascular disease risk factors within an HRA. Methods HRA participants (422 primarily non-Hispanic white men, mean age 46±10 years) from a manufacturing company completed surveys to assess fat and sweet food/beverage preference; frequency of consuming fat and sweet foods/beverages, alcoholic beverages, fiber-rich foods (whole grains, fruits, and vegetables); and physical activity. Per measured risk factors, 34% had central obesity (waist circumference ≥102 cm), 32% had hypertension (≥140 and/or ≥90 mm Hg), 52% had prehypertension (≥120 to 139 and/or ≥80 to 89 mm Hg), and 52% had an elevated total cholesterol level (≥200 mg/dL [5.2 mmol/L]). Statistical Analyses Multiple linear regression models explaining variability in waist circumference, blood pressure, and serum lipids were tested. Results Although preference and intake pairs for fat and sweets were significantly correlated, intake of fat and sweets failed to associate significantly with any risk factor. Significant variance in waist circumference was explained by age, fat preference, fiber intake, and physical activity. Those with greater circumferences liked fat more, consumed less fiber, and exercised less. Waist circumference in turn contributed significantly to models predicting serum lipid levels and blood pressure. Alcohol intake explained variability in serum lipid levels—higher intakes were associated with higher high-density lipoprotein cholesterol levels. The models predicting risk were generally more explanatory in younger ( Conclusions Including a preference measure within an HRA appears to enhance cardiovascular disease risk factor assessment. Fat preference, intake of fiber-rich foods, and alcohol proved the best dietary determinants of cardiovascular disease risk factors.

Inadequate vegetable intake appears to increase colon cancer risk. Since genetic variation in taste influences vegetable preference, we tested associations between bitterness of 6-n-propylthiouracil (PROP), a measure of taste genetics, and number of colonic polyps, a measure of colon cancer risk, in 251 men who underwent screening lower endoscopy. Patients used the general Labeled Magnitude Scale to rate bitterness of 1.6 mg PROP delivered via filter paper. A subset of 86 patients reported weekly vegetable intakes, excluding salad or potatoes. PROP bitterness correlated significantly with polyp number, an effect separate from age-associated increases in polyp number. The PROP-polyp relationship was strongest in men over 66 years, and older men with polyps were most likely to be overweight or obese. In the subset reporting vegetable intake, men who tasted PROP as more bitter consumed fewer vegetables. These preliminary findings suggest that taste genetics may influence colon cancer risk, possibly through intake of vegetables.

Studies using anesthesia provide insights into oral phantoms. The chorda tympani nerve is accessible for anesthesia at two sites. First, the chorda tympani leaves the tongue with the lingual nerve (CN V) and the two travel through the pterygomandibular space. The inferior alveolar nerve, which conveys pain from the lower teeth, passes through the same space; thus dental anesthesia abolishes taste and touch as well as pain. Secondly, the chorda tympani passes through the middle ear after separating from the lingual nerve, so injection of an anesthetic just under the skin near the ear drum anesthetizes taste but not touch. Using both procedures, we showed that anesthesia of the chorda tympani intensifies tastes evoked from the contralateral rear of the tongue, the area innervated by the glossopharyngeal nerve (Lehman et al., 1995; Yanagisawa et al., 1998). This finding supports the earlier evidence of Halpern and Nelson (1965) for central inhibitory connections between the chorda tympani and glossopharyngeal nerves. This inhibition acts as a constancy mechanism: when one nerve is damaged, its input to the central nervous system (CNS) is reduced, releasing inhibition on other taste structures and thus compensating for the loss of input from the damage. During our anesthesia experiments, about half of the subjects developed taste phantoms typically localized to the contralateral rear of the tongue (Yanagisawa et al., 1998). This suggested that clinical taste phantoms (i.e. dysgeusia) might be the result of localized taste damage. Indeed, we have found taste damage in patients reporting taste phantoms (Bartoshuk et al., 2002).

STRONG SUPPORT EXISTS for a familial component in the etiology of alcoholism and alcohol use [see Dick and Foroud (2003) for review]. Twin studies show that the heritability of alcoholism ranges from 50 to 60% (Heath et al., 1997) and that genetic influences can explain a 5-fold difference in alcohol use among adolescents in alcohol-predisposing environments (Dick et al., 2001). Genetic risk for alcoholism is complex; several different genes undoubtedly exert effects on the rewarding influence of drinking alcohol, on the metabolic tolerance of alcohol overconsumption, on brain systems that respond to reward, and on response to alcohol withdrawal (Crabbe, 2002). Specific gene mechanisms have been linked to, for example, the metabolism of alcohol via alcohol dehydrogenase (Mulligan et al., 2003; Osier et al., 1999) and aldehyde dehydrogenase (Oota et al., 2004), as well as dependence via γ-aminobutyric acid receptors (Song et al., 2003). The purpose of this study was to examine the association between genetic variation in taste and alcohol use in a group of reportedly healthy young adults. Genetic variation in taste influences the sensations from alcoholic beverages and could be one of the genetic factors that interacts with environmental factors to determine the risk of alcohol overconsumption, as suggested by models of gene-environment interaction (Heath and Nelson, 2002). The ability to taste the bitterness of phenylthiocarbamide (PTC) and 6-n-propylthiouracil (PROP), which share an group, is a well documented phenotypic polymorphism. The distribution of thresholds for PTC or PROP tasting is bimodal: “nontasters” have increased thresholds (low sensitivity), and “tasters” have lower thresholds (higher sensitivity). Family studies have generally supported the model that tasting was a dominant trait and nontasting a recessive trait (Blakeslee, 1932; Snyder, 1931). An important gene contributing to PTC perception has been identified (Kim et al., 2003). The gene (TAS2R38), located on chromosome 7q36, is a member of the bitter taste receptor family. There are two common molecular forms [proline-alanine-valine (PAV) and alanine-valine-isoleucine (AVI)] of this receptor defined by three nucleotide polymorphisms that result in three amino acid substitutions: Pro49Ala, Ala262Val, and Val296Ile. The ancestral human haplotype at these three amino acids—determined by sequencing DNA from several other ape species, an old world monkey, and a new world monkey—is PAV (Kim et al., 2003; Wooding et al., 2004). This molecular form is common in humans and is associated with tasting; the other common form, the triply derived molecular form, AVI, is associated with nontasting. Three other haplotypes have been observed: AAV, AAI, and PVI. The original report (Kim et al., 2003) studied 200 Europeans and 118 individuals from other regions. Historically, researchers have used detection thresholds to classify individuals as nontasters or tasters of these bitter compounds (e.g., Fox, 1931; Harris and Kalmus, 1949). Fischer and Griffin (1964) replaced PTC with its chemical relative PROP, which lacks the sulfurous odor of PTC and may be less toxic (Barnicot et al., 1951; Lawless, 1980). Insensitivity to PTC or PROP is estimated at 30% in European populations, although the percentages vary with sex and among ethnic groups globally (Bartoshuk et al., 1994; Guo and Reed, 2001). The taster group shows significant variability in the perceived bitterness of PROP. Although threshold measures may be used to separate individuals with low thresholds (tasters) from individuals with increased thresholds (nontasters), subsequent work by Bartoshuk et al. (1994) identified two distinct populations within the taster group. By comparing the perceived intensity of concentrated PROP, the taster group is subdivided into those who taste concentrated PROP (3.2 mM) as “strongly” bitter (medium tasters) and those who taste PROP as greater than “very strongly” bitter (supertasters) (Bartoshuk et al., 1994). Supertasters cannot be identified via thresholds, because the distributions between those who are sensitive and extremely sensitive to PROP overlap (Reed et al., 1995). Supertasters differ from medium tasters and nontasters in the number of taste papillae on the anterior tongue (fungiform papilla); PROP supertasters have, on average, the most fungiform papillae and taste buds as assessed with videomicroscopy (Bartoshuk et al., 1994). A positive relationship between PROP bitterness and fungiform papillae number is also observed by using lower magnification for papillae counting (Delwiche et al., 2001; Tepper and Nurse, 1997). Supertasting may result from an anatomical difference related to the density of fungiform papillae on the tongue, as well as an allelic variation of TAS2R38 that results in the presence or absence of a functional receptor, as proposed by Bartoshuk et al. (2001) and as supported by data shown in this article. The genetic control of fungiform papilla density is unknown. The perceived bitterness of PROP is correlated with unpleasant and pleasant sensations from alcohol. Those who taste PROP as more bitter also report ethanol (Bartoshuk et al., 1993; Duffy et al., 2004; Prescott and Swain-Campbell, 2000), some types of beer (Intranuovo and Powers, 1998), scotch (Lanier et al., 2004), and red wines (Pickering et al., 2004) as more bitter or irritating. Nontasters not only perceive scotch as less bitter but also as more sweet than do supertasters (Lanier et al., 2005). The density of fungiform papillae can explain some of the oral sensory differences associated with PROP tasting, as first suggested by Miller and Reedy (1990). The taste buds are surrounded by fibers of the trigeminal nerve (cranial nerve V), which are believed to mediate oral burn (Finger et al., 1994; Whitehead et al., 1985; Whitehead and Kachele, 1994). It is interesting to note that sucrose and ethanol stimulate similar central brain centers in rats (Lemon et al., 2004) and that ethanol stimulates taste nerve fibers responsive to sucrose in primates (Hellekant et al., 1997). Supertasters may have an inherent sensory aversion to consuming alcoholic beverages with high levels of ethanol and a pronounced alcohol flavor. Young adults who taste PROP as more bitter have been found to consume less beer (Guinard et al., 1996), including during their first year of drinking (Intranuovo and Powers, 1998). In young adults who were not college undergraduates, we found that PROP supertasters reported consuming alcoholic beverages less frequently than did nontasters (Duffy et al., 2004), a finding that was also seen in preliminary data in adults (primarily men) recruited through an industrial worksite wellness program (Hutchins et al., 2002). Not all studies, however, find associations between PROP bitterness and alcohol intake (e.g., Mattes and DiMeglio, 2001). The literature is inconsistent with respect to a relationship between PROP tasting and risk of alcoholism. In studies with alcoholics compared with controls, some report an excess of nontasters among alcoholics (DiCarlo and Powers, 1998; Peeples, 1962; Spiegel, 1972), whereas other studies do not (Reid et al., 1968; Smith, 1972; Swinson, 1973). In studies examining family history of alcoholism, Pelchat and Danowski (1992) found significantly more PROP nontasters among children of alcoholics than among children of nonalcoholics, whether or not the children themselves were alcoholic. Kranzler and colleagues, however, were unable to show a significant relationship between PROP threshold and parental history of alcohol dependence in nonalcoholic young adults (Kranzler et al., 1998) or in those with alcohol dependency (Kranzler et al., 1996). One study found comorbidity between depression and alcoholism in college students who reported PROP as very bitter (DiCarlo and Powers, 1998). Some of the inconsistencies in PROP effects on alcohol consumption behaviors could relate to the measurement of PROP tasting. A number of studies relating alcohol-ingestive behaviors to PROP have relied on a threshold procedure (Kranzler et al., 1996, 1998; Peeples, 1962; Pelchat and Danowski, 1992; Spiegel, 1972), which, because it cannot identify supertasters (Bartoshuk et al., 1994), has the potential to fail to find PROP effects. In fact, we reported positive and significant associations between the frequency of consuming alcoholic beverages and PROP bitterness, but not PROP threshold (Duffy et al., 2004). Distinguishing PROP supertasters from medium tasters and nontasters requires valid scaling methods, as reviewed previously (Bartoshuk et al., 2002b, 2004a,Bartoshuk et al., b). Discovery of allelic variation in TAS2R38, the gene for the PTC receptor, presented the opportunity for examining its ability to predict the oral sensation from an ethanol probe and the frequency of consuming alcoholic beverages in a sample of healthy adults who were recruited into a study of taste genetics and dietary behaviors and who reported consuming alcoholic beverages. Analysis of these data showed that genotype predicts PROP bitterness and, because of its association with PROP bitterness, predicts alcohol intake. However, genotype fully accounts neither for supertasting nor for some of the oral sensations from alcohol.

Labeled scales are commonly used for across-group comparisons. The labels consist of adjective/adverb intensity descriptors (e.g., "very strong"). The relative distances among descriptors are essentially constant but the absolute perceived intensities they denote vary with the domain to which they are applied (e.g., a "very strong" rose odor is weaker than a "very strong" headache), as if descriptors were printed on an elastic ruler that compresses or expands to fit the domain of interest. Variation in individual experience also causes the elastic ruler to compress or expand. Taste varies genetically: supertasters perceive the most intense tastes; nontasters, the weakest; and medium tasters, intermediate tastes. Taste intensity descriptors on conventional-labeled scales denote different absolute perceived intensities to the three groups making comparisons across the groups invalid. Magnitude matching provides valid comparisons by asking subjects to express tastes relative to a standard not related to taste (e.g., supertasters match tastes to louder sounds than do nontasters). Borrowing the logic of magnitude matching, we constructed a labeled scale using descriptors unrelated to taste. We reasoned that expressing tastes on a scale labeled in terms of all sensory experience might work. We generalized an existing scale, the Labeled Magnitude Scale (LMS), by placing the label "strongest imaginable sensation of any kind" at the top. One hundred subjects rated tastes and tones using the generalized LMS (gLMS) and magnitude matching. The two methods produced similar results suggesting that the gLMS is valid for taste comparisons across nontasters, medium tasters, and supertasters.

We hypothesize that variation in oral sensation influences chronic disease risk by impacting dietary behaviors. Bitterness of 6-n-propylthiouracil (PROP) and fungiform papilla (FP) number serve as genetic taste markers. Data support that nontasters (who taste PROP as least bitter or have lowest FP number) show dietary behaviors that increase CVD risk (e.g. higher alcohol intake, greater preference for and intake of high-fat and sweet foods) and have greater measured CVD risk (e.g. higher blood pressure, less favorable serum lipids). Taste genetics interacts with environmental factors (e.g. taste-related pathologies) to affect oral sensation, dietary behaviors and disease risk. The generalizability of oral sensory and CVD risk relationships has begun to be tested on diverse samples.

Hyperemesis gravidarum or severe vomiting during pregnancy is a condition of elusive etiology that can harm both mother and fetus. This study examined the association between increased bitter-taste perception and history of hyperemesis gravidarum. Bitter-taste perception varies genetically and can be altered with conditions that damage taste-related cranial nerves. Sixty women were divided into high- (n = 21) and low-vomit (n = 39) groups based on vomiting exposure across all pregnancies and were screened for genetic variation in taste with bitterness of saturated 6-n-propylthiouracil (PROP) delivered on filter paper. Supertasters perceive PROP as intensely bitter; nontasters, as only weakly. Each reported their history of dysgeusia (persistent taste) and taste-related pathology (otitis media and head trauma). The vomit groups did not differ in the frequency of supertasters, but the high-vomit group had fewest nontasters. The high-vomit group also reported dysgeusia most frequently. A subsample (13 high-vomit and 18 low-vomit women) rated the taste intensity of sodium chloride (1 mol), sucrose (1 mol), citric acid (0.0032 mol), and quinine hydrochloride (0.001 mol) applied to areas innervated by cranial nerves VII and IX. The groups only varied significantly in bitterness of quinine hydrochloride. High-vomit women tasted least bitterness on the anterior tongue (chorda tympani branch of VII) and highest bitterness on the posterior tongue (cranial nerve IX) and palate (superficial petrosal branch of VII). In high-vomit women, elevated bitterness on the posterior tongue and palate does not appear related to hydrochloric acid exposure in vomitus; it may explain the occurrence of dysgeusia. This pattern of spatial taste perception may indicate altered oral sensations that if present during pregnancy, could increase the risk of hyperemesis.