Clinical undernutrition states and their influence on taste

Smell and taste function in childhood cancer patients: a feasibility study

Purpose

Chemotherapy can affect smell and taste function. This has never been investigated in childhood cancer patients during chemotherapy. The objective of this study was to determine whether psychophysical smell and taste tests are suitable for children with cancer. Taste and smell function, fungiform papillae density, and eating behavior were measured before (T1) and after (T2) a cycle of chemotherapy and compared with healthy controls.

Methods

Thirty-one childhood cancer patients treated for a hematological, solid, or brain malignancy (median age 12 years, 16 girls), and 24 healthy controls (median age: 11 years, 10 girls) participated. Smell function was measured using Sniffin’ Sticks, including a threshold, discrimination, and identification test. Taste Strips were used to determine recognition thresholds for sweet, sour, salty, and bitter taste. Papillae density was investigated by counting the fungiform papillae of the anterior tongue. Eating behavior was assessed using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS).

Results

Smell and taste function could be investigated in more than 90% of the patients, while fungiform papillae density could be determined in 61% of the patients. A significant difference in smell threshold was found between patients and controls (p = 0.001), showing lower thresholds in patients. In patients, sweet taste (p < 0.001), bitter taste (p = 0.028), and total taste function (p = 0.004) were significantly different after a cycle of chemotherapy, with higher scores at T2.

Conclusion

The assessment of smell, taste, and fungiform papillae density is feasible in children with cancer. Results of the current study suggest that smell and taste sensitivity increased in children with cancer.

Neurolocalization of taste disorders

Neurolocalization of taste disorders requires a knowledge of the functional anatomy involved in mediating taste information from the peripheral mucosal surfaces through numerous peripheral cranial nerves to complex subcortical and cortical brain regions. Our understanding of this functional anatomy has advanced in recent years. Taste is an experience that is both innate and learned, and the "taste" experience involves the integration of information from other sensory modalities, such as olfaction and somatosensation. Normal taste perception is influenced by different neurophysiologic states, which involve endocrine function, emotions, and even attitudes and expectations toward eating. At its core, the normal effective ability to taste is a reflection of the proper function of many organ systems within the body and may be considered a marker for good health. Clinical taste disorders, on the other hand, involve the dysfunction of the normal neural taste pathways and/or aberrant influences on multisensory integration and cortical taste processing. The number of disease processes, which can adversely affect taste, are numerous and quite varied in their presentation. There may be contributory involvement of other organ systems within the body, and the appropriate management of taste disorders often requires a multidisciplinary approach to fully understand the disorder. Depending on the underlying cause, taste disorders can be effectively managed when identified. Treatments may include correcting underlying metabolic disturbances, eliminating infections, changing offending medications, replenishing nutritional deficiencies, operating on structural impairments, calming autoimmune processes, and even stabilizing electrochemical interactions.

Smell-taste dysfunctions in extreme weight/eating conditions: analysis of hormonal and psychological interactions

(1) The objective of this study is to analyze differences in smell-taste capacity between females in extreme weight/eating conditions (EWC) and (2) to explore the interaction between smell/taste capacity, gastric hormones, eating behavior and body mass index (BMI). The sample comprised 239 females in EWC [64 Anorexia nervosa (AN) and 80 age-matched healthy-weight controls, and 59 obese and 36 age-matched healthy-weight controls]. Smell and taste assessments were performed through "Sniffin' Sticks" and "Taste Strips," respectively. The assessment measures included the eating disorders inventory-2, the symptom check list 90-revised, and The Dutch Eating Behavior Questionnaire, as well as peptides from the gastrointestinal tract [Ghrelin, peptide YY, cholecystokinin]. Smell capacity was differentially associated across EWC groups. Smell was clearly impaired in obese participants and increased in AN (hyposmia in Obesity was 54.3 and 6.4 % in AN), but taste capacity did not vary across EWC. Ghrelin levels were significantly decreased in obese subjects and were related to smell impairment. EWC individuals showed a distinct smell profile and circulating ghrelin levels compared to controls. Smell capacity and ghrelin may act as moderators of emotional eating and BMI.

Liposomal treatment of xerostomia, odor, and taste abnormalities in patients with head and neck cancer

BACKGROUND

Smell and taste disorders, sicca symptoms, can be detected in patients with head and neck cancer. The purpose of this study was to assess the utility of local liposomal application in the treatment of patients with head and neck cancers.

METHODS

Ninety-eight patients with head and neck cancer were included in this study. The groups were defined as: group 1 = only surgery; group 2 = surgery + adjuvant radiochemotherapy; and group 3 = primarily radiochemotherapy. All patients had finished cancer treatment and received liposomal sprays for the nose and mouth for 2 months (LipoNasal, LipoSaliva; Optima Pharmaceutical GmbH, Germany) and suffered from taste and smell disorders. We performed tests with "Sniffin' Sticks," "Taste Strips," and a xerostomia questionnaire before and after treatment.

RESULTS

After application of liposomes, patients demonstrated a statistically significant increase in smell and taste, and reduced xerostomia.

CONCLUSION

Our results demonstrate that using nonpharmaceutical liposomal sprays improve smell, taste, and symptoms of xerostomia in patients with head and neck cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1232-E1237, 2016.

Characterization of chemosensory alterations in advanced cancer reveals specific chemosensory phenotypes impacting dietary intake and quality of life

CONTEXT

Taste and smell (chemosensory) alterations are common and distressing among advanced cancer patients, but their specific nature is poorly described and seldom linked to dietary intake. Details of altered chemosensory perception may help to explain food intake behaviors.

OBJECTIVES

Our goal was to characterize chemosensory alterations and their relationship with dietary intake and quality of life (QOL).

METHODS

Adult advanced cancer patients (n=192) completed a chemosensory self-assessment questionnaire to characterize changes in their sense of smell and four basic tastes (sweet, sour, salty, and bitter) since the onset of cancer, three-day food record, and QOL questionnaire.

RESULTS

Patients experienced either no alteration in any basic tastes and sense of smell sensations (26% of patients) or one of three altered chemosensory phenotypes: 1) stronger sensations overall (42%), 2) weaker sensations overall (18%), or 3) mixed (some sensations stronger and others weaker, 14%). For individual sensations (sweet, sour, salty, bitter, and smell), stronger sensation was twice more prevalent than weaker sensation (P=0.035). Patients reporting chemosensory alteration consumed 20%-25% fewer calories per day (P=0.0018), experienced greater weight loss (P=0.0036), and had poorer QOL scores (P=0.0176) compared with patients with no alterations, but results did not vary by chemosensory phenotype. Chemosensory alterations were not related to tumor type (P=0.884), gender (P=0.286), or nausea (P=0.278).

CONCLUSION

Chemosensory alterations predict dietary intake and QOL; the identification of chemosensory phenotypes provides a rationale to adjust the properties of foods and dietary recommendations in function of the specific nature of these changes.

Cancer-Associated Cachexia and Underlying Biological Mechanisms

Cancer metastases (spread to distant organs from the primary tumor site) signify systemic, progressive, and essentially incurable malignant disease. Anorexia and wasting develop continuously throughout the course of incurable cancer. Overall, in Westernized countries nearly exactly half of current cancer diagnoses end in cure and the other half end in death; thus, cancer-associated cachexia has a high prevalence. The pathophysiology of cancer-associated cachexia has two principal components: a failure of food intake and a systemic hypermetabolism/hypercatabolism syndrome. The superimposed metabolic changes result in a rate of depletion of physiological reserves of energy and protein that is greater than would be expected based on the prevailing level of food intake. These features indicate a need for nutritional support, metabolic management, and a clear appreciation of the context of life-limiting illness.

Nutritional demands in acute and chronic illness

Common to both acute and chronic disease are disturbances in energy homeostasis, which are evidenced by quantitative and qualitative changes in dietary intake and increased energy expenditure. Negative energy balance results in loss of fat and lean tissue. The management of patients with metabolically-active disease appears to be simple; it would involve the provision of sufficient energy to promote tissue accretion. However, two fundamental issues serve to prevent nutritional demands in disease being met. The determination of appropriate energy requirements relies on predictive formulae. While equations have been developed for critically-ill populations, accurate energy prescribing in the acute setting is uncommon. Only 25-32% of the patients have energy intakes within 10% of their requirements. Clearly, the variation in energy expenditure has led to difficulties in accurately defining the energy needs of the individual. Second, the acute inflammatory response initiated by the host can have profound effects on ingestive behaviour, but this area is poorly understood by practising clinicians. For example, nutritional targets have been set for specific disease states, i.e. pancreatitis 105-147 kJ (25-35 kcal)/kg; chronic liver disease 147-168 kJ (35-40 kcal)/kg, but given the alterations in gut physiology that accompany the acute-phase response, targets are unlikely to be met. In cancer cachexia attenuation of the inflammatory response using eicosapentaenoic acid results in improved nutritional intake and status. This strategy poses an attractive proposition in the quest to define nutritional support as a clinically-effective treatment modality in other disorders.

Taste alterations among patients with cancer

Patients with cancer frequently develop taste alterations, which are manifested by food aversions and decreased caloric intake. Many etiologies are recognized, including the effect of tumors, cancer cell mitosis, vitamin deficiencies, and cytokine involvement. Preventing or improving taste alterations in patients with cancer is challenging. Clinicians play an important role in assessing, educating, and referring (when indicated) patients experiencing potential or actual taste alterations. Directions for further nursing research include the development of assessment tools and preventative strategies.

Reduction in energy expenditure after liver transplantation

After successful liver transplantation (LTx), excessive weight gain is common among recipients. This rapid change in body morphology has been attributed to immunosuppressive regimens. The liver's role as a metabolic sensor and its autonomic innervation are pivotal in relaying humoral and neural information to the hypothalamus, where ingestive behavior is determined and has largely been ignored. We examined and assessed the contribution of drugs, energy intake, and energy expenditure on weight gain after LTx. Twenty-three patients were followed up at 3-mo intervals after LTx. Energy expenditure was measured by indirect calorimetry and dietary intake by diet diaries, and body composition was assessed with anthropometry and multifrequency bioelectrical impedance analysis. Cumulative drug doses were calculated, and associations between body composition and immunosuppressive regimens and energy expenditure were examined. Nine months after LTx, 20 of 23 (87%) recipients were overweight or obese, despite three-fourths of this cohort being on weight-reduction regimens. After LTx, a decrease in measured energy expenditure was observed (60.3 +/- 1.6 kJ/kg of body cell mass pre-LTx versus 53.7 +/- 2.2 kJ/kg of body cell mass after 9 mo; P < 0.05). Multiple stepwise regression analysis showed that, when adjusted for body weight, the strongest predictor of fat mass at 9 mo after LTx was resting energy expenditure. Weight gain after LTx is not predicted by immunosuppressive drug dosage. The strong association between weight gain and energy economy might be a consequence of the loss of hepatic metabolic integration and accelerated further by increased energy intake. Effective management of weight gain will not be achieved until the mechanisms involved in altered energy homeostasis are elucidated.