Flavor Learning In Utero and Its Implications for Future Obesity and Diabetes

The concept of prenatal flavor learning can be used to motivate women to eat healthy foods. The flavors of the foods in the maternal diet are found in the amniotic fluid swallowed by the fetus, with the fetus developing a preference for those flavors that is shown to persist in infancy. Furthermore, flavor preferences in infancy can persist into childhood and even into adulthood. Thus, the intrauterine environment may have a life-long influence on flavor preferences and healthy eating. This is an empowering concept for a pregnant woman: her baby will develop a preference for what she eats. However, education alone about this concept may not be sufficient to motivate behavior change. The evidence for health promotion strategies demonstrated to be effective in pregnancy is presented here, along with associated implications for prenatal flavor learning and the prevention of obesity and diabetes.     

Role of parents in the determination of the food preferences of children and the development of obesity

The role of parental behaviour in the development of food preferences is considered. Food preferences develop from genetically determined predispositions to like sweet and salty flavours and to dislike bitter and sour tastes. Particularly towards the second year of life, there is a tendency to avoid novel foods (neophobia). Food aversions can be learnt in one trial if consumption is followed by discomfort. There is a predisposition to learn to like foods with high-energy density. However, from birth genetic predispositions are modified by experience and in this context during the early years parents play a particularly important role. Parental style is a critical factor in the development of food preferences. Children are more likely to eat in emotionally positive atmospheres. Siblings, peers and parents can act as role models to encourage the tasting of novel foods. Repeated exposure to initially disliked foods can breakdown resistance. The offering of low-energy-dense foods allows the child to balance energy intake. Restricting access to particular foods increases rather than decreases preference. Forcing a child to eat a food will decrease the liking for that food. Traditionally, educational strategies have typically involved attempts to impart basic nutritional information. Given the limited ability of information to induce changes in behaviour, an alternative strategy would be to teach parents about child development in the hope that an understanding of the characteristic innate tendencies and developmental stages can be used to teach healthy food preferences.     

The development of sweet taste: From biology to hedonics

From the age of 2 years, an American child is more likely to consume a sugar-sweetened product than a fruit or vegetable on any given day—a troubling statistic, given that food preferences are established early in childhood, as well as the strong association between this dietary pattern and increased risk of developing a number of chronic diseases. Here, we review the ontogeny and biopsychology of sweet taste, highlighting how a biological drive to prefer sweetness at high concentrations during childhood, which would have conferred an advantage in environments of scarcity, now predisposes children to overconsume all that is sweet in a modern food system replete with added sugars. We review the power of sweet taste to blunt expressions of pain and mask bad tastes in foods as well as factors that predispose some to consume high-sugar diets, including experiential learning and taste preferences driven in part by genetics. Understanding children’s unique vulnerability to our current food environment, rich in both nutritive and nonnutritive sweeteners, is highlighted as a priority for future research to develop evidence-based strategies to help establish healthy dietary behaviors early in life.     

Healthier diets for all? A systematic review and meta-analysis examining socioeconomic equity of the effect of increasing availability of healthier foods on food choice and energy intake

Widespread availability of unhealthy food and drink products may contribute to socioeconomic patterning in obesity. Therefore, increasing the availability of healthier foods may be one approach to reducing obesity without widening existing inequalities. This systematic review and meta-analysis examined the impact of increasing the availability of healthier food and drink on consumer behavior among individuals with higher and lower socioeconomic position (SEP). Eligible studies were required to use experimental designs to compare conditions of higher vs lower availability of healthier vs less healthy options on food choice-related outcomes and measure SEP. Thirteen eligible studies were included. Odds of choosing a healthy item were higher when availability was increased for higher (OR = 5.0, 95% CI: 3.3, 7.7) and lower (OR = 4.9, CI: 3.0, 8.0) SEP. Increased availability of healthier foods was also associated with a decrease in energy content of selections for higher (−131 kcal; CI: −76, −187) and lower (−109 kcal; CI: −73, −147) SEP. There was no SEP moderation. Increasing the relative availability of healthier foods may be an equitable and effective approach to improve population-level diet and address obesity, though more research is required testing this in real-world environments.     

A holistic food labelling strategy for preventing obesity and dental caries

Obesity and dental caries in childhood are among the major public health concerns described as a global pandemic because of their global distribution and severe consequences. A consensus has developed as to a recently emerging and alarming common risk factor that leads to the double burden of dental caries and obesity; energy-dense foods (sugar-coated cereals, high-sugar yogurt, soft drinks) are becoming very popular among children because of their dense marketing, cheaper price, increased supply and variety. Implementation of health-promoting and -supporting marketing strategies for healthy food can be one initial cornerstone for successful application of the common risk factor approach in prevention of obesity and dental caries, as also suggested by World Health Organization. Labelling healthy food with a 'health-friendly' logo, illustrating that the teeth and the heart are both parts of the whole body (standing side by side supporting each other as close friends), both happy and protected because of consumption of healthy food for the whole body, can promote the foods that are friendly to health of the whole body, implementing the common risk factor approach under a single theme. Labelling healthy food as 'health-friendly' based on an international consensus will provide a clear and uniform picture of what is healthy to eat and result in an international integrated programme for prevention of obesity and caries.     

The impact of initiatives to limit the advertising of food and beverage products to children: a systematic review

In response to increasing evidence that advertising of foods and beverages affects children's food choices and food intake, several national governments and many of the world's larger food and beverage manufacturers have acted to restrict the marketing of their products to children or to advertise only ‘better for you’ products or ‘healthier dietary choices’ to children. Independent assessment of the impact of these pledges has been difficult due to the different criteria being used in regulatory and self‐regulatory regimes. In this paper, we undertook a systematic review to examine the data available on levels of exposure of children to the advertising of less healthy foods since the introduction of the statutory and voluntary codes. The results indicate a sharp division in the evidence, with scientific, peer‐reviewed papers showing that high levels of such advertising of less healthy foods continue to be found in several different countries worldwide. In contrast, the evidence provided in industry‐sponsored reports indicates a remarkably high adherence to voluntary codes. We conclude that adherence to voluntary codes may not sufficiently reduce the advertising of foods which undermine healthy diets, or reduce children's exposure to this advertising.     

Effects of a high-protein meal (meat) and a high-carbohydrate meal (vegetarian) on satiety measured by automated computerized monitoring of subsequent food intake, motivation to eat and food preferences

We have examined the effects on satiety of equicaloric meals with different protein and carbohydrate content. Twenty normal weight healthy women were served cooked lunch meals made of commonly used natural food items with either a high-protein (43 energy %) (a meat casserole) or a high-carbohydrate (69 energy %) (a vegetarian casserole) content in a counterbalanced repeated measures design. The subsequent ad libitum evening meal intake (4 h after lunch) was measured by a 'universal eating monitor' and subjective feelings of motivation to eat and food preferences were assessed repeatedly. At the subsequent evening meal subjects ate 12 per cent less (P less than 0.05) after the high-protein meal compared to the high-carbohydrate meal. There was no difference in motivation to eat between meals. This could partly be explained by a difference in palatability between the meals. The food-preference lists showed that before lunch there was relative preference for high-protein foods in favour of high-carbohydrate foods. After lunch either meal produced instead a relative 'aversion' for high-protein foods. This 'aversion' was greater after the high-protein lunch meal than after the high-carbohydrate lunch meal.     

Smartphone‐based cognitive bias modification training improves healthy food choice in obesity: A pilot study

Obesity is partly driven by unhealthy food choices underpinned by cognitive biases, including approach bias (a tendency to move towards food cues) and delay discounting (a preference for immediate rewards). Cognitive training strategies aimed at modifying these biases, namely, approach–avoidance training (AAT) and episodic future thinking (EFT), may improve food choice. This pilot randomised trial examined the effect of these two trainings, delivered daily for 1 week via smartphone apps, on approach bias for healthy/unhealthy foods, delay discounting for money/food, and hypothetical food choice. Sixty overweight/obese participants (18–45 years) were randomly allocated to AAT, EFT, or control. Outcomes were measured at pretraining, posttraining, and 6‐week follow‐up. AAT reduced approach bias for unhealthy food and increased healthy food choice. However, EFT did not affect delay discounting or food choice. We conclude that AAT is useful for improving food choice in obesity and that smartphones are a feasible, engaging way to deliver training.     

Prevention of overweight and obesity in children: influences on the food environment

PURPOSE: There is an epidemic of pediatric overweight and obesity leading to type 2 diabetes in youth. The purpose of this review is to describe the multiple paths of influence on the food environment of youth and to identify diabetes education strategies focused on early prevention of overweight and obesity. METHODS: A review of relevant professional literature was conducted. RESULTS: Models of obesity prevention in youth need to address genetic factors that influence the development of food preferences in the young child, parenting influences on eating pattern development, and access and availability of foods in the physical environment of the child. CONCLUSIONS: Early intervention with parents of young children is required to prevent the development of eating patterns that lead to pediatric obesity and type 2 diabetes in youth. Diabetes educators need to be able to inform parents of the multiple paths of influence on the food environment of the child and suggest strategies to encourage the development of positive food preferences and intake.     

Complementary foods and flavor experiences: setting the foundation

Increased fruit and vegetable consumption early in life may lead to life-long intake of fruits and vegetables, which in turn may be beneficial for weight control and other health outcomes in later life. Although health officials worldwide recommend delaying solid foods until 6 months of age, younger infants often receive solid food, which may affect later obesity rates. The timing of introduction to solid foods is important both nutritionally and developmentally and may affect acceptance of foods both in infancy and later in life. Infants can clearly discriminate the flavors of different fruits and vegetables. Repeated flavor experiences promote the willingness to eat a variety of foods: infants will consume more of foods that have a familiar flavor and are more accepting of novel flavors if they have experience with flavor variety. Many flavors that the mother either ingests or inhales are transmitted to her milk and/or amniotic fluid. Mothers can help the transition from a diet exclusively of milk or formula to a mixed diet by providing the infant familiar flavors in both milk or formula and solid foods. Exposure to a variety of flavors during and between meals appears to facilitate acceptance of novel foods. Providing novelty in the context of a familiar food might prove to be an optimal combination to progressively accustom infants to a diversity of novel foods. When repeatedly exposing infants to flavors of some vegetables that have bitter tastes, mothers should focus not on infants' facial expressions but on their willingness to eat the food and should continue to provide repeated opportunities to taste the food. Introducing children repeatedly to individual as well as a variety of fruits and vegetables, both within and between meals, might help them be more accepting of fruits and vegetables, which is difficult to enhance beyond toddlerhood.     

Influence of unhealthy food and beverage marketing on children's dietary intake and preference: a systematic review and meta‐analysis of randomized trials

Marketing of foods and beverages high in fat, sugar and salt are suggested to contribute to poor dietary behaviours in children and diet‐related diseases later in life. This systematic review and meta‐analysis of randomized trials aimed to assess the effects of unhealthy food and beverage marketing on dietary intake (grams or kilocalories) and dietary preference (preference score or percentage of participants who selected specific foods/beverages) among children 2 to 18 years of age. We searched MEDLINE, EMBASE and PsycINFO up to January 2015 for terms related to advertising, unhealthy foods or beverages among children. Randomized trials that assessed the effects of unhealthy food and beverage marketing compared with non‐dietary advertisement or no advertisement in children were considered eligible. Two authors independently extracted information on study characteristics and outcomes of interest and assessed risk of bias and the overall quality of evidence using grade methodology. Meta‐analysis was conducted separately for dietary intake and preference using a random‐effects model. We identified 29 eligible studies, of which 17 studies were included for meta‐analysis of dietary preference and nine for meta‐analysis of dietary intake. Almost half of the studies were at high risk of bias. Our meta‐analysis showed that in children exposed to unhealthy dietary marketing, dietary intake significantly increased (mean difference [MD] = 30.4 kcal, 95% confidence interval [CI] 2.9 to 57.9, and MD = 4.8 g, 95%CI 0.8 to 8.8) during or shortly after exposure to advertisements. Similarly, children exposed to the unhealthy dietary marketing had a higher risk of selecting the advertised foods or beverages (relative risk = 1.1, 95%CI 1.0 to 1.2; P = 0.052). The evidence indicates that unhealthy food and beverage marketing increases dietary intake (moderate quality evidence) and preference (moderate to low quality evidence) for energy‐dense, low‐nutrition food and beverage. Unhealthy food and beverage marketing increased dietary intake and influenced dietary preference in children during or shortly after exposure to advertisements. © 2016 World Obesity     

New directions in the use of virtual reality for food shopping: marketing and education perspectives

Virtual reality is used in marketing research to shape food selection and purchase decisions. Could it be used to counteract the marketing of less-nutritious foods and teach healthier food selection? This article presents interviews with Raymond Burke, Ph.D., of Indiana University Bloomington, and Rachel Jones, M.P.H., of the University of Utah College of Health. Topics covered include new marketing research technologies, including virtual reality simulations; retailing and shopper behavior; and the use of virtual grocery stores to help students explore quality of diet and food/nutrient relationships. The interviewees discuss how the technologies they have developed fit into research and behavior change related to obesity and diabetes.     

Obesity and the food system transformation in Latin America

The Latin America and the Caribbean (LAC) region faces a major diet‐related health problem accompanied by enormous economic and social costs. The shifts in diet are profound: major shifts in intake of less‐healthful low‐nutrient‐density foods and sugary beverages, changes in away‐from‐home eating and snacking and rapid shifts towards very high levels of overweight and obesity among all ages along with, in some countries, high burdens of stunting. Diet changes have occurred in parallel to, and in two‐way causality with, changes in the broad food system – the set of supply chains from farms, through midstream segments of processing, wholesale and logistics, to downstream segments of retail and food service (restaurants and fast food chains). An essential contribution of this piece is to marry and integrate the nutrition transition literature with the literature on the economics of food system transformation. These two literatures and debates have been to date largely ‘two ships passing in the night’. This review documents in‐depth the recent history of rapid growth and transformation of that broad food system in LAC, with the rapid rise of supermarkets, large processors, fast food chains and food logistics firms. The transformation is the story of a ‘double‐edged sword’, showing its links to various negative diet side trends, e.g. the rise of consumption of fast food and highly processed food, as well as in parallel, to various positive trends, e.g. the reduction of the cost of food, de‐seasonalization, increase of convenience of food preparation reducing women's time associated with that and increase of availability of some nutritious foods like meat and dairy. We view the transformation of the food system, as well as certain aspects of diet change linked to long‐run changes in employment and demographics (e.g. the quest for convenience), as broad parameters that will endure for the next decades without truly major regulatory and fiscal changes. We then focus in on what are the steps that are being and can be taken to curb the negative effects on diet of these changes. We show that countries in LAC are already among the global leaders in initiating demand‐related solutions via taxation and marketing controls. But we also show that this is only a small step forward. To shift LAC's food supply towards prices that incentivize consumption of healthier diets and demand away from the less healthy component is not simple and will not happen immediately. We must be cognizant that ultimately, food industry firms must be incentivized to market the components of healthy diets. This will primarily need to be via selective taxes and subsidies, marketing controls, as well as food quality regulations, consumer education and, in the medium term, consumers' desires to combine healthier foods with their ongoing quest for convenience in the face of busy lives. In the end, the food industry in LAC will orient itself towards profitable solutions, ie those demanded by the broad mass of consumers.     

Understanding the complexities of prevalence of trans fat and its control in food supply in Pakistan

Pakistan is among the nations with a high intake of trans‐fatty acids (TFAs), a major dietary risk factor of noncommunicable diseases (NCDs). Efforts are underway in the country to eliminate industrially produced TFAs from the food supply in keeping with the priority targets of the World Health Organization (WHO) for 2019‐2023. We reviewed the TFA content reported in industrially produced foods and discuss the regulatory landscape for TFAs, to facilitate the required policy changes in Pakistan and ultimately eliminate the TFA burden from industrial food products. The study components include review of published research and product labels as well as review of prevailing food regulations for TFA‐related information. A set of recommendations was also prepared to eliminate TFAs from Pakistan after national consultation workshops conducted in year 2019. Vanaspati ghee (partially hydrogenated vegetable oil), bakery shortening, hard margarines, and fat spreads are identified as the major sources of TFAs. Federal and provincial food authorities have recently established the limits for TFAs in few products; however, the TFA regulations are insufficient and not in line with global best practices. This study informs a comprehensive national strategy for TFA elimination based on knowledge of TFA prevalence associated regulatory control. We recommend to (1) promote actions toward replacement of traditional vanaspati ghee/bakery fats with healthier alternatives; (2) develop and implement best regulatory practices in line with WHO recommendations; and (3) amend food labeling laws so that clear information will be provided to inform consumers healthy food choices.     

Taste responses and food preferences in obese women: effects of weight cycling.

Taste preferences for sensory stimuli composed of sugar and fat are predictive of some food preferences and may help distinguish between potential subtypes of human obesity. A sample of 37 obese females was divided into high-flux and low-flux groups according to the magnitude of fluctuations in body weight. Variability in body weight is thought to be indicative of the weight cycling syndrome. The subjects tasted and rated five sucrose solutions in water and nine ice creams of varying sugar and fat content. Perceptions and preferences for sweet solutions were the same for both groups. In contrast, the high-flux group showed higher preferences for ice cream stimuli than did the low-flux group. High-flux females also rated sweet desserts higher on a food preference questionnaire than did low-flux females. Prior consumption of milkshake pre-loads did not affect preference ratings for sweet solutions. However, hedonic preferences for ice creams after pre-load consumption were reduced in the high-flux group. The weight cycling syndrome may be associated with elevated hedonic preferences for sweet and high fat foods.     

Government regulation to promote healthy food environments--a view from inside state governments

Food policy interventions are an important component of obesity-prevention strategies and can potentially drive positive changes in obesogenic environments. This study sought to identify regulatory interventions targeting the food environment, and barriers/facilitators to their implementation at the Australian state government level. In-depth interviews were conducted with senior representatives from state/territory governments, statutory authorities and non-government organizations (n =45) to examine participants' (i) suggestions for regulatory interventions for healthier food environments and (ii) support for pre-selected regulatory interventions derived from a literature review. Data were analysed using thematic and constant comparative analyses. Interventions commonly suggested by participants were regulating unhealthy food marketing; limiting the density of fast food outlets; pricing reforms to decrease fruit/vegetable prices and increase unhealthy food prices; and improved food labelling. The most commonly supported pre-selected interventions were related to food marketing and service. Primary production and retail sector interventions were least supported. The dominant themes were the need for whole-of-government and collaborative approaches; the influence of the food industry; conflicting policies/agenda; regulatory challenges; the need for evidence of effectiveness; and economic disincentives. While interventions such as public sector healthy food service policies were supported by participants, marketing restrictions and fiscal interventions face substantial barriers including a push for deregulation and private sector opposition.     

Soul foods for some older Americans.

The elderly person brings with him a lifetime of food preferences. For him, nutritional adequacy is dependent upon continuation of similar underlying influences and the varying conditions which determine the food intake of any group. The significance of individuality cannot be minimized in assessing nutritional well-being and in developing a plan of action. Among the factors affecting food acceptance and health status are foods which are foods which are considered "soul" by some persons. Recognition of, and respect for, individual food preferences can be invaluable to members of the health professions in providing services to aging Americans.     

Influence of food companies' brand mascots and entertainment companies' cartoon media characters on children's diet and health: a systematic review and research needs

Reducing the extent and persuasive power of marketing unhealthy foods to children worldwide are important obesity prevention goals. Research is limited to understand how brand mascots and cartoon media characters influence children's diet. We conducted a systematic review of five electronic databases (2000–2014) to identify experimental studies that measured how food companies' mascots and entertainment companies' media characters influence up to 12 diet‐related cognitive, behavioural and health outcomes for children under 12 years. Eleven studies met the inclusion criteria. Studies used 21 unique popular media characters, but no brand mascots. Results suggest that cartoon media character branding can positively increase children's fruit or vegetable intake compared with no character branding. However, familiar media character branding is a more powerful influence on children's food preferences, choices and intake, especially for energy‐dense and nutrient‐poor foods (e.g. cookies, candy or chocolate) compared with fruits or vegetables. Future research should use a theoretically grounded conceptual model and larger and more diverse samples across settings to produce stronger findings for mediating and moderating factors. Future research can be used to inform the deliberations of policymakers, practitioners and advocates regarding how media character marketing should be used to support healthy food environments for children.     

Parental perceptions regarding healthy behaviours for preventing overweight and obesity in young children: a systematic review of qualitative studies

Evidence is increasingly pointing towards the importance of early life strategies to prevent childhood overweight and obesity. This systematic review synthesizes qualitative research concerning parental perceptions regarding behaviours for preventing overweight and obesity in young children. During May and June 2008, a range of electronic databases were searched and together with lateral searching techniques 21 studies were identified for review. Data extraction and synthesis using thematic content analysis revealed six organizing and 32 finer level themes. These related to child factors, family dynamics, parenting, knowledge and beliefs, extra‐familial influences and resources and environment. Themes were mapped to a socioecological model which illustrated how factors at individual, interpersonal, community, organizational and societal levels interact in complex ways to impact on parental perceptions about healthy behaviours for preventing child overweight. Although parents suggested several ideas to promote healthy child weight‐related behaviours, many of their views concerned perceived barriers, some of which may be amenable to practical intervention. Furthermore, intergenerational influences on parental health beliefs and knowledge suggest that health promotion strategies may be more effective if directed at the wider family, rather than parents alone. Significantly, many parents believed strategies to promote healthy weight should start early in a child's life.     

Asthma and food allergy

PURPOSE OF REVIEW: Food allergy associated clinical and social burdens have increased substantially in prevalence in the past decade. Coexisting asthma is a significant problem as food reactions tend to be more severe when they involve the lung. Food allergy also increases asthma morbidity in adults and children. RECENT FINDINGS: Especially in early infancy, food allergy can be related to the development of future asthma. For diagnosis, cut-off values are very important for both specific IgE levels and skin-prick test when interpreting food allergy. For the treatment, oral immunotherapy is showing promise for refractory patients with IgE-mediated food allergies. SUMMARY: Food allergies can be classified as IgE-mediated or non-IgE-mediated. Besides foods, some additives and preservatives can also trigger asthma in certain people. Asthma may develop in about 5% of individuals who suffer from food allergy and current asthma may be triggered by foods among 6-8% of children and 2% of adults. Because of the difficulty of confirming diagnosis of food allergy, novel approaches are currently being investigated and new therapy modalities are being sought. For total asthma control and for better quality of life, steps should be taken to avoid foods in cases of food allergy.