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Chemosensory function, dietary preference and dietary behaviors from pre- to 6-months post-bariatric surgery: A pilot study


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Chemosensory function, dietary preference, and behaviors from pre to 6-months post-bariatric surgery: A pilot study

Andrea Stone BS; Pavlos Papasavas MD; Helen Swede PhD; Darren Tishler MD; Patrice Hubert MS, RD; Valerie B. Duffy PhD, RD

Dept. of Surgery, Hartford Hospital, Hartford, CT; Dept. of Community Medicine & Health Care, UConn, Farmington, CT; Dept. of Allied Health, University of Connecticut, Storrs, CT

•Surgery success and weight loss maintenance depends on the ability to adhere to a higher quality diet and participate in enjoyable physical activity.
•Low taste status is associated with elevated fat and sweet preferences (Drenowski et al , 1985; Bartoshuk et al, 2006; Hayes and Duffy, 2008; Shafaie et al, 2014; Tepper et al, 2014). Individuals with obesity may have elevated taste and fat thresholds (Pepino et al, 2010; Stewart et al, 2011), although some studies do not find taste-adiposity links (Donaldson et al, 2009).
•Low sugar diets (without weight loss) can reduce sweet intensity without changing preference (Wise et al, 2016) and reduction in weight can reduce fat and sweet preference (Martin et al, 2011).
•Bariatric surgery associates with changes in food preference (Primeaux et al, 2015; Scholtz et al, 2014), coupled with taste threshold changes (Pepino et al,2014).
•Post-bariatric surgery patients (10±6.7 mos) report changes in taste and smell, regardless of surgery type (Zerrweck et al, 2015).
We sought to describe changes in taste, flavor, food preference and dietary behaviors between females with morbid obesity before bariatric surgery and 6 months post-surgery

Self-reported smell and taste function: Following the NHANES protocol (Rawal et al, 2016), participants answered questions about perceived problems with smell and taste within the past 12 months; perceived alterations in smell (phantosmia) and taste (dysgeusia); perceived changes since age 25 in smell function, ability to taste specific qualities (sweet, salty, sour, bitter), and ability to “taste” food flavors.


Measured smell and taste function: Retronasal smell and taste function as well as sweet liking was assessed by sampling 4 jellybeans (nose pinched, unpinched), rating the sweetness, flavor and liking/disliking. The Tabasco jellybean provided a probe of irritation. 

 Similar to NHANES, women rated intensities of 1mM quinine (bitter) and 1 M NaCl (salt) applied to the tongue tip, and these two tastants plus 0.32M NaCl sampled (sipped-and-spit) with the whole mouth.   As a taste genetic probe, women rated intensity of 1 & 32 mM propylthiouracil (PROP).

 Dietary quality: the average of weighted food groups from a validated liking survey (Zoghbi et al, 2017).


•These data extend findings from our previous comparison of cases (post-surgery) and controls (pre-surgery) (Duffy et al, 2016) to within participant, pre-post bariatric surgery.  Morbidly obese individuals perceived alterations of smell and taste associated with the surgery.  However, these changes were not observed in pre-post surgery measurements of smell (simple retronasal probe), sweet taste intensity, taste function (NaCl and bitter intensity), and a probe of taste genetics (PROP bitterness). 
•Pre-post surgery taste function was highly variable; the variability was not attenuated by examining data normalized to a non-oral standard or by those who perceived changes or not. 
•Patients from pre to post surgery reported significant improvements in diet quality, with reductions in preference for less healthy foods (sweets, high-fat protein; trend for alcoholic beverages, refined carbohydrates) and increased preference for healthy fiber-rich foods.  The changes did not vary by level of weight loss or by type of surgery.  Our findings agree with other studies—adults after weight loss report lower preference for unhealthy foods and/or greater dietary restraint (Demos et al, 2017; Brockmeyer, 2106).
•Findings from a liking survey uncovered changes in sweet preference that were not apparent by the sampled jellybean.  Thus, for clinical practice and evaluation, a simple survey may be sufficient to track changes without the need of “taste testing.”  The liking survey also can be used to tailor interventions for longer term weight loss/maintenance as tailored interventions may be most effective for weight loss (Sharafi et al, 2013; Eaton, 2016), particularly by providing dietary behaviors toward healthy foods.
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