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Cancer patients’ eating behavior: Chemo-induced impaired taste function may lead to nutritional deficiencies

Cancer patients may exhibit a reduced taste function, particularly for sweet flavors. This diminished taste is associated with a reduced appetite; avoidance of certain foods, including meat; and a lower intake of calories and protein. This is according to a new review published in Nutrients, by US and Australian researchers. They evaluated 11 studies published between 1982 and 2018 “that psychophysically measured taste and smell function and assessed some aspect of food behavior.” The researchers note that more research is warranted to develop treatments to preserve taste bud renewal during chemotherapy and create supplements and foods tailored to patients’ taste function.

“People who are undergoing cancer treatment often report changes in taste or smell, but few studies have attempted to measure directly how this affects eating behavior,” says Alissa Nolden, Assistant Professor of Food Science at the University of Massachusetts, Amherst, US.

“Self-reported taste function can be challenging when attempting to fully understand patients’ experiences. In terms of developing new foods or beverages that better suit their taste function and possible strategies or treatments, we need to know exactly what they’re experiencing,” she outlines.

Personalization in nutrition, especially in the clinical nutrition space is growingly recognized for its importance. From swallowing difficulties, to taste impairment and specific macro- and micronutrient needs, patients increasingly demand a more tailored approach to better tackle their conditions via nutrition.

For cancer specifically, nutrition-based cancer prevention may be a crucial avenue that is not being engaged with yet, according to leading oncologists and nutritionists. A recent UK study highlighted that translating research on nutrition and diet into cancer recommendations and policies, as well as improving mechanisms to share data across continents, could galvanize proper nutrition-based prevention.

An important part of daily life
The simple pleasure of tasting and savoring food is “an important part of everyone’s daily life,” says Nolden. However, for many cancer patients, this simple pleasure can be lost at least temporarily due to the disease itself or the side effects from treatment, such as chemotherapy. “It can be very isolating, on top of going through treatment,” Nolden adds.

Nolden set out to review the literature about the impact of cancer patients’ sense of taste and smell on their “food behavior,” defined as any behavior that affects patients’ overall nutritional health, such as their desire to eat, food preferences and consumption. Nolden’s goal is to develop a better understanding of changes in taste and how that affects cancer patients’ ability to enjoy food and meet optimum nutritional needs during and after treatment.

The paper is a joint effort with co-authors from Monell Chemical Senses Center in Philadelphia, US; the University of Queensland in Australia; the Victorian Comprehensive Cancer Centre in Melbourne, Australia; and the Melbourne School of Population and Global Health in Australia.

The studies they reviewed measured patients’ ability to perceive sweet, using sucrose; sour, using citric acid; bitter, using urea or quinine; salty, using sodium chloride; and in three of the studies, umami, using monosodium glutamate.

“We learned that changes in sweet and, to a lesser extent, bitter perception were more common than changes to salt or sour perception in cancer patients, and that these changes in sweet taste perception were often tied to differences in food behaviors,” the authors note.

Although a significant number of people with cancer report differences in smell, “there wasn’t any study that showed a relationship between food behavior and smell function,” Nolden says.

The paper points out that cancer treatment affects taste and smell in different ways. Oral surgery may damage chemosensory nerves, whereas chemotherapy is likely to disrupt taste bud renewal.

Moreover, further research is needed to measure sensory changes and understand their various mechanisms, Nolden says. Additional data may help scientists one day develop treatments to preserve taste bud renewal during chemotherapy and to create oral supplements that will taste better to patients.

“We have this growing amount of evidence, but in terms of pulling it all together it can be challenging because of the differences in how researchers evaluated taste, the type of cancer and the type of treatment,” Nolden concludes.

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