Learning to Eat Vegetables in Early Life: The Role of Timing, Age and Individual Eating Traits

Vegetable intake is generally low among children, who appear to be especially fussy during the pre-school years. Repeated exposure is known to enhance intake of a novel vegetable in early life but individual differences in response to familiarisation have emerged from recent studies. In order to understand the factors which predict different responses to repeated exposure, data from the same experiment conducted in three groups of children from three countries (n = 332) aged 4–38 m (18.9±9.9 m) were combined and modelled. During the intervention period each child was given between 5 and 10 exposures to a novel vegetable (artichoke puree) in one of three versions (basic, sweet or added energy). Intake of basic artichoke puree was measured both before and after the exposure period. Overall, younger children consumed more artichoke than older children. Four distinct patterns of eating behaviour during the exposure period were defined. Most children were “learners” (40%) who increased intake over time. 21% consumed more than 75% of what was offered each time and were labelled “plate-clearers”. 16% were considered “non-eaters” eating less than 10 g by the 5th exposure and the remainder were classified as “others” (23%) since their pattern was highly variable. Age was a significant predictor of eating pattern, with older pre-school children more likely to be non-eaters. Plate-clearers had higher enjoyment of food and lower satiety responsiveness than non-eaters who scored highest on food fussiness. Children in the added energy condition showed the smallest change in intake over time, compared to those in the basic or sweetened artichoke condition. Clearly whilst repeated exposure familiarises children with a novel food, alternative strategies that focus on encouraging initial tastes of the target food might be needed for the fussier and older pre-school children

A workshop on ‘Dietary Sweetness—Is It an Issue?’

This report summarises a workshop convened by ILSI Europe on 3 and 4 April 2017 to discuss the issue of dietary sweetness. The objectives were to understand the roles of sweetness in the diet, establish whether exposure to sweetness affects diet quality and energy intake, and consider whether sweetness per se affects health. Although there may be evidence for tracking of intake of some sweet components of the diet through childhood, evidence for tracking of whole diet sweetness, or through other stages of maturity are lacking. The evidence to date does not support adverse effects of sweetness on diet quality or energy intake, except where sweet food choices increase intake of free sugars. There is some evidence for improvements in diet quality and reduced energy intake where sweetness without calories replaces sweetness with calories. There is a need to understand the physiological and metabolic relevance of sweet taste receptors on the tongue, in the gut and elsewhere in the body, as well as possible differentiation in the effects of sustained consumption of individual sweeteners. Despite a plethora of studies, there is no consistent evidence for an association of sweetness sensitivity/preference with obesity or type 2 diabetes. A multifaceted integrated approach, characterising nutritive and sensory aspects of the whole diet or dietary patterns, may be more valuable in providing contextual insight. The outcomes of the workshop could be used as a scientific basis to inform the expert community and create more useful dialogue among health care professionals

Developing healthy food preferences in preschool children through taste exposure, sensory learning and nutrition education

Purpose of Review: The present review was undertaken in order to summarize and evaluate recent research investigating taste exposure, sensory learning, and nutrition education interventions for promoting vegetable intake in preschool children. Recent Findings: Overall, taste exposure interventions yielded the best outcomes for increasing vegetable intake in early childhood. Evidence from sensory learning strategies such as visual exposure and experiential learning also show some success. While nutrition education remains the most common approach used in preschool settings, additional elements are needed to strengthen the educational program for increasing vegetable intake. There is a substantial gap in the evidence base to promote vegetable intake in food fussy children. Summary: The present review reveals the relative importance of different intervention strategies for promoting vegetable intake. To strengthen intervention effects for improving vegetable intake in preschool children, future research could consider integrating taste exposure and sensory learning strategies with nutrition education within the preschool curriculum

Dilated Eustachian tube orifice after endoscopic removal of hairy polyp

Article Outline: A 6-month-old term infant was referred with a history of snuffly breathing and obstructive sleep-disturbed breathing unless she was postured upright. From birth she had had daily right-sided rhinorrhea, which was mostly grayish and of egg-white consistency. It had not responded to antibiotics or intranasal steroids. Feeding was slow but weight gain was normal. Perinatal history was unremarkable, with cigarette smoking 4 per week the only potential teratogen identified. Clinical examination showed a left unilateral middle ear effusion, a left preauricular sinus, a bifid tip of uvula, and ankyloglossia. Flexible transnasal endoscopy demonstrated a pale skin-covered finger-like projection, arising from the left lateral nasopharyngeal wall in close proximity to the Eustachian tube, crossing to the contralateral side. CT showed patent bony choanae bilaterally with a 9 × 7-mm soft tissue density superior to the soft palate. MRI (T2 weighting and T1 fat saturation, pre- and postcontrast) showed a 7-mm-diameter lesion projecting 12.5 mm into the pharynx. It was separate to the left internal carotid artery, with slight contrast enhancement. The absence of a wide range of signal intensities and the ordered structure suggested teratoma unlikely. There appeared to be a cord-like extension with concentric ring structure immediately adjacent to the Eustachian tube, to the skull base postero-inferior to the Eustachian tube. Under general anesthesia a combined transnasal and retropalatal endoscopic approach was commenced. The attachment of the lesion to the mucosa of the anterior aspect of the Eustachian tube was needle-point diathermy-divided under vision and then with steady traction using non-thru-cut forceps the lesion was avulsed from its origin in the postero-inferior aspect of the lower third of the Eustachian tube, and delivered transorally. After removal the size of the left Eustachian tube orifice was seen to be 4 to 5 times that of the right (Fig 1 - Dilated Eustachian tube orifice after removal of hairy polyp). The operative procedure was uncomplicated. The left unilateral mucoid effusion was aspirated. Histopathology demonstrated a 15 × 7 × 7-mm polypoid lesion covered by epidermis with associated adnexae (hair follicles, sebaceous glands, and eccrine glands) overlying a core of fibroadipose tissue with minor salivary glands and skeletal muscle. This was characterized as a “hairy polyp of the Eustachian tube.” At general anesthetic for division of the ankyloglossia 5 months postexcision there was no recurrence of either the lesion or the middle ear effusion, and the orifice of the Eustachian tube had shrunk so as to be only a little larger than the contralateral side. Discussion: “Hairy polyp of the nasopharynx” is a clinico-pathological descriptive term. The clinical description derives from macroscopically visible fine hairs arising from the pale external covering of skin (Fig 2 - Hairy polyp of the Eustachian tube). At flexible or rigid transnasal or retropalatal endoscopy they typically appear as a sausage-like lesion projecting medially across the nasopharynx. Up to 2004, 114 cases of hairy polyp of the nasopharynx had been described, most arising from the lateral pharyngeal wall. Origin specifically from the Eustachian tube was thought to be excessively rare but it is quite possible that increasing use of nasal endoscopes before and after removal will show that origin from within the lower end of the Eustachian tube is more common than previously thought. It is presumably this origin that resulted in dilation of the developing cartilaginous Eustachian tube; and removal of the hairy polyp allowed remodeling towards a normal size. They most commonly present early in the first year, with a female preponderance up to 6:1. Presentation with nasal signs and symptoms occurs when nasopharyngeal and nasal obstruction predominate, and occurs with otologic signs and symptoms when Eustachian tube obstruction coexists. When larger, the lesions may be visible below the soft palate or acting as a ball-valve may obstruct the larynx causing positional cyanosis; indeed, fatal obstruction has been reported. Several theories of embryologic origin exist. Hairy polyps arising from the Eustachian tube may originate in the fourth postconceptual week from entrapped cells between the first pouch endoderm and first cleft ectoderm. Because they resemble the pinna, they have been postulated to be accessory auricles arising “internally” from the first branchial anlarge. Less likely would seem to be persistence of the bucconasal or buccopharyngeal membranes, or uncontrolled development from entrapped pluripotential cells