Poor Taste and Smell Are Associated with Poor Appetite, Macronutrient Intake, and Dietary Quality but Not with Undernutrition in Older Adults

Abstract

Background Age-related declines in taste and smell function are widely assumed to contribute to the decrease in appetite and the development of undernutrition in older adults. Objectives Here we aim to assess the associations of both taste and smell function with several nutrition-related outcomes in a single study, with poor appetite and undernutrition as primary outcomes. Methods This is a cross-sectional cohort study of 359 community-dwelling Dutch older adults, aged 65–93 y. Taste function was measured for all 5 basic tastes. Smell function was assessed with 3 tests: for odor identification, discrimination, and threshold. Self-reported taste and smell, appetite, energy (kcal/d) and macronutrient (% energy) intake, and covariates were assessed with extensive questionnaires. Dietary quality was calculated using the Dutch Healthy Diet index 2015, Alternative Healthy Eating Index 2010, and Mediterranean Diet Score. Body measurements included body weight (current and 2 y prior), height, and body impedance analysis. Data were analyzed via multiple logistic and linear regression. Results Of our sample, 9.2% had poor taste and 17.0% poor smell, 6.1% had poor appetite, and 21.4% were undernourished. Self-reported poor taste (OR: 8.44; 95% CI: 1.56, 45.56; P = 0.013) was associated with poor appetite, but no other taste or smell score was associated with either poor appetite or undernutrition. Some associations were found of individual taste and smell scores with macronutrient intake and dietary quality. Self-reported poor taste and smell were both consistently associated with poorer dietary quality. Conclusions In community-dwelling older adults, specific taste and smell impairments may have diverse consequences for appetite, food intake, or dietary quality. However, this does not necessarily result in undernutrition. The consistent associations of self-reported poor taste and smell with poor dietary quality do underline the usefulness of this information when screening for nutritional risk.

Self-Reported Olfactory Dysfunction and Diet Quality: Findings from the 2011–2014 National Health and Nutrition Examination Survey (NHANES)

“…In agreement, we observed that those with OD had diets that were more energy dense, in addition to being lower in diet quality. Our diet quality findings among U.S. adults 40 years and older largely conform with findings from findings from Dutch and Australian older adults, which also reported poorer diet quality related to OD [29,37]. Notably, analyses from the Korean NHANES [30] suggest that dietary associations with OD were particularly evident among younger and middle-aged women.…”

“…Descriptive analyses of differences in participant characteristics and dietary measures between the two groups were tested using surveyweighted chi-square tests (for categorical variables) or t-tests (for continuous variables). Given known differences in OD and dietary intake by age and sex [26,29,30], we created age/sex categories (males 40-64 years, males ≥65 years, females 40-64 years, and females ≥65 years) a priori to stratify associations between olfactory function and dietary measures. Supplementary Table S1 summarizes the demographic, clinical, and lifestyle characteristics by the four age/sex categories.…”

“…In community-based sample of free-living older women in a Northeast U.S. county, those with measured OD reported greater consumption of high fat/sweet foods than those without this dysfunction [28]. In a cohort study of 359 community-dwelling older adults in the Netherlands, self-reported OD provided more information than measured olfactory function to explain poorer appetite and diet quality [29]. In nationally representative samples from Korea and the US, the association between OD, diet and diet-related outcomes also showed sex and age effects independent of multiple demographic, health, and lifestyle variables [30,31].…”

“…Based on extensive evidence analyses, national and international dietary guidelines including those from the World Health Organization and the U.S. Dietary Guidelines have also increasingly focused on overall diet quality, with a higher quality diet being described in terms of a priori indices [32] or as being lower in energy density [33], and high in diversity [34] including diversity in types of vegetables from all subgroups (dark green; red and orange; beans, peas, and lentils; starchy; and other) [35]. While multiple studies have investigated the association of OD with energy intake and food groups, only a few have examined associations with diet quality, including a cross-sectional study of a convenience sample of adults from an Otolaryngology practice in Dresden, Germany [36], a cross-sectional analysis of free-living Dutch older adults [29], and a five-year longitudinal study of 550 U.S. older adults [37]. These studies consistently reported poor diet quality among those with poor olfactory function, but provided limited inference regarding age and sex-specific associations, as well as the underlying food components and characteristics driving the observed associations with diet quality.…”

Associations between Taste and Smell Sensitivity, Preference, and Quality of Life in Healthy Aging - The NutriAct Family Study Examinations (NFSE) Cohort

“…Unlike for sight and hearing, no corrective means such as lenses or hearing aids exist to compensate for dimishments in taste and smell, making secondary complications in areas relating to taste and smell more likely. Accordingly, taste and smell impairment have been shown to affect numerous aspects of everyday life such as reduced appetite [6] and mood changes and depression [7,8], and reduced quality of life, particularly of clinical populations [QoL; 9,10].…”