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Patients with advanced cancer experience various problems with eating, and their meals should be tailored to meet their specific needs. Two methods of food service were compared in a shared acute oncology/palliative care unit; an electrical food cart allowing patients to select their food types and portions at the bedside, and a traditional food tray delivery service that relied on meals being prepared in a centralized kitchen and then delivered by tray. Over a 10-day period, lunch meals were delivered by food cart and supper meals via food trays. Twenty-seven out of 32 patients participated in the trial. Patients significantly preferred the food cart to the trays with respect to the timing and appeal of the meal, appropriateness of food types and food portions and the variety of the food choices. A food cart as used in this trial provides a more flexible and appropriate method of food delivery to in-patients in the oncology and palliative unit. Further studies should examine whether this translates to improved caloric intake and quality of life parameters.
Chlordiazepoxide (5, 10 mg/kg) increased the time devoted to eating familiar laboratory chow without altering the response to a range of novel, palatable foods which were also available to the food-deprived rats. Prior experience with the same range of alternative foods (food familiarization) radically changed the effect of the drug. After familiarization with these foods, chow was virtually ignored as a food choice, indicating its low relative palatability; chlordiazepoxide then prolonged the time eating the familiarized foods without significantly increasing the response to chow. These results are not consistent with an anti-food neophobia action of chordiazepoxide. They suggest instead that chlordiazepoxide enhances feeding responses related to food saliency. Footshock, delivered two days before the food choice test affected performance within the test. Its effects were opposite those of chlordiazepoxide, but they competed additively with the drug's effects. These results indicate that chlordiazepoxide's action was not simply to remove any inhibitory effect on feeding produced by fear; instead the drug promoted approach to food antagonizing any deficit in approach associated with fear. These findings are viewed as consistent with an action of chlordiazepoxide to augment the level of feeding motivation. Chlordiazepoxide (15 mg/kg) may act to overcome food neophobia.
There remains considerable public concern regarding the current high level of food poisoning disease in Europe and the fact that, year by year, it continues to rise rather than fall. At the same time, there are strong and increasing demands from consumers for foods that are more convenient, fresher, more natural, less heavily processed (e.g. 'REPFEDS' and 'Sous Vide' foods, mildly heated and distributed at chill temperatures; Lund and Notermans, 1992), less heavily preserved (e.g. less acid, less salt, less sugar; Gould, 1995) and less reliant on additive preservatives than hitherto (e.g. sulphite, nitrite, organic acids and esters; Russell and Gould, 1991). Most of these trends result in a general reduction in the intrinsic preservation of foods. Furthermore, many food poisoning microorganisms escape the attention of preservation techniques altogether, reaching the consumer more or less directly from contaminated foods, most often foods of animal origin. It has therefore been argued that a substantial reduction in food poisoning in the near future will be difficult to achieve unless we obtain a greatly improved understanding of the physiology of the most important target organisms (Knochel and Gould, 1995). This knowledge must then be exploited in ways which effectively improve our means for the control of these hazards and reduce the risk to the consumer. A three year AAIR Concerted Action Programme (PL920630: 'Physiology of Food Poisoning Microorganisms') was therefore initiated in 1992 in order to bring together research groups working on the physiology and related aspects of food poisoning microorganisms. The principal objectives of the programme were: 1. To determine the physiological, biochemical and genetical bases of the organisms' survival of and responses to food-relevant stresses; 2. to determine the physiological and genetical factors influencing infectivity and toxinogenesis; 3. to understand the physiological bases of those synergistic systems that are already empirically applied or that have future potential; 4. to make a wide range of modern techniques in which particular members have expertise more widely available. As can be read in the subsequent contributions to this special issue, the area is a fruitful one for microbiological research and the Programme has been successful in bringing together disparate strands of the topic. It has also highlighted areas where this scientific knowledge may be better exploited in improving the microbiological safety of foods for the consumer.
Adverse reactions to foods, aside from those considered toxic, are caused by a particular individual intolerance towards commonly tolerated foods. Intolerance derived from an immunological mechanism is referred to as Food Allergy, the non-immunological form is called Food Intolerance. IgE-mediated food allergy is the most common and dangerous type of adverse food reaction. It is initiated by an impairment of normal Oral Tolerance to food in predisposed individuals (atopic). Food allergy produces respiratory, gastrointestinal, cutaneous and cardiovascular symptoms but often generalized, life-threatening symptoms manifest at a rapid rate-anaphylactic shock. Diagnosis is made using medical history and cutaneous and serological tests but to obtain final confirmation a Double Blind Controlled Food Challenge must be performed. Food intolerances are principally caused by enzymatic defects in the digestive system, as is the case with lactose intolerance, but may also result from pharmacological effects of vasoactive amines present in foods (e.g. Histamine). Prevention and treatment are based on the avoidance of the culprit food.
Eating takes place in a context of environmental stimuli known as ambience. Various external factors such as social and physical surroundings, including the presence of other people and sound, temperature, smell, color, time, and distraction affect food intake and food choice. Food variables such as the temperature, smell, and color of the food also influence food intake and choice differently. However, the influence of ambience on nutritional health is not fully understood. This review summarizes the research on ambient influences on food intake and food choice. The literature suggests that there are major influences of ambience on eating behavior and that the magnitude of the effect of ambience may be underestimated. Changes in intake can be detected with different levels of the number of people present, food accessibility, eating locations, food color, ambient temperatures and lighting, and temperature of foods, smell of food, time of consumption, and ambient sounds. It is suggested that the manipulation of these ambient factors as a whole or individually may be used therapeutically to alter food intake and that more attention needs to be paid to ambience in nutrition-related research.
OBJECTIVE: To assess consumption of foods from food packages provided by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) among 80 Chinese prenatal WIC recipients living in Oakland or San Francisco, Calif. DESIGN: During a single interview, a food frequency questionnaire was used to assess WIC food consumption by the prenatal patients for the period before and after receipt of WIC vouchers. SETTING: The study was conducted at Asian Health Services, Oakland, and the Chinatown Public Health Center of the San Francisco Department of Public Health in California. SUBJECTS: Eighty low-income Chinese prenatal women with limited education and limited ability to speak English, aged 21 to 43 years, with gestational stages of 15 to 38 weeks. STATISTICAL ANALYSES PERFORMED: Descriptive statistics (frequency and percent distribution) were used to report the findings of the study. RESULTS: Subjects reported that before receiving WIC vouchers, milk, eggs, and juice were the only foods in their WIC food package that had been consumed frequently (> 5 times/week) in their daily diet. Other WIC foods, including cheese, peanut butter, dried beans, and hot and cold cereals, were consumed infrequently (0 to 1 time/month). Subjects reported that with the availability of WIC vouchers, milk, eggs, and juice remained frequently consumed with 81% to 100% of monthly supply as the most prevalent reported consumption rate. Dried beans and hot and cold cereals were also consumed frequently. Cheese remained poorly consumed (0% to 20% of the monthly supply). As many as 74 of 80 subjects stated that they had shared foods from their own WIC package, except milk, with their families. The use of any WIC foods provided to other children in the family was not assessed in this study. APPLICATIONS: Data from this study indicate that most WIC foods were well used by Chinese prenatal patients. The most notable exception was cheese, which was poorly consumed. The ready consumption of milk by pregnant Chinese WIC recipients in this study suggests that milk may be readily consumed by these women, even though it is atypical of the Asian diet. The WIC food package for Chinese prenatal patients may be improved by omitting cheese and substituting more milk and/or foods such as tofu and dark green leafy vegetables.
This article describes the terms used for the various syndromes and diseases associated with reactions to foods; it outlines the principal types of food intolerance encountered in children, with particular emphasis on those caused by immune-mediated reactions of immediate hypersensitivity. Terms defined include food intolerance or food sensitivity; food allergy or food hypersensitivity; psychologically based food reactions (food aversions); and psychosocial and neurologic dysfunction. The spectrum of food sensitivity is considerable, and diagnosis is generally based on the monitoring of effects of exclusion diets and provocation tests, after appropriate objective measures are first selected. In children, manifestations of IgE-mediated food allergy (often in association with other immune mechanisms) include self-limiting and immediate reactions (e.g., urticaria, wheeze) and chronic diseases (food-sensitive enteropathies, eczema). Controversial and unresolved issues exist with some other conditions, including eosinophilic gastroenteritis, occult gastrointestinal bleeding, protein-losing enteropathy, and attention deficit disorder with hyperactivity. New methods for clinical investigation of gastrointestinal tract function and intestinal immune reactions are required to assess the relevance of foods in these conditions.
OBJECTIVE: Conceptual understanding of how management of food and eating is linked to life course events and experiences. DESIGN/SETTING: Individual qualitative interviews with adults in upstate New York. PARTICIPANTS: Fourteen men and 11 women with moderate to low incomes. PHENOMENON: Food choice capacity. ANALYSIS: Constant comparative method. RESULTS: A conceptual model of food choice capacity emerged. Food choice capacity represented participants' confidence in meeting their standards for food and eating given their food management skills and circumstances. Standards (expectations for how participants felt they should eat) were based on life course events and experiences. Food management skills (mental and physical talents to keep food costs down and prepare meals) were sources of self-esteem for many participants. Most participants had faced challenging and changing circumstances (income, employment, social support, roles, health conditions). Participants linked strong food management skills with high levels of food choice capacity, except in the case of extreme financial circumstances or the absence of strong standards. IMPLICATIONS FOR RESEARCH AND PRACTICE: Recognizing people's experiences and perspectives in food choice is important. Characterizing food management skills as durable, adaptive resources positions them conceptually for researchers and in a way that practitioners can apply in developing programs for adults.