SIGNIFICANCE:Taste perception is based on chemical sensitivity of receptors on the tongue; genetic variation in receptor sensitivity secondarily gives rise to unique perceptions of certain tastes. Taste perception influences food preferences and, along with environmental influences, may significantly contribute to dietary choices. These factors are important for occupational therapists to consider when developing interventions for children with difficulty feeding and eating.

INNOVATION:This is the first occupational therapy study to utilize measures of chemical taste sensitivity in a population of children with feeding/eating disorders. We attempt to answer the following research question: Does chemical taste sensitivity influence food preferences and feeding behaviors in boys with Barth syndrome (hereinafter referred to as Barth)?

Barth is a rare genetic condition (∼400 known cases) that affects only boys. Preliminary data show that ∼50% of boys with Barth have increased taste and smell sensitivity and atypical food preferences; they crave intensely salty/cheesy foods while refusing many other foods eaten by the family or peers. The purpose of this study was to further explore the dietary preferences of boys with Barth and to determine whether their food preferences were related to a genetic predisposition to certain chemical tastes.

METHOD:We used a descriptive, cross-sectional design. The setting took place at an international conference and a public research university.

Participants included 24 boys with Barth (μ age = 9.3 yr) and 26 typically developing boys (μ age = 11.2 yr). A chemical taste sensitivity test included taste strips for phenylthiocarbamide (PTC; bitter compound) and sodium benzoate (NaB; salty compound). The Short Sensory Profile (SSP) was used as a behavioral report of sensory sensitivity. A modified Food Inventory was used to record feeding behaviors (past and present) as well as food preferences of the child and family. Various statistical methods were used, including descriptive statistics, one-way analysis of variance (ANOVA), and Pearson chi-square test.

RESULTS:Significant differences were found between boys with and without Barth in response to both PTC and NaB. Boys with Barth were more likely to be supertasters of PTC (p = .028) and nontasters of NaB (p = .007). Taster status of PTC and NaB did not predict the number of different foods eaten by either group, but it did predict the frequency with which certain foods (e.g., salty foods) were eaten. On the Food Inventory, groups differed significantly in the areas of food refusal, overactive gag, requesting separate meals, appetite, and whether eating habits matched the family (p < .01 to p < .05). Lower taste/smell sensitivity scores on the SSP were significantly related to food refusal (p = .002). Boys with Barth did not differ from the control group in the area of tactile sensitivity on the SSP, and they also did not report having a greater aversion to food textures.

CONCLUSION:Feeding behaviors in children with Barth are likely due to differences in perception of chemical tastes and taste/smell sensitivities and not to tactile sensitivity or aversion to food textures. Future studies on problem food behaviors in children should consider utilizing measures of chemical taste sensitivity to rule out, or control for, genetic differences in their sample. Specifically, for boys with Barth, dietary interventions may be needed in conjunction with occupational therapy to reduce problems with low energy and growth delays caused by poor nutritional intake.