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Sistema de Información Científica
Red de Revistas Científicas de América Latina y el Caribe, España y Portugal
483
Received: Feb. 29
th
2016; Accepted: June 25
th
2016.
Rev Rene. 2016 July-Aug; 17(4):483-9.
DOI: 10.15253/2175-6783.2016000400007
www.revistarene.ufc.br
Original Article
Evaluation of the sensory perception of sweet taste in people with
Diabetes Mellitus type 2
Avaliação da percepção sensorial ao gosto doce em pessoas com Diabetes Mellitus tipo 2
Vanéria Ribeiro Dias
1
, Jamille Marinho Brazil
1
, Juliane Angelica Reges Almeida
1
, Camile de Souza Silva
1
, Maria
Patrícia Milagres
1
Objective
: to evaluate the perception of patients with type 2 diabetes through the threshold index test for
the sweet taste.
Methods
: a cross-sectional study with 80 adults of both genders, divided into two groups:
control, composed of non-diabetics, and test, with diabetic patients. The evaluation of sensory perception held
by the sensitivity test to determine the threshold index. The tests were conducted on five sections containing
different concentrations of sucrose. Statistical analysis was held using the t test, adopted P<0.05.
Results
: when
comparing the average of the thresholds to detect sweet taste between diabetics and non-diabetics, it was
known that diabetics are less sensitive to sweet stimuli.
Conclusion
: individuals with Diabetes Mellitus 2 have
higher threshold index value for the sweet taste, which may contribute to the increase in sugar consumption.
Descriptors:
Diabetes Mellitus, Type 2; Sensory Thresholds; Ageusia.
Objetivo:
avaliar a percepção sensorial de pacientes com Diabetes Mellitus tipo 2, por meio do teste de índice
limiar para o gosto doce.
Métodos:
estudo transversal, composto por 80 adultos de ambos os sexos, divididos
em dois grupos: controle, composto por não diabéticos, e teste, formado por pacientes diabéticos. Avaliação da
percepção sensorial realizada pelo teste de sensibilidade para determinação do índice limiar. Testes conduzidos
em cinco sessões, contendo as concentrações diferentes de sacarose. Análise estatística por meio do teste t,
adotado p˂0,05.
Resultados:
ao comparar a média dos limiares para detecção do gosto doce entre diabéticos e
não diabéticos foi notório que os diabéticos são menos sensíveis ao estímulo doce.
Conclusão:
indivíduos com
Diabetes Mellitus 2 apresentam valor de índice limiar maior para o gosto doce, o que pode contribuir para o
aumento do consumo de açúcar.
Descritores:
Diabetes Mellitus Tipo 2; Limiar Sensorial; Ageusia.
1
Universidade Estadual do Sudoeste da Bahia. Jequié, BA, Brazil.
Corresponding author: Jamille Marinho Brazil
Rua José Moreira Sobrinho, s/n – Jequiezinho, CEP: 45206-190. Jequié, BA, Brazil. E-mail: jamille.marinho@hotmail.com
Dias VR, Brazil JM, Almeida JAR, Silva CS, Milagres MP
Rev Rene. 2016 July-Aug; 17(4):483-9.
484
Introduction
The taste plays an important role in the people´s
security and quality of life, as the loss or impairment
of gustatory function creates an environment to
domestic accidents, such as the risk of food poisoning
by eating spoiled food
(1)
. Also, the taste influence on
the food choices, allowing the individual to choose the
food he likes most from the sensory characteristics
provided by the substances contained in it
(2)
.
In this perspective, taste sensitivity impairment
may lead to the need of the individual ingest greater
quantities of substances for the perception of taste,
contributing to increasing the sodium and sugar intake.
The exacerbated consumption of these nutrients can
contribute to the development or worse the diseases
such as hypertension and diabetes mellitus type 2
(3)
.
Furthermore, studies that correlate the taste
perception in food choice are key to understanding
factors related to the anatomy and physiology of taste,
and to hormonal modulation and genetic variation
involved in this process. In this context, understanding
factors related to taste perception, allows evaluating
the feeding behavior of chronic patients
(4)
.
Thus, the perception of taste occurs in the
taste buds, primary sensory cells responsible for
taste. These cells can recognize the basic tastes:
sweet, sour, salty, bitter and umami. The response
caused by Sweet stimuli are associated with specific
membrane receptors, mediated by messengers,
adenosine 3’,5’-cyclic monophosphate and inositol
triphosphate
(5)
.
Sensory analysis is a widely used tool to
evaluate the gustatory system because it allows the
individual to understand, identify and/or distinguish
qualitatively and/or quantitatively one or more stimuli
received. Among the sensitivity of tests used, the
electrogustometry and the whole mouth stimulation
test can be highlighted
(6)
.
The electrogustometry is based on the weak
electrical stimulation and reliable method for
measuring taste in a high concentration. However,
it has the limitation to evaluate the bitter taste
(7)
.
In turn, the stimulation of mouth allows extensive
contact with gustatory stimulation buttons present
in the buds located on the surface of the tongue and
the palate mucosa and, in smaller numbers, in throat
areas
(8)
.
The threshold index method for the whole
mouth stimulation technique has been used on a
large scale. In this method, the basic taste thresholds
detection are determined on the sessions, in which
three samples are provided to the participant (two
are water, and one is the solution containing the
taste), being asked to identify the different, passing
the sample through the mouth. In each session,
the stimulus concentration is increased. Thus, the
session is determined when the individual began to
detect the stimulus. Thus, the threshold detection is
the minimum concentration of a substance that the
evaluator can identify a different feel pattern
(9)
.
In this context, researchers have used the
threshold index test for studies on eating habits,
attitudes, and diseases related to taste sensitivity
for a given substance
(10-11)
. A study conducted to
determine the threshold detection in cancer patients
treated with chemotherapy concluded that they have
lower threshold detection rates than the control
group
(10)
. Research using the threshold index test in
hospitalized patients found that the mortality rate is
higher in people less sensitive to tastes
(12)
. Another
study of alcoholics found that alcohol consumption
may decrease the salty and sweet taste sensitivity
(13)
.
Thus, it is noted that some diseases and
lifestyle contribute to the development of disorders in
taste, such as Diabetes Mellitus type 2, liver diseases,
tumors and alcohol use. Furthermore, the use of drugs,
head trauma, upper respiratory tract infections and
exposure to toxic substances significantly influence to
the taste loss
(5,11)
.
Rev Rene. 2016 July-Aug; 17(4):483-9.
Evaluation of the sensory perception of sweet taste in people with Diabetes Mellitus type 2
485
In patients with diabetes, the increase in
glucose levels can produce an inadequate response
to the perception of sweet taste, and bring micro and
macrovascular complications
(14)
. Thus, lifestyle change
is important to maintain adequate levels of plasma
glucose, such as the consumption of healthy food, loss
and/or weight control and physical activity
(15)
.
The
food
choice
is
inFluenced
by
several
factors, highlighting the sensory characteristics of
the food such as taste. The altered taste sensitivity
may interfere with the perception of sweet taste,
contributing to the increase in sugar intake. The
exposure to high amounts of this nutrient contributes
to the development and worsening of diabetes.
Therefore, it is emphasized the importance of studying
the taste sensitivity in patients with Diabetes Mellitus
type 2, since studies show that there is a reduction in
salivary Flow in diabetic patients
(15-16)
interfering with
the taste sensitivity. However, there are few studies
involving these individuals and the threshold index
detection for a sweet taste.
Highlighting that control sugar consumption is
essential for the treatment, control, and prevention of
comorbidities in diabetic patients, and that changes in
the threshold index can change this control, the aim of
this study was to evaluate the perception of patients
with Diabetes mellitus type 2 by the threshold index
test for sweet taste.
Methods
It is a cross-sectional study with a convenience
sample, consisted of 80 volunteers of both genders,
aged 20 to 59 years old, divided into two groups:
control and test.
The control group had 40 non-diabetic
individuals, students, teachers and employees of a
State University, who were invited to participate in the
research. The test group had 40 patients diagnosed
with Diabetes Mellitus Type 2, patients of two
health centers. The number of participants is by the
provisions of the Brazilian Association of Technical
and Standards
(17)
.
People with a dental prosthesis and or
complications in the oral cavity, people who had drunk
alcohol in the last 24 hours, smokers, elderly people,
and individuals with a cold or Flu, or with something
that could inFluence the perception of taste were
excluded. Data collection was conducted from August
to November 2014 in the city of Jequié, Bahia, Brazil.
The sensitivity test was performed to evaluate
the perception of the participants, determining the
threshold index detection to sweet taste. For this, the
methodology described in the Brazilian Standard
(17)
and International Organization for Standardization
was used
(18)
.
The quick method of determining threshold
index test was used, where each evaluator conducted
a series of Five sensory tests of type 3-Alternative
Forced Choice for a sweet taste. The samples were
submitted to continuous and triangular way, in a
monodic form, following increasing intensity of
sucrose concentration, the concentrations being used
in 0.5; 1.0; 2.0; 4.0 and 8.0 grams of sucrose to one
liter of water.
In each type 3-Alternative Forced Choice, the
evaluator received three coded samples with three-
digit random numbers, being two control samples
(only mineral water) and one test sample (sucrose at
a certain concentration).
The evaluators were asked to identify the
sample who thought different, through an evaluation
form. They were instructed to taste the samples from
left to right, and then write the code sample in the
form and circle the sample code that thought different.
Evaluators were located in individual cabins
and instructed to rinse the mouth between each
session to clean the taste buds. Moreover, a disposable
cup for disposal of the solutions was available if they
do not ingest the samples.
Dias VR, Brazil JM, Almeida JAR, Silva CS, Milagres MP
Rev Rene. 2016 July-Aug; 17(4):483-9.
486
The samples were given at room temperature
in disposable cups with a capacity of 50 ml. The
taste sensitivity test was performed in Five sessions,
containing the concentrations of sucrose in 0.5;
1.0; 2.0; 4.0 and 8.0 grams (g)/liters (L), prepared
according to the geometric series, recommended by
the International Organization for Standardization
(17)
.
The standard samples in the concentrations
above were prepared at the State University of Food
Technology Laboratory of Southwest Bahia, using
mineral water and sucrose as a solute, measured
by analytical scale SHIMADZU AUW220D and then
the samples were stored in containers at room
temperature.
The tests results analysis was carried out from
each participant threshold. The data were tabulated,
following the application of Equation 1 to determine
the individual threshold for each evaluator.
Equation 1 determining the individual threshold
considered that C
0
is the highest concentration
detected/recognized by the evaluator i and C
+
is
the lowest concentration detected/recognized by
a particular evaluator i, then for this evaluator, the
individual threshold is given by equation 2.
After determining the individual thresholds for
each participant, Equation 3 was applied for obtaining
the two groups threshold calculating the geometric
mean of the L
i
values. Thus, for a group of 40 evaluators,
the threshold index is given by equation 4.
For the statistical analysis, the Statistical
Package for the Social Sciences, version 21.0 was
performed. The t-test (p<0.05) was used to compare
the threshold for the sweet taste of the control group
and the sweet test of the tasting group.
The study complied with the formal require-
ments contained in the national and international
regulatory standards of research involving human
beings.
Results
The study population ranged between 20 and
59 years old, 70.0% of the control group participants
(n=28) were female, and the other 30.0% were male
(n=12). In the test group, there were 67.5% women
(n=27) and 32.5% were male (n=13).
According to the results of the in threshold index
test, sessions 1 (0.5g/L), 2 (1.0g/L) and 3 (2.0g/L),
respectively can be seen that only 3.0% (n=1), 13.0%
(n=5), and 40.0% (n=16) of the test group detected
sweet taste stimuli. However, 20.0% (n=8) 35.0%
(n=14) and 63.0% (n=25) of the control participants
(n=8) detected the stimulus in the corresponding
sessions.
In sections 4 (4.0g/L) and 5 (8.0g/L), it was
noted the increase in the number of the control group
individuals who identiFied sweet taste stimuli, being
68.0% (n=27) in section 4 and 90.0% (n=36) in section
5. When comparing the results obtained in the test
group and the control group in these sessions, there
was a difference between groups to detect the sweet
taste, since, in the sessions 4 and 5, 100.0% (n=40) of
the control group identiFied the stimulus.
Through the rapid method, the values found in
the sessions allow to observe that the taste sensitivity
to the sweet taste of nondiabetic is smaller in solute
detected in a growing number of solutions presented
than in the diabetic people.
When performing the calculation using the
individual thresholds by the geometric mean of the
highest concentration not detected and the lower
concentration detected in diabetics and non-diabetics,
it is possible to identify the average detection
thresholds for sweet taste, being 1,35g/L for the test
group and 2.48 g/L for the control group.
When comparing the average of the thresholds
to detect sweet taste among non-diabetic patients and
Rev Rene. 2016 July-Aug; 17(4):483-9.
Evaluation of the sensory perception of sweet taste in people with Diabetes Mellitus type 2
487
in those with type 2 diabetes, there was a statistically
significant diFFerence (p <0.05). Thus, the diabetic
group is less sensitive to sweet stimuli, with higher
threshold index value.
Discussion
In this study, it was observed that the average
thresholds to detect sweet taste were higher for
diabetic patients (p<0.05). Thus, the results showed
a decrease or loss of sensitivity to sweet taste for
diabetic patients with the threshold index, compared
to the control group.
The reduction and or loss of sensitivity to sweet
taste can contribute to an increase in the intake of
refined carbohydrates because this dysFunction may
lead to higher consumption of sugar
(19)
. This fact is a
risk factor for diabetics because the higher intake of
sugar, the greater the increase in blood glucose.
The loss of taste perception in individuals with
type 2 Diabetes Mellitus is related to hyposalivation,
xerostomia and low production of taste protein.
±urthermore, the deficiency or absence oF taste
interferes in salivation and maturation of the taste
buds, causing changes in the perception of taste
(3)
. One
of the limitations of the study was the use of only a
primary taste, instead oF the five tastes.
The
mouth
threshold
index
evaluation
technique was eFficient to evaluate the taste sensitivity
in diabetic patients since the results of this study show
that the average threshold to detect the sweet taste
in non-diabetic individuals is lower when compared
to diabetic individuals. These results corroborated
with another study with a control group, pre-diabetic
and diabetic patients, where it was observed that
the average thresholds to detect sweet taste were
different between the groups. The control group had
a lower mean than the pre-diabetic and finally the
diabetic individual
(19)
.
The loss of taste sensitivity may hinder to
control sugar intake in the patient since he may think
that he is consuming food with low sugar by feeling a
little sweetness, but in fact, this feeling is related to the
low sensitivity of the patient. This reported situation
may even hinder the work of health professionals in
the assessment and treatment of patients. Thus, it is
suggested the use of gustatory sensitivity testing by
health professionals as a way to evaluate the clinical
and laboratory status of the affected patient of
Diabetes Mellitus Type 2.
By being a disease that, at times, is
asymptomatic, the clinical and laboratory evaluation is
relevant to identify the actual pathological condition of
the patient to contribute to a more suitable treatment.
Thus, evaluation of taste sensitivity may be a new tool
for the control of the clinical status of patients with
Diabetes Mellitus type 2.
Identifying the loss of taste sensitivity in
patients with type 2 Diabetes, the development of
studies are necessary to minimize or eliminate this
clinical condition. In this sense, physiology studies
of taste tissues are highlighted, such as receptors.
The T1R2/T1R3 receptor is responsible for the
sweet taste perception, being the regulator of several
metabolic processes, such as macronutrients ingested
in the diet. This fact contributes to the treatment
and maintenance of metabolic disorders such as
diabetes
(20)
.
Conclusion
The threshold index to detect the sweet taste
is higher in people with Diabetes Mellitus type 2
compared with non-diabetic individuals. Therefore,
diabetic patients have lower sensitivity to sweet taste,
requiring higher sucrose concentrations to identify
the sweetness of food and beverages.
Therefore, the loss of sensitivity to sweet
taste in diabetics may contribute to intake food with
high sugar concentration, being a risk factor for the
worsening of the disease. However, it is necessary to
develop new studies on the subject to intervening in
improving sensitivity to sweet taste and consequently
favor choices and healthier eating habits.
Dias VR, Brazil JM, Almeida JAR, Silva CS, Milagres MP
Rev Rene. 2016 July-Aug; 17(4):483-9.
488
Acknowledgment
To the Health Centre Júlia Magalhães and Jequié
Health Center.
Collaborations
Dias VR, Brazil JM, Almeida JAR, Silva CS and
Milagres MP participated in the conception and project
or analysis and interpretation of data, article writing,
relevant critical review of the intellectual content and
final approval oF the version to be published.
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