The topic of sweet taste and the relationship to health is one that has been of interest to researchers for many years and continues on today. One unique aspect to this area of research is its multidisciplinary nature—sweet taste research encompasses the fields of sensory science, psychology, receptor biology, nutrition science, and more. The relationship of sweet taste to nutrition and dietary preferences is especially exciting for some researchers including Professors Appleton (a biological psychologist) and de Graaf (a professor of sensory science and eating behavior), who presented some of their work in 2020 during an American Society for Nutrition webinar. This article summarizes the work presented, divided by research topics of interest.
The World Health Organization currently recommends that the intake of free sugars (defined as monosaccharides and disaccharides added to foods, plus sugars that are naturally present in honey, syrups, and fruit juices) be reduced to less than 10% of total energy intake, and a further reduction to less than 5% of total energy intake would provide additional health benefits.1 Additionally, the recently released Dietary Guidelines for Americans 2020–2025 recommends that added sugars consumption be limited to 10% of calories.2 These recommendations are based on associations between sugar consumption and increased risk of dental caries and on evidence that the consumption of excess energy intake, especially from sugar-sweetened beverages, is associated with weight gain.1–3
To assist in reducing sugar consumption, some authoritative bodies currently recommend reducing the consumption of sweet-tasting foods and beverages, regardless of the source of the sweet taste (ie, caloric or low/no-calorie sweeteners).2,4,5 These recommendations stem from concerns that human attraction to sweetness may be a potential risk for developing less healthy eating patterns. A hypothesis behind these recommendations is that increased exposure to sweet-tasting foods and beverages could train palates to crave sweet, increasing preferences for sweet taste, and increasing intakes of sweet foods, resulting in obesity. Similarly, the hypothesis states that consumer palates could adapt to a lower level of sweetness if offered and therefore reduce energy and sugar intakes, favoring weight management. Research is needed to test these hypotheses and many others related to the relationship between sweet taste and health.
Sweet Taste Exposure, Preferences, and Intakes
It has been hypothesized that dietary exposure to sweetness influences the way individuals perceive foods and beverages and what and how much is consumed. Yet there is little empirical evidence to support such a relationship. Recently, a team of international researchers led by Professor Appleton conducted a systematic review of the published literature on the influence of dietary exposure to sweet-tasting foods or beverages on the subsequent generalized acceptance, preference, or choice of sweet foods and beverages in the diet, and presented these findings.6 After systematic procedures to identify relevant literature, 21 studies were found, comprising 7 population cohort studies involving 2320 children and 14 controlled studies involving 1113 individuals.
Taken together, these studies provided no clear or consistent support for a relationship between sweet taste exposure and subsequent preferences or sweet food intakes. The limited evidence from short-term controlled studies suggests that a higher sweet taste exposure tends to lead to reduced preferences for sweetness, but no impacts were found on sweet food intake. Very limited effects that were largely equivocal were found in the longer term as well as in the population cohort studies. Overall, the evidence found was highly heterogeneous in methodology, received many judgments of high risk of bias, and addressed the research question only indirectly. In addition, few studies involved manipulation of the whole diet or assessed perceptions of the manipulation, and few studies were of sufficient duration for effects to be expected. The next section summarizes Professor Appleton's presentation on further evidence from studies completed or in process and reanalysis planned since the aforementioned review, to address the question of whether sweet taste exposure impacts on generalized sweet food preferences and intakes.
There is little evidence to support a relationship between sweet taste exposure, preferences for, and intakes of sweet tasting foods and beverages.
i-Sense Study—de Graaf, Appleton, Mars, 2019-2024
Well-designed long-term studies are needed. There is a trial currently underway exploring the effects of sweetness exposure within the whole diet on changes in sweet taste preferences, sweet taste perceptions, and ad libitum sweet food and energy intakes over 6 months (registered at www.clinicaltrials.gov: NCT04497974). One hundred fifty healthy Dutch adults are being randomized to 1 of 3 interventions, consuming either a regular sweetness exposure diet (25%–30% of total energy from sweet-tasting foods), a low-sweetness diet (10%–15% of total energy from sweet-tasting foods), or a high-sweetness diet (40%–45% total energy from sweet-tasting foods). Sweet taste is provided from sugar, low/no-calorie sweeteners, or fruits in all of the intervention arms (in comparable proportions); thus, this is an investigation of sweet taste exposure, not an investigation of the sources of sweet taste. The primary outcome measure is sweet taste preference assessed using a taste test consisting of 5 versions (varying in taste intensity) of 3 familiar sweet foods, 3 unfamiliar sweet foods, and 2 familiar nonsweet foods. The secondary outcomes are sweetness intensity perception, sweet food choice, and dietary taste preferences and cravings. Additional tertiary measures include measures of body weight, anthropometry, and markers of glucose homeostasis. Outcomes are measured at baseline and at 1, 3, and 6 months during the intervention, as well as 1 and 4 months following the intervention. The study is anticipated to be complete in 2024.
Sweet Breakfasts Study: Appleton, Rogers, 2018-2020
The greatest evidence of an effect of sweetness exposure in the systematic review6 was found from short-term intervention studies. To add to the short-term evidence, a parallel-design, randomized clinical trial was recently completed at Bournemouth University, United Kingdom, to assess the impact of repeated sweet breakfast consumption versus repeated nonsweet breakfast consumption on subsequent sweet and nonsweet food preferences and intakes (registered at www.clinicaltrials.gov: NCT03442829). Fifty-four regular breakfast eaters were randomized to receive either sweet or nonsweet breakfasts for 3 consecutive weeks. Participants were provided with breakfasts to take and consume at home consisting of a box of nonsweet plain breakfast cereal and either a bag of sucralose or no bag. If a bag was provided, participants were instructed to add 2 teaspoons to their breakfast cereal and 1 teaspoon to any drinks. If no bag was provided, participants were instructed to add nothing to the cereal and consume nonsweet drinks. Study researchers were blind to who received the sweet (bag of sucralose) and the nonsweet breakfasts (no bag). Participants were not blinded to whether they were consuming a sweet breakfast, but they were blinded as to whether they were consuming sugar or low/no-calorie sweeteners and to the study hypotheses. The primary outcomes were sweet food preferences and intakes at breakfast. Secondary outcomes were sweet food preferences and sweet food intakes at lunch, and preferences for nonsweet foods at breakfast and lunch. Food preferences were assessed using a taste test, and sweet food intakes were assessed during an ad libitum buffet meal composed of sweet and nonsweet foods, and the same meal was provided for all breakfast and lunch meals. Multiple measures, such as percent weight consumed from sweet foods, percent energy consumed from sweet foods, and sugar consumption, were used to measure sweet taste in the diet given that there is no current consensus on the most appropriate measure for characterizing dietary sweetness. Outcomes were measured at baseline and after 1 and 3 weeks of intervention.
Overall, preliminary results suggest that there were no effects of sweet food exposure on sweet food intakes or on the rated pleasantness of sweet foods. Over the 3 weeks, participants consistently rated the sweet foods as more pleasant than nonsweet foods, yet there were no effects of exposure to the sweet breakfasts on the rated pleasantness of sweet foods or on sweet food intakes. Some effects over time were found regardless of exposure group. These effects of time demonstrate a sensitivity in the measures used, which was also demonstrated by the detection of correlations between the taste test measures and intake measures for the foods in the taste test. Thus, the absence of effects of exposure was not considered to be due to the measures used. The results from this study mirror the findings of the aforementioned systematic review6 in terms of sweet food intake and extend the findings of the systematic review in terms of pleasantness by suggesting that the effect in preferences may be not as strong as originally suggested. These results also mirror the findings from 2 additional studies published after the systematic review.7,8
Evidence From Reanalysis of Existing Data Sets
More evidence to address the question of sweet taste exposure may also be gained, not by conducting new studies but by reanalysis of existing data sets from previously published studies. Many studies have been conducted to investigate the impact of sweet taste or sweet foods on subsequent consumption, where intake was measured in terms of total energy intake or total weight consumed, and where test meals were often composed of sweet and nonsweet foods but not analyzed in that manner. To test this approach, a reanalysis is planned on data obtained from previous work conducted by Professor Appleton.9 In this randomized crossover trial study, 20 participants came into the laboratory on 3 separate days. On each day, the participants consumed 4 portions of sugar-sweetened beverages, low calorie sweetened beverages, or water. Ad libitum energy intakes were assessed throughout the day (Figure 1).
The original analyses looked at total energy intake; however, sweet and nonsweet foods were used in test meals and snacking periods. The reanalysis of the data will now look at differences between sweet and nonsweet food intake. To note, there are criticisms to this approach. The original studies were set up to answer a different research question, and the test meals were not designed to look at differences between intakes of sweet and nonsweet foods, so the sweet and nonsweet foods may differ on other characteristics, such as healthfulness, which may also drive consumption.
Based on current evidence, the recommendation to reduce the consumption of sweet taste in order to reduce preferences and subsequent intakes of sweet foods may need rethinking. The findings from an increasing number of studies suggest no impact of sweet taste exposure on sweet taste preferences or intakes. The relationship between preferences and intake is likely, but what is being questioned is whether exposure impacts these preferences and therefore intakes.
Well-designed, long-term studies are needed to understand if limiting exposure to a sweet diet can change preferences and intakes of sweet foods.
Sweet Taste, Appetite, and Obesity
There are certain characteristics of sweet taste that are well understood, including the fact that humans have an inborn preference for sweetness. It is also well established that optimal preferred levels of sweetness in foods and drinks decline from birth until adulthood.10 An interesting finding from Professor de Graaf's laboratory is that the sweetness intensity levels of foods across a number of countries around the world (the Netherlands, France, Australia, and Malaysia) are very similar.11–14 In addition to what is known about sweet taste, there are also many unanswered questions on this topic. This section will summarize Professor de Graaf's presentation on research that has been conducted on sweet taste, appetite, and obesity.
Sweet Taste and Energy Content of Food
Table 1 (adapted from Lease et al,11 van Langeveld et al,12 Teo et al,13 and Martin and Issanchou14) shows correlation data collected across food supplies from five countries. The data reflect the relationship between sweetness intensity and energy content, sweetness intensity and carbohydrate content, umami intensity and protein content, salt taste intensity and sodium content, and fat sensation and fat content, respectively. These data suggest that across the world, sweetness intensity is not predictive of calorie content. There appears to be some relationship between sweetness intensity and carbohydrate content, but it is not a perfect relationship. The data also suggest relationships between umami intensity to protein content, salt taste to sodium content, and fat sensation to fat content. These data help us understand that taste intensity represents nutrient concentrations in foods, but there is no obvious relationship between sweetness intensity and energy content of foods.
TABLE 1 -
Taste Nutrient Signaling (That Is, The Correction Coefficient Times 100) Between Rated Taste Intensities and Nutrient Concentrations From Food Composition Databases Across Representative Food Supplies Around the World11–14
The taste intensities were assessed with the help of a trained panel using the Spectrum method; ie, taste intensities were defined with the help of physical references (eg, 2 and 5 g sucrose/100 mL solution were assigned values of 13 and 33 mm on 100 mm visual analog scale). The foods selected were based on frequently consumed foods as measured by the National Food Consumption Surveys in Australia, the Netherlands and Malaysia.
Abbreviations: CHO, carbohydrate; PRO, protein; n.a., not available.
Sweet Taste Preference and Weight Status
Because sweetness is presumed to signal energy, there is a hypothesis that obese people will have a higher preference for and consume more sweet foods. Frijters and Rasmussen-Conrad15 conducted one of the first studies on this topic over 35 years ago. The authors studied sweetness intensity and preferences among 12 overweight and 12 normal-weight people. There were no differences in psychophysical functions (the relationship between sweetness concentration and perceived sweetness intensity) or psychohedonic functions (the relationship between sweetness concentration and perceived pleasantness) between overweight and normal-weight people. One of the most recent studies conducted on this topic is from the Bobowski and Mennella,10 who investigated the optimal preferred levels of sucrose and sucralose among adults and children, obese and normal-weight. Figure 2 from this study suggests that there are no differences between optimal levels of sweetness among obese and normal-weight people. There are many other studies addressing this question, and they have all come to the same conclusion that sweetness preferences do not differ by body mass index; obesity cannot be explained by a high degree of sweetness preference.16–24
Sweet-Tasting Foods and Energy Intakes by Gender and Weight Status
Professor de Graaf and colleagues looked at the Dutch national food consumption survey (which is equivalent to the National Health and Nutrition Examination Survey in the United States) and selected more than 450 foods that represent greater than 80% of total energy intake in the Netherlands. The team then profiled these foods using the Spectrum method (defined levels of different tastes; see van Langeveld et al25 for more information on the Spectrum method) and categorized foods into taste clusters using cluster analysis. Next, the researchers calculated the contribution of taste clusters to the total energy intake by age, gender, and weight status in 2 cohorts in the Netherlands using the nutrition survey data.25
Table 2 illustrates the distinctions in different taste clusters including a fat sensation cluster of 37 foods with mayonnaise as an example, a neutral cluster of 130 foods, a cluster of 66 sweet/sour foods including fruits, a salt/umami/fat cluster of 119 foods, a sweet/fat cluster of 113 foods, and a bitter cluster that comprised 16 foods. Professor de Graaf and colleagues then summed up the foods that people ate and calculated the contribution of the taste clusters to total energy intake of the diet. Figure 3 shows the contribution of sweet/fatty foods and sweet/sour-tasting foods to the total energy content of the diet for men and for women. In order to correct for potential underreporting, subjects with energy intake/basal metabolic rates ratios of less than 1.3 were excluded. In general, women consumed slightly more calories from sweet/fatty foods and sweet/sour foods compared with men such that there was a greater contribution of sweet/fatty foods and sweet/sour-tasting foods to the energy content of the total diet for women than for men. This is one of the first data sets to show that women may consume more sweet foods than men.
TABLE 2 -
Mean Taste Intensity ± SD of 481 Foods Divided Into 6 Taste Clusters With Different Taste Profiles25
|Mean Taste Intensity (0-100 mm)
||22 ± 20
||11 ± 14
||4 ± 9
||8 ± 11
||17 ± 17
||31 ± 24
||7 ± 6
||13 ± 16
||2 ± 3
||6 ± 6
||20 ± 14
||80 ± 11
||10 ± 8
||4 ± 3
||3 ± 4
||4 ± 5
||10 ± 9
||13 ± 9
||Bread brown wheat
||31 ± 15
||36 ± 15
||3 ± 5
||1 ± 4
||5 ± 7
||11 ± 12
||Apple with skin average
||8 ± 6
||9 ± 7
||1 ± 2
||23 ± 9
||42 ± 9
||46 ± 14
||Cheese Gouda 48+ average
||51 ± 11
||5 ± 7
||3 ± 5
||1 ± 1
||8 ± 5
||37 ± 16
||Chocolate bar milk nuts
||12 ± 8
||12 ± 11
||47 ± 11
||1 ± 1
||2 ± 1
||5 ± 4
Figure 4 illustrates the contribution of sweet-tasting foods as a percentage of energy intake for men, grouped by weight status. Obese men consumed a slightly lower percentage of calories from sweet/fatty foods than normal-weight men. Figure 5 shows the same data set for women. Obese women consumed a slightly lower percentage of calories from sweet foods than normal-weight women. These data suggest that overweight and obese people do not eat more sweet foods than normal-weight individuals and that there are slight differences in sweet food intakes by gender.
No differences have been found in levels of sweet food/beverage consumption among normal-weight and overweight/obese individuals.
Satiating Effects of Sweet-Tasting Foods
Professor de Graaf's laboratory conducted a study looking at the relationship between sweet taste and satiation, as measured by meal termination. The study utilized 2 different rice meals, one with a savory taste (like an Asian rice dish) and one with a sweet taste (similar to rice pudding). Everything about the meals was matched including texture, fiber content, palatability, and macronutrient content resulting in identical meals, which differed only in taste profile. The study was conducted 3 times in slightly different methodological settings. The results from the 3 testing conditions are presented in Figure 6 separated out to show the difference in ad libitum intake by a sweet or savory meal. It was very clear from this study that satiation, as measured by the weight of food consumed, was not different between the savory and sweet meals; having a sweet meal did not result in increased consumption as compared with a savory meal.26
In addition to the effects on satiation, it has been suggested that consuming sweet foods results in additional desire for sweet foods, leading to higher intakes and preference. A study that was conducted by de Graaf's laboratory attempted to answer that question but was limited to a 24-hour period.27 In this study, 39 subjects participated in a 3-condition, within-subjects crossover study, which included a sweet condition with only sweet foods, a savory condition with only savory foods, and a mixed condition where the provided energy/number of foods was similar, but contained sweet and savory foods. Participants were divided into 3 groups, with one receiving a sweet diet, one group given a savory diet, and the third group receiving a mixed diet for 24 hours. Following the 24-hour period, intake was measured at an ad libitum buffet lunch, which comprised high-protein savory foods, low-protein savory foods, high-protein sweet foods, and low-protein sweet foods.
Figure 7 shows the results of this study in terms of energy intake and proportion of consumption by macronutrients. Interestingly, energy intakes at the ad libitum buffet lunch were identical between the taste conditions. Additionally, these results illustrate the concept of “sensory specific satiety,”28 as evidenced by those participants who followed the sweet diet choosing more savory foods, whereas those on the savory diet ate more sweet foods. Those who were on the mixed diet consumed equal amounts of both sweet and savory foods.27 This study is one of those that contributed to the systematic review on the impacts of sweet taste exposure by Appleton and colleagues.6
The research presented here addresses the relationship between sweet taste and energy content, energy intakes, and weight status. Sweetness does not equate to the energy content in the food supply, although it may relate to carbohydrate content. There is no difference in sweetness perception and liking as a function of weight status, which has been shown repeatedly for more than 40 years. Professor de Graaf's research suggests that overweight and obese people consume slightly less sweet foods and more savory, fatty-tasting foods than normal-weight individuals. Sweet and savory tastes seem to have similar effects on energy intake with strong sensory specific satiety effects.
Unanswered Questions for Future Research
There are many remaining and exciting issues related to sweetness and health that need further research. One important question is whether one can change sweetness preference. A second question is about energy compensation. For example, if one consumes a reduced-calorie sweet food, will the body want to compensate for those missing calories, resulting in greater hunger? Many studies have shown that people may not compensate fully for the energy in liquids,29 but is the same true for solid forms? Solid foods remain longer in the mouth, leading to a higher orosensory exposure than liquid foods.30,31 There is little known about the long-term effects of diets low and high in sweetness exposure on energy intake and energy balance and on subsequent health conditions. One final topic with little scientific understanding is the area of genetic differences in sweetness preferences and intakes. Why do some people like higher sweetness levels than others? Although there is quite a bit known about sweet taste, there is much still to investigate and understand as we try to optimize dietary recommendations on taste and nutrition for health and quality of life.
Since the date of the webinar (July 28, 2020), the reanalysis of data suggested by Professor Appleton in her talk has been undertaken and published. This publication is available at: Appleton KM. Repeated exposure to and subsequent consumption of sweet taste: reanalysis of test meal intake data following the repeated consumption of sweet vs nonsweet beverages [published online October 27, 2020]. Physiol Behav 2021;229:113221. https://doi.org/10.1016/j.physbeh.2020.113221.
The authors thank Katherine M. Appleton, PhD, professor of psychology at Bournemouth University, United Kingdom and Kees de Graaf, PhD, professor of sensory science and eating behavior at Wageningen University & Research, the Netherlands, for editorial assistance.
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