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nutrients
Review
Early Taste Experiences and Later Food Choices
Valentina De Cosmi 1, Silvia Scaglioni 2and Carlo Agostoni 3, *
1Valentina De Cosmi Pediatric Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore
Policlinico, Branch of Medical Statistics, Biometry, and Epidemiology “G. A. Maccacaro”, Department of
Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
valentina.decosmi@gmail.com
2Silvia Scaglioni Fondazione De Marchi Department of Pediatrics, Fondazione IRCCS Cà Granda Ospedale
Maggiore Policlinico, 20122 Milan, Italy; silviascaglioni50@gmail.com
3Carlo Agostoni Pediatric Intermediate Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore
Policlinico, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
*Correspondence: carlo.agostoni@unimi.it; Tel.: +39-025-503-2497
Received: 4 November 2016; Accepted: 24 January 2017; Published: 4 February 2017
Abstract:
Background. Nutrition in early life is increasingly considered to be an important factor
influencing later health. Food preferences are formed in infancy, are tracked into childhood and
beyond, and complementary feeding practices are crucial to prevent obesity later in life. Methods.
Through a literature search strategy, we have investigated the role of breastfeeding, of complementary
feeding, and the parental and sociocultural factors which contribute to set food preferences early in
life. Results. Children are predisposed to prefer high-energy, -sugar, and -salt foods, and in pre-school
age to reject new foods (food neophobia). While genetically determined individual differences exist,
repeated offering of foods can modify innate preferences. Conclusions. Starting in the prenatal
period, a varied exposure through amniotic fluid and repeated experiences with novel flavors during
breastfeeding and complementary feeding increase children’s willingness to try new foods within a
positive social environment.
Keywords:
early taste; food preferences; breastfeeding; complementary feeding; feeding strategy;
children obesity; food choices
1. Introduction
Childhood is a period of very rapid growth and development. In this critical phase,
food preferences are formed, are tracked into childhood and beyond, and foundations are laid for
a healthy adult life [
1
]. The characterization of feeding practices is important for the determination
of which factors of the early environment can be modified and thus are amenable to intervention.
Since early life exposures may contribute to the risk of obesity [
2
], the topic is highly recognized to be
of social and public health interest [3,4].
Infants’ and children’s eating and activity behaviors are influenced by both intrinsic (genetics, age,
gender) and environmental (family, peers, community, and society) factors [
5
]. These factors are fully
displayed in Figure 1.
Firstly, prenatal exposure, and then breastfeeding, have been associated with flavor stimulation
and moderately lower childhood obesity risk in many studies [
2
,
6
,
7
]. Later on, the period of
complementary feeding is also crucial, both for obesity prevention and for setting taste preferences
and infant attitude towards food. Parents act by teaching children in different ways how, what, when,
and how much to eat and by transmitting cultural and familial beliefs and practices surrounding food
and eating [
8
]. Parents’ influence is significant: it is reflected both by what is on the plate and the
context in which it is offered [9].
Nutrients 2017,9, 107; doi:10.3390/nu9020107 www.mdpi.com/journal/nutrients
Nutrients 2017,9, 107 2 of 9
Nutrients2017,9,1072of8
BMI:BodyMassIndex
Figure1.Environmentalfactorsthatinfluencechildeatingbehavior.
Obesityisaburdensocialdisease,linkedtolifestyleandfoodchoiceschanges,characterizedby
lowlevelofphysicalactivity,highenergydensity,andfreesugar‐richfood.Asnutritionalhabitsare
trackedfrominfancytoadulthood,weinvestigatedfactorsinsidethechildmilieu,possiblyconnected
toflavorlearningandfeedingpractices.Inparticular,wefocusedonstrictlychild‐relatedfactors.
Parentalinfluenceisonlydescribedintermsoffoodofferingfeedingstyle,whileparentalmodeling
isnotatopicofourreview.Wereviewed(1)thebiologicalandsocialearly‐lifeexposures;(2)the
prenatalinfluenceoftheamnioticfluid;(3)howbreastmilkandformulamayinfluencetaste
development;(4)theroleofcomplementaryfeeding;(5)theparentalandsocioculturalfactors
associatedwithtrajectoriesofhealthinadulthood.
2.Methods—LiteratureSearchStrategy
Electronicdatabases(Pubmed,Medline,Embase,GoogleScholar)weresearchedtolocateand
appraiserelevantstudies.WecarriedoutthesearchtoidentifyarticlespublishedinEnglishonthe
relationbetweenchildren’searlytasteexperiencesandtheirfoodchoicesduringchildhood.Relevant
articlespublishedafter2005anduptoAugust2016wereidentifiedusingthefollowingsearchwords
invariouscombinations.Theliteraturesearchwasnotaimedtoconductasystematicreviewormeta‐
analysisofalloftheavailableliteratureonthistopic,buttoexplorethepertinentobservationsina
periodof10years.Ourworkisanarrativereview,andsearchtermswereinsertedindividuallyand
usingthebooleansANDandOR.Thefollowingtermswereincludedinthesearchstrategy:(“early
tasteexperiences”OR“earlyfoodpreferences”)&(“foodchoicesinchildhood”)OR(“parental
feedingpractices”OR“parent’sfeedingstrategies”OR“parentalmodeling”)&(“family
environmentalfactors”OR“familyeatingenvironments”)&(“earlyexposure”AND“obesityrisk”
AND“childhoodobesityriskfactors”)&(“amnioticfluid”OR“breastmilk”AND“tasteANDflavor
development”)&(“earlydietexperiences”OR“developmentofeatinghabits”)&(“Foodchoices”).
Morethan5000referencesmatchedthetermsofthesearch,andaround1500hadbeenpublishedin
thepast10years.Theauthorsselectedthearticlesandassessedthepotentiallyrelevantones.
Figure 1. Environmental factors that influence child eating behavior.
Obesity is a burden social disease, linked to lifestyle and food choices changes, characterized by
low level of physical activity, high energy density, and free sugar-rich food. As nutritional habits are
tracked from infancy to adulthood, we investigated factors inside the child milieu, possibly connected
to flavor learning and feeding practices. In particular, we focused on strictly child-related factors.
Parental influence is only described in terms of food offering feeding style, while parental modeling is
not a topic of our review. We reviewed (1) the biological and social early-life exposures; (2) the prenatal
influence of the amniotic fluid; (3) how breast milk and formula may influence taste development;
(4) the role of complementary feeding; (5) the parental and sociocultural factors associated with
trajectories of health in adulthood.
2. Methods—Literature Search Strategy
Electronic databases (Pubmed, Medline, Embase, Google Scholar) were searched to locate and
appraise relevant studies. We carried out the search to identify articles published in English on the
relation between children’s early taste experiences and their food choices during childhood. Relevant
articles published after 2005 and up to August 2016 were identified using the following search words
in various combinations. The literature search was not aimed to conduct a systematic review or
meta-analysis of all of the available literature on this topic, but to explore the pertinent observations in
a period of 10 years. Our work is a narrative review, and search terms were inserted individually and
using the booleans AND and OR. The following terms were included in the search strategy: (“early taste
experiences” OR “early food preferences”) & (“food choices in childhood”) OR (“parental feeding
practices” OR “parent’s feeding strategies” OR “parental modeling”) & (“family environmental
factors” OR “family eating environments”) & (“early exposure” AND “obesity risk” AND “childhood
obesity risk factors”) & (“amniotic fluid” OR “breast milk” AND “taste AND flavor development”)
& (“early diet experiences” OR “development of eating habits”) & (“Food choices”). More than
5000 references matched the terms of the search, and around 1500 had been published in the past
10 years. The authors selected the articles and assessed the potentially relevant ones.
Nutrients 2017,9, 107 3 of 9
2.1. Effects of Early Taste Experiences
According to a working hypothesis, the first thousand days of life represent a sensitive period
for the development of healthy eating habits, and for this reason, interventions are likely to have a
strong impact on health outcomes later during childhood and adulthood. This critical period starts
with feeding through the cord during gestation, passes toward oral feeding with milk, and then the
complementary feeding begins and the infant discovers a variety of foods and flavors. Humans
generally have inborn positive responses to sugar and salt, and negative responses to bitter taste [
10
].
Genetically determined individual differences also exist, and interact with experience to ensure
that children are not genetically restricted to a narrow range of foodstuffs [
11
]. Children are also
predisposed to prefer high-energy foods, to reject new foods, and to learn associations between food
flavors and the post-ingestive consequences of eating [
12
]. This genetic predisposition appears to have
evolved over thousands of years when foods—especially those high in energy density—were scarce.
Few children—PROP (6-n-propylthiouracil) tasters—are sensitive to bitter taste and have higher liking
and consumption of bitter foods, such as cruciferous vegetables. Additionally, those children who
are unable to taste PROP (nontasters) like and consume more dietary fat and are prone to obesity;
thus, genetic variation in the ability to taste bitter compounds may have important implications as a
marker for dietary patterns and chronic health in children. The available literature suggests that some
children may require additional strategies to accept and consume bitter-tasting fruits and vegetables
and that genetic predisposition may be modified by repeated exposures [13,14].
2.2. Amniotic Fluid and Breast Milk
The ability to recognize a variety of flavors involves multiple chemosensory sensations, primarily
the sense of taste and smell. Food experiences begin prenatally, since chemosensory systems have
an adaptive and evolutionary role and are functional before birth [
10
]. The exposure to an in utero
environment may cause permanent effects on the developing tissue. These effects are referred to as
“programming”, and are important risk factors for chronic diseases in later adulthood [15].
Children usually prefer foods that are high in sugar and salt over those which are sour and
bitter tasting, such as some vegetables. Preferences for salt and the refusal of bitter can be modified
early through repeated exposure to flavors in amniotic fluid, mother’s milk, and solid foods during
complementary feeding. Flavor senses are well developed at birth, and continue to change throughout
childhood and adolescence, serving as gatekeepers throughout the life span, controlling whether to
accept or reject a foreign substance. Since amniotic fluid and breast milk both reflect to a variable
degree the food composition of the maternal diet, a repeated exposure to their flavors increases infants’
acceptance of foods [
16
]. While the knowledge of the influence of the maternal diet on breast milk is
mostly indirect [
17
], the sensory experiences with food flavors in mothers who ate a varied diet may
explain why their breastfed children tend to be less picky [
18
] and more willing to try new foods during
childhood [
11
,
19
,
20
]. A cohort study [
21
] on 1160 mother–infant pairs showed that preponderance of
breastfeeding in the first 6 months of life and breastfeeding duration were associated with less maternal
restrictive behavior and less pressure to eat. Accordingly, compared with bottle-feeding, breastfeeding
may promote maternal feeding styles that are less controlling and more responsive to infant cues of
hunger and satiety, thereby allowing infants to develop a greater self-regulation of energy intake [
21
].
2.3. Formula-Fed Infants
The early flavor experience of formula-fed infants is markedly different from that of breast-fed
infants. Exclusively formula-fed children do not benefit from the ever-changing flavor profile of breast
milk. Their flavor experience is more monotone and lacks the flavors of the foods of the mother’s
diet. There are striking differences in flavors among the different types of formulas and brands of
formulas, and formula-fed infants learn to prefer the flavors of the formula they are fed and foods
containing these flavors [
11
]. There is a plethora of infant formulas on the market that differ in
Nutrients 2017,9, 107 4 of 9
macronutrient composition. When evaluating the effect of diet composition on growth and health
outcomes, it may no longer be appropriate to consider all formula-fed infants as a homogeneous group,
because infant formulas may also differ in both fat and carbohydrate composition/structure as well
as protein composition, and these differences may in turn affect growth and flavor development [22].
Consequently, it is important to understand the composition of the diet to which breastfeeding is being
compared before drawing conclusions. European and US populations reveal an association between
breastfeeding and a reduced prevalence of obesity in a meta-analysis; however, in a large randomized
controlled trial, there was no effect of breastfeeding on body mass index in later childhood [
23
].
When infants are fed with a formula that is more similar in protein content to breast milk (lower vs.
higher protein), their weight-for-length at 24 months of age does not differ from breastfed infants [
24
].
Another difference is found in infants consuming protein hydrolysate formula when compared with
cow’s milk formula: they are satiated sooner and have a less excessive rates of weight gain [
25
].
The mechanism of this effect is currently unknown, but is hypothesized to be related to differences in
free glutamate (which is abundant in human breast milk) [26,27].
2.4. Complementary Feeding and Future Consumption of Fruits and Vegetables during Childhood
Early learning about flavours continues during the complementary feeding period, through the
introduction of solids and changing exposures to a variety of new foods. In this peculiar time of
the child’s life, there is the transition from breast/formula feeding to a complementary solid diet,
and infants discover the sensory (texture, taste, and flavour) and nutritional properties (energy density)
of the foods that will ultimately compose their adult diet [
28
]. Being exposed to a variety of foods
during the complementary feeding period helps modulate the acceptance of new foods in the first year,
whereas exposure in the second year may have a more limited impact [29].
Young children (especially 2–5 years old) exhibit heightened levels of food neophobia during this
time. This means that they are unwilling to eat novel foods; it is interpreted as an adaptive behaviour,
ensuring children consume foods that are familiar and safe [30].
Distaste—dislike of the sensory characteristics of a food—appears to be the strongest driver of
neophobia in young children [
31
]. Indeed, the two strongest predictors of young children’s food
preferences are familiarity and sweetness, reflecting unlearned preferences. However, these innate
tendencies are paired with a predisposition to learn from early experiences through associative learning
and repeated exposure, allowing the child to learn how to accept and prefer the foods that are available
within his particular environment [
30
]. Repeated exposures to a food increase their familiarity, and it
is one of the primary determinants of its acceptance. Several studies have shown that a food is
consumed more and is judged as more liked by the infant after several offers. For instance, an increase
in acceptance of a new green vegetable was observed after at least eight exposures to this food [
31
].
The effect of repeated exposure is potent enough to increase the acceptance of foods which had
been previously identified by the mother as being refused by her infant during the beginning of the
complementary feeding, which were most often green vegetables, but also pumpkin [
32
]. However,
despite the efficacy of this mechanism, foods are most often only presented a limited number of times
(often less than five times) before the parents decide that the infant dislikes this food [33–35].
Reactions towards new foods differ according to food groups [
28
]. Lange et al. (2013) asked
mothers to report their infant’s reactions to new foods at the beginning of complementary feeding,
and they found that fruits and vegetables, which are firstly offered to infants, are less accepted than
other food groups [36].
A study of de Launzon et al. investigated the long-term effects of early parental feeding practices
on fruit and vegetable intake. The study used data from four European cohorts, in which data on
fruits and vegetables consumption were assessed with a questionnaire. These cohorts reported
different findings. Fruit and vegetable intake in early childhood varied with an average intake of
<1 vegetable/day in the Greek EuroPrevall study and >3 vegetables/day in the Generation XXI Birth
Cohort. Moreover, longer breastfeeding duration was found in Generation XXI than in the others.
Nutrients 2017,9, 107 5 of 9
The timing of complementary feeding varied too: complementary foods were introduced mainly
between 3 and 4 months of age in ALSPAC (British Avon Longitudinal Study of Parents and Children),
at
≈
4 months in Generation XXI, and at
≈
5 months in Greek Euro-Prevall. In EDEN (French Etude
des De’terminants pre et postnatals de la sante’ et du de’veloppement de l’Enfant), there was no peak
age for introduction to complementary foods.
A concordant positive association between breastfeeding duration and fruit and vegetable intake
was found in different cultural contexts, with a longer breastfeeding duration consistently related to
higher fruit and vegetable intake in young children, whereas the associations with age of introduction
to fruit and vegetable intake were weaker and less consistent [37].
Similarly, 2- to 8-year old children who were breastfed for three or more months were more likely
to eat vegetables, as compared to children who were breastfed for a shorter time [
28
,
38
]. Taste may
impact the acceptance of new foods, since vegetables added with salt or a salty ingredient are more
easily accepted [
39
]. However, this observation should not encourage parents to use salt or salty
ingredients, because sodium is not recommended for infants [
2
,
35
]. Furthermore, acceptance of green
beans appears more difficult than that of carrot, in part due to the difference in the tastes of the
two vegetables, since carrots are sweeter than beans [35].
Therefore, the attraction towards new foods in the absence of imprinting and/or learning seems to
depend on their tastes and on the sensory properties of foods. At the same time, some individuals may
be more sensitive to taste features. In particular, for the sour, sweet, and umami tastes, the individual
sensitivity to taste in water solutions at the age of 6 months was predictive of the positive reaction
towards foods bearing these tastes [39].
Nicklaus and coworkers in 2014 studied the effect of repeated exposure and of flavor-flavor
learning on toddlers’ (2–4 years) acceptance of a non-familiar vegetable, and concluded that repeated
exposure is the simplest choice to increase vegetable intake in the short and long term [
29
,
35
].
The NOURISH is a randomized controlled trial which evaluated an intervention commencing in infancy
to provide anticipatory guidance to first-time mothers on a “protective” pattern of complementary
feeding practices that were hypothesized to reduce childhood obesity risk. In agreement with the
results, investing in early advice on training mothers about responsive complementary feeding can
improve maternal feeding practices, and suggests that complementary feeding practices promoting
the self-regulation of intake and preference for healthy foods may have positive effects on obesity risk
up to 5 years of age [15,40].
Early experiences with nutritious foods and flavour variety may maximize the likelihood that
children will choose a healthier diet as they grow, because they like the tastes and the variety of the
foods it contains. A recent investigation demonstrated that early exposure to a rotation of vegetable
flavours first added to milk and then to cereals increased the intake and liking of these vegetables.
Infants assigned to the intervention ate more of the target vegetables in the laboratory and at home
than those assigned to the control group [12].
During childhood, the strongest predictors of what foods young children eat are (1) whether they
like how the foods taste; (2) how long they were breastfed and whether their mothers ate these foods;
and (3) whether they had been eating these foods from an early age [
20
,
41
]. During early childhood,
infants are more likely to accept new foods, and parents should promote a varied diet and the child’s
curiosity towards food to reduce neophobia in toddlers [
41
,
42
]. After the age of 3–4 years, reported
dietary patterns/food habits remained quite stable, further highlighting the importance of getting
children on the right track from the initial stages of learning to eat [43].
2.5. Sociocultural and Family Environment
Social support plays a key role starting from birth. Accordingly, the initiation and continuation of
breastfeeding and cultural beliefs—shared through kin, friend, and neighbors networks—may serve to
promote or limit breastfeeding [
2
]. Parents create food environments for children’s early experiences
with food and eating, and also influence their children’s eating by modeling their own eating behaviors,
Nutrients 2017,9, 107 6 of 9
taste preferences, and food choices. As children grow and become more independent, familial
influences on eating behavior may diminish, and other factors such as those of peers may become
more influential [
44
]. Parents and caregivers play a role in structuring early feeding, which in turn
is embedded in the larger micro- and macro-environments that shape parental beliefs, decisions,
and practices [
45
]. It has been shown that forcing a child to eat a particular food will decrease the
liking for that food, and that restricting access to particular foods increases rather than decreases
preferences [14].
Social influences become increasingly important for the development of food preferences
throughout infancy, and may either support or contrast the preferences learned during the prenatal and
early postnatal periods [
30
]. Beauchamp and Moran [
46
] examined the preference for sweet solutions
versus water in approximately 200 infants. At birth, all of the infants preferred sweet solutions to
water, but by 6 months of age, the preference for sweetened water was linked to the infants’ dietary
experience. Infants who were routinely fed sweetened water by their mothers showed a greater
preference for it than did infants who were not. Therefore, offering complementary foods without
added sugars and salt may be advisable not only for short-term health but also to set the infant’s
threshold for sweet and salty tastes at lower levels later in life [
14
]. Neophobic tendencies can be
reduced and preferences can be increased by exposing infants and young children repeatedly to novel
foods. Children need to be exposed to a novel food between 6 and 15 times before increases in intake
and preferences are seen. A recent study found that repeatedly exposing children to a novel food
within a positive social environment was especially effective in increasing children’s willingness to try
it. These findings suggest the importance of both the act of repeatedly exposing children to new foods
and the context within which this exposure occurs [30].
3. Discussion
The prevalence of childhood obesity is rising, and multiple studies indicate that most of the
risk factors develop during the early phases of life. These factors may range from the prenatal to
postnatal period.
Within this context, strategies to successfully promote better acceptance of vegetables should be
identified. In spite of a huge body of literature, practical aspects and the results of their application
are still poorly understood. This is due to the high complexity related to physiological mechanisms
underlying early sensory experiences and the development of sensory preferences.
Breast-fed infants more easily accept a new vegetable, and have higher acceptance of new foods
as they are introduced into the infant’s diet. There are many factors which influence infants’ feeding
behaviours; they interact and contribute to the creation of future eating habits. Mothers who consume
an array of healthy foods themselves throughout pregnancy and lactation—and subsequently feed
their children these foods at the complementary feeding period—can promote healthful eating habits in
their children and families. Although a large part of food-preference development occurs during early
childhood, food preferences continue to change during adolescence up to adulthood, and the factors
that influence these changes become more complex through the years [
30
]. While it is emphasized that
an excessive intake of foods high in salt and refined sugars early in life may be associated with later
non-communicable disorders, the individual genetic background and sensitivity to specific nutrients
makes it difficult to substantiate a precise cause and effect dose-dependent relationship.
On the other side, food likes and dislikes are learned, and the learning process begins early and
depends on biological and sociocultural attitudes.
4. Conclusions
Attention should be paid to the different socio-cultural contexts of eating in future studies,
and cohort studies are needed to quantify the effect of early stimulation of taste and preferences.
Randomized controlled trials on early diet, focusing on both caregivers and children’s behaviours
Nutrients 2017,9, 107 7 of 9
and adjusted for food-related genotype are also essential for understanding how preferences can be
modified to promote healthful diets across the life course [30].
Acknowledgments: The authors thank all the members of the Pediatric Unit for their kindly support.
Author Contributions:
Valentina De Cosmi, Silvia Scaglioni, Carlo Agostoni contributed equally in the writing
and revising of the manuscript.
Conflicts of Interest: The authors declare no conflict of interest.
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