in patients with dry mouths, e.g., those with primary biliary Impairment of gustatory acuity may influence nutrient incirrhosis and associated Sjo Β¨gren's syndrome. 10 Second, patake and hence nutritional status. The aim of this study was tients and healthy volunteers were not matched for certain to evaluate gustatory acuity in patients with cirrhosis and its factors known to affect gustatory function, such as smoking relationship to circulating concentrations of micronutrients, behavior 11,12 or denture wearing. 13 and food preferences. Gustatory evaluation was undertaken, Zinc and vitamin A are both important in maintaining taste using a rinsing technique, in 75 cirrhotic patients and 75 integrity, although their exact roles have not been elucicomparable healthy volunteers. Circulating concentrations of dated. 14 Although assessment of zinc status in humans is magnesium, zinc, vitamin A, and aand b-carotene were meadifficult, zinc depletion is commonly reported in individuals sured, and food preferences were assessed by questionnaire.
with cirrhosis. [15][16][17] However, no conclusive association has The cirrhotic patients showed impaired gustatory function been reported between zinc depletion and impaired gustatory with significantly higher (less sensitive) median thresholds function in patients with liver disease. 4,5,7,18,19 Indicators of for detection of salt, sweet, and sour and for recognition of vitamin A status are also reduced in this patient populabitter, salt, sweet, and sour, together with a higher overall tion, 20,21 and there is evidence that vitamin A supplementamedian gustatory score (P Γ΅ .0001). Mean circulating concention may improve gustatory function in cirrhotic patients trations of magnesium, zinc, vitamin A, and aand b-carotene who are vitamin A-depleted. 6 Magnesium deficiency has were significantly lower in the patient population. Serum magbeen documented in patients with cirrhosis, 22 and although nesium was significantly negatively associated with detection it has not previously been associated with taste integrity, of salt (P Γ
.02) and gustatory score (P Γ
.02). Patients' the anorexia commonly observed in cirrhotic patients may subjective assessment of taste acuity did not correspond with resolve after magnesium supplementation. 23 objective measurements. Overall, no differences were ob-There is little information on the relationship between imserved in food preferences between the two groups, nor was paired taste perception and alterations in food selection and any association found between food preferences and gustatory eating habits, although it is reasonable to suppose that they acuity. Patients with cirrhosis have impaired gustatory acuity may be interrelated. 8,24 Aversions to fatty foods, meat, and that is associated with hypomagnesemia but apparently does fried dishes and a preference for citrus fruits have been renot affect food selection. (HEPATOLOGY 1997;26:40-48.) ported in patients with liver disease, 8,25,26 although gustatory acuity was not formally tested in any of these studies. Patients with cirrhosis are often malnourished [1][2][3] ; this mal-
The aims of this study were: 1) to evaluate taste thresholds nourishment may, at least in part, reflect a reduction in food in patients with cirrhosis and in a group of healthy volunteers intake. Many such patients are anoreic, and although this is comparable in age, sex, smoking behavior, and denture wearusually ascribed to generalized ill health, the unpalatability ing; 2) to measure their circulating concentrations of magneof prescribed diets, the pressure effects of ascites, and the sium, zinc, vitamin A, and aand b-carotene; 3) to investipossibility that it also represents alterations in taste acuity, gate their food preferences by questionnaire; and 4) to and hence food preferences, needs to be considered.
observe the interrelationships, if any, among these variables. Disorders in gustatory acuity have been reported in individuals with liver disease 4-8 manifest as changes, usually a
PATIENTS AND METHODS
reduction, in taste acuity for detection and recognition of A total of 87 cirrhotic patients were screened for the study. The some or all of the basic tastes of bitter, salt, sweet, and sour. etiology of liver disease was determined on the basis of historical, However, the studies undertaken to date may be criticized clinical, laboratory, endoscopic, and radiological variables. The for a number of reasons. First, the dropping technique used functional severity of the liver injury was determined using Pugh's to evaluate gustatory acuity 9 may overestimate impairment modification of the Child's grading system. 27 Patients were excluded from the study if they were unwilling or considered too sick to participate, if they did not speak English fluently, or if they were currently ''nil by mouth.'' Patients with hepatitis B-or C-related