Alcohol and Alcoholism Advance Access originally published online on January 31, 2007
Alcohol and Alcoholism 2007 42(2):75-79; doi:10.1093/alcalc/agl097
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PERCEIVED INTENSITY AND PLEASANTNESS OF SUCROSE TASTE IN MALE ALCOHOLICS
ZATORSKI4
1 Department of Psychiatry, Pomeranian Medical Academy Szczecin
2 Department of Psychiatry Nursing, School of Medicine at Bydgoszcz, Nicolaus Copernicus University Torun
3 Department of Psychiatry II, Institute of Psychiatry and Neurology Warsaw, Poland
4 Department of Pharmacology, Institute of Psychiatry and Neurology Warsaw, Poland
5 Consultant Otolaryngologist, Institute of Psychiatry and Neurology Warsaw
6 Department of Otolaryngology, Warsaw Medical Academy Warsaw
7 Mille Medica Outpatient Clinic Warsaw, Poland
*Author to whom correspondence should be addressed at: Department of Otolaryngology, Warsaw Medical Academy, Czerniakowski Hospital, 19/25 Stepinska St., PL-00739 Warsaw, Poland. Tel./fax: +48 22 31 86 266; E-mail: scinska{at}yahoo.com.
Received 19 September 2006; first review notified 20 October 2006; accepted 28 October 2006
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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Aims: The aim of the present study was to evaluate a possible relationship between taste responses to sweet solutions and alcoholic status. Methods: The rated intensity and pleasantness of sucrose taste was compared in male alcoholics (n = 45) and non-alcoholic controls (n = 33). Results: The rated intensity, but not pleasantness, of water taste (0% sucrose) was higher in the alcoholics. The two groups did not differ with respect to the rated intensity or pleasantness of sucrose solutions (1–30%). The proportion of sweet-likers, i.e. subjects rating 30% sucrose as most pleasant, was similar in both groups (the controls: 57.6%, the alcoholics: 62.2%). A subgroup of alcoholics with a paternal history of alcoholism (n = 22) rated the highest sucrose concentration as more pleasant compared to alcoholics without alcoholic fathers. The proportion of sweet-likers among the alcoholics with a paternal history of alcoholism (77.3%) was significantly higher than that found in the alcoholics without a familial history of alcoholism (47.8%). Conclusions: The present results suggest the following: (i) alcohol dependence is not associated with any major alterations in taste responses to sucrose solutions, (ii) sweet liking is a phenotypic marker of male alcoholics with a paternal history of alcoholism.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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Mice and rats with a high preference for sweet solutions consume more ethanol than animals with a low sweet preference. The above association has been reported for both selectively bred alcohol-preferring lines and outbred strains of rats (Sinclair et al., 1992
; Bachmanov et al., 1996; Kampov-Polevoy et al., 1999). Therefore, it has been suggested that altered reactivity to sweet taste could serve as a marker of alcoholism risk. In line with this prediction, Kampov-Polevoy et al. (1997, 2001) have shown that 46–65% of abstinent male alcoholics were sweet-likers, i.e. preferred high-concentration sucrose solution (0.83 M), as compared with 12–16% of non-alcoholic controls. In addition, an association between paternal history of alcoholism and sweet preference was found for both alcoholic and non-alcoholic subjects (Kampov-Polevoy et al., 2001, 2003ab).
Contrary to the above-mentioned data, we have shown that neither paternal history of alcoholism (Scinska et al., 2001) nor alcohol dependence by itself (Bogucka-Bonikowska et al., 2001) were associated with hedonic responses to sucrose taste. Our former results were supported by a report of Kranzler et al. (2001). The authors classified 76.9% of non-alcoholic participants as sweet-likers by using the procedure similar to that described by Kampov-Polevoy et al. (1997). Sweet liking was defined as preferring a sucrose concentration 
0.42 M and 25 subjects preferring 0.21 M sucrose were excluded. The proportion of sweet-likers was similar in subjects with and subjects without an alcoholic father. Pleasantness ratings of sweet solutions were not associated with paternal history of alcoholism. In line with the above, no correlation between familial history of alcoholism and sweets consumption was found in abstinent alcoholics (Amit et al., 2003; Junghanns et al., 2005).
While considering any possible associations between sweet liking and alcohol dependence, one should remember that there were some basic procedural differences between our study (Bogucka-Bonikowska et al., 2001) and the studies conducted by Kampov-Polevoy et al. (1997, 2001). Tastants other than sucrose (quinine, citric acid, and sodium chloride) were used only in the former study. Although the volume of each taste sample was kept constant (1 ml) and the order of sample administration was randomized, the inclusion of other tastants could alter gustatory responses to sweet solutions (Rankin and Marks, 1992). Kampov-Polevoy et al. (1997, 2001) did not include distilled water samples (0% sucrose) and did not control volumes of sweet solutions sipped by their subjects. Despite the above differences, the proportions of sweet-likers among male alcoholics reported by Bogucka-Bonikowska et al. (63%) and Kampov-Polevoy et al. (46–65%) were strikingly similar. In contrast, the percentage of sweet-likers among control subjects reported by our group (53%) was much higher than that found by Kampov-Polevoy et al. (1997, 2001) (12–16%). The value reported by Bogucka-Bonikowska et al. was comparable to the proportion of sweet-likers in healthy men (40–75%; Pangborn, 1970; Looy and Weingarten, 1991; Kranzler et al., 2001; Kampov-Polevoy et al., 2003a). Recently, it has been shown that the percentage of sweet-likers in hospitalized non-alcoholic men varied from 28 to 40% (Kampov-Polevoy et al., 2004; Krahn et al., 2006). Thus, different criteria for selection of control groups may explain the discrepancy between the studies on sweet preference in alcoholic patients. While Bogucka-Bonikowska et al. recruited healthy non-alcoholic men, Kampov-Polevoy and co-workers either did not describe the method of recruitment (Kampov-Polevoy et al., 1997) or recruited non-alcoholic inpatients undergoing treatment in departments of ophthalmology and neurosurgery (Kampov-Polevoy et al., 2001). Notably, even subjects with a diagnosis of ‘peripheral nerve damage’ served as controls in the latter study.
The aim of the present study was 2-fold. First, given the discrepancies mentioned in the previous paragraphs, we decided to further evaluate taste responses to sucrose solutions in alcoholic and non-alcoholic men. Second, we aimed at investigating possible associations between the history of paternal alcoholism and sweet liking in alcoholic men.
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METHODS |
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Subjects
Forty-five abstinent male alcoholics who met the ICD-10 criteria for alcohol dependence were recruited from inpatients at the Department of Psychiatry, Pomeranian Medical Academy, Szczecin, and from the Department of Psychiatry, School of Medicine, Nicolaus Copernicus University, Bydgoszcz. Prospective participants with psychotic disorders or another substance use disorders other than nicotine dependence were excluded. All patients admitted for the treatment of alcohol dependence were free of alcohol withdrawal symptoms and did not meet the ICD-10 criteria for anxiety or affective disorders at the time of testing. Alcohol withdrawal symptomatology was assessed with the revised Clinical Institute Withdrawal Assessment for Alcohol Scale (Sullivan et al., 1989
). Subjects with active liver disease were also eliminated but mild elevation of baseline transaminase levels was accepted. The mean (± SEM) duration of alcohol dependence was 10.4 ± 1.4 years (range: 1–30 years). The mean duration of last abstinence was 32.2 ± 3.3 days (range: 7–112 days). The alcoholic subjects consumed 31.2 ± 3.5 standard drinks/day in the last week before admission. A standard drink was defined as 10 g of ethanol.
Thirty-three male volunteers without a history of psychiatric disorders and consuming 
1 standard drink/day served as controls. Only subjects without a parental history of alcoholism and with Alcohol Use Disorders Identification Test (AUDIT; Babor and Grant, 1989) scores <8 were included in the study. The controls were recruited from families of staff members, through the institutions involved in the study. The subjects in both groups were Caucasians, aged 21–70 years (see Table 1 for details), in good medical health, and had no recent history of endocrine or neurological disorders known to alter gustatory or olfactory functions (Cullen and Leopold, 1999).
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The individuals with alcoholic parents were selected by using a single screening question (Hodgins and Shimp, 1995
). The control subjects were free of any parental (paternal or maternal) history of alcoholism. Twenty-three alcoholic patients (51%) had no paternal history of alcoholism Paternal History Negative (PHN). Twenty-two patients (49%) had a paternal history of alcoholism PHP. Three subjects from the PHP subgroup also had a maternal history of alcoholism. The PHN and PHP patients were comparable with respect to age, weight, height, education, employment status, tea and coffee drinking, percentage of current smokers, Fagerström Test for Nicotine Dependence (FTND; Fagerström et al., 1996) scores, and adding sugar to caffeinated beverages (P > 0.05). The study was carried out in accordance with the ‘Declaration of Helsinki’ of the World Medical Association. The protocol for the study was reviewed and approved by the local Ethics Committee on Human Studies. Each participant read and signed an informed consent form after the study procedures had been fully explained. The participants were not paid for their participation.
Procedure
The range of sucrose concentrations was identical to that used in our previous studies (Bogucka-Bonikowska et al., 2001; Scinska et al., 2001). The highest sucrose concentration (30.0% = 0.88 M) was comparable to that (0.83 M) used by other researchers (Kampov-Polevoy et al., 1997, 2001; Kranzler et al., 2001). The sucrose solutions were administered in two repetitions. Deionized water served as a control stimulus (0% sucrose). Rows of 1 ml single-use syringes were filled with the sucrose solutions (syringe 1 = 0% sucrose, syringe 2 = 1% sucrose, syringe 3 = 10% sucrose, syringe 4 = 30% sucrose, syringe 5 = 0% sucrose, syringe 6 = 1% sucrose, syringe 7 = 10% sucrose, syringe 8 = 30% sucrose) and stored at –4°C until use.
The basic aspects of the procedure were identical to those described in our previous reports (for details, see Scinska et al., 2001; Wrobel et al., 2005). The subjects received an additional 1 ml sample of deionized water on an unblinded basis as a neutral reference point. Then, the sucrose samples (syringes 1–8) were administered in a volume of 1 ml on the anterior tongue. The participants were asked to thoroughly taste each sample within the entire oral cavity and to rate its intensity and pleasantness on 100 mm lines. The subjects were instructed to spit out the solutions. A longer waiting time (5 min) was introduced between the first and second series of sucrose samples, i.e. between syringe 4 and syringe 5. The solutions were served at room temperature.
Statistics
Between-group differences in basic socio-demographic parameters were analysed with the aid of the Student's t-test and the Fisher exact probability test (for quantal measures). The taste responses to the sucrose samples were averaged across the two repetitions. Sucrose concentration rated as the most pleasant was identified for each participant. The subjects preferring 30% sucrose (0.88 M) were designated as sweet-likers (Kampov-Polevoy et al., 1997, 2001; Bogucka-Bonikowska et al., 2001). A two-way ANOVA (Group x Concentration) with repeated measures on concentration was used to assess differences in taste responses between the alcoholic and the non-alcoholic group. The Newman–Keuls test was chosen for post hoc comparisons. A separate series of ANOVAs was performed in order to assess the differences between the PHN and PHP alcoholics and the non-alcoholic group. The Fisher exact probability test was used to compare proportions of sweet-likers in the study groups. The Pearson product–moment correlation test was employed to search for correlations between selected taste responses and clinical parameters.
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RESULTS |
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Baseline characteristics of study groups
There were no significant differences between the controls and the alcoholics in terms of age, weight, height, adding sugar to caffeinated beverages, and tea drinking. The alcoholics were less educated and were more frequently unemployed. The percentage of current smokers was significantly higher in the alcoholic group. Moreover, FTND scores were higher in the alcoholic than in the non-alcoholic smokers. The alcoholics consumed significantly more coffee (Table 1).
Intensity ratings of sucrose taste—controls vs. alcoholics
The two-way ANOVA revealed that intensity ratings increased with concentration [F(3,228) = 314.18, P < 0.001]. A Group effect did not reach significance [F(1,76) = 0.45, P > 0.05] but a Group x Concentration interaction was significant [F(3,228) = 3.25, P < 0.05]. The post hoc analysis revealed that the rated intensity of deionized water (0% sucrose) was significantly higher in the alcoholics than in the controls. The difference in intensity ratings of water taste remained significant after controlling for the between-group differences in coffee drinking and cigarette smoking. The rated intensity of other samples did not differ between the groups (Table 2).
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Intensity ratings of water taste in the alcoholic group did not correlate with the duration of alcohol dependence, alcohol consumption in the week before admission, and abstinence duration (P > 0.05).
Intensity ratings of sucrose taste—controls vs. PHN and PHP alcoholics
The ANOVA indicated a non-significant Group effect [F(2,75) = 0.32, P > 0.05]. However, a Group x Concentration interaction was significant [F(6,225) = 2.17, P < 0.05]. The post hoc analysis revealed that the PHP alcoholics rated deionized water as more intense in comparison to the control group (Table 2).
Pleasantness ratings of sucrose taste—controls vs. alcoholics
Pleasantness ratings increased with sucrose concentration [F(3,228) = 44.39, P < 0.001]. However, neither a Group effect nor a Group x Concentration interaction was significant (F < 1.73, P > 0.05). The proportion of sweet-likers among the alcoholic subjects (62.2%) was comparable to that found in the control group (57.6%; P > 0.05).
Pleasantness ratings of sucrose taste—controls vs. PHN and PHP alcoholics
The ANOVA revealed a non-significant Group effect [F(2,75) = 0.75, P > 0.05]. However, a Group x Concentration interaction was significant [F(6,225) = 3.12, P < 0.01]. The post hoc analysis revealed that the PHP alcoholics rated the highest offered sucrose concentration as more pleasant as compared to the PHN subjects. The proportion of sweet-likers among the PHP subjects (77.3%) was significantly higher than the proportion of sweet-likers in the PHN subgroup (47.8%; P < 0.05). However, there was no significant difference between the above proportions and the percentage of sweet-likers in the control group (57.6%).
Maternal history of alcoholism may be a confounding factor as it leads to prenatal alcohol exposure. The differences between the PHN and PHP subjects remained significant (P < 0.05) after excluding three subjects with a maternal history of alcoholism from the PHP group.
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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Contrary to the previous reports (Kampov-Polevoy et al., 1997
, 2001), the rated pleasantness of sucrose solutions did not differ between the control and alcoholic subjects. The percentage of sweet-likers and the amounts of sugar added to caffeinated beverages were also similar in the two study groups. The present results agree with those published by Bogucka-Bonikowska et al. (2001; see Introduction) and with two recent reports by Kampov-Polevoy et al. (2003b 2004). Sweet liking by itself was insufficient to predict either alcoholic or drug-dependent status in psychiatric patients admitted to residential treatment programmes (Kampov-Polevoy et al., 2003b, 2004). In line with the above, the proportion of sweet-likers did not differ between methadone-maintained opioid-dependent men and non-dependent controls (Bogucka-Bonikowska et al., 2002). In another study, pleasantness ratings of sweet taste were actually reduced among abstinent cigarette smokers (Perkins et al., 1990). Thus, it seems that sweet liking is not a marker of alcohol and drug dependence in humans.
Recently, Krahn et al. (2006) have assessed sweet preference in a prospective study on the relationship between dietary recommendations and relapse to alcohol drinking. The proportion of sweet-likers among male alcoholics decreased from 71% at the baseline assessment to 59 and 50% at the 1 month and 6 month assessments, respectively. The proportion of sweet-likers among control subjects increased from 37 to 41% in the course of the study. Except for the baseline assessment, there was no significant difference between the percentage of sweet-likers among the controls and alcoholics. Interestingly, the alcoholics who failed to maintain abstinence were more likely to be classified as sweet-likers. The latter report may suggest that increased pleasantness of stronger sweet solutions in abstinent alcoholics is limited to early abstinence and that sweet liking may be a risk marker of relapse (Krahn et al., 2006; but see also Junghanns et al., 2005).
The subgroup of alcoholics with a paternal history of alcoholism (PHP) rated the highest sucrose concentration as more pleasant as compared to the PHN alcoholics. Kranzler et al. (2001) and Scinska et al. (2001) did not find any association between sweet liking and paternal history of alcoholism but the latter studies were done on non-alcoholic children of alcoholic fathers. Our finding supports the previous reports (Kampov-Polevoy et al., 2001, 2003b 2004) indicating that paternal history of alcoholism increases the likelihood of being a sweet-liker in male alcoholics. Given that sons of alcoholic fathers are at increased genetic risk of developing alcohol dependence (Cloninger et al., 1981; Goodwin, 1985; Rose, 1998), one may hypothesize that sweet liking is a marker of genetically determined subtype of alcoholism. In line with this notion, Kampov-Polevoy et al. (1998) have shown that the personality profile of sweet-liking alcoholics is similar to that found in a highly heritable Type B clinical subtype of alcoholism (Yoshino et al., 1994).
Neural mechanisms of the association between sweet liking and paternal history of alcoholism in male alcoholics remain unknown. The rewarding effects of alcohol and sweets are thought to be related to the activation of dopamine and opioid neurotransmission (Herz, 1997; Small et al., 2003; Gianoulakis, 2004). Notably, ß-endorphin response to alcohol challenge was found to be associated with familial history of alcoholism (Gianoulakis, 2004). A significant association was also reported between the –141C Del variant of the dopamine D2 receptor and parental history of alcoholism (Johann et al., 2005). Therefore, it is possible that the PHP alcoholics preferred the strongest sucrose solution because of genetically determined abnormalities in dopaminergic and/or opioidergic transmission.
Non-genetic factors could also contribute to sweet-liking status of alcoholics with a paternal history of alcoholism. The PHP and PHN individuals were matched with respect to several socio-demographic and clinical parameters but the two subgroups could differ in terms of environmental factors which are difficult to control in a clinical study. For example, families with paternal alcoholism are often characterized by unhealthy food habits, poor diet, and high levels of childhood physical abuse (Woodside et al., 1993; Windle et al., 1995).
It is assumed that heavy drinking may compromise the taste function, but sound evidence supporting this notion is sparse. Alcohol dependence was found to be associated with deficit in threshold taste reactivity (Smith, 1972; Wrobel et al., 2005). In contrast, alcoholic and non-alcoholic individuals did not differ with respect to the rated intensity of suprathreshold sweet, bitter, sour, salty, and umami stimuli (Jones et al., 1978; Kampov-Polevoy et al., 1997; Bogucka-Bonikowska et al., 2001; Wrobel et al., 2005). The present results add to a growing body of evidence which indicates that alcohol dependence does not compromise responses to suprathreshold gustatory cues.
In the present study, the alcoholics rated the taste of deionized water as more intense as compared to the controls. Hedonic responses to water taste did not differ between the groups. In our previous study (Bogucka-Bonikowska et al., 2001), the rated intensity of water taste was also higher in alcohol-dependent men. It should be remembered that water is a potent sensory cue stimulating a number of afferent nerves, including gustatory afferents, emanating from the oral cavity. Distilled water may produce taste responses by removing other tastants (Liljestrand and Zotterman, 1954; Bartoshuk et al., 1964, 1971; Gilbertson, 2002) or through specific receptor molecules expressed in the taste bud (Gilbertson et al., 2006). Our findings may indicate that chronic alcohol drinking alters peripheral and/or central elements of the gustatory system involved in the perception of water taste.
The limitations of the present study lie in the fact that (i) it included a relatively small sample size, (ii) it was restricted to male alcoholics only, and (iii) non-alcoholic controls with a paternal history of alcoholism were not included. It is also possible that the alcoholics recruited for the study did not represent the whole population of alcohol addicts. For example, men with more severe forms of alcohol dependence, like those with more antisocial behaviour, are less likely to seek professional help and to enter treatment programmes.
Concluding, the present results suggest that (i) alcohol dependence is not associated with any major alterations in taste responses to sucrose solutions, (ii) sweet liking is a phenotypic marker of male alcoholics with a paternal history of alcoholism.
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ACKNOWLEDGEMENTS |
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The study was supported by the Warsaw Medical Academy and the Institute of Psychiatry and Neurology (grant no. 67/06).
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