v
Search
Advanced Search

Publications > Journals > Exploratory Research and Hypothesis in Medicine > Article Full Text

  • OPEN ACCESS

The Association between Consumption of Bitter-taste Vegetables in Asian Culture and Metabolic Syndrome Risk Factors in Children: A Narrative Review

  • Wai Yew Yang1,* ,
  • Kah Yen Lim1,
  • Pei Ling Yen1,
  • Shu Hwa Ong2,
  • Nenad Naumovski3,4 and
  • Rati Jani5
 Author information
Exploratory Research and Hypothesis in Medicine   2024;9(1):47-54

doi: 10.14218/ERHM.2022.00129

Abstract

Childhood obesity has been escalating in Asian countries in recent decades resulting in the younger age groups being diagnosed with metabolic syndrome (MetS). Brassicaceae vegetables that contain high bioactive compounds with anti-inflammatory and anti-oxidative properties might be beneficial in preventing MetS. This narrative review presents; (a) the consumption of vegetables in the world population and the availability of bitter-taste vegetables in Asian culture; (b) the interaction between food preference and childhood obesity and (c) potential associations between the consumption of bitter-taste vegetables in Asian culture and clinical outcomes. A number of online searches were conducted for publications in the English language from the year 1990 until October 2022 with a two-step search strategy adopted: initial searches were conducted in four electronic databases (MEDLINE, CINAHL, EMBASE, and Cochrane Library), and a second search using all identified keywords and indexes by including two additional electronic databases (ProQuest and Scopus). The keywords included “bitter”; “vegetables”; “weight status”; “metabolic profile”, “Asia”, “culture”, and “children”. Brassica vegetables in Asian countries are abundantly available and commonly consumed, yet the overall vegetable intake in children was inadequate or below the recommended daily intake. Childhood obesity can be influenced by their preference for and consumption of bitter-taste vegetables, and excessive body weight is associated with the risk of developing MetS. It remains inconclusive whether brassicas vegetables play a dominant role in the group. Future longitudinal studies to investigate the taste sensitivity, vegetable acceptance, and effect of brassicas vegetables on the risk of MetS in Asian children are warranted.

Keywords

Bitter, Vegetables, Weight status, Metabolic profile, Asia, Children

Introduction

The worldwide rise in the prevalence of childhood obesity over the last decade continues to be a serious health concern, impacting approximately 340 million children and adolescents between 5 and 9 years old.1 This was observed in both genders and with similar percentages of prevalence (18% in girls and 19% in boys).2 For children below 5 years of age, overweight (weight-for-height >2 standard deviation (SD)) and obesity (weight-for-height >3 SD) cases were reported at 39 million in 2020.1 In 2016, a global estimate of more than 41 million overweight children below 5 years of age was reported, with the Asian sub-population contributing up to 50%.2 These findings were similar in the adolescent group, which recorded the highest obesity rates across developing countries in Asia. Furthermore, there were large variations within the different countries of the Asian continent with the lowest found in rural Bangladesh (3.5%), followed by China (12.5%), Iran, Saudi Arabia (30% respectively), and the Maldives (65%).3

Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors that include abdominal obesity (WC: Waist Circumference ≥90th percentile), elevated blood pressure (SBP: Systolic Blood Pressure ≥130 mmHg or DBP: Diastolic Blood Pressure ≥85 mmHg), impaired fasting blood glucose (FBG ≥ 100 mg/dL), high triglycerides (TG ≥ 150 mg/dL) and low high-density lipoprotein-cholesterol (HDL-C < 40 mg/dL).4 Although there are some variations in the diagnostic criteria for MetS in children and adolescents in different countries, there is a strong association between childhood obesity and MetS where there is 11.9% and 29.2% of MetS prevalence among overweight and obese children, respectively (Figure 1).5–25 These numbers were also higher in Hispanics than their Caucasians and African American equivalents.19,26 Almost 90% of obese children and adolescents develop at least one MetS characteristic.27

Aetiology of childhood obesity and metabolic syndrome.
Fig. 1  Aetiology of childhood obesity and metabolic syndrome.

BP, Blood Pressure; HDL, High-Density Lipoprotein; TG, Triglycerides.

In South Asia, nearly one-third of urban-dwelling children and adolescents present MetS characteristics,28 with 30% of Asian Indians presenting with insulin resistance.29 Furthermore, a review by Misra et al. indicated that MetS was more prevalent among Asian Indian adolescents when fasting hyperinsulinemia was accounted for in its defining criteria, from 0.8% to 4.2% (modified NCEP, ATP III definition).30 An overall MetS prevalence of 2.3% was also recorded in China, which increased with age and peaked at 17 years of age (3.9%).31 Dyslipidaemia defined by total cholesterol ≥170–200 mg/dL, low-density lipoprotein cholesterol (LDL-C) ≥110–130 mg/dL, high-density lipoprotein cholesterol (HDL-C) <35–45 mg/dL, TG ≥ 75–100 mg/dL for 0–9 years and ≥90–130 mg/dL for 10–19 years is one of the many components of MetS and had the greatest prevalence among Chinese school-aged children (21%), followed by hypertension (14%),32 and obesity (6.7%).33 In Taiwan, the prevalence of MetS was higher in boys than girls (5.56% vs 6.39%) in a group of 6 to 12-year-olds.34 In contrast, MetS among Thai adolescents had a prevalence of 4.27%, with the prevalence among females being greater than that of their male counterparts (5.22% vs 3.36%).35

Taste sensitivity differs individually based on age, sex, ethnicity, body weight status, taste bud development, taste concentration, and saliva composition.36–40 It is proposed that obese subjects must consume more to compensate for their impaired sensitivity and gain the same stimulation of taste and oral somatosensory system. This lacking sensitivity is hypothesized to have relationships with food intake and body weight variation with implications on long-term health outcomes. However, data concerning correlations between taste sensitivity and obesity are inconsistent41 and centered mainly on bitter-taste responsiveness, whereas little is currently known about other taste qualities, especially in children.

Sensitivity to bitter taste has broad implications for taste perception, food preferences, and dietary behavior, with potential impacts on nutritional status and health outcomes.42 Based on 6-n-propylthiouracil (PROP) or phenylthiocarbamide (PTC) sensitivity, individuals can be classified into three PROP taster categories: non-tasters (not at all or taste PROP at a high concentration of 0.32 mmol/l), medium tasters, and PROP super-tasters (perceive extreme bitterness when tasting PROP).43 It has been proposed that those individuals identified as super-tasters are more responsive to other taste qualities including fats44 and that PROP tasting is associated with variations in food acceptability, selection of vegetables and fruits, and increased health risk parameters for overweight and obesity.45–47 A recent study amongst 156 Caucasians and 67 Asians aged 18–65 years in the UK reported a higher proportion of Asians were super-tasters as compared to Caucasians (55% vs. 24%, p < 0.01), however, evidence is scarce amongst children from Asia.48 Our previous pilot study among Malay children aged 7 to 12 years in Kuala Lumpur found no difference between normal and obese children in taste sensitivity and preferences (All p’s > 0.05).49 Comparatively, there are more varieties of bitter-taste vegetables used in Asian than in European cuisine, however, their impact on children’s weight status and metabolic profile is still relatively limited.50,51

While genetics is an important determinant, it is beyond the scope of this study. Given the lack of existing reviews specifically focusing on bitter-taste vegetables available in Asian culture and weight status and metabolic profile in children, the aim of the present narrative review was to describe the availability of bitter-taste vegetables in Asian culture and consumption of vegetables in the world population, discuss the potential interaction between food preference on childhood obesity and metabolic syndrome, and establish the potential associations between consumption of bitter-taste vegetables in Asian culture and clinical outcomes.

An online search was conducted for publications in English from 1990 until October 2022 with no restriction on the study design but only included studies conducted in humans. The keywords included “bitter”; “vegetables”; “weight status”; “metabolic profile”, “Asia”, “culture”, and “children”. A two-step search strategy was adopted with initial searches performed in four electronic databases (MEDLINE, CINAHL, EMBASE, and Cochrane Library) followed by an analysis of the text words contained in the title and abstract. A second search using all identified keywords and index terms was then undertaken in two additional electronic databases (ProQuest and Scopus). The systematic search strategy conducted in this review is shown in Supplementary Table 1.

Consumption of vegetables in the world population

Data from the Food and Agriculture Organization of the United Nations regarding global vegetable consumption in 2013 indicated the highest yearly consumption rate per capita in Asia (176.83 kg), followed by Europe (115.10 kg), North America (113.42 kg), Oceania (101.47), Africa (67.57 kg), and the lowest being South America (52.6 kg). Among different vegetable types, the intake of the Brassica family seems to mirror that of the global trend with Europe (85 million tonnes) and America (67 million tonnes) following behind Asia’s consumption at 70% or 540 million tonnes. With 355 million tonnes, China was ranked first among the top 10 Brassica-consuming nations in the world, followed by India, the United States, Turkey, the Russian Federation, Japan, Egypt, the Islamic Republic of Iran, Italy, and the Republic of Korea. The population of Greece, however, had the highest per capita consumption (275 kg/person/year), with China coming in a close second (270 kg/person/year).52

Among children aged 6 to 23 months, the UNICEF Infant and Young Child Feeding (IYCF) Global Database showed a 47% and 27% global consumption of vitamin A-rich and other fruits and vegetables, respectively.53 The intake of vitamin A-rich fruits and vegetables, when observed from the Demographic and Health Surveys data, was also 5.7 times more apparent in children from wealthier families as compared to their poorer counterparts.54

Despite inadequate fruit and vegetable consumption being common across all geographical regions, it was most apparent amongst South Asians, where 97% and 90% of girls consume fruits and vegetables below the recommended daily servings, respectively.55 These numbers vary between countries, ranging from 60% in China,56 85% in India, 75% in Indonesia, 83% in Myanmar, 77% in Sri Lanka, 67% in Thailand, to over 95% in Nepal.57,58 Similarly, the Malaysian Adolescent Nutrition Survey 2017 mirrored these findings where a majority of adolescents (10–17 years) did not achieve sufficient vegetable intake (92%).59 However, compared to children from Asia, a lower number of European adolescent children from 12 to 17 years old evidenced a daily fruit and vegetable intake lower than the recommended amount at 35% (boys) and 21% (girls).60,61

Availability of bitter-taste vegetables in Asian culture and their nutritional composition

The Brassicaceae, often referred to as the Cruciferae, is one of the most commercially significant plant families globally with a diverse worldwide distribution of 372 genera and 4,060 species.62 Around the world, various Brassicaceae vegetable species are cultivated, which include Brassica oleracea (cabbage, broccoli, and cauliflower), Brassica rapa (Chinese cabbage, pak choi, choy-sum, and turnips), Brassica juncea (mustard greens), and Raphanus sativus (daikon radish).62

Among the Asian varieties, B. oleracea and B. rapa are the most widely grown and consumed. In different countries and regions, the production and consumption of different Brassicaceae vegetable types are attributed to social and economic factors. In China, R. sativus is the main Raphanus species consumed, which mirrors the consumption in Japan, in addition to B. oleracea, B. rapa, and B. juncea.62 Within Southeast Asia, the Chinese leafy vegetable kailan and choy-sum are the primary crops grown in varying climates, particularly in Thailand.63 In 2017, the Thailand market supply identified the Brassicaceae varieties (B. juncea, B. oleracea, and B. rapa) to possess the greatest diversity in terms of species and cultivars.64 Cruciferous vegetables of the B. oleracea species i.e., cabbage, broccoli, and cauliflower were among the most common vegetables consumed in the Malaysian diet.65,66 These vegetable crop types were also similarly yielded in central Taiwan, together with kailan, Chinese cabbage, and radish.67

The consumption of Brassica vegetables has been associated with anticarcinogenic, antioxidant, and anti-inflammatory properties and they serve as a source of vitamins, minerals, and several phytochemicals.68 These vegetables, particularly broccoli, contain high quantities of carotenoid, tocopherol, vitamin C, and folic acid all of which have been associated with a reduction in the risk of the development of chronic diseases.69 In a study by Wills and Rangga,70 the analysis of seven leafy Chinese vegetables identified sixteen carotenoids in Chinese cabbage, pak choi, and choy-sum with lutein (20–36%) and β-carotene (16–21%) being the most abundant. Among the vegetable folate sources, broccoli was reported to have the highest levels (110–135 µg/100g).71 Folate is also present in raw cauliflower (696 ± 111 µg/100g).72

In addition to being a rich source of vitamins, Brassica vegetables are also rich in dietary minerals.69 One of the highest mineral sources includes kale with its high contents of potassium (24.2 to 40.8 g/kg), phosphorus (3.2 to 6.4 g/kg), calcium (2.8 g/kg), selenium (1.0 to 1.29 µg/kg), iron (23.5 to 45.7 mg/kg), and zinc (35.8 mg/kg).73,74 Several other Brassicas, such as Chinese cabbage, white cabbage, Brussels sprouts, broccoli, and cauliflower also contain substantial amounts of essential minerals.73 Besides being highly bioavailable in calcium, this plant family possesses high selenium levels, especially when cultivated and grown on selenium-rich soils. In vegetables such as broccoli, selenium is stored as selenocysteine69 before being relatively quickly absorbed into the systemic circulation. As a prominent antioxidant, selenium has been associated with a reduction in obesity and the subsequent development of MetS through its influence on adipocyte physiology.6

The high antioxidant capacity of Brassicas is attributed to their high phenolic contents.7 Flavonoids, being one of the most common phenolic compounds in these vegetables, play a vital role in maintaining good health via a reduction in the development of reactive oxygen species. Furthermore, the high polyphenolic content has also been associated with the reduction in oxidative stress-related diseases such as various types of cancer, obesity, and cardiovascular disease.8 A study by Miean and Mohamed reported that, out of 62 vegetables analyzed, Chinese cabbage, green-white cabbage, kailan, broccoli, and cauliflower are high in flavonoids, ranging from 148–219 mg/kg.9

Brassicas vegetables have been identified as one of the richest sources of glucosinolates (GSL) in the human diet. These compounds are secondary plant metabolites responsible for the bitterness and pungency of several different plants such as kailan, kale, cabbage, turnip, broccoli, and cauliflower.62 GSL-based research is predominately orientated towards their anticarcinogenic properties. However, relatively recent emerging evidence on the antioxidative impact of GSL-derived isothiocyanates in decreasing the risk of cardiometabolic disorders when incorporating cruciferous vegetables into the diet has garnered special attention.12,75 Several potential mechanisms of action have been associated with these compounds: in particular, changes in insulin sensitivity and glycemic response management, lower blood pressure, and improved endothelial function as well as reduced atherosclerotic plaque development and its progression.12

Bitter-taste-related genes and their association with food preference

Differences in taste perception and sensitivity may be explained by genetic variations,36–38 as polymorphisms of the genes coding for taste are closely linked to the inter-individual differences.40 In humans, bitter taste perception is controlled by the TAS2R family of genes, which has 25 functional genes. Of all these genes, TAS2R38 has been proven to be the PTC/PROP taste receptor accounting for a quarter of the total phenotypic variance in bitter-taste. Three functional single nucleotide polymorphisms in gene nucleotide positions 145 (rs713598 C/G), 785 (rs126866 C/T) and 886 (rs10246939 G/A) encode amino acids at position 49 (alanine/proline, A49P), 262 (valine/alanine, V262A), and 296 (isoleucine/valine, I296V) explaining the differences between the non-taster allele of PTC genes from the taster allele.76 The two predominant haplotypes globally are the major taster form [known as Proline-Alanine-Valine (PAV)], and the major non-taster form [Alanine-Valine-Isoleucine (AVI)]. The worldwide variations in non-tasters have been observed in Africa (3%), China (between 6% and 23%), North America (about 30%), and India (as high as 40%).76

A systematic review exploring the genetic background of taste perception and preferences and their nutritional implications suggests a significant association exists between TAS2R38 variants (rs713598, rs1726866, rs10246939) and bitter taste preference while fat taste responsiveness is related to rs176667 (CD36).77 As the AVI/AVI homozygotes possess lesser bitter sensitivity than heterozygous or homozygous PAV carriers, it has been hypothesized that individuals with increased bitter-taste sensitivity might avoid a wide range of bitter compounds such as coffee, brassica vegetables, and spinach.19 In the adult studies, higher vegetable consumption was reported amongst the AVI/AVI diplotype compared to those from the PAV/AVI and PAV/PAV diplotype,78 especially regarding the intake of brassica vegetables.79 However, amongst a sample of preschoolers, PROP taster children demonstrated a greater preference for sweets than non-taster children,80 highlighting differences between children and adults in their taste sensitivity driven by both genetic and developmental factors. The interaction between bitterness sensitivity and actual food consumption that can predispose to obesity and other health risks in children has yet to be fully understood and calls for more exploration.

Effect of food preference on childhood obesity and metabolic syndrome

At the nexus between hereditary and environmental components, children’s food preference is considered an integral factor in the development of childhood obesity. Their preference for discretionary foods (sweet-tasting over bitter/sour-natured fruits and vegetables) may be due to the underlying genetic-environmental determinants such as an inherent evolutionary preference for sweet foods, hereditary genotype markers, and bitter-taste endophenotype vs parental feeding practices, food availability, accessibility, and exposure.10,11,13,18 In some children, an endophenotype sensitivity towards bitter-taste can become a probable cause of their food rejections, including bitter cruciferous vegetables, with a simultaneous preference for sweeter food choices.10,81

Children and adolescents require adequate energy intake for optimal growth and development, however, excessive energy intake combined with a decrease in activity can lead to the development of obesity.14 Moreover, the consumption of ultra-processed and refined diets and sugar-sweetened beverages has been purported to be the contributor to rising obesity prevalence.37 A recent systematic review of the worldwide consumption of ultra-processed foods concluded high variability in the intake with young people, men, and overweight/obese generally having higher levels of consumption.16 In turn, environmental changes leading to higher caloric consumption have been accompanied by factors predisposing the young to decreased energy expenditure such as reduced physical activity levels and increased time spent in sedentary activities.17 Moreover, it has been demonstrated that children’s eating habits and the risk of childhood obesity were associated with parental feeding practices.82–84

A short-term shift in food type consumption can eventually lead to a chronic increased energy intake, resulting in a subsequent body weight increment over time. Thus, increasing vegetable consumption as a replacement for that of energy-dense foods should be the primary strategy for family food practices and behavioral weight management programs in targeting the obesity epidemic amongst children and adolescents.85,86 The fundamentals of this weight control concept stem from reduced caloric consumption through the lower energy density and satiety-enhancing properties of water and fiber within the vegetables.87,88

Potential associations between consumption of bitter-taste vegetables in Asian culture and clinical outcomes

Increased adiposity is closely associated with increased biomarkers of oxidative stress and inflammation.89 The phytochemicals found in fruits and vegetables have been shown to have anti-obesity properties due to their possible role in suppressing adiposity-associated metabolic biomarkers.90,91 To date, the richest sources of vegetables for potential anti-obesity phytochemicals include the red varieties of onion (Allium cepa), lettuce (Lactuca sativa), capsicum (Capsicum annum), curly kale (Brassica oleracea var sabellica) and orange-fleshed type of sweet potato (Ipomoea batatas).20 In contrast to the modern diet, which is strong in wheat, processed meat, and fast food, the traditional Chinese diet, which includes a high intake of rice, vegetables, poultry, pork, and fish, was found to be inversely associated with later obesity.21 This study was conducted in China over 5 years from 2006 to 2011 and followed 489 participants aged 6–14 years.

In a recent narrative review of more than 60 prospective cohorts, most included studies found an inverse or no association between intake of various vegetable groups (green leafy vegetables, cruciferous vegetables, allium vegetables, yellow-orange-red vegetables, and legumes) and risk of developing atherosclerotic vascular diseases, heart disease, and stroke.22 However, in the meta-analysis of 23 studies by Gan et al., when compared with the lowest consumption levels of total fruits and vegetables, the relative risk of coronary heart disease was 0.84 (95% CI: 0.79–0.90), 0.86 (95% CI: 0.82–0.91), 0.87 (95% CI: 0.81–0.93), respectively. Specifically, the inverse associations between fruit and/or vegetable consumption and risk of coronary heart disease were not observed in Asian populations, contrary to Western populations,23 despite Food and Agriculture Organization of the United Nations reporting the highest consumption of vegetables in Asia compared to other parts of the world.52 This valuable finding could be partially explained by the cooking methods and overall intake of fruit and vegetables in Asia. Asian cooking primarily involves the boiling and steaming of vegetables, which may cause the loss of water-soluble, heat-sensitive, and oxygen-labile nutrients while higher salt usage during home cooking may also reduce the benefits of vegetables.86 More studies are warranted to further investigate the cultural differences in fruit and vegetable intake, and health risks.

The DONALD cohort study compared data on flavonoid intake from vegetables and fruits during adolescence (females: 9–15 years; males: 10–16 years) with fasting blood samples provided in adulthood (18–39 years).24 Results revealed that a higher flavonoid intake from the consumption of fruits and vegetables was related to higher homeostasis model assessment insulin sensitivity (HOMA-2%S) among females (p = 0.03) but not males (p = 0.05). The HOMA-2%S is a method used to quantify cellular sensitivity to insulin. The authors concluded that flavonoid intake during adolescence is associated with a favorable risk profile for T2DM in early adulthood,24 yet data on the relationship between vegetable consumption as an individual dietary component and MetS remain inconsistent. This discrepancy in results may be caused by variations in the amounts and distinct vegetable subgroups employed in different studies. A cohort study that followed 424 Iranian children and adolescents over 3.6 years reported a negative correlation between overall vegetable consumption and the risk of MetS. Among vegetable subgroups and participants with 1 component of MetS, the consumption of green leafy and allium vegetables was negatively related to the risk of MetS, OR = 0.23, 95% CI [0.07–0.71]; OR = 0.29, 95% CI [0.07–0.71], respectively. The associations were observed after accounting for the major potential confounders such as demographic characteristics (age, gender, physical activity, family history of diabetes), total energy and cholesterol intake, and BMI at baseline.25

Future directions

Vegetable intake, particularly if it is high in bioactive components yet bitter in taste, might be beneficial for preventing MetS, however, these findings can only be attributed to the associations rather than the cause and effect. Thus, future longitudinal studies investigating taste sensitivity, vegetable acceptance, and the effect of brassicas vegetables on the metabolic syndrome risk in Asian children are warranted. In the ethnically diverse population of children in Asia, in-depth research exploring genetics and taste sensitivity is fundamentally important. The body of evidence can be strengthened by investigating children with differing weight status as weight is a complex phenotype and strong determinant predisposing obese children to chronic diseases including MetS.

Conclusion

Evidently, MetS can be prevented through a healthy lifestyle including active living and a balanced diet. There is supportive evidence showing that an overall increased vegetable intake was negatively associated with the development of MetS in children and adolescents, but the intakes could be influenced by bitter-taste vegetable preference and consumption.

Supporting information

Supplementary material for this article is available at https://doi.org/10.14218/ERHM.2022.00129 .

Supplementary Table 1

Systematic search strategy.

(DOCX)

Abbreviations

AVI: 

alanine-valine-isoleucine

GSL: 

glucosinolates

HDL-C: 

high-density lipoprotein-cholesterol

LDL-C: 

low-density lipoprotein-cholesterol

MetS: 

metabolic syndrome

PAV: 

proline-alanine-valine

PROP: 

6-n-propylthiouracil

PTC: 

phenylthiocarbamide

TG: 

triglyceride

Declarations

Acknowledgement

None to declare.

Data sharing statement

The data used to support the findings of this study are included in the article.

Funding

None to declare.

Conflict of interest

One of the co-authors, Nenad Naumovski, is the Associate Editor of Exploratory Research and Hypothesis in Medicine. Other authors declare they have no conflict of interests related to this publication.

Authors’ contributions

WYY conceptualized the manuscript, contributed to the methodology, supervision, project administration, and investigation, conducted the formal analysis and data curation, and prepared the original draft of the manuscript. SHO, KYL, and PLY contributed to the investigation, contributed to the methodology, conducted the formal analysis and data curation, and reviewed and edited the manuscript. NN and RJ: conceptualized, reviewed, and edited the manuscript. All authors read and approved the final version of the manuscript.

References

  1. World Health Organization. Obesity and overweight. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed October 15, 2022
  2. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 2017;390(10113):2627-2642 View Article PubMed/NCBI
  3. Mazidi M, Banach M, Kengne AP, Lipid and Blood Pressure Meta-analysis Collaboration Group. Prevalence of childhood and adolescent overweight and obesity in Asian countries: a systematic review and meta-analysis. Arch Med Sci 2018;14(6):1185-1203 View Article PubMed/NCBI
  4. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes 2007;8(5):299-306 View Article PubMed/NCBI
  5. Al-Hamad D, Raman V. Metabolic syndrome in children and adolescents. Transl Pediatr 2017;6(4):397-407 View Article PubMed/NCBI
  6. Wongdokmai R, Shantavasinkul PC, Chanprasertyothin S, Panpunuan P, Matchariyakul D, Sritara P, et al. The Involvement of Selenium in Type 2 Diabetes Development Related to Obesity and Low Grade Inflammation. Diabetes Metab Syndr Obes 2021;14:1669-1680 View Article PubMed/NCBI
  7. Soengas Fernández MD, Sotelo Pérez T, Velasco Pazos P, Cartea González ME. Antioxidant properties of Brassica vegetables. Funct Plant Sci Biotechnol 2011;5(2):43-55
  8. Dias JS. Nutritional quality and effect on disease prevention of vegetables. Food Nutr Sci 2019;10(04):369-402 View Article
  9. Miean KH, Mohamed S. Flavonoid (myricetin, quercetin, kaempferol, luteolin, and apigenin) content of edible tropical plants. J Agric Food Chem 2001;49(6):3106-3112 View Article PubMed/NCBI
  10. Keller KL, Reid A, MacDougall MC, Cassano H, Song JL, Deng L, et al. Sex differences in the effects of inherited bitter thiourea sensitivity on body weight in 4-6-year-old children. Obesity (Silver Spring) 2010;18(6):1194-1200 View Article PubMed/NCBI
  11. Jani Mehta R, Mallan KM, Mihrshahi S, Mandalika S, Daniels LA. An exploratory study of associations between Australian-Indian mothers’ use of controlling feeding practices, concerns and perceptions of children’s weight and children’s picky eating: Feeding practices of Australian-Indian mothers. Nutr Diet 2014;71(1):28-34 View Article
  12. Connolly EL, Sim M, Travica N, Marx W, Beasy G, Lynch GS, et al. Glucosinolates From Cruciferous Vegetables and Their Potential Role in Chronic Disease: Investigating the Preclinical and Clinical Evidence. Front Pharmacol 2021;12:767975 View Article PubMed/NCBI
  13. Taylor CM, Wernimont SM, Northstone K, Emmett PM. Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Appetite 2015;95:349-359 View Article PubMed/NCBI
  14. Aggarwal B, Jain V. Obesity in Children: Definition, Etiology and Approach. Indian J Pediatr 2018;85(6):463-471 View Article PubMed/NCBI
  15. Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics 2004;113(1 Pt 1):112-118 View Article PubMed/NCBI
  16. Marino M, Puppo F, Del Bo’ C, Vinelli V, Riso P, Porrini M, et al. A Systematic Review of Worldwide Consumption of Ultra-Processed Foods: Findings and Criticisms. Nutrients 2021;13(8):2778 View Article PubMed/NCBI
  17. Biddle SJ, García Bengoechea E, Wiesner G. Sedentary behaviour and adiposity in youth: a systematic review of reviews and analysis of causality. Int J Behav Nutr Phys Act 2017;14(1):43 View Article PubMed/NCBI
  18. Dubois L, Diasparra M, Bédard B, Kaprio J, Fontaine-Bisson B, Tremblay R, et al. Genetic and environmental influences on eating behaviors in 2.5- and 9-year-old children: a longitudinal twin study. Int J Behav Nutr Phys Act 2013;10:134 View Article PubMed/NCBI
  19. Wittcopp C, Conroy R. Metabolic Syndrome in Children and Adolescents. Pediatr Rev 2016;37(5):193-202 View Article PubMed/NCBI
  20. Williams DJ, Edwards D, Hamernig I, Jian L, James AP, Johnson SK, et al. Vegetables containing phytochemicals with potential anti-obesity properties: A review. Food Res Int 2013;52(1):323-333 View Article
  21. Zhen S, Ma Y, Zhao Z, Yang X, Wen D. Dietary pattern is associated with obesity in Chinese children and adolescents: data from China Health and Nutrition Survey (CHNS). Nutr J 2018;17(1):68 View Article PubMed/NCBI
  22. Blekkenhorst LC, Sim M, Bondonno CP, Bondonno NP, Ward NC, Prince RL, et al. Cardiovascular Health Benefits of Specific Vegetable Types: A Narrative Review. Nutrients 2018;10(5):595 View Article PubMed/NCBI
  23. Gan Y, Tong X, Li L, Cao S, Yin X, Gao C, et al. Consumption of fruit and vegetable and risk of coronary heart disease: a meta-analysis of prospective cohort studies. Int J Cardiol 2015;183:129-137 View Article PubMed/NCBI
  24. Penczynski KJ, Herder C, Krupp D, Rienks J, Egert S, Wudy SA, et al. Flavonoid intake from fruit and vegetables during adolescence is prospectively associated with a favourable risk factor profile for type 2 diabetes in early adulthood. Eur J Nutr 2019;58(3):1159-1172 View Article PubMed/NCBI
  25. Hosseinpour-Niazi S, Bakhshi B, Betru E, Mirmiran P, Darand M, Azizi F. Prospective study of total and various types of vegetables and the risk of metabolic syndrome among children and adolescents. World J Diabetes 2019;10(6):362-375 View Article PubMed/NCBI
  26. Silveira LS. Metabolic syndrome: Criteria for diagnosing in children and adolescents. Endocrinol Metab Syndr 2013;2(3):1-6 View Article
  27. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 2003;157(8):821-827 View Article PubMed/NCBI
  28. Misra A, Khurana L. The metabolic syndrome in South Asians: epidemiology, determinants, and prevention. Metab Syndr Relat Disord 2009;7(6):497-514 View Article PubMed/NCBI
  29. Misra A, Misra R, Wijesuriya M, Banerjee D. The metabolic syndrome in South Asians: continuing escalation & possible solutions. Indian J Med Res 2007;125(3):345-354 PubMed/NCBI
  30. Misra A, Khurana L, Vikram NK, Goel A, Wasir JS. Metabolic syndrome in children: current issues and South Asian perspective. Nutrition 2007;23(11-12):895-910 View Article PubMed/NCBI
  31. Zhu Y, Zheng H, Zou Z, Jing J, Ma Y, Wang H, et al. Metabolic Syndrome and Related Factors in Chinese Children and Adolescents: Analysis from a Chinese National Study. J Atheroscler Thromb 2020;27(6):534-544 View Article PubMed/NCBI
  32. Piernas C, Wang D, Du S, Zhang B, Wang Z, Su C, et al. Obesity, non-communicable disease (NCD) risk factors and dietary factors among Chinese school-aged children. Asia Pac J Clin Nutr 2016;25(4):826-840 View Article PubMed/NCBI
  33. Wei X, Peng R, Cao J, Kang Y, Qu P, Liu Y, et al. Serum vitamin A status is associated with obesity and the metabolic syndrome among school-age children in Chongqing, China. Asia Pac J Clin Nutr 2016;25(3):563-570 View Article PubMed/NCBI
  34. Lee MS, Wahlqvist ML, Yu HL, Pan WH. Hyperuricemia and metabolic syndrome in Taiwanese children. Asia Pac J Clin Nutr 2007;16(Suppl 2):594-600 PubMed/NCBI
  35. Siwarom S, Pirojsakul K, Aekplakorn W, Paksi W, Kessomboon P, Neelapaichit N, et al. Waist-to-Height Ratio Is a Good Predictor of Metabolic Syndrome in Adolescents: A Report From the Thai National Health Examination Survey V, 2014. Asia Pac J Public Health 2022;34(1):36-43 View Article PubMed/NCBI
  36. Rodrigues L, Espanca R, Costa AR, Antunes CM, Pomar C, Capela-Silva F, et al. Comparison of salivary proteome of children with different sensitivities for bitter and sweet tastes: association with body mass index. Int J Obes (Lond) 2019;43(4):701-712 View Article PubMed/NCBI
  37. Lim J, Pullicin AJ. Oral carbohydrate sensing: Beyond sweet taste. Physiol Behav 2019;202:14-25 View Article PubMed/NCBI
  38. Deshaware S, Singhal R. Genetic variation in bitter taste receptor gene TAS2R38, PROP taster status and their association with body mass index and food preferences in Indian population. Gene 2017;627:363-368 View Article PubMed/NCBI
  39. Forestell CA, Mennella JA. Handbook of Olfaction and Gustation. Hoboken, USA: John Wiley & Sons, Inc; 2015, 795-828 View Article
  40. Vignini A, Borroni F, Sabbatinelli J, Pugnaloni S, Alia S, Taus M, et al. General Decrease of Taste Sensitivity Is Related to Increase of BMI: A Simple Method to Monitor Eating Behavior. Dis Markers 2019;2019:2978026 View Article PubMed/NCBI
  41. Cox DN, Hendrie GA, Carty D. Sensitivity, hedonics and preferences for basic tastes and fat amongst adults and children of differing weight status: A comprehensive review. Food Qual Prefer 2016;48:359-367 View Article
  42. Lanfer A, Bammann K, Knof K, Buchecker K, Russo P, Veidebaum T, et al. Predictors and correlates of taste preferences in European children: The IDEFICS study. Food Qual Prefer 2013;27(2):128-136 View Article
  43. Laureati M, Pagliarini E, Toschi TG, Monteleone E. Research challenges and methods to study food preferences in school-aged children: A review of the last 15years. Food Qual Prefer 2015;46:92-102 View Article
  44. Weaver MR, Brittin HC. Food preferences of men and women by sensory evaluation versus questionnaire. Fam Consum Sci Res J 2001;29(3):288-301 View Article
  45. Davis C, Patte K, Levitan R, Reid C, Tweed S, Curtis C. From motivation to behaviour: a model of reward sensitivity, overeating, and food preferences in the risk profile for obesity. Appetite 2007;48(1):12-19 View Article PubMed/NCBI
  46. Deglaire A, Méjean C, Castetbon K, Kesse-Guyot E, Hercberg S, Schlich P. Associations between weight status and liking scores for sweet, salt and fat according to the gender in adults (The Nutrinet-Santé study). Eur J Clin Nutr 2015;69(1):40-46 View Article PubMed/NCBI
  47. Sia B, Low S, Foong W, Pramasivah M, Say YH. Demographic differences of preference, intake frequency and craving hedonic ratings of sweet foods among Malaysian subjects in Kuala Lumpur. Malays J Med Health Sci 2013;9(1):55-64
  48. Hill JO, Wyatt HR, Peters JC. Energy balance and obesity. Circulation 2012;126(1):126-132 View Article PubMed/NCBI
  49. Lim LS, Tang XH, Yang WY, Ong SH, Naumovski N, Jani R. Taste Sensitivity and Taste Preference among Malay Children Aged 7 to 12 Years in Kuala Lumpur-A Pilot Study. Pediatr Rep 2021;13(2):245-256 View Article PubMed/NCBI
  50. Tepper BJ. Nutritional implications of genetic taste variation: the role of PROP sensitivity and other taste phenotypes. Annu Rev Nutr 2008;28:367-388 View Article PubMed/NCBI
  51. Keller KL, Adise S. Variation in the Ability to Taste Bitter Thiourea Compounds: Implications for Food Acceptance, Dietary Intake, and Obesity Risk in Children. Annu Rev Nutr 2016;36:157-182 View Article PubMed/NCBI
  52. Cartea ME, Lema M, Francisco M. Genetics, Genomics and Breeding of Vegetable Brassicas. Boca Raton: CRC Press; 2011, 1-34
  53. United Nations Children's Fund (UNICEF). 2021 Child Nutrition Report. New York: UNICEF; 2021
  54. Choudhury S, Headey DD, Masters WA. First foods: Diet quality among infants aged 6-23 months in 42 countries. Food Policy 2019;88:101762 View Article PubMed/NCBI
  55. Keats EC, Rappaport AI, Shah S, Oh C, Jain R, Bhutta ZA. The Dietary Intake and Practices of Adolescent Girls in Low- and Middle-Income Countries: A Systematic Review. Nutrients 2018;10(12):1978 View Article PubMed/NCBI
  56. Cheng G, Duan R, Kranz S, Libuda L, Zhang L. Development of a Dietary Index to Assess Overall Diet Quality for Chinese School-Aged Children: The Chinese Children Dietary Index. J Acad Nutr Diet 2016;116(4):608-617 View Article PubMed/NCBI
  57. Peltzer K, Pengpid S. Fruits and vegetables consumption and associated factors among in-school adolescents in five Southeast Asian countries. Int J Environ Res Public Health 2012;9(10):3575-3587 View Article PubMed/NCBI
  58. Dhungana RR, Bista B, Pandey AR, de Courten M. Prevalence, clustering and sociodemographic distributions of non-communicable disease risk factors in Nepalese adolescents: secondary analysis of a nationwide school survey. BMJ Open 2019;9(5):e028263 View Article PubMed/NCBI
  59. Institute of Public Health.
  60. World Health Organization. WHO European Childhood Obesity Surveillance Initiative (COSI) Report on the fourth round of data collection, 2015–2017. Geneva: World Health Organization; 2021
  61. Diethelm K, Jankovic N, Moreno LA, Huybrechts I, De Henauw S, De Vriendt T, et al. Food intake of European adolescents in the light of different food-based dietary guidelines: results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr 2012;15(3):386-398 View Article PubMed/NCBI
  62. Zhu B, Liang Z, Zang Y, Zhu Z, Yang J. Diversity of glucosinolates among common brassicaceae vegetables in China. Hortic Plant J 2022 View Article
  63. Issarakraisila M, Ma Q, Turner DW. Photosynthetic and growth responses of juvenile Chinese kale (Brassica oleracea var. alboglabra) and Caisin (Brassica rapa subsp. parachinensis) to waterlogging and water deficit. Sci Hortic 2007;111(2):107-113 View Article
  64. Turreira-García N, Vilkamaa AM, Byg A, Theilade I. Diversity, Knowledge, and use of leafy vegetables in Northern Thailand-maintenance and transmission of ethnobotanical knowledge during urbanisation. Nat Hist Bull Siam Soc 2017;62(1):85-105
  65. National Coordinating Committee on Food and Nutrition. Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Ministry of Health Malaysia; 2013
  66. Izzah AN, Aminah A, Pauzi AM, Lee YH, Wan Rozita WM, et al. Patterns of fruits and vegetable consumption among adults of different ethnics in Selangor, Malaysia. Int Food Res J 2012;19(3):1095-1107
  67. Ali M, Wu SN, Wu MH. Evaluation of the net nutritive gain of policy interventions: An application to Taiwan household survey data. Taiwan: Asian Vegetable Research and Development Center; 2000
  68. Dias JC da S. Emerging Trends in Disease and Health Research. Book Publisher International; 2022, 53-73
  69. Dias JC da S. Highlights on Medicine and Medical Science. Book Publisher International; 2021, 27-71 View Article
  70. Wills RBH, Rangga A. Determination of carotenoids in Chinese vegetables. Food Chem 1996;56(4):451-455 View Article
  71. Konings EJ, Roomans HH, Dorant E, Goldbohm RA, Saris WH, van den Brandt PA. Folate intake of the Dutch population according to newly established liquid chromatography data for foods. Am J Clin Nutr 2001;73(4):765-776 View Article PubMed/NCBI
  72. Melse-Boonstra A, Verhoef P, Konings EJ, Van Dusseldorp M, Matser A, Hollman PC, et al. Influence of processing on total, monoglutamate and polyglutamate folate contents of leeks, cauliflower, and green beans. J Agric Food Chem 2002;50(12):3473-3478 View Article PubMed/NCBI
  73. Puupponen-Pimiä R, Häkkinen ST, Aarni M, Suortti T, Lampi AM, Eurola M, et al. Blanching and long-term freezing affect various bioactive compounds of vegetables in different ways: Effect of blanching and freezing on vegetables. J Sci Food Agric 2003;83(14):1389-1402 View Article
  74. Hedges LJ, Lister CE. Nutritional attributes of Brassica vegetables. New Zealand: New Zealand Institute for Crop & Food Research; 2006, 46
  75. Kamal RM, Abdull Razis AF, Mohd Sukri NS, Perimal EK, Ahmad H, Patrick R, et al. Beneficial Health Effects of Glucosinolates-Derived Isothiocyanates on Cardiovascular and Neurodegenerative Diseases. Molecules 2022;27(3):624 View Article PubMed/NCBI
  76. Drayna D. Human taste genetics. Annu Rev Genomics Hum Genet 2005;6:217-235 View Article PubMed/NCBI
  77. Garcia-Bailo B, Toguri C, Eny KM, El-Sohemy A. Genetic variation in taste and its influence on food selection. OMICS 2009;13(1):69-80 View Article PubMed/NCBI
  78. Duffy VB, Hayes JE, Davidson AC, Kidd JR, Kidd KK, Bartoshuk LM. Vegetable Intake in College-Aged Adults Is Explained by Oral Sensory Phenotypes and TAS2R38 Genotype. Chemosens Percept 2010;3(3-4):137-148 View Article PubMed/NCBI
  79. Sacerdote C, Guarrera S, Smith GD, Grioni S, Krogh V, Masala G, et al. Lactase persistence and bitter taste response: instrumental variables and mendelian randomization in epidemiologic studies of dietary factors and cancer risk. Am J Epidemiol 2007;166(5):576-581 View Article PubMed/NCBI
  80. Keller KL, Olsen A, Cravener TL, Bloom R, Chung WK, Deng L, et al. Bitter taste phenotype and body weight predict children’s selection of sweet and savory foods at a palatable test-meal. Appetite 2014;77:113-121 View Article PubMed/NCBI
  81. Gibson EL, Cooke L. Understanding Food Fussiness and Its Implications for Food Choice, Health, Weight and Interventions in Young Children: The Impact of Professor Jane Wardle. Curr Obes Rep 2017;6(1):46-56 View Article PubMed/NCBI
  82. Naidu BM, Mahmud SZ, Ambak R, Sallehuddin SM, Mutalip HA, Saari R, et al. Overweight among primary school-age children in Malaysia. Asia Pac J Clin Nutr 2013;22(3):408-415 View Article PubMed/NCBI
  83. Baharudin A, Man CS, Ahmad MH, Wong NI, Salleh R, Megat Radzi MR, et al. Associated Factors to Prevalence of Childhood under Nutrition in Malaysia: Findings from the National Health and Morbidity Survey (NHMS 2016). Health Sci J 2019;13(1):627 View Article
  84. Scaglioni S, Arrizza C, Vecchi F, Tedeschi S. Determinants of children’s eating behavior. Am J Clin Nutr 2011;94(6 Suppl):2006S-2011S View Article PubMed/NCBI
  85. Epstein LH, Gordy CC, Raynor HA, Beddome M, Kilanowski CK, Paluch R. Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity. Obes Res 2001;9(3):171-178 View Article PubMed/NCBI
  86. Epstein LH, Paluch RA, Beecher MD, Roemmich JN. Increasing healthy eating vs. reducing high energy-dense foods to treat pediatric obesity. Obesity (Silver Spring) 2008;16(2):318-326 View Article PubMed/NCBI
  87. Grunwald GK, Seagle HM, Peters JC, Hill JO. Quantifying and separating the effects of macronutrient composition and non-macronutrients on energy density. Br J Nutr 2001;86(2):265-276 View Article PubMed/NCBI
  88. Rolls BJ, Ello-Martin JA, Tohill BC. What can intervention studies tell us about the relationship between fruit and vegetable consumption and weight management?. Nutr Rev 2004;62(1):1-17 View Article PubMed/NCBI
  89. Marseglia L, Manti S, D’Angelo G, Nicotera A, Parisi E, Di Rosa G, et al. Oxidative stress in obesity: a critical component in human diseases. Int J Mol Sci 2014;16(1):378-400 View Article PubMed/NCBI
  90. González-Castejón M, Rodriguez-Casado A. Dietary phytochemicals and their potential effects on obesity: a review. Pharmacol Res 2011;64(5):438-455 View Article PubMed/NCBI
  91. Yeon JY, Kim HS, Sung MK. Diets rich in fruits and vegetables suppress blood biomarkers of metabolic stress in overweight women. Prev Med 2012;54(Suppl):S109-S115 View Article PubMed/NCBI
  • Exploratory Research and Hypothesis in Medicine
  • pISSN 2993-5113
  • eISSN 2472-0712
Back to Top

The Association between Consumption of Bitter-taste Vegetables in Asian Culture and Metabolic Syndrome Risk Factors in Children: A Narrative Review

Wai Yew Yang, Kah Yen Lim, Pei Ling Yen, Shu Hwa Ong, Nenad Naumovski, Rati Jani
  • Reset Zoom
  • Download TIFF