Pediatric oncology patients prefer cocoa over oral nutritional supplements in a double-blinded feeding-trial

Rassner, Mark; Buchner, Hannes; Bauer, Hans; Schmid, Irene; Tenius, Lisa (2026): Pediatric oncology patients prefer cocoa over oral nutritional supplements in a double-blinded feeding-trial. Frontiers in Nutrition, 13: 1847634. ISSN 2296-861X

Abstract

Background: Malnutrition is a common problem during the treatment of pediatric cancer. Therapy-induced taste alterations (dysgeusia) can further exacerbate this and may reduce the acceptance of oral nutritional supplements (ONS). There are no available data on the acceptability of commercially available ONS among children and adolescents in Germany.

Methods: In a prospective, double-blind tasting trial, 36 pediatric oncology patients (6–20 years) evaluated commercially available ONS and a cocoa-based reference beverage. The primary outcome was overall liking (taste rating) on a 1–6 ordinal scale (1 = excellent; 6 = unacceptable). Additional assessments included ratings of appearance and temperature, perceived basic taste qualities, and free-text flavour descriptions. Using linear mixed models, beverage taste ratings were compared globally and pairwise (adjusted for multiple comparisons), and sensory characteristics associated with higher acceptance were explored.

Results: Cocoa was rated best overall (mean taste rating 1.42 ± 0.7) and significantly outperformed all tested ONS in taste (Bonferroni-corrected p = 0.025 compared to next-best), appearance, and temperature. The best-rated supplements were predominantly sweet or sweet–sour (red fruits: 2.42 ± 1.3; summer fruit smoothie: 2.64 ± 1.5); the other products were rated rather poorly (all ≥3.47) and most were not accepted (4.0). For salty/savoury beverages, patients’ qualitative taste descriptions frequently diverged from manufacturer-declared flavours. Ratings of appearance and temperature, along with perceived sweetness, and in many cases sourness, emerged as the most robust predictors of overall taste evaluations. However, a model comparison indicated that these characteristics did not fully explain between-beverage differences (likelihood-ratio test p < 0.001), suggesting additional unmeasured determinants of acceptance.

Conclusion: Among patients in pediatric oncology, receiving chemotherapy, cocoa was consistently preferred over commercially available high-energy ONS. While cocoa served as a highly accepted reference beverage, the findings highlight the importance of flavour characteristics for acceptance. Strategies focusing on flavour optimization of nutritionally complete supplements may help improve oral intake during therapy. In addition to fruit-based beverages, cocoa-based formulations – particularly when combined with energy enrichment approaches – may represent a practical and cost-efficient strategy to support oral nutritional intake when acceptance of standard ONS is limited.

• Doc-Type: Article (LMU Hospital)
• Organisational unit (Faculties): 07 Medicine > Medical Center of the University of Munich > Pediatric Clinic and Outpatient Clinic in the Dr. von Hauner Children‘s Hospital
• DFG subject classification of scientific disciplines: Life sciences
• DFG: Funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) - 491502892