Individual Food Preferences for the Mediterranean Diet in Cancer Patients

The self-administered questionnaires to be completed at the time of inclusion will be presented to the patient on a tablet during the inclusion visit and will be completed on the same day in the Day Hospital using the Compusense software. Online self-questionnaires and sensory tests at the 9th week of treatment will also be conducted using the Compusense software in small groups at a designated location within the center.

The MediLite questionnaire consists of nine items that assess daily consumption of fruits, vegetables, grains, meats and meat products, dairy products, alcohol, and olive oil, as well as weekly consumption of legumes and fish.

The CITAS is a self-administered questionnaire consisting of 18 items evaluated on a five-point Likert scale and divided into three dimensions: 1) quantitative changes in taste perception (hypogeusia and ageusia), 2) qualitative changes in taste perception (heterogeusia, cacogeusia), and 3) nutrition-related problems (difficulty eating hot or fatty foods). Using a Likert scale ranging from 1 to 5 (where 1 = no difficulty or absence of disturbance and 5 = maximum difficulty or disturbance), CITAS assesses the four dimensions of taste disturbances: taste intensity, discomfort, phantogeusia, and parageusia, as well as overall taste alterations. For the original version by Kano and Kanda (2013), five items assessing changes in smell from the modified CITAS version by Drareni et al. 2021 will be added in this study.

Food neophobia will be assessed using the Food Neophobia Scale (FNS) developed by Pliner \& Hobden (1992). The FNS consists of ten statements evaluated on a 7-point agreement scale ranging from 1 = "I strongly disagree" to 7 = "I strongly agree." Individual FNS scores are calculated as the sum of the ratings given to the ten statements after reversing the neophilic items; thus, scores theoretically range from 10 to 70, with higher scores reflecting higher levels of food neophobia.

The quality of life related to food in cancer patients is composed of 46 items with a 4-point scale (never, almost never, almost always, always). The questionnaire is divided into different subdomains: Cooking, where one eats and conviviality, Eating and drinking, After eating.

Individual baseline disgust sensitivity is assessed using the Disgust Sensitivity-Short Form (DS-SF) questionnaire; this questionnaire is a shortened version of the disgust scale aimed at measuring disgust of animal origin, based on contamination and revulsion (Haidt, 2004; Haidt et al., 1994; Inbar, Pizarro, and Bloom, 2009; Olatunji et al., 2007). This measure consists of 8 items divided into 2 parts. In the first part, statements were rated on a scale from 1 (not at all agree-very false about me) to 5 (completely agree-very true about me); for the second part, additional statements were rated from 1 (not at all disgusting) to 5 (extremely disgusting). The total disgust sensitivity score is obtained by summing the scores after two items have been reversed and ranges from 8 to 40.

The subscale of reward sensitivity from the short version of reward and punishment sensitivity has been selected (17 items). Each item will be assessed on a 4-point Likert scale, ranging from 1 (completely no) to 4 (completely yes).

The EmoPrefMed questionnaire was developed to measure declared appreciation and emotional responses to selected Mediterranean diet (RM) products and changes in appreciation before and after chemotherapy. The assessment of the acceptability of a series of RM foods (listed in the questionnaire appendix) will be evaluated using a nine-point hedonic scale ranging from a minimum of 1 = "I don't like it at all" to a maximum of 9 = "I like it a lot" (Peryam \& Pilgrim, 1957). Emotions will be assessed using a check-all-that-apply (CATA) list of emotions, including 4 negative and 4 positive emotions with low, moderate, and high arousal levels (It brings me joy, It intrigues me, It relaxes me, It annoys me, It leaves me indifferent, It makes me sad, It's monotonous, It disgusts me). Patients will be asked to select all the emotions they deem appropriate to describe the food product.

Food-related attitudes will be measured using the HTAS (Health and Taste Attitude Scale) proposed by Roininen et al. (1999), consisting of six subscales focusing on perceived health and taste aspects of foods. The two scales selected in this study are general interest in health (eight items, measuring overall interest in a healthy diet) and the use of food as a reward (six items, measuring attitudes towards using food as a reward). Each subscale consists of an equal number of statements phrased positively and negatively (Roininen et al., 1999). All items were rated on a seven-point category scale, ranging from "strongly disagree" to "strongly agree." As suggested by Roininen et al. (1999), negative statements were reversed and recoded for the calculation of final scores.

The response to PROP (6-n-propyl-2-thiouracil) is measured using 1.5 cm diameter paper disks previously soaked in a solution of deionized water with a concentration of 3.2 mM PROP, dissolving 0.5477 g/L of PROP. Each paper disk will contain approximately 0.280 mg of PROP. Participants are asked to place the paper disk on the tip of their tongue for 20 seconds, then remove it and assess the perceived bitter intensity on a Labelled Magnitude Scale (LMS). The LMS scale consists of a vertical line of 100 units with labels placed at no sensation, 0; barely detectable, 1.4; weak, 6; moderate, 17; strong, 34.7; very strong, 52.5; and the strongest imaginable sensation of any kind, 100. Numeric labels are not reported on the scale. Participants are instructed to think of the "strongest imaginable sensation" as the most intense sensation they can imagine in the realm of taste. Participants are encouraged to ask questions about the use of the scale if they need more clarification.

The odors (Mint, Anise, Banana, Pine, Garlic, Cinnamon, Lemon) are trapped in tightly packed microcapsules (aminoplast type, diameter: 4-8 μm). Microcapsule-based ink is printed on cardboard paper (SILK-250 g; Size: 11 cm × 21 cm). Each odorant has been printed in a defined area (2 cm in diameter). The odor is released by simply rubbing the printed microcapsule reserve (scratch-and-sniff method).Patients receive a disposable single-use sample and are asked to identify the odors and evaluate on a visual analog scale the perceived intensity, perceived irritation, and appreciation of each odor.

Two model foods were developed to investigate responses to variations in sweetness, acidity, and freshness. The first range consists of Apple-Mint Juice, composed of four samples containing different concentrations of mint syrup (0, 15, 60, 240 g/kg). The second range is a chickpea mousse made up of four samples containing different quantities of citric acid and glucose-fructose syrup (glucose-fructose syrup: 0, 50, 100, 200 g/kg; citric acid: 8, 6, 4, 4 g/kg). Participants are asked to evaluate the samples using the Labelled Affective Magnitude Scale. Regarding the LAM scale, subjects are instructed to consider the extremes of appreciation, "the best I can imagine" and "the worst I can imagine". After a break, they are asked to taste the samples again and rate the intensity of sweetness, acidity, apple flavor, mint flavor, and freshness on the Labeled Magnitude Scale: from 'not detectable' to 'the strongest imaginable'.