New chemosensory component in the U.S. National Health and Nutrition Examination Survey (NHANES): first-year results for measured olfactory dysfunction

  • Howard J. Hoffman
  • Shristi Rawal
  • Chuan-Ming Li
  • Valerie B. Duffy


The U.S. NHANES included chemosensory assessments in the 2011–2014 protocol. We provide an overview of this protocol and 2012 olfactory exam findings. Of the 1818 NHANES participants aged ≥40 years, 1281 (70.5 %) completed the exam; non-participation mostly was due to time constraints. Health technicians administered an 8-item, forced-choice, odor identification task scored as normosmic (6–8 odors identified correctly) versus olfactory dysfunction, including hyposmic (4–5 correct) and anosmic/severe hyposmic (0–3 correct). Interviewers recorded self-reported smell alterations (during past year, since age 25, phantosmia), histories of sinonasal problems, xerostomia, dental extractions, head or facial trauma, and chemosensory-related treatment and changes in quality of life. Olfactory dysfunction was found in 12.4 % (13.3 million adults; 55 % males/45 % females) including 3.2 % anosmic/severe hyposmic (3.4 million; 74 % males/26 % females). Selected age-specific prevalences were 4.2 % (40–49 years), 12.7 % (60–69 years), and 39.4 % (80+ years). Among adults ≥70 years, misidentification rates for warning odors were 20.3 % for smoke and 31.3 % for natural gas. The highest sensitivity (correctly identifying dysfunction) and specificity (correctly identifying normosmia) of self-reported olfactory alteration was among anosmics/severe hyposmics (54.4 % and 78.1 %, respectively). In age- and sex-adjusted logistic regression analysis, risk factors of olfactory dysfunction were racial/ethnic minority, income-to-poverty ratio ≤ 1.1, education <high school, and heavy drinking. Moderate-to-vigorous physical activity reduced risk of impairment. Olfactory dysfunction is prevalent, particularly among older adults. Inexpensive, brief odor identification tests coupled with questions (smell problems past year, since age 25, phantosmia) could screen for marked dysfunction. Healthcare providers should be prepared to offer education on non-olfactory avoidance of hazardous events.


Olfaction disorders Epidemiology Taste Risk factors Public health surveillance Health status 



The authors wish to thank the study participants and the dedicated staff who helped organize and conduct the chemosensory (taste and smell) interview and examination components in the National Health and Nutrition Examination Survey (NHANES). We also wish to acknowledge the valuable contribution of our colleagues, Dr. Richard Doty (University of Pennsylvania), Dr. John Hayes (Pennsylvania State University), and Dr. Charles Dillon (Project Officer for the 2011-2014 NHANES Chemosensory Protocol, NCHS/CDC), as well as several experts in chemosensation science who provided critical counsel and encouragement over sustained periods, Dr. Linda Bartoshuk, Dr. Susan Coldwell, Dr. Beverly Cowart, Dr. Karen Cruickshanks, Dr. Pamela Dalton, Dr. Barry Davis [deceased], Dr. Claire Murphy, and multiple others. Also, Dr. Shristi Rawal was partially supported by the intramural research program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Preliminary analyses of the findings were presented at an invited Clinical Symposium for the annual meeting of the Association for Chemoreception Sciences meeting in Bonita Springs, Florida, April 9-12, 2014. The chemosensory component of NHANES 2011–2014 was supported by Interagency Agreement (Y1-DC-0013) between the National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH) and the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC).

The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Research Data Center, NCHS, CDC, or of the NIDCD and NICHD, National Institutes of Health, or of the University of Connecticut.

Compliance with ethical standards

Conflict of interest

None of the authors has any conflict of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Howard J. Hoffman
    • 1
  • Shristi Rawal
    • 2
    • 3
  • Chuan-Ming Li
    • 1
  • Valerie B. Duffy
    • 3
  1. 1.Epidemiology and Statistics ProgramDivision of Scientific Programs, National Institute on Deafness and other Communication Disorders (NIDCD) at the National Institutes of Health (NIH)BethesdaUSA
  2. 2.Epidemiology Branch, Division of Intramural Population Health ResearchEunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIHRockvilleUSA
  3. 3.Department of Allied Health SciencesUniversity of ConnecticutStorrsUSA

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