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Olfaction is a Marker of Severity but Not Diagnosis in Anorexia Nervosa: a Systematic Review and Meta-Analysis

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Abstract

Researchers have examined if olfaction is a sensitive biomarker of anorexia nervosa, but considerable heterogeneity across studies makes it difficult to reach a consensus. This review and meta-analysis sought to clarify if olfaction is altered in individuals with anorexia nervosa and explore potential moderators of olfaction in this population. We performed quantitative and qualitative analyses of olfactory function in individuals with anorexia nervosa compared with healthy controls. A random effect model was used to estimate pooled effect sizes, and meta-regression was conducted to identify potential moderators. We found that individuals with anorexia nervosa had largely intact olfactory function compared with healthy controls in terms of threshold (g = −0.09, 95% confidence interval [CI] (−0.65,0.47), p = 0.757), identification (g = −0.06, 95% CI (−0.32,0.20), p = 0.642), and overall olfactory function (g = −0.47, 95% CI (−1.02,0.07), p = 0.090). Discrimination was different from control (g = −0.51, 95% CI (−0.97,-0.05), p = 0.029). However, after sensitivity analysis, the pooled effect size was nonsignificant in discrimination. Olfactory sensitivity covaried with anorexia nervosa severity, body mass index (BMI) positively moderated olfactory threshold score (β = 0.79, 95% CI (0.18,1.41), p = 0.020) in individuals with anorexia nervosa. Disease duration negatively moderated olfactory threshold score (β = −0.21, 95% CI (−0.40,-0.03), p = 0.034). The results suggest that olfaction is not a sensitive marker of anorexia nervosa diagnosis, but olfactory sensitivity may be a useful indicator of anorexia nervosa severity.

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Acknowledgments

LQZ was supported by the National Natural Science Foundation of China (31700963), the Natural Science Foundation of Guangdong Province, China (2017A030310069), and the Medical Science and Technology Foundation of Guangdong Province, China (201906546). JBZ was supported by the MOE (Ministry of Education in China) Youth Foundation Project of Humanities and Social Sciences (No. 2018YJCZH260).

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  1. Department of Psychology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, Guangdong, China

    Yiling Mai, Xin Zhang, Zetian Li, Xiaohua Wu, Baoer Zeng, Yuan Fang, Laiquan Zou & Jiubo Zhao

  2. Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China

    Laiquan Zou & Jiubo Zhao

  3. Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany

    Laiquan Zou & Thomas Hummel

  4. Chemical Senses and Mental Health Lab, Department of Psychology, School of Public Health, Southern Medical University, No. 1023 Shatainan Road, Guangzhou, 510515, Guangdong, China

    Laiquan Zou

  5. School of Public Health, Southern Medical University, No. 1023 Shatainan Road, Guangzhou, 510515, Guangdong, China

    Jiubo Zhao

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  1. Yiling Mai
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Mai, Y., Zhang, X., Li, Z. et al. Olfaction is a Marker of Severity but Not Diagnosis in Anorexia Nervosa: a Systematic Review and Meta-Analysis. Neuropsychol Rev 30, 251–266 (2020). https://doi.org/10.1007/s11065-020-09438-4

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