1
|
Fornazieri MA, Garcia ECD, Montero RH, Borges R, Bezerra TFP, Pinna FR, Doty RL, Voegels RL. Prevalence and Magnitude of Olfactory Dysfunction in Allergic Rhinitis. Am J Rhinol Allergy 2024:19458924241253642. [PMID: 38759958 DOI: 10.1177/19458924241253642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
BACKGROUND Although allergic rhinitis (AR) can negatively impact the ability to smell, the degree to which this occurs is not clear and prevalence estimates vary among studies. This study had 4 main objectives: (1) To estimate the prevalence and the degree of olfactory dysfunction in AR patients; (2) To compare olfactory perception between AR patients with different persistence and severity of symptoms and determine if olfactory testing may aid in differentiating among Allergic Rhinitis and its Impact on Asthma (ARIA) groups; (3) To determine whether allergic reactions to different allergens differentially impact olfactory function, and (4) Verify possible changes in the olfactory epithelium (OE) caused by AR. METHODS One hundred thirty-three patients with AR and one hundred controls were tested. The main outcome was the score in University of Pennsylvania Smell Identification Test (UPSIT®). The OE was examined using immunofluorescence markers for neuronal activity, apoptosis, oxidative stress, signal transduction, eosinophils, and epithelial thickness. RESULTS Prevalence of olfactory dysfunction in the AR patients was higher (AR: 42.9% vs controls: 9%, P < .001). No difference was found either between intermittent and persistent disease cases (P = .58) or between cases with mild and those with moderate/severe symptomatology (P = .33). Lower olfactory capacity was not associated with the reaction to more (P = .48) or diverse types of allergens (Ps > .05). Although not significant, patients with AR had a greater amount of eosinophilia and a lower amount of cAMP (cyclic adenosine monophosphate) in the OE. CONCLUSION The study highlights a higher prevalence of olfactory dysfunction in AR patients compared to controls, but olfactory testing may not effectively differentiate AR severity or allergen sensitivities. Although trends suggest potential pathophysiological changes in the OE of AR patients, further research is needed to validate these findings.
Collapse
Affiliation(s)
- Marco A Fornazieri
- Department of Surgery, Londrina State University, Londrina, Brazil
- Department of Medicine, Pontifical Catholic University of Paraná, Londrina, Brazil
- Department of Otorhinolaryngology, University of São Paulo, São Paulo, Brazil
- Department of Otolaryngology, Smell and Test Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ellen C D Garcia
- Department of Surgery, Londrina State University, Londrina, Brazil
| | | | - Ricardo Borges
- Department of Surgery, Londrina State University, Londrina, Brazil
| | - Thiago F P Bezerra
- Department of Otorhinolaryngology, University of São Paulo, São Paulo, Brazil
- Department of Surgery, Federal University of Pernambuco, Recife, Brazil
| | - Fábio R Pinna
- Department of Otorhinolaryngology, University of São Paulo, São Paulo, Brazil
| | - Richard L Doty
- Department of Otolaryngology, Smell and Test Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Richard L Voegels
- Department of Otorhinolaryngology, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
2
|
On A, Moein ST, Khan R, Doty RL. The 8-item NHANES pocket smell test ®: Normative data. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-6. [PMID: 37410621 PMCID: PMC10770295 DOI: 10.1080/23279095.2023.2224480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
This study provides normative data useful for interpreting scores from the Pocket Smell Test® (PST®), a brief "scratch & sniff" neuropsychological olfactory screening test comprised of 8 items from the 40-item University of Pennsylvania Smell Identification Test (UPSIT®). We combined 3,485 PST® scores from the 2013 to 2014 National Health and Nutrition Survey (NHANES) of persons 40 years of age and older with equivalent PST® items extracted from an UPSIT® database of 3,900 persons ranging in age from 5 to 99 years. Decade-related age- and gender-adjusted percentile normative data were established across the entire age spectrum. Cut-points for defining clinically useful categories of anosmia, probable microsmia, and normosmia were determined using receiver operating characteristic (ROC) curve analyses. An age-related decline in test scores was evident for both sexes after the age of 40 years, with women outperforming men. Based on the ROC analyses, subjects scoring 3 or less (AUC = 0.81) defines anosmia. Regardless of sex, a score of 7 or 8 on the N-PST® signifies normal function (AUC of 0.71). Probable microsmia is classified as scores extending from 3 to 6. These data provide an accurate means for interpreting PST® scores within a number of clinical and applied settings.
Collapse
Affiliation(s)
- Aretha On
- Smell & Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shima T Moein
- Smell & Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Research Division, Sensonics International, Haddon Heights, New Jersey, USA
| | - Rafa Khan
- Smell & Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard L Doty
- Smell & Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Peters JC, Breen JA, Pan Z. Effects of Culinary Spices on Liking and Consumption of Protein Rich Foods in Community-Dwelling Older Adults. Nutrients 2023; 15:nu15051172. [PMID: 36904171 PMCID: PMC10005771 DOI: 10.3390/nu15051172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
Insufficient protein intake is a common challenge among older adults, leading to loss of muscle mass, decreased function and reduced quality of life. A protein intake of 0.4 g/kg body weight/meal is recommended to help prevent muscle loss. The purpose of this study was to assess whether the protein intake of 0.4 g/kg body weight/meal could be achieved with typical foods and whether culinary spices could enhance protein intake. A lunch meal test was conducted in 100 community-dwelling volunteers; 50 were served a meat entrée and 50 were served a vegetarian entrée with or without added culinary spices. Food consumption, liking and perceived flavor intensity were assessed using a randomized, two-period, within subjects crossover design. Within the meat or vegetarian treatments, there were no differences in entrée or meal intakes between spiced and non-spiced meals. Participants fed meat consumed 0.41 g protein/kg body weight/meal, while the vegetarian intake was 0.25 g protein/kg body weight/meal. The addition of spice to the vegetarian entrée significantly increased liking and flavor intensity of both the entrée and the entire meal, while spice addition only increased flavor for the meat offering. Culinary spices may be a useful tool to improve the liking and flavor of high-quality protein sources among older adults, especially when used with plant-based foods, although improving liking and flavor alone are insufficient to increase protein intake.
Collapse
Affiliation(s)
- John C. Peters
- Anschutz Health and Wellness Center, 12348 E. Montview Blvd., MailStop C263, Aurora, CO 80045, USA
- Division of Endocrinology, Diabetes and Metabolism, University of Colorado Denver, Anschutz Medical Campus, 12801 E. 17th Ave., RC1 South Rm 7103, Aurora, CO 80045, USA
- Correspondence:
| | - Jeanne Anne Breen
- Anschutz Health and Wellness Center, 12348 E. Montview Blvd., MailStop C263, Aurora, CO 80045, USA
| | - Zhaoxing Pan
- Department of Pediatrics, University of Colorado Denver, Anschutz Medical Campus, 13123 E. 16th Ave., B065, Aurora, CO 80045, USA
| |
Collapse
|
4
|
Self-awareness of olfactory dysfunction in elderly individuals without neurodegenerative diseases. Eur Arch Otorhinolaryngol 2023; 280:473-478. [PMID: 36053357 PMCID: PMC9438353 DOI: 10.1007/s00405-022-07614-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/12/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE The decrease in smell in the elderly population is frequent and considered a natural process. However, sometimes it can be associated with the decline of cognitive functions, and it is considered a warning for the early stage of neurodegenerative diseases and social impairment. OBJECTIVE To assess the prevalence of olfactory dysfunction in previous healthy elderly that attended a tertiary hospital in Brazil as escorts and the clinical alterations associated in this population. METHODS Subjects 60 years or over attending the University Hospital of Campinas were evaluated. Each participant answered a questionnaire, followed by an otorhinolaryngological exam with flexible nasal endoscopy and the Connecticut smell test produced by the Connecticut Chemosensory Clinical Research Center (CCCRC). Elderly people with nasosinusal diseases or with a history of nasal surgery were excluded. RESULTS Of the total of 103 participants, 16 (15.5%) reported olfactory complaints and 68 (66%) presented impairment in the olfactory test. It was observed that older individuals showed more changes in olfactory function (p = 0.001). Gender, education, lifestyle, comorbidities, medications in use and exposure to pollutants did not influence the impairment olfactory function of this population. CONCLUSIONS There is a significant prevalence of olfactory dysfunction in the elderly population evaluated. Most of these elderlies also present an inability to identify odours, not having awareness of this olfactory impairment.
Collapse
|
5
|
Klarendic M, Zupanic E, Zalaznik M, Georgiev D, Tomazic J, Kojovic M. Olfactory evaluation in hospitalised and self-isolated patients with COVID-19: a single-centre experience on 55 cases. Postgrad Med J 2022; 98:902-905. [PMID: 34772796 PMCID: PMC8594974 DOI: 10.1136/postgradmedj-2021-140315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 10/08/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Smell loss is a common symptom of COVID-19 infection. Majority of the studies that evaluated olfactory impairment in COVID-19 used questionnaires (subjective smell evaluations) and did not compare the results with objective or semiobjective measures of smell. We performed smell testing in hospitalised and self-isolated patients with COVID-19 and control participants. METHODS Fifty-five COVID-19 and 44 control participants underwent smell testing, using Burghart Sniffin' Sticks 'Screening 12 Test'. Participants also rated their smelling capability on the numerical scale. Differences between groups and correlation between smell loss and time from acute onset of symptoms were tested, as well as correlation between results of smell test and subjective assessment of smell. RESULTS Hospitalised patients with COVID-19 correctly determined 6.5/12 odorants compared with 10/12 in the self-isolated and 11/12 in the control group (p<0.001). Hyposmia or anosmia were present in 87.5% of hospitalised and 29.0% of self-isolated patients (p<0.001). The correlation between subjective self-assessment and results of smell testing was non-significant in both groups of patients with COVID-19, while there was a moderate positive correlation (p=0.001, Spearman's correlation coefficient=0.499) in control participants. CONCLUSION Contrary to some previous reports suggesting that the presence of olfactory loss may predict milder course of disease, our study found that a vast majority of hospitalised patients with COVID-19 had prominent olfactory impairment. The absence of correlation between self-rated and objective smell evaluation in patients with COVID-19 indicates that subjective smell assessment is unreliable.
Collapse
Affiliation(s)
- Maja Klarendic
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Eva Zupanic
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mateja Zalaznik
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department for Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Dejan Georgiev
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Janez Tomazic
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department for Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maja Kojovic
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
6
|
Chemosensory Dysfunction in Long-Term COVID-19 Assessed by Self-Reported and Direct Psychophysical Methods. Life (Basel) 2022; 12:life12101487. [PMID: 36294922 PMCID: PMC9604579 DOI: 10.3390/life12101487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022] Open
Abstract
Chemosensory dysfunction is a frequent postacute sequela of COVID-19. Depending on the type of test used to measure it (self-report vs. direct test), the degree of chemosensory dysfunction in long-term COVID-19 has been found to be highly variable. In this manuscript, we report the cross-sectional data (first assessment) of a longitudinal study (6-month follow-up) examining smell, taste, and chemesthesis in participants affected by long-term COVID-19 (COVID+) and participants without COVID-19 (COVID−) by means of both self-reported and direct psychophysical methods. In total, 208 Italian participants (COVID+ n = 133; COVID− n = 75) completed the Smell and Taste Check developed by the Global Consortium for Chemosensory Research (GCCR), which includes self-reports on smell, taste, and chemesthetic abilities as well as direct intensity ratings of unstandardized smell, taste, and chemesthetic household items. Furthermore, all participants completed SCENTinel, a validated direct smell test. We found a positive association between the self-reported, unstandardized direct test and the validated direct test for smell, indicating moderate to large agreement across measures. Furthermore, the performance on SCENTinel was significantly associated with self-reported smell loss. A positive association between the self-reports and the intensity of household items was also retrieved for taste and chemesthesis. The time relative to COVID-19 onset (267.3 ± 113.9 days) did not modulate the chemosensory performance of self-reported abilities, intensity ratings, and SCENTinel. All in all, we confirm the impairment of three chemical senses (smell, taste, and chemesthesis) in an independent sample of Italian participants affected by long-term COVID-19 by using and comparing self-reported and direct psychophysical methods. We contribute to the discussion on best practices to monitor chemosensory dysfunction in individuals affected by long-term COVID-19.
Collapse
|
7
|
Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A, Appenzeller S, Costanzo RM, Croy I, Davis GE, Dehgani-Mobaraki P, Doty RL, Duffy VB, Goldstein BJ, Gudis DA, Haehner A, Higgins TS, Hopkins C, Huart C, Hummel T, Jitaroon K, Kern RC, Khanwalkar AR, Kobayashi M, Kondo K, Lane AP, Lechner M, Leopold DA, Levy JM, Marmura MJ, Mclelland L, Miwa T, Moberg PJ, Mueller CA, Nigwekar SU, O'Brien EK, Paunescu TG, Pellegrino R, Philpott C, Pinto JM, Reiter ER, Roalf DR, Rowan NR, Schlosser RJ, Schwob J, Seiden AM, Smith TL, Soler ZM, Sowerby L, Tan BK, Thamboo A, Wrobel B, Yan CH. International consensus statement on allergy and rhinology: Olfaction. Int Forum Allergy Rhinol 2022; 12:327-680. [PMID: 35373533 DOI: 10.1002/alr.22929] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). METHODS Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. RESULTS The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. CONCLUSION This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.
Collapse
Affiliation(s)
- Zara M Patel
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric H Holbrook
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Justin H Turner
- Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Nithin D Adappa
- Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark W Albers
- Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aytug Altundag
- Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey
| | - Simone Appenzeller
- Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Richard M Costanzo
- Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Ilona Croy
- Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany
| | - Greg E Davis
- Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA
| | - Puya Dehgani-Mobaraki
- Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Richard L Doty
- Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie B Duffy
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | | | - David A Gudis
- Otolaryngology, Columbia University Irving Medical Center, New York, USA
| | - Antje Haehner
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | - Thomas S Higgins
- Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Claire Hopkins
- Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK
| | - Caroline Huart
- Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | | | - Robert C Kern
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashoke R Khanwalkar
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Masayoshi Kobayashi
- Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kenji Kondo
- Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Andrew P Lane
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matt Lechner
- Otolaryngology, Barts Health and University College London, London, UK
| | - Donald A Leopold
- Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Joshua M Levy
- Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Marmura
- Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisha Mclelland
- Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Takaki Miwa
- Otolaryngology, Kanazawa Medical University, Ishikawa, Japan
| | - Paul J Moberg
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin K O'Brien
- Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Teodor G Paunescu
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Carl Philpott
- Otolaryngology, University of East Anglia, Norwich, UK
| | - Jayant M Pinto
- Otolaryngology, University of Chicago, Chicago, Illinois, USA
| | - Evan R Reiter
- Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David R Roalf
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas R Rowan
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Schlosser
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - James Schwob
- Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen M Seiden
- Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Timothy L Smith
- Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - Leigh Sowerby
- Otolaryngology, University of Western Ontario, London, Ontario, Canada
| | - Bruce K Tan
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Thamboo
- Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bozena Wrobel
- Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Carol H Yan
- Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA
| |
Collapse
|
8
|
Rawal S, Duffy VB, Berube L, Hayes JE, Kant AK, Li CM, Graubard BI, Hoffman HJ. Self-Reported Olfactory Dysfunction and Diet Quality: Findings from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). Nutrients 2021; 13:nu13124561. [PMID: 34960113 PMCID: PMC8704378 DOI: 10.3390/nu13124561] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 01/20/2023] Open
Abstract
We identified associations between self-reported olfactory dysfunction (OD) and dietary attributes in participants aged ≥40 years (n = 6,356) from the nationally representative 2011–2014 National Health and Nutrition Examination Survey (NHANES). The chemosensory questionnaire and 24-h dietary recalls were administered by trained interviewers. OD was defined as self-report of either smell problems in the last year, worse smell relative to age 25, or perceiving phantom odors. Dietary outcomes included Healthy Eating Index 2015 score (HEI) with adequacy and moderation components (higher scores indicated higher diet quality), dietary diversity, energy density, and intake of major food groups. Survey-weighted linear regression models estimated OD–diet associations, adjusting for socio-demographic, lifestyle, and clinical factors. Adjusted mean difference (95% CI) between those with versus without OD, showed that adults with OD had significantly lower HEI moderation score (−0.67 (−1.22, −0.11)) and diets higher in energy density (0.06 (0.00, 0.11)), and percent energy from saturated fat (0.47 (0.12, 0.81)), total fat (0.96 (0.22, 1.70)), and added sugar (1.00 (0.33, 1.66)). Age and sex-stratified analyses showed that younger females (40–64 years) primarily accounted for the associations with diet quality and total/saturated fat intake. These findings inform dietary screening and recommendations for adults who report OD, including those experiencing transient or persistent smell loss with COVID-19.
Collapse
Affiliation(s)
- Shristi Rawal
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, 65 Bergen Str., Newark, NJ 07107-1709, USA
- Correspondence:
| | - Valerie B. Duffy
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd., Storrs, CT 06269, USA;
| | - Lauren Berube
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA;
| | - John E. Hayes
- Sensory Evaluation Center, The Pennsylvania State University, 220 Erickson Food Science Building, University Park, PA 16802, USA;
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, 220 Erickson Food Science Building, University Park, PA 16802, USA
| | - Ashima K. Kant
- Department of Family, Nutrition, and Exercise Sciences, Queens College, City University of New York, Flushing, NY 11367, USA;
| | - Chuan-Ming Li
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders, National Institutes of Health (NIH), 10 Center Dr., Bethesda, MD 20892, USA; (C.-M.L.); (H.J.H.)
| | - Barry I. Graubard
- Division of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20894, USA;
| | - Howard J. Hoffman
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders, National Institutes of Health (NIH), 10 Center Dr., Bethesda, MD 20892, USA; (C.-M.L.); (H.J.H.)
| |
Collapse
|
9
|
Dan X, Wechter N, Gray S, Mohanty JG, Croteau DL, Bohr VA. Olfactory dysfunction in aging and neurodegenerative diseases. Ageing Res Rev 2021; 70:101416. [PMID: 34325072 PMCID: PMC8373788 DOI: 10.1016/j.arr.2021.101416] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 12/15/2022]
Abstract
Alterations in olfactory functions are proposed to be early biomarkers for neurodegeneration. Many neurodegenerative diseases are age-related, including two of the most common, Parkinson's disease (PD) and Alzheimer's disease (AD). The establishment of biomarkers that promote early risk identification is critical for the implementation of early treatment to postpone or avert pathological development. Olfactory dysfunction (OD) is seen in 90% of early-stage PD patients and 85% of patients with early-stage AD, which makes it an attractive biomarker for early diagnosis of these diseases. Here, we systematically review widely applied smelling tests available for humans as well as olfaction assessments performed in some animal models and the relationships between OD and normal aging, PD, AD, and other conditions. The utility of OD as a biomarker for neurodegenerative disease diagnosis and future research directions are also discussed.
Collapse
Affiliation(s)
- Xiuli Dan
- Section on DNA Repair, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Noah Wechter
- Section on DNA Repair, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Samuel Gray
- Section on DNA Repair, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Joy G Mohanty
- Section on DNA Repair, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Deborah L Croteau
- Section on DNA Repair, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Vilhelm A Bohr
- Section on DNA Repair, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA; Danish Center for Healthy Aging, University of Copenhagen, 2200 Copenhagen, Denmark.
| |
Collapse
|
10
|
Jang SS, Choi JS, Kim JH, Kim N, Ference EH. Discordance Between Subjective and Objective Measures of Smell and Taste in US Adults. Otolaryngol Head Neck Surg 2021; 166:572-579. [PMID: 34154442 DOI: 10.1177/01945998211018386] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Examine the rates and factors associated with under- and overreporting of subjective changes in smell or taste as compared with objective measures. STUDY DESIGN Cross-sectional analysis. SETTING National Health and Nutrition Examination Survey (2013-2014). METHODS We examined participants ≥40 years old who completed subjective questionnaires (smell, n = 3510; taste, n = 3089), validated objective 8-odor pocket smell tests, and NaCl/quinine taste tests. Over- and underreporting was determined by the difference in subjective and objective results. Univariate and multivariate logistic regression analyses incorporated sampling weights. RESULTS A majority of participants correctly classified impairment: smell (73.7%; 95% CI, 71.2%-76.1%) and taste (78.3%; 95% CI, 75.6%-80.7%). Age ≥65 years (odds ratio, 2.23; P = .001) was associated with underreporting impairment, and persistent cold symptoms (odds ratio, 2.15; P = .001) were associated with overreporting smell impairment. Smoke, onion, and natural gas scents were incorrectly identified more frequently by individuals aged ≥65 years after Bonferroni correction. No factors were associated with under- and overreporting taste impairment. CONCLUSION Although the concordance rate between subjective and objective assessment of smell and taste impairment remains high, we found that older age was associated with incorrect report of impairment. This suggests that the subjective perception of smell varies across demographical and clinical factors, and it is important to not overlook such factors in clinical practice. Potentially using a simplified odor assessment regularly in the clinical setting may aid in early detection and intervention.
Collapse
Affiliation(s)
- Sophie S Jang
- Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Janet S Choi
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - James H Kim
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Natalie Kim
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| |
Collapse
|
11
|
Olofsson JK. Olfaction and Aging: A Review of the Current State of Research and Future Directions. Iperception 2021; 12:20416695211020331. [PMID: 34249327 PMCID: PMC8239976 DOI: 10.1177/20416695211020331] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Olfaction, the sense of smell, is characterized by a notable age-dependency such that aging individuals are more likely to have poor olfactory abilities. These impairments are considered to be mostly irreversible and as having potentially profound effects on quality of life and food behavior, as well as constituting warning signs of mortality, cognitive dysfunction, and dementia. Here, we review the current state of research on aging and olfaction, focusing on five topics which we regard to be of particular relevance for the field: nutrition and health, cognition and dementia, mortality, environment and genetics, and training-based enhancement. Under each of these headlines, we provide a state-of-the-art overview and discuss gaps in our knowledge which might be filled by further research. Understanding how olfactory abilities are diminished in aging, and how they may be alleviated or recovered, involves a set of challenging tasks for researchers in the years to come.
Collapse
Affiliation(s)
- Jonas K. Olofsson
- Gösta Ekman Laboratory, Stockholm University, Stockholm, Sweden; Department of Psychology, Stockholm University, Stockholm, Sweden
| |
Collapse
|
12
|
Kim JH, Choi J, Jang SS, Wrobel BB, Ference EH. Smell and Taste Impairment in a Nationwide Sample of US Adults With Chronic Rhinosinusitis Symptoms. OTO Open 2021; 5:2473974X20986756. [PMID: 33598596 PMCID: PMC7863166 DOI: 10.1177/2473974x20986756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/12/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To estimate the prevalence of objectively confirmed olfactory and gustatory dysfunction in US adults reporting chronic rhinosinusitis (CRS) symptoms in a nationally representative database. Study Design Cross-sectional epidemiologic analysis. Setting Data were analyzed from the smell and taste component of the 2013-2014 NHANES data set (National Health and Nutrition Examination Survey). Methods Individuals reporting the presence of ≥2 cardinal CRS symptoms (nasal blockage, sinus pain, discolored mucus, and dysosmia) were identified as patients with a potential diagnosis of CRS. Associations were examined between the presence of CRS symptoms and both self-reported and objectively measured smell and taste. Results One-third (33%) of adults who have ≥2 CRS symptoms report subjective olfactory impairment, though only 18% of these adults have quantifiable olfactory dysfunction on objective testing. Of these adults, 27% report subjective taste impairment, but just 17% have quantifiable gustatory dysfunction on objective testing. The presence of ≥2 CRS symptoms was not significantly associated with objective olfactory or gustatory dysfunction, although the individual symptoms of subjective dysosmia and discolored mucus were associated with objectively confirmed olfactory dysfunction. Conclusion The prevalence of objective olfactory and gustatory dysfunction was higher among adults reporting the presence of ≥2 CRS symptoms, but the differences were not statistically significant. Specific sinonasal symptoms, including discolored mucus and subjective smell dysfunction, were significantly associated with objective smell impairment.
Collapse
Affiliation(s)
- James H Kim
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Janet Choi
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Sophie S Jang
- Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Bozena B Wrobel
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
13
|
Reed DR, Alhadeff AL, Beauchamp GK, Chaudhari N, Duffy VB, Dus M, Fontanini A, Glendinning JI, Green BG, Joseph PV, Kyriazis GA, Lyte M, Maruvada P, McGann JP, McLaughlin JT, Moran TH, Murphy C, Noble EE, Pepino MY, Pluznick JL, Rother KI, Saez E, Spector AC, Sternini C, Mattes RD. NIH Workshop Report: sensory nutrition and disease. Am J Clin Nutr 2021; 113:232-245. [PMID: 33300030 PMCID: PMC7779223 DOI: 10.1093/ajcn/nqaa302] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/30/2020] [Indexed: 12/13/2022] Open
Abstract
In November 2019, the NIH held the "Sensory Nutrition and Disease" workshop to challenge multidisciplinary researchers working at the interface of sensory science, food science, psychology, neuroscience, nutrition, and health sciences to explore how chemosensation influences dietary choice and health. This report summarizes deliberations of the workshop, as well as follow-up discussion in the wake of the current pandemic. Three topics were addressed: A) the need to optimize human chemosensory testing and assessment, B) the plasticity of chemosensory systems, and C) the interplay of chemosensory signals, cognitive signals, dietary intake, and metabolism. Several ways to advance sensory nutrition research emerged from the workshop: 1) refining methods to measure chemosensation in large cohort studies and validating measures that reflect perception of complex chemosensations relevant to dietary choice; 2) characterizing interindividual differences in chemosensory function and how they affect ingestive behaviors, health, and disease risk; 3) defining circuit-level organization and function that link and interact with gustatory, olfactory, homeostatic, visceral, and cognitive systems; and 4) discovering new ligands for chemosensory receptors (e.g., those produced by the microbiome) and cataloging cell types expressing these receptors. Several of these priorities were made more urgent by the current pandemic because infection with sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the ensuing coronavirus disease of 2019 has direct short- and perhaps long-term effects on flavor perception. There is increasing evidence of functional interactions between the chemosensory and nutritional sciences. Better characterization of this interface is expected to yield insights to promote health, mitigate disease risk, and guide nutrition policy.
Collapse
Affiliation(s)
| | - Amber L Alhadeff
- Monell Chemical Senses Center, Philadelphia, PA, USA
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Nirupa Chaudhari
- Department of Physiology and Biophysics, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
- Program in Neurosciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Valerie B Duffy
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Monica Dus
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Alfredo Fontanini
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, NY, USA
| | - John I Glendinning
- Department of Biology, Barnard College, Columbia University, New York, NY, USA
- Department of Neuroscience and Behavior, Barnard College, Columbia University, New York, NY, USA
| | - Barry G Green
- The John B Pierce Laboratory, New Haven, CT, USA
- Department of Surgery (Otolaryngology), Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Paule V Joseph
- National Institute of Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA
- National Institute of Nursing, NIH, Bethesda, MD, USA
| | - George A Kyriazis
- Department of Biological Chemistry and Pharmacology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Mark Lyte
- Interdepartmental Microbiology Graduate Program, Iowa State University, Ames, IA, USA
- Department of Veterinary Microbiology and Preventive Medicine, Iowa State University, Ames, IA, USA
| | - Padma Maruvada
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - John P McGann
- Behavioral and Systems Neuroscience, Department of Psychology, Rutgers University, Piscataway, NJ, USA
| | - John T McLaughlin
- Division of Diabetes, Endocrinology, & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
- Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Timothy H Moran
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claire Murphy
- Department of Psychology, San Diego State University, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Emily E Noble
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
| | - M Yanina Pepino
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jennifer L Pluznick
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kristina I Rother
- Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - Enrique Saez
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Alan C Spector
- Department of Psychology, Florida State University, Tallahassee, FL, USA
- Program in Neuroscience, Florida State University, Tallahassee, FL, USA
| | - Catia Sternini
- Digestive Disease Division, Departments of Medicine and Neurobiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Richard D Mattes
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| |
Collapse
|
14
|
Abstract
Age-related olfactory dysfunction, or presbyosmia, is a common sensory impairment in aging adults. People in this demographic group with comorbid conditions or exposure to viral, traumatic, or environmental insults remain at the greatest risk for impairment. Several methods for assessing olfaction exist, but they are only available in special settings and require consideration of age, sex, ancestry, and cognition. Perhaps most importantly, olfactory dysfunction has been suggested as an early sign of Alzheimer's and Parkinson's disease and therefore may serve as a tool in the diagnosis and prognosis of these neurodegenerative conditions. Outside of this context, olfactory loss also impacts nutrition, safety, and social relationships, and even predicts mortality itself. This review covers the detection and manifestations of olfactory decline in aging individuals and the myriad ways in which olfactory impairment is connected to their health and well-being.
Collapse
Affiliation(s)
- Emily J Papazian
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| |
Collapse
|
15
|
Mainland JD, Barlow LA, Munger SD, Millar SE, Vergara MN, Jiang P, Schwob JE, Goldstein BJ, Boye SE, Martens JR, Leopold DA, Bartoshuk LM, Doty RL, Hummel T, Pinto JM, Trimmer C, Kelly C, Pribitkin EA, Reed DR. Identifying Treatments for Taste and Smell Disorders: Gaps and Opportunities. Chem Senses 2020; 45:493-502. [PMID: 32556127 PMCID: PMC7545248 DOI: 10.1093/chemse/bjaa038] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The chemical senses of taste and smell play a vital role in conveying information about ourselves and our environment. Tastes and smells can warn against danger and also contribute to the daily enjoyment of food, friends and family, and our surroundings. Over 12% of the US population is estimated to experience taste and smell (chemosensory) dysfunction. Yet, despite this high prevalence, long-term, effective treatments for these disorders have been largely elusive. Clinical successes in other sensory systems, including hearing and vision, have led to new hope for developments in the treatment of chemosensory disorders. To accelerate cures, we convened the "Identifying Treatments for Taste and Smell Disorders" conference, bringing together basic and translational sensory scientists, health care professionals, and patients to identify gaps in our current understanding of chemosensory dysfunction and next steps in a broad-based research strategy. Their suggestions for high-yield next steps were focused in 3 areas: increasing awareness and research capacity (e.g., patient advocacy), developing and enhancing clinical measures of taste and smell, and supporting new avenues of research into cellular and therapeutic approaches (e.g., developing human chemosensory cell lines, stem cells, and gene therapy approaches). These long-term strategies led to specific suggestions for immediate research priorities that focus on expanding our understanding of specific responses of chemosensory cells and developing valuable assays to identify and document cell development, regeneration, and function. Addressing these high-priority areas should accelerate the development of novel and effective treatments for taste and smell disorders.
Collapse
Affiliation(s)
| | - Linda A Barlow
- Department of Cell & Developmental Biology, Rocky Mountain Taste and Smell Center, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Steven D Munger
- Center for Smell and Taste, Department of Pharmacology and Therapeutics, 1200 Newell Drive, University of Florida, Gainesville, FL, USA
| | - Sarah E Millar
- Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Natalia Vergara
- Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Peihua Jiang
- Monell Chemical Senses Center, Philadelphia, PA, USA
| | - James E Schwob
- Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, MA, USA
| | - Bradley J Goldstein
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, 40 Duke Medicine Cir Clinic 1F, Durham, NC, USA
| | - Shannon E Boye
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jeffrey R Martens
- Center for Smell and Taste, Department of Pharmacology and Therapeutics, 1200 Newell Drive, University of Florida, Gainesville, FL, USA
| | - Donald A Leopold
- Division of Otolaryngology Head and Neck Surgery, University of Vermont Medical Center, Burlington, VT, USA
| | - Linda M Bartoshuk
- Department of Food Science and Human Nutrition, Center for Smell and Taste, University of Florida, Gainesville, FL, USA
| | - Richard L Doty
- Smell and Taste Center and Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, 3400 Spruce Street, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas Hummel
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technische Universität Dresden, Fetscherstrasse, Dresden, Germany
| | - Jayant M Pinto
- Section of Otolaryngology—Head and Neck Surgery, Department of Surgery, The University of Chicago, MC, Chicago, IL, USA
| | | | | | - Edmund A Pribitkin
- Department of Otolaryngology—Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | |
Collapse
|
16
|
Glennon SG, Huedo-Medina T, Rawal S, Hoffman HJ, Litt MD, Duffy VB. Chronic Cigarette Smoking Associates Directly and Indirectly with Self-Reported Olfactory Alterations: Analysis of the 2011-2014 National Health and Nutrition Examination Survey. Nicotine Tob Res 2020; 21:818-827. [PMID: 29121272 DOI: 10.1093/ntr/ntx242] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/07/2017] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Population-based studies show inconsistent effects of cigarette smoking on olfactory function. We aimed to identify direct and indirect associations between measures of smoking exposure/nicotine dependence and altered olfaction in a nationally representative sample of adults. METHODS NHANES 2011-2014 (n = 7418) participants (mean age = 57.8 ± 12.2 years) self-reported olfaction and related health and demographic risks. Affirmative answers to three questions defined altered olfaction (olfactory problems in the past years; worse ability since age 25; phantom smells). Smoking (never, former, current) was self-reported by chronicity (pack years, PY) and dependency (time to first cigarette upon waking) and verified by serum cotinine. Associations were tested with logistic regression, reporting odds ratios (ORs) and 95% confidence intervals (CIs), and mediation models. RESULTS Estimated prevalence of altered olfaction was 22.3%, with age-related increases. Nearly half of the sample were former/current smokers (47.4%). Controlling for olfactory-related risks, ≥10 PY smokers had significantly greater odds of altered olfaction versus never smokers (OR 1.36, CI: 1.06-1.74). The odds of altered olfaction were heightened among current smokers (≥10 PY) who also had high nicotine dependence (smoked ≤30 min of waking) (OR 1.41, CI: 1.01-1.99). Light smokers (≤10 PY smokers) did not show increased odds versus never smokers. Current smokers who also were heavy drinkers (≥4 drinks/day) had the highest odds for altered olfaction (OR 1.96, CI: 1.20-3.19). Olfactory-related pathologies (sinonasal problems, serious head injury, tonsillectomy, xerostomia) partially mediated the association between smoking and altered olfaction. CONCLUSIONS Chronic cigarette smoking was associated with increased odds of self-reported olfactory alterations, directly and indirectly via olfactory-related pathologies. IMPLICATIONS Analysis of the US nationally representative data revealed significant positive associations between chronic smoking and alterations in the sense of smell. Rates of smell alteration (self-reported problems in the past year, losses with aging, and phantom smells) increased from 23% among adults to 33% for chronic smokers and 38% for chronic smokers who also reported heavy drinking. Chronic smoking showed associations with smell alteration that were direct and indirect through exposure to olfactory-related pathologies (naso-sinus problems, dry mouth, head/facial injury). Smell alteration can impact smokers' quality of life by challenging the ability to sense warning odors, food flavor, and olfactory-stimulated emotions and memories.
Collapse
Affiliation(s)
| | - Tania Huedo-Medina
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT
| | - Shristi Rawal
- Department of Nutritional Sciences, School of Health Professions, Rutgers University, Newark, NJ
| | - Howard J Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD
| | - Mark D Litt
- Department of Behavioral Sciences and Community Health, University of Connecticut School of Medicine, Farmington, CT
| | - Valerie B Duffy
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT
| |
Collapse
|
17
|
Influences of Age, Sex and Smoking Habit on Flavor Recognition in Healthy Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030959. [PMID: 32033174 PMCID: PMC7036887 DOI: 10.3390/ijerph17030959] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 12/20/2022]
Abstract
(1) Background: Flavor is one of the main factors influencing food preferences and dietary choices, and a reduction in flavor recognition has been associated with several diseases. A novel quantitative test to assess flavor has been recently developed and validated. The aim of the present work was to define the standard of flavor recognition in the general healthy population. (2) Methods: Three hundred and forty-eight healthy volunteers (18–80 years) performed the flavor test (FT). The test consisted of the oral administration of aqueous aromatic solutions, identifying 21 different compounds. Flavor score (FS) was calculated as the sum of the properly recognized flavors (range 0–21). (3) Results: Normal ranges for FT were produced. Flavor recognition was found to decrease with age. Females obtained slightly higher scores than males, mostly at older ages. Cigarette smoking seemed not to influence flavor recognition. (4) Conclusion: The normal values found for the flavor test in the healthy population will allow its usage as a diagnostic tool in several diseases.
Collapse
|
18
|
Gallo S, Byham-Gray L, Duffy VB, Hoffman HJ, Hayes JE, Rawal S. Associations of olfactory dysfunction with anthropometric and cardiometabolic measures: Findings from the 2013-2014 national health and nutrition examination survey (NHANES). Physiol Behav 2019; 215:112702. [PMID: 31629766 DOI: 10.1016/j.physbeh.2019.112702] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/04/2019] [Accepted: 10/06/2019] [Indexed: 12/14/2022]
Abstract
We examined associations of olfactory dysfunction with anthropometric and cardiometabolic measures in a nationally representative sample of US adults. In the 2013-2014 National Health and Nutrition Examination Survey (NHANES), 3,815 participants, 40 years and older, completed a standardized taste and smell protocol, which consisted of an 8-item odor identification test and a chemosensory questionnaire. Measured dysfunction was incorrect identification of ≥3 of 8 odors; self-reported dysfunction was affirmative response to either a recent smell problem, worse ability since age 25, or phantosmia. Survey-weighted linear regression models tested associations of olfactory dysfunction with body mass index (BMI), waist circumference (WC), blood pressure, serum total cholesterol (TC) with fractions, triglycerides, and glucose levels. Models were adjusted for age, race, education, physical activity, self-reported general health condition, smoking history, and income-to-poverty ratio, stratifying by sex and age group (middle-age 40-64 years; older ≥65 years). Relative to normal, measured olfactory dysfunction was associated with lower BMI [β=-1.6 (95% CI: -3.2, -0.01)] in older men. In middle-age women, dysfunction was associated with higher BMI and WC, whether assessed by examination [β's for BMI=3.1 (0.6, 5.5), WC=5.0 (0.3, 9.8)] or self-report [β's for BMI=2.5 (0.6, 4.3), WC=6.1 (2.2, 9.9)]. Measured dysfunction was associated with significantly higher TC [β=12.8 (7.5, 18.1)] and LDL [β=18.1 (9.1, 27.2)] among older men, but significantly lower TC [β=-15.0 (-25.0, -5.7)] and marginally lower LDL [β=-12.0 (-25.0, 1.2)] among older women. Between measured dysfunction and fasting glucose, the association was inverse [β=-7.9 (-13.0, -2.6)] among middle-age men, but positive [β=15.6 (1.5, 29.7)] among older women. No significant associations were observed with blood pressure levels. In conclusion, among US adults ≥40 years, olfactory dysfunction is associated with anthropometric and glucose and lipid levels, with associations varying by sex and age group.
Collapse
Affiliation(s)
- Samantha Gallo
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, 65 Bergen St., Newark, NJ 07107-1709 USA.
| | - Laura Byham-Gray
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, 65 Bergen St., Newark, NJ 07107-1709 USA.
| | - Valerie B Duffy
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Storrs, CT 06269, USA.
| | - Howard J Hoffman
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders, National Institutes of Health (NIH), 10 Center Dr., Bethesda, MD 20892, USA.
| | - John E Hayes
- Sensory Evaluation Center, The Pennsylvania State University, 220 Erickson Food Science Building, University Park, PA 16802, USA; Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, 220 Erickson Food Science Building, University Park, PA 16802, USA.
| | - Shristi Rawal
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, 65 Bergen St., Newark, NJ 07107-1709 USA.
| |
Collapse
|
19
|
Shrestha S, Kamel F, Umbach DM, Freeman LEB, Koutros S, Alavanja M, Blair A, Sandler DP, Chen H. High Pesticide Exposure Events and Olfactory Impairment among U.S. Farmers. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:17005. [PMID: 30648881 PMCID: PMC6378679 DOI: 10.1289/ehp3713] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Olfactory impairment (OI) is common among older adults and independently predicts all-cause mortality and the risk of several major neurodegenerative diseases. Pesticide exposure may impair olfaction, but empirical evidence is lacking. OBJECTIVE We aimed to examine high pesticide exposure events (HPEEs) in relation to self-reported OI in participants in the Agricultural Health Study (AHS). METHODS We conducted multivariable logistic regression to examine the associations between HPEEs reported at enrollment (1993–1997) and self-reported OI at the latest AHS follow-up (2013–2015) among 11,232 farmers, using farmers without HPEEs as the reference or unexposed group. RESULTS A total of 1,186 (10.6%) farmers reported OI. A history of HPEEs reported at enrollment was associated with a higher likelihood of reporting OI two decades later {odds ratio [Formula: see text] [95% confidence interval (CI): 1.28, 1.73]}. In the analyses on the HPEE involving the highest exposure, the association appears to be stronger when there was a [Formula: see text] delay between HPEE and washing with soap and water [e.g., [Formula: see text] (95% CI: 1.48, 2.89) for 4-6 h vs. [Formula: see text] (95% CI: 1.11, 1.75) for [Formula: see text]]. Further, significant associations were observed both for HPEEs involving the respiratory or digestive tract [[Formula: see text] (95% CI: 1.22, 1.92)] and dermal contact [[Formula: see text] (95% CI: 1.22, 1.78)]. Finally, we found significant associations with several specific pesticides involved in the highest exposed HPEEs, including two organochlorine insecticides (DDT and lindane) and four herbicides (alachlor, metolachlor, 2,4-D, and pendimethalin). HPEEs that occurred after enrollment were also associated with OI development. CONCLUSIONS HPEEs may cause long-lasting olfactory deficit. Future studies should confirm these findings with objectively assessed OI and also investigate potential mechanisms. https://doi.org/10.1289/EHP3713.
Collapse
Affiliation(s)
- Srishti Shrestha
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, North Carolina, USA
| | - Freya Kamel
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, North Carolina, USA
| | - David M Umbach
- Biostatistics and Computational Biology Branch, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, USA
| | - Laura E Beane Freeman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, Maryland, USA
| | - Stella Koutros
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, Maryland, USA
| | - Michael Alavanja
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, Maryland, USA
| | - Aaron Blair
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, Maryland, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, North Carolina, USA
| | - Honglei Chen
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, North Carolina, USA
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| |
Collapse
|
20
|
Heightened olfactory dysfunction and oral irritation among chronic smokers and heightened propylthiouracil (PROP) bitterness among menthol smokers. Physiol Behav 2018; 201:111-122. [PMID: 30557565 DOI: 10.1016/j.physbeh.2018.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/05/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022]
Abstract
Chronic cigarette smoking may influence chemosensory function, which in turn, may affect cigarette usage. Because menthol in cigarettes can attenuate nicotine bitterness, choice of menthol/nonmenthol cigarettes may be influenced by ability to perceive bitterness. We examined chemosensory function of chronic smokers, hypothesizing they would show altered function in comparison to non-smokers and by menthol cigarette preference. In laboratory-based measures, chronic smokers (N = 135; 84 menthol smokers) self-reported their chemosensory function and participated in smell (identification task with perceived intensity) and taste (quinine and NaCl intensity on tongue-tip and whole mouth) testing. A taste genetics probe (propylthiouracil (PROP) bitterness) also was assessed. Self-reported and measured chemosensory function were compared with nationally-representative 2013-2014 National Health and Nutrition Examination Survey (NHANES) data generated with similar measures. The taste measures also were compared between smokers and age- and sex-matched non-smokers from a laboratory database. Frequencies of self-reported smell and taste alterations among smokers exceeded NHANES prevalence estimates for non-smokers. The rate of measured smell dysfunction also exceeded NHANES prevalence for hyposmia. Compared to non-smokers, smokers reported elevated tongue-tip and whole mouth intensities from 1 M NaCl, with no significant differences in whole mouth quinine or 0.32 M NaCl. Inconsistent with previous hypotheses, smokers were not more likely to report depressed PROP bitterness than non-smokers. However, as expected, menthol smokers reported greater PROP bitterness than non-menthol smokers. In conclusion, chemosensory alterations were more frequent among chronic smokers, including hyposmia and heightened intensity from NaCl at an oral-irritant concentration. PROP supertasters were most likely to prefer mentholated cigarettes.
Collapse
|
21
|
Adams DR, Wroblewski KE, Kern DW, Kozloski MJ, Dale W, McClintock MK, Pinto JM. Factors Associated with Inaccurate Self-Reporting of Olfactory Dysfunction in Older US Adults. Chem Senses 2017; 42:223-231. [PMID: 28007787 DOI: 10.1093/chemse/bjw108] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Self-reported olfactory function has poor sensitivity (i.e., people with measured olfactory dysfunction are unlikely to accurately report it). We aimed to identify factors associated with lack of awareness of smell dysfunction. Objective odor identification was evaluated using a validated 5-item test in respondents from the National Social Life, Health, and Aging Project, a representative sample of home-dwelling, US adults ages 57-85 (n = 1468). Self-reported olfaction was assessed with a 5-point Likert scale. Using multivariate logistic regression, we tested factors that might influence inaccuracy of self-reported olfaction, including age, gender, race/ethnicity, education, marital status, cognition, comorbidity, smoking, depression, anxiety, self-rated mental and physical health, and social activity. Among older US adults, 12.4% reported their sense of smell as fair or poor, while 22.0% had objective olfactory dysfunction (≤3 items correct out of 5). Among those with measured olfactory dysfunction, 74.2% did not recognize it; these individuals were more likely to be older, Black, never married, and to have worse cognitive function compared to individuals who recognized their dysfunction (P < 0.05, all). Individuals who lacked awareness of their olfactory dysfunction had the greatest cognitive impairment at 5-year follow-up, followed by individuals aware of their dysfunction and finally normosmics (P < 0.001). Older Americans with measured olfactory dysfunction are unlikely to report it, and those who lack awareness of this dysfunction have distinct demographic, social, and cognitive characteristics. Therefore, clinicians should objectively test patients. Individuals who lack awareness of their olfactory dysfunction have poor cognitive outcomes and should receive additional clinical scrutiny.
Collapse
Affiliation(s)
- Dara R Adams
- Pritzker School of Medicine, The University of Chicago, 924 E 57th St, Chicago, IL 60637, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - David W Kern
- Department of Psychology, Northeastern Illinois University, 5500 North St. Louis Avenue, Chicago, IL 60625, USA
| | - Michael J Kozloski
- National Opinion Research Center, 1155 East 60th Street, 3rd Floor, Chicago, IL 60637, USA
| | - William Dale
- Section of Geriatrics and Palliative Medicine, Department of Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Martha K McClintock
- Department of Comparative Human Development and the Institute for Mind and Biology, The University of Chicago, 5736 South Woodlawn Avenue #102, Chicago, IL 60637, USA and
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| |
Collapse
|
22
|
Murphy C, Vertrees R. Sensory Functioning in Older Adults: Relevance for Food Preference. Curr Opin Food Sci 2017; 15:56-60. [PMID: 30555793 DOI: 10.1016/j.cofs.2017.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The world's population is aging and older adults represent the fastest growing segment of the consumer market. Changes in sensory, perceptual and cognitive function in this segment of the population have been described psychophysically, however, more is known about the young-old than the old-old or oldest-old. Only now are we exploring the potential for neuroimaging tools to probe the changes in central nervous system function related to taste and smell that are relevant to sensory perception, reward value, anticipation of and consumption of food stimuli. There is real potential for brain imaging to provide a greater understanding of older adults' consumer behavior.
Collapse
Affiliation(s)
- Claire Murphy
- San Diego State University, San Diego, CA 92120-4913.,SDSU/UCSD Joint Doctoral Program, San Diego, CA 92120-4913
| | | |
Collapse
|
23
|
Savage SA, Butler CR, Milton F, Han Y, Zeman AZ. On the nose: Olfactory disturbances in patients with transient epileptic amnesia. Epilepsy Behav 2017; 66:113-119. [PMID: 28038387 PMCID: PMC6197428 DOI: 10.1016/j.yebeh.2016.09.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE While olfactory hallucinations are relatively rare in epilepsy, a high prevalence (up to 42%) has been reported in one form - Transient Epileptic Amnesia (TEA). TEA is characterized by recurring amnestic seizures and is commonly associated with persistent interictal memory deficits. Despite reports of changes in smell, olfactory ability has not been objectively assessed in this group. The aim of this study was to measure olfactory ability in patients with TEA and explore whether olfactory symptoms relate to other clinical variables. METHODS Fifty-five participants with TEA were recruited from The Impairment of Memory in Epilepsy project database. The presence of olfactory symptoms was obtained via case notes and clinical interview. Participants completed questionnaires to evaluate their olfaction and memory function subjectively. Olfactory ability was measured using the University of Pennsylvania Smell Identification Test (UPSIT). TEA participants' performance was compared to 50 matched healthy control participants. A subset of TEA participants (n=26) also completed a battery of memory tests including standard neuropsychological measures, and assessment of accelerated long-term forgetting and autobiographical memory. RESULTS Olfactory hallucinations were reported in 55% of patients with TEA. A significant reduction in smell identification (UPSIT) was found between patients with TEA and healthy controls (p<0.001). Epilepsy variables, including history of olfactory hallucinations, were not predictive of olfactory ability. Patients reported ongoing memory difficulties and performed below normative values on objective tests. While no correlation was found between objective measures of memory and olfactory performance, subjective complaints of route finding difficulty was associated with UPSIT score. CONCLUSIONS Impairments in odor identification are common in patients with TEA and exceed changes that occur in normal aging. Olfactory hallucinations occurs in approximately half of patients with TEA, but do not always coincide with reduced sense of smell. Olfactory impairment and interictal memory problems both occur frequently in TEA but are not closely associated.
Collapse
Affiliation(s)
- Sharon A. Savage
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke’s Campus, Exeter, EX1 2LU, UK,corresponding author:
| | - Christopher R. Butler
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, John Radcliffe Hospital, OX3 9DU, UK
| | - Fraser Milton
- Discipline of Psychology, University of Exeter, Washington Singer Laboratories, Exeter, EX4 4QG, UK
| | - Yang Han
- Health Statistics, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU, UK
| | - Adam Z. Zeman
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke’s Campus, Exeter, EX1 2LU, UK
| |
Collapse
|
24
|
Ajmani GS, Suh HH, Pinto JM. Effects of Ambient Air Pollution Exposure on Olfaction: A Review. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:1683-1693. [PMID: 27285588 PMCID: PMC5089874 DOI: 10.1289/ehp136] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 02/25/2016] [Accepted: 05/20/2016] [Indexed: 05/03/2023]
Abstract
BACKGROUND Olfactory dysfunction affects millions of people worldwide. This sensory impairment is associated with neurodegenerative disease and significantly decreased quality of life. Exposure to airborne pollutants has been implicated in olfactory decline, likely due to the anatomic susceptibility of the olfactory nerve to the environment. Historically, studies have focused on occupational exposures, but more recent studies have considered effects from exposure to ambient air pollutants. OBJECTIVES To examine all relevant human data evaluating a link between ambient pollution exposure and olfaction and to review supporting animal data in order to examine potential mechanisms for pollution-associated olfactory loss. METHODS We identified and reviewed relevant articles from 1950 to 2015 using PubMed and Web of Science and focusing on human epidemiologic and pathophysiologic studies. Animal studies were included only to support pertinent data on humans. We reviewed findings from these studies evaluating a relationship between environmental pollutant exposure and olfactory function. RESULTS We identified and reviewed 17 articles, with 1 additional article added from a bibliography search, for a total of 18 human studies. There is evidence in human epidemiologic and pathologic studies that increased exposure to ambient air pollutants is associated with olfactory dysfunction. However, most studies have used proxies for pollution exposure in small samples of convenience. Human pathologic studies, with supporting animal work, have also shown that air pollution can contact the olfactory epithelium, translocate to the olfactory bulb, and migrate to the olfactory cortex. Pollutants can deposit at each location, causing direct damage and disruption of tissue morphology or inducing local inflammation and cellular stress responses. CONCLUSIONS Ambient air pollution may impact human olfactory function. Additional studies are needed to examine air pollution-related olfactory impacts on the general population using measured pollution exposures and to link pollution exposure with olfactory dysfunction and related pathology. Citation: Ajmani GS, Suh HH, Pinto JM. 2016. Effects of ambient air pollution exposure on olfaction: a review. Environ Health Perspect 124:1683-1693; http://dx.doi.org/10.1289/EHP136.
Collapse
Affiliation(s)
- Gaurav S. Ajmani
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Helen H. Suh
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Jayant M. Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
- Address correspondence to J.M. Pinto, Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago Medicine and Biological Sciences, MC103, 5841 South Maryland Ave., Chicago, IL 60647 USA. Telephone: (773) 702-6727. E-mail:
| |
Collapse
|
25
|
Pusswald G, Tropper E, Kryspin-Exner I, Moser D, Klug S, Auff E, Dal-Bianco P, Lehrner J. Health-Related Quality of Life in Patients with Subjective Cognitive Decline and Mild Cognitive Impairment and its Relation to Activities of Daily Living. J Alzheimers Dis 2016; 47:479-86. [PMID: 26401569 DOI: 10.3233/jad-150284] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Health related quality of life (HRQOL) is an important issue in the context of dementia care. OBJECTIVES The purpose of this study was to investigate HRQOL in patients with subjective cognitive decline (SCD) and mild cognitive impairment (MCI) and its relation to Activity of Daily Living (ADL). METHODS In this cross sectional study, four experimental groups (each n = 98), controls, SCD, naMCI and aMCI, were compared. For data collection, neuropsychological methods (NTBV) and psychological questionnaires (SF-36 and B-ADL) were used. Multivariate analysis of variance was calculated to detect differences in HRQOL between groups. Correlations between HRQOL and ADL were explored. RESULTS The dimensions of HRQOL showed mainly consistent differences between the control and the SCD group and MCI subgroups. In almost every dimension of HRQOL, the control group scored higher than subjects with SCD, naMCI, or aMCI. The controls showed low to moderate negative correlations between HQROL and B-ADL in some dimensions of the HRQOL. In the SCD group, low negative correlations with ADL were observed in some HRQOL scales. Low to moderate correlations were found between each scale of the SF-36 and the B-ADL in both MCI subtypes. We found gender differences in HRQOL. CONCLUSION In conclusion, we could demonstrate that patients with SCD report reduced quality of life. This knowledge is important to get a better understanding of the individuals with SCD and may pave the way for the development of early intervention.
Collapse
Affiliation(s)
- Gisela Pusswald
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Elisa Tropper
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Doris Moser
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stefanie Klug
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Eduard Auff
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Johann Lehrner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
26
|
Hoffman HJ, Rawal S, Li CM, Duffy VB. New chemosensory component in the U.S. National Health and Nutrition Examination Survey (NHANES): first-year results for measured olfactory dysfunction. Rev Endocr Metab Disord 2016; 17:221-40. [PMID: 27287364 PMCID: PMC5033684 DOI: 10.1007/s11154-016-9364-1] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
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.
Collapse
Affiliation(s)
- Howard J Hoffman
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and other Communication Disorders (NIDCD) at the National Institutes of Health (NIH), Bethesda, MD, USA
| | - Shristi Rawal
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Rockville, MD, USA
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269, USA
| | - Chuan-Ming Li
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and other Communication Disorders (NIDCD) at the National Institutes of Health (NIH), Bethesda, MD, USA
| | - Valerie B Duffy
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269, USA.
| |
Collapse
|
27
|
Abstract
Insights into risk factors for olfactory decline are needed, because knowledge about its origin is limited. This impairment has important implications for human health. Several epidemiologic studies of olfaction provide insight into the prevalence of olfactory disorders. Here, we review the major population studies carried out on this topic to date. Our purpose is to characterize knowledge about olfactory disorders from human studies. We also describe the existing methods for measuring the sense of smell in population studies, present recent insights into the epidemiology of smell disorders, and discuss the risk factors identified to date. Synthesis of these data shows that olfactory dysfunction increases as people age and is worse in men. Further study of olfaction is warranted for gaining better information on the etiologies affecting its impairment, research that will have a large public health impact.
Collapse
Affiliation(s)
- Jingpu Yang
- Department of Otolaryngology-Head and Neck Surgery, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, Jilin Province, 130041, China
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago Medicine and Biological Sciences, 5841 South Maryland Avenue, MC1035, Chicago, IL 60637
| |
Collapse
|
28
|
Rawal S, Hoffman HJ, Bainbridge KE, Huedo-Medina TB, Duffy VB. Prevalence and Risk Factors of Self-Reported Smell and Taste Alterations: Results from the 2011-2012 US National Health and Nutrition Examination Survey (NHANES). Chem Senses 2015; 41:69-76. [PMID: 26487703 DOI: 10.1093/chemse/bjv057] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Chemosensory problems challenge health through diminished ability to detect warning odors, consume a healthy diet, and maintain quality of life. We examined the prevalence and associated risk factors of self-reported chemosensory alterations in 3603 community-dwelling adults (aged 40+ years), from the nationally representative, US National Health and Nutrition Examination Survey (NHANES) 2011-2012. In this new NHANES component, technicians surveyed adults in the home about perceived smell and taste problems, distortions, and diminished abilities since age 25 (termed "alterations"), and chemosensory-related health risks and behaviors. The prevalence of self-reported smell alteration was 23%, including phantosmia at 6%; taste was 19%, including dysgeusia at 5%. Prevalence rates increased progressively with age, highest in those aged 80+ years (smell, 32%; taste, 27%). In multivariable logistic regression, controlling for sociodemographics, health behaviors, and chemosensory-related conditions, the strongest independent risk factor for smell alteration was sinonasal symptoms (odds ratio [OR] = 2.06; 95% confidence interval [CI]: 1.63-2.61), followed by heavy drinking, loss of consciousness from head injury, family income ≤110% poverty threshold, and xerostomia. For taste, the strongest risk factor was xerostomia (OR = 2.65; 95% CI: 1.97-3.56), followed by nose/facial injury, lower educational attainment, and fair/poor health. Self-reported chemosensory alterations are prevalent in US adults, supporting increased attention to decreasing their modifiable risks, managing safety/health consequences, and expanding chemosensory screening/testing and treatments.
Collapse
Affiliation(s)
- Shristi Rawal
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA and
| | - Howard J Hoffman
- Epidemiology & Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Kathleen E Bainbridge
- Epidemiology & Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Tania B Huedo-Medina
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA and
| | - Valerie B Duffy
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA and
| |
Collapse
|
29
|
Rawal S, Hoffman HJ, Honda M, Huedo-Medin TB, Duffy VB. The Taste and Smell Protocol in the 2011-2014 US National Health and Nutrition Examination Survey (NHANES): Test-Retest Reliability and Validity Testing. CHEMOSENS PERCEPT 2015; 8:138-148. [PMID: 27833669 DOI: 10.1007/s12078-015-9194-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The US NHANES 2011-2014 protocol includes a taste and smell questionnaire (CSQ) in home-based interviews and brief assessments in mobile exam centers. We report the short- and longer-term test-retest reliability and validity of this protocol against broader chemosensory measures. METHODS A convenience sample of 73 adults (age=39.5±20.8 years) underwent the NHANES protocol at baseline, 2 weeks and 6 months. For taste, participants rated intensities of two tastants (1 M NaCl, 1 mM quinine) applied to the tongue tip and three tastants (1 M NaCl, 1 mM quinine, 0.32 M NaCl) sampled with the whole mouth. Smell function was assessed with a Pocket Smell Test™ (PST; eight-item odor identification test). The CSQ asked about chemosensory problems, distortions, and age-related changes. Broader baseline measurements were a 40-item olfactometer-generated identification task and additional whole-mouth taste intensities (1 M sucrose, 32 mM citric acid, 3.2 mM propylthiouracil). RESULTS Intraclass correlations (ICCs) for NHANES taste measures showed moderate-to-good agreement after 2 weeks and 6 months (ICCs 0.42-0.71). Whole-mouth quinine intensity was significantly correlated with other taste intensities, supporting its utility as a marker for overall taste functioning. Olfactory classification from PSTs agreed for 98.5 % of participants across 2 weeks (κ=0.85; 95 % CI 0.71-0.99) and had good correspondence with the olfactometer task. CSQ items showed good-to-excellent agreement over 6 months (ICCs 0.66-0.90). CONCLUSIONS These findings further support that the NHANES chemosensory protocol has moderate-to-good test-retest reliability when administered to healthy, educated adults. Despite being a brief procedure with limited measures, the NHANES taste and smell assessments provided good information when compared to broader measures of taste and smell function.
Collapse
Affiliation(s)
- Shristi Rawal
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT 06269, USA
| | - Howard J Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Mallory Honda
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT 06269, USA
| | - Tania B Huedo-Medin
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT 06269, USA
| | - Valerie B Duffy
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT 06269, USA
| |
Collapse
|