无过去一年症状报告的实测嗅觉功能障碍：美国成年人中的患病率及营养相关因素

文献信息

中文摘要

目的： 描述实测嗅觉功能与过去一年症状报告之间的不一致，并探讨无此类报告的实测功能障碍的营养相关因素。
方法： 本横断面分析使用NHANES 2013-2014年40岁及以上成年人数据。实测功能障碍定义为八项气味识别测试中正确回答≤5项。采用调查加权模型比较无过去一年症状报告的功能障碍者与评分正常者。主要结局为第1天健康饮食指数-2015（HEI-2015）。采用美国国家癌症研究所模型估计习惯性蛋白质摄入量；六项次要比较经错误发现率校正。审稿后敏感性分析评估认知、鼻窦鼻腔因素、损害严重程度及实测人体测量学指标。
结果： 在3,515名参与者中，531人存在无症状报告的实测功能障碍（加权患病率10.9%；95%置信区间[CI]，8.8%-13.0%）。在功能障碍参与者中，80.5%报告过去一年无问题，相当于症状问题的敏感性为19.5%（95% CI，14.9%-24.1%）。在2,599例完整病例中，校正后HEI-2015差异为-0.09分（95% CI，-2.37至2.20；P=.937）。无原始次要比较达到错误发现率阈值（最小q=0.096）。额外分析未确立一致的营养缺乏。
结论： 实测嗅觉功能障碍常无过去一年症状报告，尽管未报告并不等同于无觉察。该表型在第1天HEI-2015上未见明显差异；蛋白质发现仍属探索性。其临床相关性需通过前瞻性评估及全面嗅觉和营养测量加以确定。

英文摘要

PURPOSE: To characterize discordance between measured olfactory function and past-year symptom reporting and examine nutritional correlates of measured dysfunction without such reporting.
METHODS: This cross-sectional analysis used NHANES 2013-2014 data from adults aged ≥ 40 years. Measured dysfunction was defined as ≤ 5 correct responses on an eight-item odor-identification test. Survey-weighted models compared participants with dysfunction versus normal scores, both without past-year symptom reporting. The primary outcome was day-1 Healthy Eating Index-2015 (HEI-2015). A National Cancer Institute model estimated usual protein intake; six secondary comparisons underwent false-discovery-rate correction. Post-review sensitivity analyses assessed cognition, sinonasal factors, impairment severity and measured anthropometry.
RESULTS: Among 3,515 participants, 531 had measured dysfunction without symptom reporting (weighted prevalence, 10.9%; 95% confidence interval [CI], 8.8%-13.0%). Among participants with dysfunction, 80.5% reported no past-year problem, equivalent to symptom-question sensitivity of 19.5% (95% CI, 14.9%-24.1%). In 2,599 complete cases, the adjusted HEI-2015 difference was - 0.09 points (95% CI, - 2.37 to 2.20; P=.937). No original secondary comparison met the false-discovery-rate threshold (minimum q=0.096). Additional analyses did not establish a consistent nutritional deficit.
CONCLUSION: Measured olfactory dysfunction frequently occurred without past-year symptom reporting, although nonreporting does not establish unawareness. This phenotype showed no clear difference in day-1 HEI-2015; protein findings remained exploratory. Its clinical relevance warrants prospective assessment with comprehensive olfactory and nutritional measures.