Non-Cochrane · aetiology · PM41440166
Evaluating Salivary Cortisol and Alpha-Amylase as Candidate Biomarkers in Anorexia Nervosa: A Systematic Review and Meta-Analysis.
Seura Takahiro, Nanba Yuuna · European journal of investigation in health, psychology and education · 2025 · PubMed · doi:10.3390/ejihpe15120260
Findings
11 findings
| Population | ||||
|---|---|---|---|---|
| Patients with anorexia nervosa (any age or sex) | Anorexia nervosa (diagnosed by clinical evaluation or DSM/ICD criteria; exposure) | Healthy normal-weight controls | Salivary cortisol level Various collection times · Overall (all reports) | SMD 0.69 [0.54, 0.85] GRADE not reported 17 studies · 1189 participants |
| Patients with anorexia nervosa (any age or sex) | Anorexia nervosa (diagnosed by clinical evaluation or DSM/ICD criteria; exposure) | Healthy normal-weight controls | Salivary alpha-amylase level Various collection times · Sensitivity analysis excluding four studies with possibly overlapping datasets | SMD -1.12 [-2.16, -0.09] GRADE not reported 2 studies |
| Patients with anorexia nervosa (any age or sex) | Anorexia nervosa (diagnosed by clinical evaluation or DSM/ICD criteria; exposure) | Healthy normal-weight controls | Salivary cortisol level Various collection times · Sensitivity analysis excluding four studies with possibly overlapping datasets | SMD 0.68 [0.5, 0.85] GRADE not reported 13 studies |
| Patients with anorexia nervosa (any age or sex) | Anorexia nervosa (diagnosed by clinical evaluation or DSM/ICD criteria; exposure) | Healthy normal-weight controls | Salivary alpha-amylase level Various collection times · Overall (all reports) | SMD -0.48 [-1.05, 0.1] GRADE not reported 6 studies · 438 participants |
| Patients with anorexia nervosa (any age or sex) | Anorexia nervosa (diagnosed by clinical evaluation or DSM/ICD criteria; exposure) | Healthy normal-weight controls | Salivary cortisol level Various collection times · Meta-regression on mean patient age (after excluding four studies) | Meta-regression coefficient (SMD per unit of age) -0.005 [-0.41, 0.3] GRADE not reported Studies not reported |
| Patients with anorexia nervosa (any age or sex) | Anorexia nervosa (diagnosed by clinical evaluation or DSM/ICD criteria; exposure) | Healthy normal-weight controls | Salivary cortisol level Various collection times · Meta-regression on mean patient BMI (after excluding four studies) | Meta-regression coefficient (SMD per BMI unit) 0.021 [-0.07, 1.5] GRADE not reported Studies not reported |
| Patients with anorexia nervosa (any age or sex) | Anorexia nervosa (diagnosed by clinical evaluation or DSM/ICD criteria; exposure) | Healthy normal-weight controls | Salivary cortisol level Various collection times · Subgroup by measurement method: ELISA (after excluding four studies) Unresolved: the two extractors disagree on this row. | SMD 0.76 [0.54, 0.98] GRADE not reported Studies not reported |
| Patients with anorexia nervosa (any age or sex) | Anorexia nervosa (diagnosed by clinical evaluation or DSM/ICD criteria; exposure) | Healthy normal-weight controls | Salivary cortisol level Various collection times · Subgroup by measurement method: Other methods (RIA, EIA, LIA) (after excluding four studies) Unresolved: the two extractors disagree on this row. | SMD 0.55 [0.27, 0.83] GRADE not reported Studies not reported |
| Individuals of any age or sex with anorexia nervosa (AN) and healthy normal-weight controls | Anorexia nervosa (diagnosed by clinical evaluation or DSM/ICD criteria); Saliva collected within 30 min after awakening | Healthy normal-weight controls | Salivary cortisol level 30 min after awakening · Subgroup by timing of saliva collection: 30 min after awakening | SMD 0.97 [0.60, 1.34] GRADE not reported 4 studies |
| Individuals of any age or sex with anorexia nervosa (AN) and healthy normal-weight controls | Anorexia nervosa (diagnosed by clinical evaluation or DSM/ICD criteria); Saliva collected in the morning (AM) | Healthy normal-weight controls | Salivary cortisol level Morning (AM) · Subgroup by timing of saliva collection: AM | SMD 0.53 [0.24, 0.83] GRADE not reported 8 studies |
| Individuals of any age or sex with anorexia nervosa (AN) and healthy normal-weight controls | Anorexia nervosa (diagnosed by clinical evaluation or DSM/ICD criteria); Saliva collected in the afternoon or evening (PM) | Healthy normal-weight controls | Salivary cortisol level Afternoon or evening (PM) · Subgroup by timing of saliva collection: PM | SMD 0.71 [0.45, 0.97] GRADE not reported 8 studies |
Included primary studies 19
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Paszynska 2015 Salivary enzyme activity in anorexic persons—a controlled clinical trial. PMID:25753979 | 2015 | 1 other review | not stated | not extracted yet |
| Paszynska 2017 Enzyme activities in parotid saliva of patients with the restrictive type of anorexia nervosa. PMID:28068524 | 2017 | 1 other review | not stated | not extracted yet |
| A. M. Monteleone 2015 Childhood trauma and cortisol awakening response in symptomatic patients with anorexia nervosa and bulimia nervosa. PMID:25808182 | 2015 | this review only | not stated | not extracted yet |
| A. M. Monteleone 2016 Underweight subjects with anorexia nervosa have an enhanced salivary cortisol response not seen in weight restored subjects with anorexia… PMID:27236605 | 2016 | this review only | not stated | not extracted yet |
| A. M. Monteleone 2018 Deranged emotional and cortisol responses to a psychosocial stressor in anorexia nervosa women with childhood trauma exposure: Evidence… PMID:29936175 | 2018 | this review only | not stated | not extracted yet |
| dos Santos 2007 Absence of circadian salivary cortisol rhythm in women with anorexia nervosa. PMID:17289511 | 2007 | this review only | not stated | not extracted yet |
| Oskis 2012 Diurnal patterns of salivary cortisol and DHEA in adolescent anorexia nervosa. PMID:22356124 | 2012 | this review only | not stated | not extracted yet |
| P. Monteleone 2011a Asymmetry of salivary cortisol and α-amylase responses to psychosocial stress in anorexia nervosa but not in bulimia nervosa. PMID:21284914 | 2011 | this review only | not stated | not extracted yet |
| P. Monteleone 2011b Abnormal diurnal patterns of salivary α-amylase and cortisol secretion in acute patients with anorexia nervosa. PMID:21745126 | 2011 | this review only | not stated | not extracted yet |
| Paszynska 2016 Salivary alpha-amylase, secretory IgA and free cortisol as neurobiological components of the stress response in the acute phase of… PMID:26983011 | 2016 | this review only | not stated | not extracted yet |
| Paszynska 2020 Is there a link between stress and immune biomarkers and salivary opiorphin in patients with a restrictive-type of anorexia nervosa? PMID:30880537 | 2020 | this review only | not stated | not extracted yet |
| Putignano 2001 Salivary cortisol measurement in normal-weight, obese and anorexic women: comparison with plasma cortisol. PMID:11454512 | 2001 | this review only | not stated | not extracted yet |
| Schmalbach 2020 Cortisol reactivity in patients with anorexia nervosa after stress induction. PMID:32778654 | 2020 | this review only | not stated | not extracted yet |
| Schorr 2015 Cortisol Measures Across the Weight Spectrum. PMID:26171799 | 2015 | this review only | not stated | not extracted yet |
| Seed 2002 Basal activity of the HPA axis and cognitive function in anorexia nervosa. PMID:14609004 | 2002 | this review only | not stated | not extracted yet |
| Shibuya 2011 Changes in salivary cortisol levels as a prognostic predictor in children with anorexia nervosa. PMID:21906636 | 2011 | this review only | not stated | not extracted yet |
| Vaz-Leal 2018 Blunted cortisol response to stress in patients with eating disorders: Its association to bulimic features. PMID:29464867 | 2018 | this review only | not stated | not extracted yet |
| Westwater 2021 Dissociable hormonal profiles for psychopathology and stress in anorexia and bulimia nervosa. PMID:32460904 | 2021 | this review only | not stated | not extracted yet |
| Zonnevylle-Bender 2005 Adolescent anorexia nervosa patients have a discrepancy between neurophysiological responses and self-reported emotional arousal to… PMID:15893382 | 2005 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Oral Manifestations in Children and Adolescents with Eating Disorders or Eating-Disorder Risk: A Systematic Review and Stratified… (2026) | 2 | 0.05 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Individuals of any age or sex, adults and children | Patients with AN and healthy controls aged 14 to 31 years; 18 female-only studies and 1 mixed-sex (441 AN and 556 controls in the 19 studies) |
| Intervention | Exposure: patients diagnosed with anorexia nervosa by clinical evaluation or DSM/ICD criteria | Anorexia nervosa (cortisol: 517 AN; alpha-amylase: 218 AN) |
| Comparison | Healthy normal-weight control group | Healthy controls (cortisol: 672; alpha-amylase: 220) |
| Outcomes | Salivary cortisol and/or alpha-amylase (means or medians with SD, SE or IQR) | Salivary alpha-amylase (6 studies, 8 reports); salivary cortisol (17 studies, 24 reports) |
| Study designs | Observational studies (cross-sectional, cohort, case-control) or interventional trials (baseline values) | 19 observational studies, mostly cross-sectional (NOS: 4 satisfactory, 12 good, 3 very good) |
| Timing | Not specified | Not specified |