{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T05:33:06Z","timestamp":1766122386302,"version":"3.48.0"},"reference-count":66,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["24K20659"],"award-info":[{"award-number":["24K20659"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["EJIHPE"],"abstract":"<jats:p>Objectives: This systematic review and meta-analysis investigated whether salivary cortisol and alpha-amylase levels differ between patients with anorexia nervosa (AN) and healthy controls. Methods: A systematic literature search was conducted in PubMed, ScienceDirect, SpringerLink, and Scopus for relevant studies published up to December 2024. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Statistical heterogeneity was assessed using Cochran\u2019s Q and the I2 statistic. Results: Data on salivary alpha-amylase were extracted from six studies including 218 patients with AN and 220 healthy controls. No significant group difference was observed (SMD = \u22120.48; 95% CI, \u22121.05 to 0.10; I2 = 86%), though sensitivity analysis indicated significantly lower levels in AN (SMD = \u22121.12; 95% CI, \u22122.16 to \u22120.09; I2 = 82%). Salivary cortisol was assessed in 24 reports from 17 studies (517 patients with AN, 672 controls), revealing significantly higher levels in AN (SMD = 0.69; 95% CI, 0.54\u20130.85; I2 = 30%). Sensitivity analyses showed stable effect sizes. Meta-regression indicated that neither age nor body mass index significantly moderated the results. Conclusions: Salivary cortisol may serve as a reliable, noninvasive biomarker for AN, with potential utility in early identification and prevention of disease progression.<\/jats:p>","DOI":"10.3390\/ejihpe15120260","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T15:53:46Z","timestamp":1765986826000},"page":"260","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating Salivary Cortisol and Alpha-Amylase as Candidate Biomarkers in Anorexia Nervosa: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2874-7151","authenticated-orcid":false,"given":"Takahiro","family":"Seura","sequence":"first","affiliation":[{"name":"Department of Home Economics and Technology, Hokkaido University of Education, Asahikawa Campus, 9 Hokumon-cho, Asahikawa 070-8621, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuuna","family":"Nanba","sequence":"additional","affiliation":[{"name":"Department of Home Economics and Technology, Hokkaido University of Education, Asahikawa Campus, 9 Hokumon-cho, Asahikawa 070-8621, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Abbate-Daga, G., Buzzichelli, S., Amianto, F., Rocca, G., Marzola, E., McClintock, S. 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