Bioavailability of vitamin D in malnourished adolescents with anorexia nervosa

Abstract

Context: Young women with anorexia nervosa (AN) have a normal vitamin D status. The bioavailability of vitamin D during malnutrition is unknown.

Objective: The objective of the study was to examine the serum response to oral ergocalciferol in AN.

Design/setting: This was a prospective cohort study, conducted in 2007-2009 at a tertiary care center.

Patients/interventions: Twelve adolescents with AN (age 19.6 ± 2.0 yr, body mass index 16.5 ± 1.4 kg/m²) and 12 matched healthy controls (20.0 ± 2.4 yr, 22.7 ± 1.0 kg/m²) received one baseline 50,000 IU oral dose of ergocalciferol.

Main outcomes: Serum D₂, D₃, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D, collected before ingestion, at 6 and 24 h and weekly for 4 wk, and body composition measures were measured.

Results: The AN group was severely malnourished (77.2 ± 6.3% median body weight), whereas the control group was normal weighted (106.2 ± 6.2%). From a common baseline D₂ (1.5 ± 1.6 nmol/liter, P =0.34) the groups diverged (time × group interaction P = 0.04), peaking at 70 ± 34 nmol/liter at 6 h in controls compared with 43 ± 28 nmol/liter in AN subjects (P = 0.008). The D₂ trajectories converged at 24 h (57 nmol/liter, P = 0.98) and returned to near baseline at 1 wk. Baseline D₃ was higher in AN subjects (12.1 ± 9.6 vs. 3.1 ± 2.3 nmol/liter, P < 0.001) and remained higher throughout. 25-Hydroxyvitamin D followed a common trajectory (time × group interaction P = 0.15), rising to 45 ± 10 nmol/liter at 24 h but returning to baseline by wk 3 (P = 0.36). Correlating vitamin D levels with fat measures (body mass index, body fat) produced similar findings.

Conclusions: Despite severe malnutrition, young women with AN had a similar bioavailability of oral ergocalciferol as the healthy-weighted controls. Vitamin D dosing for patients suffering from malnutrition may not differ from that for normal-weighted adolescents.

Figures

Fig. 1.

Mean serum vitamin D2 (ergocalciferol) concentrations in the control (●) and anorexic (■) groups 0–24 h after oral intake of vitamin D2 (50,000 IU, 1.25 mg). Vitamin D2 rose rapidly to 6 h after intake and then declined slightly thereafter. Normal-weighted subjects had higher peak concentrations of vitamin D2 than did subjects with AN (P = 0.04 for time × group interaction). The error bars indicate ±1 se on the log scale from repeated-measures ANOVA.

Fig. 2.

Correlation between body fat percentage or BMI and serum vitamin D2 concentrations in adolescents with AN (●) or normal-weighted adolescents (■) at 6 h after an oral dose of ergocalciferol (50,000 IU). The correlation coefficients were r = 0.38 for fat percentage (P = 0.07) and r = 0.47 for BMI (P = 0.02).