Anorexia nervosa and Vitamin D - several studies

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Anorexia Nervosa - 10 year update - Oct 2021

Anorexia Nervosa—What Has Changed in the State of Knowledge about Nutritional Rehabilitation for Patients over the Past 10 Years? A Review of Literature
Nutrients 2021, 13(11), 3819; https://doi.org/10.3390/nu13113819
by Katarzyna Jowik *ORCID,Marta Tyszkiewicz-Nwafor †ORCID andAgnieszka Słopień †
Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, 60-572 Poznan, Poland

Anorexia nervosa (AN) is a psycho-metabolic disorder with a high risk of somatic complications such as refeeding syndrome (RFS) and carries the highest mortality rate of all psychiatric illnesses. To date, the consensus on the care for patients with AN has been based on recommendations for a combination of alimentation and psychotherapy. It is important to establish an initial caloric intake that will provide weight gain and minimize the risk of complications in the treatment of undernourished patients. Research over the past few years suggests that current treatment recommendations may be too stringent and should be updated. The aim of this paper is to systematize the current reports on nutritional rehabilitation in AN, to present the results of studies on the safe supplementation of patients and its potential impact on improving prognosis and the healing process. This review of literature, from 2011–2021, describes the changing trend in the nutritional protocols used and the research on their efficacy, safety, and long-term effects. In addition, it presents previous reports on the potential benefits of introducing vitamin, pro-and prebiotic and fatty acid supplementation.
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Vitamin D status in anorexia nervosa: A meta-analysis - 2014

International Journal of Eating Disorders, Article first published online: 29 NOV 2014, DOI: 10.1002/eat.22370
Nicola Veronese MD1,†,*, Marco Solmi MD2,†, Wanda Rizza MA3, Enzo Manzato MD1, Giuseppe Sergi MD1, Paolo Santonastaso MD2, Lorenza Caregaro MD4, Angela Favaro MD, PhD2 andChristoph U. Correll MD5,6,7,8, ilmannato at gmail.com
1 Department of Medicine, DIMED, Geriatrics Section, University of Padova, Padova, Italy
2 Department of Neurosciences, University of Padova, Padova, Italy
3 Department of Food and Human Nutrition Science, University Campus Bio-Medico, Rome, Italy
4 Department of Medicine, DIMED, University of Padova, Padova, Italy
5 The Zucker Hillside Hospital, Department of Psychiatry, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA
6 Hofstra North Shore LIJ School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, New York, USA
7 The Feinstein Institute for Medical Research, Psychiatric Neuroscience Center of Excellence, Manhasset, New York, USA
8 Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, New York, USA

Objective
In anorexia nervosa (AN), osteoporosis and osteopenia are common, which have been associated with low circulating levels of vitamin D (VitD) in other settings. We aimed to meta-analyze cross-sectional studies reporting on VitD parameters in patients with AN and healthy controls (HCs).

Method
Electronic PubMed search from database inception until December 31, 2013 and meta-analysis of cross-sectional studies comparing serum levels of 25-hydroxyvitamin D (25OH-D), 1,25-dihydroxyvitamin D (1,25OH-D) and dietary VitD between patients with AN and HCs, before or after VitD supplementation. We calculated random effects standardized mean differences (SMDs) ±95% confidence intervals (CIs) as effect size measures.

Results
Out of 1,739 initial hits, 15 studies with a total of 927 participants (AN = 408 and HCs = 519) were meta-analyzed. In the unsupplemented state, both serum 25OH-D (studies = 4; n = 168; SMD = −0.43; 95%CI: −0.83 to −0.03; p = .03) and 1,25OH-D levels (studies = 4; n = 113; SMD = −1.06; 95%CI: −1.47 to −0.66; p < .00001) were significantly lower in AN than HCs. In AN patients treated with cholecalciferol supplementation, serum 25OH-D levels were significantly higher than in HCs (studies = 5; n = 449; SMD = 0.66; 95%CI: 0.01–1.31; p = .05). Paradoxically, despite lower 25OH-D and 1,25OH-D levels, AN patients reported similar intake of VitD compared to HCs (studies = 6; n = 314; SMD = 0.33; 95%CI: −0.16, 0.81; p = .19).

Discussion
Although AN patients reported similar dietary VitD intake compared to HCs, AN patients had significantly lower 25OH-D and 1,25OH-D levels without supplementation. Conversely, supplementation with cholecalciferol fully normalized VitD serum levels. Future studies are needed to clarify the role of VitD supplementation in AN for improving bone health. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014)

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Strong relationship between vitamin d status and bone mineral density in anorexia nervosa - May 2015

Bone, Available online 14 May 2015, doi:10.1016/j.bone.2015.05.014
Davide Gattia, Marwan El Ghochb, Ombretta Viapianaa, , , Antonella Ruoccob, Elisa Chignolab, Maurizio Rossinia, Alessandro Giolloa, Luca Idolazzia, Silvano Adamia, Riccardo Dalle Graveb

Highlights

• vitamin D deficiency is widespread in AN untreated patients
• we found a strong relationship between vitamin D status and hip BMD values
• vitamin D supplements should be recommended in order to bring 25OHD levels above 30 ng/ml before starting any pharmacological therapy

Background
Anorexia nervosa (AN) is associated with impaired bone health and low bone mineral density (BMD) as a consequence of an inadequate peak bone mass in adolescence and bone loss in young adulthood. The vitamin D status with its implications for bone health in patients affected by AN has only been examined previously in small studies.

Objective
to evaluate the prevalence of vitamin D deficiency and tested the hypothesis that patients with AN and vitamin D deficiency might have worse bone metabolism and lower bone density as compared with AN with adequate vitamin D repletion.

Design
we analyzed the vitamin D status and bone metabolism in a large cohort (n=89) of untreated patients affected by AN, with amenorrhoea.

Results
vitamin D deficiency is widespread in untreated patients with AN: 16.9% had 25OH vitamin D levels below 12 ng/ml, 36% below 20 ng/ml and 58.4% below 30 ng/ml. PTH values were higher and BMD at both femoral sites were lower in patients with vitamin D < 20 ng/ml. Progressively higher values of BMD were observed by 4 ranks of 25 OH vitamin D values (severe deficiency: < 12 ng/ml, deficiency :≥12 ng/ml and < 20 ng/ml), insufficiency: ≥ 20 and < 30 ng/ml and normal: ≥ 30 ng/ml). In patients with severe vitamin D deficiency BMD at the hip were significantly lower than that measured in groups with values over 20 ng/ml (p<0.001 for trend). The level of significance did not change for values adjusted for BMI or body weight.

Conclusion
we found a strong relationship between vitamin D status and hip BMD values with additional benefits for those with 25OHD levels above 20 ng/ml. Our results support the design of a randomized placebo-controlled clinical trial on the effect of vitamin D on BMD in patients with AN. The second point, whether 25OHD should be above 20 or 30 ng/ml remains a discussion point.

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AN after low seasonal vitamin D during pregnancy or high latitude - 2013

Vitamin D: A role in eating disorders? Aug 2013
Reporting on

• Maternal vitamin D levels during pregnancy and offspring eating disorder risk in adolescence - Nov 2013 study DOI: 10.1002/eat.22147 PDF
• {AN} is more common at higher latitudes
• some studies show emergency admissions for AN are seasonal.
• 1.8X more likely to have AN if mother had < 18 ng of vitamin D vs mothers with > 30 ng

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Anorexia resulted in vitamin D level 25 ng/ml – Aug 2014

High prevalence of vitamin D deficiency and insufficiency in adolescent inpatients diagnosed with eating disorders.
Int J Eat Disord. 2014 Aug 18. doi: 10.1002/eat.22347
Modan-Moses D1, Levy-Shraga Y, Pinhas-Hamiel O, Kochavi B, Enoch-Levy A, Vered I, Stein D.

OBJECTIVE: Previous studies assessing vitamin D status in adolescents with eating disorders showed inconsistent results. The aim of the current study was to assess vitamin D status in a large cohort of adolescent inpatients with eating disorders and its relation to bone mineral density (BMD) and depression.

METHOD:25-Hydroxyvitamin D (25OHD), calcium, phosphorus, and alkaline phosphatase levels as well as BMD and depression were assessed on admission in 87 inpatients (aged 16 ± 2 years, females = 81) with eating disorders [anorexia nervosa (AN) = 64; bulimia nervosa (BN) = 5; eating disorders not otherwise specified-binge/purge type (EDNOS-B/P) = 18].

RESULTS: Mean 25OHD levels were 24.1 ± 7.5 ng/ml (25.0 ± 7.6, 25.4 ± 9.9, and 22.0 ± 9.9 ng/ml in patients with AN, BN, and EDNOS-B/P, respectively). Vitamin D deficiency (<15 ng/ml) was found in 7.8% of the patients, and insufficiency (15-20 ng/ml) in 22.2%. Only 16.7% had levels >32 ng/ml, considered optimal by some experts. No associations were found between 25OHD levels and BMD or comorbid depression. 25OHD levels during winter were significantly lower than summer levels (p < .001). Mean lumbar spine BMD z-score in patients with AN and EDNOS-B/P type was low (-1.5 ± 1.1) and correlated with body mass index standard deviation score (p = .03).

DISCUSSION: Adolescents with eating disorders show a high prevalence of vitamin D deficiency and insufficiency. Given the risk of osteoporosis in this population, 25OHD levels found in this group may not offer optimal bone protection. Vitamin D levels should be routinely checked and supplementation should be administered as required.

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Season of birth related to AN – 11 studies conclude an association - 2012

Anorexia Nervosa: Can We Blame The Season Of Birth
Dec 2012 Answer = YES

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Season of birth and anorexia nervosa May 2011

Has the following chart

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Speculation: Supplementing with vitamin D while pregnant will reduce later anorexia

No studes (positive nor negative), so far, as to Vitamin D being able to treat anorexia
Hint that Vitamin D intervention might treat AN: Vitamin D Intervention treats many other SOB diseases - (see chart below)
 Download the PDF from VitaminDWiki
Speculation by VitaminDWiki
Infant was programmed (epigenetics) to expect low vitamin D in the environment they were being born into - and thus appreciate vitamin D when it was found
Later in liife the person learned that they were able to get a "high" by generating vitamin D by losing weight.

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See also VitaminDWIki

• 2.8 X higher risk of eating disorder in teen girls if mom had low Vitamin D while pregnant - Nov 2013 Nov 2013
• Is There a Link Between Autism and Anorexia (yes, vitamin D) – Feb 2016
• Search VitaminDWiki for “Bulimia nervosa” OR “anorexia nervosa” OR “binge eating” OR “eating disorder” 114 items as of May 2024
• Season of Birth category listing has 27 items along with related searches
• Schizophrenia increased 40 percent for Spring births after Danes stopped vitamin D fortification – April 2014
• Diseases correlated to month of birth – 2008 which has the following chart - which has Eating Disorders

• Search VitaminDWiki for “Bulimia nervosa” OR “anorexia nervosa” OR “binge eating” OR “eating disorder” 1190 items (mainly in PDFs as of Dec 2023

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