J Clin Endocrinol Metab. 2011 Jun 1.
Divasta AD, Feldman HA, Brown JN, Giancaterino C, Holick MF, Gordon CM.
Division of Adolescent Medicine (A.D.D., J.N.B., C.G., C.M.G.), Division of Pediatric and Adolescent Gynecology (A.D.D.), Clinical Research Program (H.A.F.), Division of Endocrinology (H.A.F., C.M.G.), Children's Hospital Boston, Boston, Massachusetts 02115; and Section of Endocrinology, Diabetes, and Nutrition (M.F.H.), Boston University Medical Center, Boston, Massachusetts 02118.
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/m(2)) and 12 matched healthy controls (20.0 ± 2.4 yr, 22.7 ± 1.0 kg/m(2)) received one baseline 50,000 IU oral dose of ergocalciferol.
Main Outcomes: Serum D(2), D(3), 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 D(2) (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 D(2) trajectories converged at 24 h (57 nmol/liter, P = 0.98) and returned to near baseline at 1 wk. Baseline D(3) 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.
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