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Vitamin D status in anorexia nervosa: A meta-analysis
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
† Nicola Veronese and Marco Solmi equally contributed to this research.
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.