Bioavailability of Vitamin D in Malnourished Adolescents with Anorexia Nervosa

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 x 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 x group interaction P = 0.15), rising to 45 +/- 10 nmol/liter at 24 h but returning to baseline by wk3 (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. (J Clin Endocrinol Metab 96: 2575-2580, 2011)