Low prevalence of vitamin D deficiency among adolescents with anorexia nervosa

Haagensen, Alexandra; Feldman, Henry A.; Ringelheim, Julie; Gordon, Catherine M.

doi:10.1007/s00198-007-0476-z

Cited by 57 publications

(58 citation statements)

References 22 publications

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“…Patients with AN have been shown previously to have a better vitamin D status compared to healthy control subjects. 28 The benefit is related in part to more consistent compliance with vitamin D supplementation and potentially, to increased levels of bioavailable vitamin D in underweight patients. The positive effects of vitamin D on the oral health of the current patients with AN, in addition to not having the deleterious effects of the binging/purging behavior, may have improved the overall oral health of this current clinic-based sample.…”

Section: Discussionmentioning

confidence: 99%

Oral Health and Bone Density in Adolescents and Young Women with Anorexia Nervosa

Shaughnessy

Feldman

Cleveland

et al. 2008

Journal of Clinical Pediatric Dentistry

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Purpose-To evaluate the dental and periodontal health of adolescents and young women with restrictive anorexia nervosa (AN), and relationship between bone mineral density (BMD) assessed by dual energy X-ray absorptiometry (DXA) and dental radiographs.Study Design-Twenty-three young women, median age 17.6 years (range 14.4-27.2), were studied within three months of entering a clinical trial. DXA BMD measurements were obtained and subjects underwent a comprehensive dental examination, including panoramic and bitewing dental radiographs. Three observers assessed mandibular cortical width (MCW) in the mental foramen region on panoramic radiographs.Results-Dental findings included very good to excellent oral hygiene. Gingival recession was evident in 10 participants (43%). Dental erosion was not seen and the mean decayed missing or filled teeth (DMFT) was 8.6. There was a weak positive correlation between BMD by DXA and MCW on radiographs.Conclusions-We report dental manifestations associated with restrictive AN, and the association between bone assessments by DXA and dental radiographs in this patient group. Despite subnormal DXA measurements in most patients, essentially all adolescents had a normal dental examination. Dental providers should be cognizant of the fact that many patients with eating disorders may not display the "classic" findings reported in the literature.

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Section: Discussionmentioning

confidence: 99%

Oral Health and Bone Density in Adolescents and Young Women with Anorexia Nervosa

Shaughnessy

Feldman

Cleveland

et al. 2008

Journal of Clinical Pediatric Dentistry

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“…Of note, only 2 of the 63 (3 %) Japanese patients studied were taking a multivitamin supplement containing vitamin D2 [1]. In our study, 85 % of patients reported taking vitamin D supplements [2]. In addition, our patients' mean body mass index (BMI) was 18±1.6 kg/m 2 , whereas their sample included a much lower mean BMI of 14.6±2.5 kg/m 2 .…”

mentioning

confidence: 75%

“…Thus, the degree of malnutrition was significantly worse among their study subjects than ours. Our patients reported drinking 1.7 glasses of vitamin D-supplemented milk daily [2]. Dr. Hotta's letter did not specify milk consumption in the Japanese cohort.…”

mentioning

confidence: 99%

Response to Hotta: High prevalence of vitamin D insufficiency and deficiency among patients with anorexia nervosa in Japan

2014

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Dear Editor, We read with interest Dr. Hotta's letter reporting the high prevalence of vitamin D deficiency and insufficiency in a cohort of Japanese patients with anorexia nervosa. Of note, only 2 of the 63 (3 %) Japanese patients studied were taking a multivitamin supplement containing vitamin D2 [1]. In our study, 85 % of patients reported taking vitamin D supplements [2]. In addition, our patients' mean body mass index (BMI) was 18±1.6 kg/m 2 , whereas their sample included a much lower mean BMI of 14.6±2.5 kg/m 2 . Thus, the degree of malnutrition was significantly worse among their study subjects than ours. Our patients reported drinking 1.7 glasses of vitamin D-supplemented milk daily [2]. Dr. Hotta's letter did not specify milk consumption in the Japanese cohort. However, given the high incidence of lactose malabsorption among Japanese children, reported at 85 % in one report of school children [3], it is likely that Hotta's cohort was consuming much less vitamin D-fortified milk than our American patients.Hotta mentioned a reduction in the consumption of seafood products as a possible contributor to the increase in prevalence of vitamin D insufficiency among the general Japanese population. We did not specifically evaluate seafood consumption in our patients. Interestingly, Vaz et al. have reported food aversions, including fish aversion in patients with anorexia nervosa. However, the level of fish avoidance was lower than that of fresh meat, cereals, milk/egg derivatives, and other foods. Patients with anorexia nervosa reported avoiding all foods, but avoiding fish products to a lesser degree than other food products [4]. An anecdotal impression is that patients with anorexia nervosa tend to prefer seafood as a relatively lean protein alternative.Hotta also mentioned recent trends in Japan toward avoidance of sunbathing. We did not assess sunbathing practices among our patients. O'Leary recently reported that approximately 10 % of the US population uses indoor tanning devices, with 29.3 % of non-Hispanic white female high school students reporting the use of indoor tanning during the past 12 months [5]. We also assume that due to cultural differences, American adolescents are more likely to sunbathe than those in Japan.In summary, our patients were relatively healthier, more likely to be taking a vitamin D supplement, more likely to be drinking vitamin D-supplemented milk, equally or more likely to be eating seafood products, and more likely to have been sunbathing. These factors provide the likely explanation for the discrepancy in the results between our study group and that of Hotta. References 1. Hotta M (2014) High prevalence of vitamin D insufficiency and deficiency among patients with anorexia nervosa in Japan. Osteoporosis Int.

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“…In the United States, more girls with AN receive vitamin D supplementation than healthy controls, and the prevalence of vitamin D deficiency is thus lower among adolescents with AN than in healthy subjects in that country (19). However, in Japan, the general population, as well as patients with AN, exhibits a high prevalence of vitamin D insufficiency.…”

Section: Discussionmentioning

confidence: 97%

Osteomalacia, Severe Thoracic Deformities and Respiratory Failure in a Young Woman with Anorexia Nervosa

2015

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The recent trends in avoiding sunbathing and eating fewer fish products have resulted in a high prevalence of vitamin D deficiency in the general Japanese population. We herein report the case of a young woman with enduring anorexia nervosa (AN) who suffered from osteomalacia, thoracic deformities and respiratory failure. Her vitamin D deficiency had been overlooked for years. Although the serum 25-hyroxyvitamin D [25(OH)D] level is a marker of vitamin D stores, it is not routinely examined because the cost is not covered by the national health insurance program. However, measuring the serum 25(OH)D levels in AN patients with hypocalcemia is recommended to prevent osteomalacia and osteoporosis.

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Low prevalence of vitamin D deficiency among adolescents with anorexia nervosa

Cited by 57 publications

References 22 publications

Oral Health and Bone Density in Adolescents and Young Women with Anorexia Nervosa

Oral Health and Bone Density in Adolescents and Young Women with Anorexia Nervosa

Response to Hotta: High prevalence of vitamin D insufficiency and deficiency among patients with anorexia nervosa in Japan

Osteomalacia, Severe Thoracic Deformities and Respiratory Failure in a Young Woman with Anorexia Nervosa

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