Kells Meredith R, Roske Chloe, Watters Ashlie, Puckett Leah, Wildes Jennifer E, Crow Scott J, Mehler Philip
University of Rochester.
Albert Einstein College of Medicine.
Res Sq. 2023 Jul 17:rs.3.rs-3101384. doi: 10.21203/rs.3.rs-3101384/v1.
Refeeding hypophosphatemia (RH) is a common complication of nutritional restoration in malnourished individuals, yet clear risk stratification remains elusive. Individuals with anorexia nervosa (AN) and avoidant/restrictive food intake disorder (ARFID) may be deficient in vitamin D, an important component of dietary phosphorus absorption in the gut. The relationship between vitamin D and RH in AN and ARFID is unknown. Therefore, the aims of this of this study were to 1) describe the prevalence of low serum 25-hydroxy vitamin D levels and RH in AN and ARFID 2) report associations between nadir phosphorus level and variables associated with RH in extant literature and 3) examine the relationship between 25-hydroxy vitamin D levels and serum phosphorus nadir in AN and ARFID.
Analyses included retrospective chart review of 307 individuals admitted to the ACUTE Center for Eating Disorders and Severe Malnutrition with a diagnosis of AN or ARFID. Variables of interest included admission laboratory values (vitamin D level, comprehensive metabolic panel, hemoglobin, point-of-care blood glucose), anthropometric measures (weight, body mass index [BMI], % ideal body weight [IBW]), age, duration of illness, length of stay, feeding method, and serum phosphorus nadir. Pearson and Spearman rank correlation, one-way ANOVA, and regression analyses were used to determine the relationship between variables and serum phosphorus.
Over 1/3 of the sample (35.3%) had serum phosphorus levels ≤ 2.9 mg/dL. There were no significant differences between groups in phosphorus nadir (p = .17, η = 0.12) or hypophosphatemia (p = .16, ϕc = 0.11); 44% of individuals with ARFID and 33% of individuals with AN had hypophosphatemia. Nadir phosphorus showed a positive association with weight, BMI, %IBW, potassium, and calcium on admission, and a negative association with length of stay, hemoglobin, and total number of tube-fed days. Higher levels of 25-hydroxy vitamin D moderated the relationship between serum phosphorus nadir and weight on admission (p = .0004).
Individuals diagnosed with ARFID are as nutritionally fragile as those with AN regarding vitamin D and RH. The negative feedback loop involving vitamin D that maintains phosphorus homeostasis may play a role in the development of RH in AN and ARFID.
再喂养低磷血症（RH）是营养不良个体营养恢复过程中常见的并发症，但明确的风险分层仍不明确。神经性厌食症（AN）和回避/限制性食物摄入障碍（ARFID）患者可能缺乏维生素D，而维生素D是肠道中膳食磷吸收的重要组成部分。AN和ARFID中维生素D与RH之间的关系尚不清楚。因此，本研究的目的是：1）描述AN和ARFID患者血清25-羟基维生素D水平低和RH的患病率；2）报告现存文献中最低磷水平与RH相关变量之间的关联；3）研究AN和ARFID患者25-羟基维生素D水平与血清最低磷水平之间的关系。
分析包括对307名入住饮食失调与严重营养不良急性中心且诊断为AN或ARFID的患者进行回顾性病历审查。感兴趣的变量包括入院时的实验室检查值（维生素D水平、综合代谢指标、血红蛋白、即时血糖）、人体测量指标（体重、体重指数[BMI]、理想体重百分比[IBW]）、年龄、病程、住院时间、喂养方式以及血清最低磷水平。采用Pearson和Spearman等级相关性分析、单因素方差分析和回归分析来确定变量与血清磷之间的关系。
超过1/3的样本（35.3%）血清磷水平≤2.9mg/dL。各组在最低磷水平（p = 0.17，η = 0.12）或低磷血症（p = 0.16，ϕc = 0.11）方面无显著差异；44%的ARFID患者和33%的AN患者患有低磷血症。最低磷水平与入院时的体重、BMI、IBW百分比、钾和钙呈正相关，与住院时间、血红蛋白和管饲天数总数呈负相关。较高水平的25-羟基维生素D调节了血清最低磷水平与入院时体重之间的关系（p = 0.0004）。
就维生素D和RH而言，诊断为ARFID的个体与AN患者一样在营养方面较为脆弱。维持磷稳态的涉及维生素D的负反馈回路可能在AN和ARFID的RH发生过程中起作用。
