Oral doses of 2,000 IU vitamin D(3) daily and 50,000 IU vitamin D(2) weekly for 6 wk are superior to 2,000 IU vitamin D(2) daily for 6 wk in raising serum 25OHD concentration and are well-tolerated among children and adolescents with IBD. The change in serum PTH concentration did not differ among arms.

Daily oral vitamin D2 doses up to 2000 IU were inadequate to maintain optimal 25OHD but were well tolerated. The finding of lower incidence of elevated inflammatory markers and cytokines among participants receiving higher vitamin D2 doses merits further study.

Objective-To determine the prevalence and predictors of abnormal liver enzyme levels in ambulatory young women with anorexia nervosa (AN).Study design-In this cross-sectional study of 53 females with AN, serum concentrations of liver enzymes and hormones were measured. Anthropometric, dietary, and body composition information was collected. Correlational analyses were performed between liver enzyme concentrations and these variables.Results-Elevated alanine aminotransferase (ALT) and gamma-glutamyltranspeptidase (GGT) levels were found in 14 subjects (26%) and 5 subjects (9%), respectively. ALT and GGT were inversely correlated with body mass index (r = −0.27 to −0.30, p ≤ 0.049) and percentage body fat (r = −0.36 to −0.47, p ≤ 0.007), but showed no relationship with lean body mass. Subjects with percentage body fat < 18% had higher ALT levels than those above this threshold (median 26.5 vs. 18.0 U/L, p = 0.01). Liver enzyme concentrations did not correlate with dietary variables, except for GGT and percentage of calories from protein (r = 0.28, p = 0.04).Conclusions-Serum ALT and GGT concentrations are inversely related to adiposity in young women with AN. Future studies are needed to determine if these liver enzyme elevation signify unrecognized, clinically relevant liver disease.Keywords eating disorders; adolescents; liver; malnutrition; alanine aminotransferase; gammaglutamyltranspeptidase Corresponding author: Catherine M. Gordon, MD, MSc, Divisions of Adolescent Medicine and Endocrinology, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02215, Tel: 617-355-8492, Fax: 617-730-0195, Email: catherine.gordon@childrens.harvard.edu For reprints, please contact the corresponding author, Catherine M. Gordon, MD, MSc. Edited by WFB Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. In this study, we sought to determine the prevalence and predictors of abnormal liver enzyme levels in ambulatory young women with AN. We hypothesized that individuals with more severe disease, as reflected by lower body mass index (BMI) and body fat, would be more likely to exhibit elevated ALT and gamma-glutamyltranspeptidase (GGT) levels. We also hypothesized that insulin resistance would be a predictor of abnormal ALT and GGT concentrations. We predicted that there would be a significant association between macronutrient caloric distribution and liver enzyme concentrations. Methods DesignThis study was a cross-sectional evaluation of data obtained from the baseline visit of a clinical bone density trial. SubjectsAdolescents and young women with AN were recruited from the Chil...

Background & Aims There are very few published studies of agents having the potential to improve bone health in children with inflammatory bowel disease (IBD). Our aim was to establish the efficacy and safety of intranasal calcitonin in improving bone mineral density (BMD) in young patients with IBD and to define additional factors that impact bone mineral accrual. Methods We conducted a randomized, placebo-controlled, double-blind clinical trial in sixty-three participants, ages 8 to 21 yrs, with a spinal BMD Z-score ≤ −1.0 SD measured by dual energy X-Ray absorptiometry (DXA). Subjects were randomized to 200 IU intranasal calcitonin (n=31) or placebo (n=32) daily. All received age-appropriate calcium and vitamin D supplementation. Subsequent BMD measurements were obtained at 9 and 18 months. Results Intranasal calcitonin was well-tolerated. Adverse event frequency was similar in both treatment groups, and such events were primarily minor, reversible, and limited to the upper respiratory tract. The BMD Z-score change documented at screening and 9 months and screening and 18 months did not differ between the two therapeutic arms. In participants with Crohn’s disease (CD) the spinal BMD Z-score improved between screening and 9 months [ΔZSBMD(9-0)] in the calcitonin group (ΔZSBMD(9-0)calcitonin = 0.21 (0.37), ΔZSBMD(9-0)placebo = −0.15 (0.5), p = 0.02), however this was only a secondary subgroup analysis. Bone mineral accrual rates during the trial did not lead to normalization of BMD Z-scores in this cohort. Factors favoring higher bone mineral accrual rate were: lower baseline BMD and higher baseline body mass index (BMI) Z-score, improvement in height Z-score, higher serum albumin, hematocrit and iron concentration, and more hours of weekly weight-bearing activity. Factors associated with lower bone mineral accrual rate were: more severe disease – as indicated by elevated inflammatory markers, need for surgery, hospitalization and the use of immunomodulators - and higher amount of caffeine intake. Conclusions Intranasal calcitonin is well-tolerated but does not offer a long-term advantage in youth with IBD and decreased BMD. Bone mineral accrual rates remain compromised in youth with IBD and low bone mineral density raising concerns for long-term bone health outcomes. Improvement in nutritional status, catch-up linear growth, control of inflammation, increase in weight-bearing activity, and lower caffeine intake may be helpful in restoring bone density, especially in children with IBD and low baseline BMD.

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