Anna Svedlund: Monitoring bone density crucial for patients undergoing nutritional treatment


High intake of vitamin D is recommended during nutritional treatment for anorexia nervosa, and it is crucial to monitor bone density both early on and in the long term. Modified Atkins diet can be considered a safe treatment for childhood cases regarding growth and bone density. These findings come from Anna Svedlund’s doctoral thesis.

Dissertation: September 29, 2023
Doctoral Thesis: Bone health and nutrition treatment - studies on young women with anorexia nervosa and children with epilepsy
Research Area: Pediatrics
Sahlgrenska Academy, Institute of Clinical Sciences

What is the background of your thesis?
“Bone mass is aquired during childhood and adolescence, with peak bone mass reached between the ages of 20 and 30. Insufficient mineralization of the skeleton during growth leads to reduced peak bone mass and an increased risk of osteoporosis and fractures later in life. Several factors regulate bone formation, with nutrition being a crucial one,” says Anna Svedlund, pediatrician at Queen Silvia Children’s Hospital. “Inadequate nutrition can negatively impact bone mass and growth. For individuals with anorexia nervosa, nutritional treatment is given to restore normal weight. Nutritional treatment is also used for children and adolescents with epilepsy who don’t respond to medication. They are put on Modified Atkins Diet (MAD), which is a low-carbohydrate diet.”

Cover image for Anna Svedlund's doctoral thesis. "The Ten Largest, No. 2, Childhood", painting by Hilma af Klint.

Levels of vitamin D decreased

What is the focus of your research?
“We investigated the effect of nutritional treatment on bone development in young women with severe anorexia nervosa. We also studied how bone density and growth are affected in children and adolescents receiving MAD as a treatment for severe epilepsy.”

What are the key findings for anorexia patients?
“The levels of vitamin D decreased in women with severe anorexia nervosa who were hospitalized for nutritional treatment. This happened even though their diet contained the recommended amount of vitamin D. Three years after treatment, they maintained a stable BMI and body composition. Various bone markers measured in the blood showed positive changes for the skeleton. However, anorexia nervosa patients had lower bone density compared to a control group of healthy young women.”

Figure 3, page 10 in the thesis: Bone mass throughout life.

Importance of monitoring bone density

What conclusions can be drawn from these findings?
“A high intake of vitamin D is essential during nutritional treatment for anorexia patients. The results also emphasize the importance of early bone health evaluation in young women with anorexia nervosa and the need for a structured long-term follow-up of bone density,” says Anna Svedlund.

What did the study reveal about children with epilepsy treated with the Modified Atkins Diet?
“They responded well to the treatment. Half of the individuals experienced a reduction of more than 50% in the frequency of seizures, and some became seizure-free. We also observed no negative impacts on their growth or bone density during 24 months of MAD treatment. This suggests that such treatment is safe regarding growth and bone density.”

Text: Jakob Lundberg