The Association of Vitamin D Deficiency with Depressive Disorders in Patients with Eating Disorders: A Cross-Sectional Study

The Association of Vitamin D Deficiency with Depressive Disorders in Patients with Eating Disorders: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Association of Vitamin D Deficiency with Depressive Disorders in Patients with Eating Disorders: A Cross-Sectional Study Rami Bou Khalil, Hala Kerbage, Myriam Zarzour, Robertas Strumila, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9135597/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Vitamin D deficiency and depressive disorders are both common in patients with eating disorders (EDs). However, the association between vitamin D status and current depressive disorder (CDD) in ED populations remains insufficiently explored. Methods We conducted a cross-sectional study including 481 outpatients with EDs assessed at a specialized ED unit in Montpellier, France. Psychiatric diagnoses were established using the Mini-International Neuropsychiatric Interview (M.I.N.I.). ED severity was assessed with the Eating Disorder Examination Questionnaire (EDE-Q). Serum 25-hydroxyvitamin D levels were measured as part of routine clinical assessment, and vitamin D deficiency was defined as < 20 ng/mL. Odds ratios (ORs) were estimated using logistic regression. Results Vitamin D deficiency was significantly associated with higher odds of CDD (OR 1.98, 95% CI 1.20–3.28; p = 0.008). This association persisted after adjustment for ED severity, psychiatric comorbidities, and season of assessment. No significant interactions were found between vitamin D deficiency and ED subtype, EDE-Q score, or season. Conclusions Vitamin D deficiency was associated with the presence of a current depressive disorder in patients with eating disorders, independently of ED subtype, severity, and seasonality. These findings support the clinical relevance of assessing vitamin D status in patients with EDs presenting with depressive symptoms. Longitudinal studies are needed to clarify the direction and clinical implications of this association. Eating disorders vitamin D deficiency depression seasonality eating disorder subtype Plain English Summary People with eating disorders often have low vitamin D levels, and depression is also common in this group. We studied 481 outpatients seen in a specialist eating disorder service in Montpellier, France, to find out whether vitamin D deficiency was more frequent in those who also had a current depressive disorder. Vitamin D deficiency was defined as a blood level below 20 ng/mL. We found that patients with vitamin D deficiency were almost twice as likely to have a current depressive disorder as those without deficiency. This relationship remained after taking into account eating disorder severity, other psychiatric conditions, and the season of assessment. It was also similar across different eating disorder subtypes. Because this was a cross-sectional study, we cannot determine whether low vitamin D contributes to depression, whether depression contributes to low vitamin D, or whether both are influenced by other factors. Still, our findings support checking vitamin D status in patients with eating disorders who present with depressive symptoms. Background Vitamin D is a steroid hormone obtained from dietary sources or through the endogenous conversion of 7-dehydrocholesterol following exposure to solar ultraviolet B radiation [ 1 , 2 ]. After hepatic and renal transformation, the biologically active form, calcitriol (1α,25-dihydroxyvitamin D or 1,25(OH)2D3), is produced [ 3 ]. Calcitriol regulates gene transcription and contributes to calcium and phosphorus homeostasis, metabolic functions, and bone health [ 4 – 8 ]. Vitamin D also has potential relevance for brain function because of its antioxidant, anti-inflammatory, pro-neurogenic, and neuromodulatory properties [ 8 , 9 ]. In the general population, vitamin D deficiency has been associated with depression, particularly in older adults and during the postpartum period [ 10 – 13 ]. Low vitamin D levels have also been reported in several psychiatric conditions, including first-episode psychosis and fibromyalgia, especially when depressive symptoms are present [ 14 , 15 ]. Meta-analytic evidence suggests that vitamin D supplementation may improve depressive symptoms in some settings [ 16 , 17 ]. Patients with eating disorders may be especially vulnerable to vitamin D deficiency because of malnutrition, reduced dietary fat intake, limited sunlight exposure, disturbed daily routines, and medical comorbidities affecting vitamin D metabolism [ 18 – 27 ]. Previous studies have reported vitamin D deficiency rates ranging from 18% to 36% in eating-disorder populations, with possible variation across diagnostic subtypes [ 26 , 28 – 31 ]. Despite the high prevalence of both vitamin D deficiency and depressive disorders in people with eating disorders (ED), the relationship between these conditions remains insufficiently explored in ED populations [ 31 ]. Existing studies were generally limited by small samples, a focus on anorexia nervosa, adolescent inpatient settings, or incomplete consideration of seasonal variation and metabolic confounders [ 28 , 31 ]. Accordingly, this study examined whether patients with eating disorders and a current depressive disorder had a higher prevalence of vitamin D deficiency than patients without depression. We also investigated whether any association between vitamin D deficiency and current depressive disorder varied according to ED subtype, ED severity, or season of assessment. Methods Participants This cross-sectional study included outpatients aged 15–65 years with a diagnosis of an eating disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria [ 33 ]. Participants were assessed at a specialized ED day-care unit in Montpellier, France, between February 2012 and January 2020, before treatment initiation. All participants provided informed consent; for participants younger than 18 years, consent was obtained from a parent or legal guardian. Exclusion criteria were: (1) lack of consent; (2) intellectual disability or psychotic disorder precluding valid consent; (3) serious physical comorbidity requiring full-time hospital admission; (4) ongoing vitamin D supplementation; and (5) missing serum vitamin D data. The data used in this study were collected as part of two previous studies approved by CPP Sud-Méditerranée IV (reference 11-04-SC) and CPP Sud-Est 6 (reference AU13-13). The study was conducted in accordance with the Declaration of Helsinki. Measures Eating disorder diagnosis: ED diagnosis was established through an unstructured multidisciplinary clinical assessment conducted by psychiatrists, psychologists, and nutritionists according to DSM-5 criteria [ 33 ]. Anthropometric measurements: Weight and height were measured in a standardized manner during the morning clinical examination, and body mass index (BMI) was calculated at the time of assessment. Structured clinical interview: The Mini-International Neuropsychiatric Interview (M.I.N.I., version 5.0.0) was used to assess psychiatric comorbidities frequently encountered in ED populations, including depressive disorders, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and alcohol and/or other substance use disorders (SUD) [ 34 ]. Lifetime suicide attempts were also recorded. Current depressive disorder (CDD) was defined as the presence of a current major depressive episode according to the M.I.N.I. Self-administered assessment: The 28-item Eating Disorder Examination Questionnaire (EDE-Q) was used to assess ED psychopathology over the preceding 28 days. The instrument provides a global score and four subscales (restraint, eating concern, shape concern, and weight concern). Higher scores indicate greater ED severity; a global score ≥ 4 was considered indicative of severe ED psychopathology [ 35 ]. In the present sample, Cronbach’s alpha for the total EDE-Q score was 0.723. Body composition: Bioelectrical impedance analysis was used to estimate fat mass (FM). Resistance and reactance were determined using a four-terminal impedance plethysmograph (BIACORPUS RX 4000, Lainate, Italy). Resting energy expenditure: Resting energy expenditure (REE) was measured by open-circuit indirect calorimetry with the QUARK RMR system (COSMED, Rome, Italy). Measurements were obtained in the morning, after an overnight fast and smoking abstinence. Laboratory evaluations: Fasting peripheral blood samples were collected between 8:00 and 9:00 a.m. Serum calcium, phosphate, and alkaline phosphatase were measured using a Cobas 8000 analyser (Roche Diagnostics, Meylan, France). Vitamin D status was assessed using serum 25-hydroxyvitamin D. In line with commonly used clinical thresholds, vitamin D deficiency was defined as < 20 ng/mL [ 37 , 38 ]. Seasonality: Samples obtained from autumn and winter were grouped as the low-light season, and samples obtained from spring and summer were grouped as the high-light season. Statistical analysis Categorical variables were described using counts and percentages, and continuous variables using medians and interquartile ranges because several variables were not normally distributed. Demographic, clinical, and biological characteristics were compared between patients with and without CDD using logistic regression models. Associations between vitamin D status and CDD were quantified with odds ratios (ORs) and 95% confidence intervals (CIs). Multivariable logistic regression models were used to estimate adjusted ORs, including variables associated with CDD in univariable analyses. Sequential models adjusted for ED severity, smoking status, anxiety disorders, lifetime suicide attempts, OCD, PTSD, SUD, and season of assessment. When appropriate, interaction terms were tested using the Wald χ2 test. The significance threshold was set at p < 0.05. Analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). Results Sample characteristics Of the 622 participants included in the two source cohorts, 481 had complete data on both CDD and vitamin D status and were therefore included in the present analysis. Median age was 24.56 years (interquartile range, 20.32–33.08), and 449 participants (93.35%) were female. CDD was present in 146 participants (30.35%), and vitamin D deficiency was present in 24.7% of the sample. A significant negative correlation was observed between BMI and serum vitamin D levels (r = − 0.35, p < 0.0001). Participants with vitamin D deficiency had a higher mean BMI than those without deficiency (24.29 ± 8.80 vs. 19.77 ± 5.16 kg/m², p < 0.01), but BMI was not associated with the presence of a current depressive disorder. Associations with current depressive disorder Compared with participants without CDD, those with CDD had higher EDE-Q scores (p < 0.0001) and were more likely to present with anxiety disorders (p < 0.0001), OCD (p = 0.02), PTSD (p < 0.0001), substance use disorders (p = 0.04), and a lifetime history of suicide attempt (p = 0.0003). Assessment during the low-light season was also more frequent among participants with CDD (p = 0.02). No significant associations with CDD were found for age, sex, BMI, fat mass, REE, smoking status, ED subtype, or the biological parameters reported in the source manuscript. Vitamin D deficiency and current depressive disorder Vitamin D deficiency was associated with higher odds of CDD in the unadjusted model (OR 1.98, 95% CI 1.20–3.28; p = 0.008). The association remained significant after adjustment for EDE-Q total score and after additional adjustment for smoking status, anxiety disorders, lifetime suicide attempts, OCD, SUD, PTSD, and season of assessment. When vitamin D was analysed as a continuous variable, no significant association with CDD was observed. Interaction analyses No significant interactions were detected between vitamin D deficiency and ED subtype, EDE-Q score, or season of assessment in relation to the presence of CDD. The association between vitamin D deficiency and CDD was therefore not meaningfully modified by diagnostic subtype, ED severity, or seasonality in this sample. Discussion In this relatively large outpatient sample of patients with ED, vitamin D deficiency was associated with nearly twice the odds of a CDD. This relationship remained significant after adjustment for ED severity, psychiatric comorbidities, and season of assessment, and it did not differ according to ED subtype or EDE-Q severity. These findings extend previous work showing that vitamin D deficiency is common in ED populations [ 26 , 28 – 31 , 40 ] and that depressive disorders are frequent comorbidities in ED [ 41 – 43 ]. Our results differ from earlier studies in adolescent inpatient samples, which did not identify a clear relationship between vitamin D status and depression [ 28 , 31 ]. Compared with those studies, the present work included a larger sample, a broader range of ED subtypes, and explicit consideration of seasonality and clinical confounders. Several biological mechanisms could plausibly link vitamin D deficiency and depression. Vitamin D may influence inflammatory pathways, oxidative stress, and neurotrophic signalling, all of which have been implicated in affective disorders [ 9 , 39 ]. In patients with ED, these pathways may interact with malnutrition, circadian disruption, and reduced sunlight exposure [ 26 , 27 , 44 – 46 ]. However, the present cross-sectional design does not allow conclusions about causality, and interventional studies are needed before any therapeutic implications can be established in ED populations. From a clinical perspective, the findings support systematic assessment of depressive symptoms in patients with eating disorders and consideration of vitamin D testing when depressive comorbidity is present. The absence of significant interaction by season suggests that this issue should not be viewed as relevant only in winter. Similarly, the absence of interaction by ED subtype suggests that attention to vitamin D status should not be restricted to anorexia nervosa alone. This study has several limitations. First, its cross-sectional design precludes any inference about directionality. Second, the sample was recruited from a single specialist centre in Montpellier, France, which may limit generalisability. Third, the study took place in Southern France, where ambient sunlight is relatively abundant, and seasonal findings may differ at higher latitudes. Finally, the BED subgroup likely underrepresented patients with obesity because local referral pathways more often direct such patients to nutrition or endocrinology services rather than psychiatric ED units. Despite these limitations, the study contributes clinically relevant evidence from a sizeable sample assessed with standardized psychiatric and ED measures. Conclusions Vitamin D deficiency was associated with the presence of a CDD in patients with ED, independently of ED subtype, ED severity, and season of assessment. These findings support the clinical relevance of assessing vitamin D status in patients with eating disorders who present with depressive symptoms. Longitudinal and interventional studies are needed to clarify directionality and to determine whether correcting vitamin D deficiency can improve clinical outcomes in this population. Abbreviations BMI Body mass index CDD Current depressive disorder CI Confidence interval DSM-5 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ED Eating disorder EDE-Q Eating Disorder Examination Questionnaire FM Fat mass M.I.N.I. Mini-International Neuropsychiatric Interview OCD Obsessive-compulsive disorder OR Odds ratio PTSD Post-traumatic stress disorder REE Resting energy expenditure SUD Substance use disorder Declarations Ethics approval and consent to participate The data used in this study were collected as part of two previous studies approved by CPP Sud-Méditerranée IV (reference 11-04-SC) and CPP Sud-Est 6 (reference AU13-13). All participants provided informed consent; for participants younger than 18 years, consent was obtained from a parent or legal guardian. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request, subject to institutional and ethical constraints. Competing interests To be confirmed by all authors before submission. Funding Funding information was not provided in the source manuscript and should be completed before submission. Authors' contributions This section should be completed by the authors before submission. Acknowledgements Not applicable. Authors' information Optional; add if desired before submission. References Charoenngam, N.; Shirvani, A.; Holick, M.F. Vitamin D for Skeletal and Non-Skeletal Health: What We Should Know. J. Clin. Orthop. Trauma. 2019, 10, 1082–1093. Holick, M.F. Vitamin D: A D-Lightful Solution for Health. J. Investig. Med. 2011, 59, 872–880. Hossein-nezhad, A.; Holick, M.F. Vitamin D for Health: A Global Perspective. Mayo Clin. Proc. 2013, 88, 720–755. 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Light Treatment for Nonseasonal Depression: Speed, Efficacy, and Combined Treatment. J. Affect. Disord. 1998, 49, 109–117. Germain, A.; Kupfer, D.J. Circadian Rhythm Disturbances in Depression. Hum. Psychopharmacol. 2008, 23, 571–585. Tables Table 1. Description of Sociodemographic, Clinical and Biological Parameters in Patients with Eating Disorders (N=481) and Comparison Between Those With and Without Current Depressive Disorder. Current depressive disorder Whole population N=481 No N=335 Yes N=146 Variable n (%) n (%) n (%) p-value Gender, Female 449 (93.35) 310 (92.54) 139 (95.21) 0.32 Age (years) (1) 481 ; 24.56 (20.32; 33.08) 335; 24.27 (20.16; 32.63) 146; 25.33 (20.75; 34.50) 0.28 Body mass index (kg/m 2)(1) 481 ; 18.55 (16.58; 22.10) 335; 18.60 (16.54; 22.02) 146; 18.36 (16.60; 23.09) 0.70 Smoking status, Current smoker 185 (39.11) 119 (36.39) 66 (45.21) 0.07 Resting energy expenditure (Kcal/day) (1) 459; 1236.00 (1075.00; 1402.00) 322; 1226.50 (1071.00; 1380.00) 137; 1253.00 (1080.00; 1427.00) 0.61 Fatty mass (kg) (1) 454; 12.87 (8.36; 19.78) 317; 12.48 (8.09; 18.91) 137; 13.16 (9.06; 22.07) 0.26 Eating disorder 0.40 Anorexia Nervosa 267 (55.51) 182 (54.33) 85 (58.22) Bulimia 115 (23.91) 83 (24.78) 32 (21.92) Binge eating disorder 53 (11.02) 34 (10.15) 19 (13.01) Unspecified 46 (9.56) 36 (10.75) 10 (6.85) Total EDE-Q score (1) 448; 3.71 (2.27; 4.65) 377; 3.31 (1.83; 4.29) 71; 4.32 (3.38; 5.09) <0.0001 Total EDE-Q score, ≥4 187 (41.74) 107 (33.97) 80 (60.15) <0.0001 Anxiety disorder, Yes 244 (51.05) 142 (42.51) 102 (70.83) < 0.0001 Suicide attempt, Yes 115 (24.06) 64 (19.28) 51 (34.93) 0.0003 Obsessive-compulsive disorder, Yes 61 (12.76) 35 (10.45) 26 (18.18) 0.02 Substance use disorder, Yes 40 (8.32) 22 (6.57) 18 (12.33) 0.04 PTSD, Yes 35 (7.35) 10 (3.00) 25 (17.48) < 0.0001 Season at time of assessment, High-light 265 (55.09) 196 (58.51) 69 (47.26) 0.02 Biological parameters Prothrombin time (%) 455; 100.00 (94.00; 100.00) 315; 100.00 (94.00; 100.00) 140; 100.00 (93.00; 100.00) 0.67 Vitamin B12 (pg/mL) 468; 298.50 (217.50; 391.00) 328; 299.50 (210.00; 386.50) 140; 293.00 (229.00; 402.50) 0.87 C-reactive protein (mg/L) 452; 0.40 (0.30; 1.65) 319; 0.50 (0.30; 1.60) 133; 0.40 (0.30; 1.70) 0.99 Haemoglobin (g/dl) 474; 13.30 (12.70; 14.10) 331; 13.40 (12.70; 14.00) 143; 13.20 (12.60; 14.30) 0.45 Ferritin (Microg/mL) 459; 46.00 (24.00; 83.00) 321; 46.00 (25.00; 81.00) 138; 45.00 (23.00; 86.00) 0.76 TSH (mUI/L) 442; 1.86 (1.28; 2.65) 313; 1.81 (1.25; 2.60) 129; 2.00 (1.30; 2.79) 0.27 Albumin (g/L) 443; 46.00 (44.00; 49.00) 306; 46.00 (44.00; 49.00) 137; 46.00 (44.00; 48.00) 0.51 Creatinine (µmol/L) 475; 68.00 (60.00; 76.00) 330; 69.00 (61.00; 76.00) 145; 67.00 (59.00; 75.00) 0.24 (1) Continuous variable was expressed as number, median (First quartile; Third quartile). Abbreviations: EDE-Q=Eating Disorder Examination Questionnaire; PTSD=Post-Traumatic Stress Disorder. Table 2. Association Between Vitamin D Status and the Presence of Current Depressive Disorder. Current depressive disorder Variable Whole population N=481 No N=335 Yes N=146 Model 0 (2) Model 1 (3) Model 2 (4) Model 3 (5) Variable n (%) n (%) n (%) OR [95%CI] p OR [95%CI] p OR [95%CI] p OR [95%CI] p Vitamin D deficiency 0.008 0.02 0.02 0.04 ≥20 ng/ml 405 (84.20) 292 (87.16) 113 (77.40) 1 1 1 1 <20 ng/ml 76 (15.80) 43 (12.84) 33 (22.60) 1.98 [1.20; 3.28] 1.90 [1.09; 3.29] 2.03 [1.12; 3.68] 1.89 [1.03; 3.46] Vitamin D serum concentration (ng/ml) (1) OR for a 20-units decrease 481; 33.00 (24.00; 43.00) 335; 33.60 (24.50; 43.30) 146; 31.75 (21.00; 40.00) 1.33 [1.00; 1.77] 0.049 1.30 [0.96; 1.76] 0.09 1.24 [0.89; 1.74] 0.21 1.18 [0.84; 1.66] 0.35 (1) Continuous variable was expressed as number, median (First quartile; Third quartile). (2) Crude association. (3) Model 1 was adjusted for Total EDE-Q score. (3) Model 2 was adjusted for Total EDE-Q score plus smoking status, anxiety disorders, suicidal attempts, obsessive-compulsive disorder, substance abuse disorders, PTSD. (3) Model 3 was adjusted for all the covariates in Model 2 plus season at time of assessment. Abbreviations: EDE-Q=Eating Disorder Examination Questionnaire; OR=Odds ratio; CI=Confidence Intervals; PTSD=Post-Traumatic Stress Disorder. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9135597","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":616487835,"identity":"85017225-b378-4940-9a62-a8215f1d35bf","order_by":0,"name":"Rami Bou Khalil","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYJCCA4wNDAwSEgyMBxIKbEB8BgYeBgYZAyK0MBxIMEiDa+HBp4UBroXB4DBEBJ8W8/bTiQcYd9gkzpzd/ODAA4PzifMbDzA+eNvGwGOOQ4vMmdwNBxjPpCXOljlmAHTY7cQNBw4wG84FarFswK5FggGkpe1w4jyJBKgWhgNs0rxALQYHcGjhfwvTkv4BqOVc4vyGA+y/8WqRgNoyWyIHZMuBxIYDB9iY8WsB2pJ4Js145oycAqCWZOMNBw42S845J4HbL/y5mz983GEjO+NG+saHPyrsZOfPOHzww5syGzlcIQYGCaimHGwAhwsJgB+Hg0bBKBgFo2DEAgDiP2ewF5q1CwAAAABJRU5ErkJggg==","orcid":"","institution":"Saint Joseph University","correspondingAuthor":true,"prefix":"","firstName":"Rami","middleName":"Bou","lastName":"Khalil","suffix":""},{"id":616487836,"identity":"5bc57336-1cfb-4b45-a46e-8e30082949cc","order_by":1,"name":"Hala Kerbage","email":"","orcid":"","institution":"Saint Eloi University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hala","middleName":"","lastName":"Kerbage","suffix":""},{"id":616487837,"identity":"3e003e72-0757-478e-b1c8-f3a85e72ea5e","order_by":2,"name":"Myriam Zarzour","email":"","orcid":"","institution":"Saint Joseph University","correspondingAuthor":false,"prefix":"","firstName":"Myriam","middleName":"","lastName":"Zarzour","suffix":""},{"id":616487838,"identity":"486fbf16-f660-48b0-ae99-1fe17ef59805","order_by":3,"name":"Robertas Strumila","email":"","orcid":"","institution":"Vilnius University","correspondingAuthor":false,"prefix":"","firstName":"Robertas","middleName":"","lastName":"Strumila","suffix":""},{"id":616487839,"identity":"1f28ef3b-c141-4414-8d31-687231a4266f","order_by":4,"name":"Maude Seneque","email":"","orcid":"","institution":"Montpellier University Hospital Centre","correspondingAuthor":false,"prefix":"","firstName":"Maude","middleName":"","lastName":"Seneque","suffix":""},{"id":616487840,"identity":"1c65b582-49e5-49cd-8315-e462e863beba","order_by":5,"name":"Ariane Sultan","email":"","orcid":"","institution":"Lapeyronie University Hospital Centre","correspondingAuthor":false,"prefix":"","firstName":"Ariane","middleName":"","lastName":"Sultan","suffix":""},{"id":616487841,"identity":"253d4880-61a3-4b3a-a6c7-28c35d93b5d2","order_by":6,"name":"Antoine Avignon","email":"","orcid":"","institution":"Lapeyronie University Hospital Centre","correspondingAuthor":false,"prefix":"","firstName":"Antoine","middleName":"","lastName":"Avignon","suffix":""},{"id":616487842,"identity":"ef274e30-48a3-4cd4-8bf7-0e8397368814","order_by":7,"name":"Philippe Courtet","email":"","orcid":"","institution":"Montpellier University Hospital Centre","correspondingAuthor":false,"prefix":"","firstName":"Philippe","middleName":"","lastName":"Courtet","suffix":""},{"id":616487843,"identity":"04823d65-3a68-4034-a3f3-a165ba2d8d39","order_by":8,"name":"Isabelle Jaussent","email":"","orcid":"","institution":"Montpellier University","correspondingAuthor":false,"prefix":"","firstName":"Isabelle","middleName":"","lastName":"Jaussent","suffix":""},{"id":616487844,"identity":"c33bc15e-511e-4364-893b-188bbf0cb5f9","order_by":9,"name":"Sebastien Guillaume","email":"","orcid":"","institution":"Montpellier University Hospital Centre","correspondingAuthor":false,"prefix":"","firstName":"Sebastien","middleName":"","lastName":"Guillaume","suffix":""}],"badges":[],"createdAt":"2026-03-16 09:12:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9135597/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9135597/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106236294,"identity":"06408cba-c801-41c7-8053-ec0d32ab1915","added_by":"auto","created_at":"2026-04-06 13:56:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":757955,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9135597/v1/5fadfcc5-5ac2-4ee9-b37a-470c84da9d47.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Association of Vitamin D Deficiency with Depressive Disorders in Patients with Eating Disorders: A Cross-Sectional Study","fulltext":[{"header":"Plain English Summary","content":"\u003cp\u003ePeople with eating disorders often have low vitamin D levels, and depression is also common in this group. We studied 481 outpatients seen in a specialist eating disorder service in Montpellier, France, to find out whether vitamin D deficiency was more frequent in those who also had a current depressive disorder. Vitamin D deficiency was defined as a blood level below 20 ng/mL. We found that patients with vitamin D deficiency were almost twice as likely to have a current depressive disorder as those without deficiency. This relationship remained after taking into account eating disorder severity, other psychiatric conditions, and the season of assessment. It was also similar across different eating disorder subtypes. Because this was a cross-sectional study, we cannot determine whether low vitamin D contributes to depression, whether depression contributes to low vitamin D, or whether both are influenced by other factors. Still, our findings support checking vitamin D status in patients with eating disorders who present with depressive symptoms.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eVitamin D is a steroid hormone obtained from dietary sources or through the endogenous conversion of 7-dehydrocholesterol following exposure to solar ultraviolet B radiation [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. After hepatic and renal transformation, the biologically active form, calcitriol (1α,25-dihydroxyvitamin D or 1,25(OH)2D3), is produced [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Calcitriol regulates gene transcription and contributes to calcium and phosphorus homeostasis, metabolic functions, and bone health [\u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVitamin D also has potential relevance for brain function because of its antioxidant, anti-inflammatory, pro-neurogenic, and neuromodulatory properties [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In the general population, vitamin D deficiency has been associated with depression, particularly in older adults and during the postpartum period [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Low vitamin D levels have also been reported in several psychiatric conditions, including first-episode psychosis and fibromyalgia, especially when depressive symptoms are present [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Meta-analytic evidence suggests that vitamin D supplementation may improve depressive symptoms in some settings [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients with eating disorders may be especially vulnerable to vitamin D deficiency because of malnutrition, reduced dietary fat intake, limited sunlight exposure, disturbed daily routines, and medical comorbidities affecting vitamin D metabolism [\u003cspan additionalcitationids=\"CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Previous studies have reported vitamin D deficiency rates ranging from 18% to 36% in eating-disorder populations, with possible variation across diagnostic subtypes [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan additionalcitationids=\"CR29 CR30\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the high prevalence of both vitamin D deficiency and depressive disorders in people with eating disorders (ED), the relationship between these conditions remains insufficiently explored in ED populations [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Existing studies were generally limited by small samples, a focus on anorexia nervosa, adolescent inpatient settings, or incomplete consideration of seasonal variation and metabolic confounders [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccordingly, this study examined whether patients with eating disorders and a current depressive disorder had a higher prevalence of vitamin D deficiency than patients without depression. We also investigated whether any association between vitamin D deficiency and current depressive disorder varied according to ED subtype, ED severity, or season of assessment.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThis cross-sectional study included outpatients aged 15\u0026ndash;65 years with a diagnosis of an eating disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Participants were assessed at a specialized ED day-care unit in Montpellier, France, between February 2012 and January 2020, before treatment initiation.\u003c/p\u003e \u003cp\u003e All participants provided informed consent; for participants younger than 18 years, consent was obtained from a parent or legal guardian. Exclusion criteria were: (1) lack of consent; (2) intellectual disability or psychotic disorder precluding valid consent; (3) serious physical comorbidity requiring full-time hospital admission; (4) ongoing vitamin D supplementation; and (5) missing serum vitamin D data.\u003c/p\u003e \u003cp\u003eThe data used in this study were collected as part of two previous studies approved by CPP Sud-M\u0026eacute;diterran\u0026eacute;e IV (reference 11-04-SC) and CPP Sud-Est 6 (reference AU13-13). The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eEating disorder diagnosis: ED diagnosis was established through an unstructured multidisciplinary clinical assessment conducted by psychiatrists, psychologists, and nutritionists according to DSM-5 criteria [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnthropometric measurements: Weight and height were measured in a standardized manner during the morning clinical examination, and body mass index (BMI) was calculated at the time of assessment.\u003c/p\u003e \u003cp\u003eStructured clinical interview: The Mini-International Neuropsychiatric Interview (M.I.N.I., version 5.0.0) was used to assess psychiatric comorbidities frequently encountered in ED populations, including depressive disorders, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and alcohol and/or other substance use disorders (SUD) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Lifetime suicide attempts were also recorded. Current depressive disorder (CDD) was defined as the presence of a current major depressive episode according to the M.I.N.I.\u003c/p\u003e \u003cp\u003eSelf-administered assessment: The 28-item Eating Disorder Examination Questionnaire (EDE-Q) was used to assess ED psychopathology over the preceding 28 days. The instrument provides a global score and four subscales (restraint, eating concern, shape concern, and weight concern). Higher scores indicate greater ED severity; a global score\u0026thinsp;\u0026ge;\u0026thinsp;4 was considered indicative of severe ED psychopathology [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In the present sample, Cronbach\u0026rsquo;s alpha for the total EDE-Q score was 0.723.\u003c/p\u003e \u003cp\u003eBody composition: Bioelectrical impedance analysis was used to estimate fat mass (FM). Resistance and reactance were determined using a four-terminal impedance plethysmograph (BIACORPUS RX 4000, Lainate, Italy).\u003c/p\u003e \u003cp\u003eResting energy expenditure: Resting energy expenditure (REE) was measured by open-circuit indirect calorimetry with the QUARK RMR system (COSMED, Rome, Italy). Measurements were obtained in the morning, after an overnight fast and smoking abstinence.\u003c/p\u003e \u003cp\u003eLaboratory evaluations: Fasting peripheral blood samples were collected between 8:00 and 9:00 a.m. Serum calcium, phosphate, and alkaline phosphatase were measured using a Cobas 8000 analyser (Roche Diagnostics, Meylan, France). Vitamin D status was assessed using serum 25-hydroxyvitamin D. In line with commonly used clinical thresholds, vitamin D deficiency was defined as \u0026lt;\u0026thinsp;20 ng/mL [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeasonality: Samples obtained from autumn and winter were grouped as the low-light season, and samples obtained from spring and summer were grouped as the high-light season.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eCategorical variables were described using counts and percentages, and continuous variables using medians and interquartile ranges because several variables were not normally distributed. Demographic, clinical, and biological characteristics were compared between patients with and without CDD using logistic regression models.\u003c/p\u003e \u003cp\u003eAssociations between vitamin D status and CDD were quantified with odds ratios (ORs) and 95% confidence intervals (CIs). Multivariable logistic regression models were used to estimate adjusted ORs, including variables associated with CDD in univariable analyses. Sequential models adjusted for ED severity, smoking status, anxiety disorders, lifetime suicide attempts, OCD, PTSD, SUD, and season of assessment.\u003c/p\u003e \u003cp\u003eWhen appropriate, interaction terms were tested using the Wald χ2 test. The significance threshold was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSample characteristics\u003c/h2\u003e \u003cp\u003eOf the 622 participants included in the two source cohorts, 481 had complete data on both CDD and vitamin D status and were therefore included in the present analysis. Median age was 24.56 years (interquartile range, 20.32\u0026ndash;33.08), and 449 participants (93.35%) were female.\u003c/p\u003e \u003cp\u003eCDD was present in 146 participants (30.35%), and vitamin D deficiency was present in 24.7% of the sample. A significant negative correlation was observed between BMI and serum vitamin D levels (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.35, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Participants with vitamin D deficiency had a higher mean BMI than those without deficiency (24.29\u0026thinsp;\u0026plusmn;\u0026thinsp;8.80 vs. 19.77\u0026thinsp;\u0026plusmn;\u0026thinsp;5.16 kg/m\u0026sup2;, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), but BMI was not associated with the presence of a current depressive disorder.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAssociations with current depressive disorder\u003c/h2\u003e \u003cp\u003eCompared with participants without CDD, those with CDD had higher EDE-Q scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and were more likely to present with anxiety disorders (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), OCD (p\u0026thinsp;=\u0026thinsp;0.02), PTSD (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), substance use disorders (p\u0026thinsp;=\u0026thinsp;0.04), and a lifetime history of suicide attempt (p\u0026thinsp;=\u0026thinsp;0.0003). Assessment during the low-light season was also more frequent among participants with CDD (p\u0026thinsp;=\u0026thinsp;0.02).\u003c/p\u003e \u003cp\u003eNo significant associations with CDD were found for age, sex, BMI, fat mass, REE, smoking status, ED subtype, or the biological parameters reported in the source manuscript.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVitamin D deficiency and current depressive disorder\u003c/h3\u003e\n\u003cp\u003eVitamin D deficiency was associated with higher odds of CDD in the unadjusted model (OR 1.98, 95% CI 1.20\u0026ndash;3.28; p\u0026thinsp;=\u0026thinsp;0.008). The association remained significant after adjustment for EDE-Q total score and after additional adjustment for smoking status, anxiety disorders, lifetime suicide attempts, OCD, SUD, PTSD, and season of assessment.\u003c/p\u003e \u003cp\u003eWhen vitamin D was analysed as a continuous variable, no significant association with CDD was observed.\u003c/p\u003e\n\u003ch3\u003eInteraction analyses\u003c/h3\u003e\n\u003cp\u003eNo significant interactions were detected between vitamin D deficiency and ED subtype, EDE-Q score, or season of assessment in relation to the presence of CDD. The association between vitamin D deficiency and CDD was therefore not meaningfully modified by diagnostic subtype, ED severity, or seasonality in this sample.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this relatively large outpatient sample of patients with ED, vitamin D deficiency was associated with nearly twice the odds of a CDD. This relationship remained significant after adjustment for ED severity, psychiatric comorbidities, and season of assessment, and it did not differ according to ED subtype or EDE-Q severity.\u003c/p\u003e \u003cp\u003eThese findings extend previous work showing that vitamin D deficiency is common in ED populations [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan additionalcitationids=\"CR29 CR30\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] and that depressive disorders are frequent comorbidities in ED [\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Our results differ from earlier studies in adolescent inpatient samples, which did not identify a clear relationship between vitamin D status and depression [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Compared with those studies, the present work included a larger sample, a broader range of ED subtypes, and explicit consideration of seasonality and clinical confounders.\u003c/p\u003e \u003cp\u003eSeveral biological mechanisms could plausibly link vitamin D deficiency and depression. Vitamin D may influence inflammatory pathways, oxidative stress, and neurotrophic signalling, all of which have been implicated in affective disorders [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In patients with ED, these pathways may interact with malnutrition, circadian disruption, and reduced sunlight exposure [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan additionalcitationids=\"CR45\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. However, the present cross-sectional design does not allow conclusions about causality, and interventional studies are needed before any therapeutic implications can be established in ED populations.\u003c/p\u003e \u003cp\u003eFrom a clinical perspective, the findings support systematic assessment of depressive symptoms in patients with eating disorders and consideration of vitamin D testing when depressive comorbidity is present. The absence of significant interaction by season suggests that this issue should not be viewed as relevant only in winter. Similarly, the absence of interaction by ED subtype suggests that attention to vitamin D status should not be restricted to anorexia nervosa alone.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, its cross-sectional design precludes any inference about directionality. Second, the sample was recruited from a single specialist centre in Montpellier, France, which may limit generalisability. Third, the study took place in Southern France, where ambient sunlight is relatively abundant, and seasonal findings may differ at higher latitudes. Finally, the BED subgroup likely underrepresented patients with obesity because local referral pathways more often direct such patients to nutrition or endocrinology services rather than psychiatric ED units. Despite these limitations, the study contributes clinically relevant evidence from a sizeable sample assessed with standardized psychiatric and ED measures.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eVitamin D deficiency was associated with the presence of a CDD in patients with ED, independently of ED subtype, ED severity, and season of assessment.\u003c/p\u003e \u003cp\u003eThese findings support the clinical relevance of assessing vitamin D status in patients with eating disorders who present with depressive symptoms. Longitudinal and interventional studies are needed to clarify directionality and to determine whether correcting vitamin D deficiency can improve clinical outcomes in this population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCDD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCurrent depressive disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eDSM-5\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eED\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEating disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eEDE-Q\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEating Disorder Examination Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFM\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFat mass\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eM.I.N.I.\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMini-International Neuropsychiatric Interview\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eOCD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eObsessive-compulsive disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePTSD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePost-traumatic stress disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eREE\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eResting energy expenditure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSUD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSubstance use disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThe data used in this study were collected as part of two previous studies approved by CPP Sud-Méditerranée IV (reference 11-04-SC) and CPP Sud-Est 6 (reference AU13-13). All participants provided informed consent; for participants younger than 18 years, consent was obtained from a parent or legal guardian.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request, subject to institutional and ethical constraints.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eTo be confirmed by all authors before submission.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eFunding information was not provided in the source manuscript and should be completed before submission.\u003c/p\u003e\n\u003ch2\u003eAuthors' contributions\u003c/h2\u003e\n\u003cp\u003eThis section should be completed by the authors before submission.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAuthors' information\u003c/h2\u003e\n\u003cp\u003eOptional; add if desired before submission.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCharoenngam, N.; Shirvani, A.; Holick, M.F. Vitamin D for Skeletal and Non-Skeletal Health: What We Should Know. J. Clin. Orthop. Trauma. 2019, 10, 1082\u0026ndash;1093.\u003c/li\u003e\n \u003cli\u003eHolick, M.F. Vitamin D: A D-Lightful Solution for Health. J. Investig. Med. 2011, 59, 872\u0026ndash;880.\u003c/li\u003e\n \u003cli\u003eHossein-nezhad, A.; Holick, M.F. Vitamin D for Health: A Global Perspective. Mayo Clin. Proc. 2013, 88, 720\u0026ndash;755.\u003c/li\u003e\n \u003cli\u003eWacker, M.; Holick, M.F. Vitamin D\u0026mdash;Effects on Skeletal and Extraskeletal Health and the Need for Supplementation. Nutrients. 2013, 5, 111\u0026ndash;148.\u003c/li\u003e\n \u003cli\u003eHaussler, M.R.; Whitfield, G.K.; Kaneko, I.; Haussler, C.A.; Hsieh, D.; Hsieh, J.-C.; Jurutka, P.W. Molecular Mechanisms of Vitamin D Action. Calcif. Tissue Int. 2013, 92, 77\u0026ndash;98.\u003c/li\u003e\n \u003cli\u003eHossein-nezhad, A.; Holick, M.F. Optimize Dietary Intake of Vitamin D: An Epigenetic Perspective. Curr. Opin. Clin. Nutr. Metab. Care. 2012, 15, 567\u0026ndash;579.\u003c/li\u003e\n \u003cli\u003eHossein-nezhad, A.; Spira, A.; Holick, M.F. Influence of Vitamin D Status and Vitamin D3 Supplementation on Genome-Wide Expression of White Blood Cells: A Randomized Double-Blind Clinical Trial. PLoS One. 2013, 8, e58725.\u003c/li\u003e\n \u003cli\u003eChristakos, S.; Dhawan, P.; Verstuyf, A.; Verlinden, L.; Carmeliet, G. Vitamin D: Metabolism, Molecular Mechanism of Action, and Pleiotropic Effects. Physiol. Rev. 2016, 96, 365\u0026ndash;408.\u003c/li\u003e\n \u003cli\u003eKouba, B.R.; Camargo, A.; Gil-Mohapel, J.; Rodrigues, A.L.S. Molecular Basis Underlying the Therapeutic Potential of Vitamin D for the Treatment of Depression and Anxiety. Int. J. Mol. Sci. 2022, 23, 7077.\u003c/li\u003e\n \u003cli\u003eGanji, V.; Milone, C.; Cody, M.M.; McCarty, F.; Wang, Y.T. Serum Vitamin D Concentrations Are Related to Depression in Young Adult U.S. Population: The Third National Health and Nutrition Examination Survey. Int. Arch. Med. 2010, 3, 29.\u003c/li\u003e\n \u003cli\u003eBouloukaki, I.; Markakis, M.; Pateli, R.; Lyronis, I.; Schiza, S.; Tsiligianni, I. Vitamin D Levels in Primary Care Patients: Correlations with Clinical, Seasonal, and Quality-of-Life Parameters. Fam. Pract. 2022, 39, 678\u0026ndash;684.\u003c/li\u003e\n \u003cli\u003eGastaldon, C.; Solmi, M.; Correll, C.U.; Barbui, C.; Schoretsanitis, G. Risk Factors of Postpartum Depression and Depressive Symptoms: Umbrella Review of Current Evidence from Systematic Reviews and Meta-Analyses of Observational Studies. Br. J. Psychiatry. 2022, 27, 1\u0026ndash;12.\u003c/li\u003e\n \u003cli\u003eVan den Berg, K.S.; Hegeman, J.M.; Van den Brink, R.; Rhebergen, D.; Oude Voshaar, R.C.; Marijnissen, R.M. A Prospective Study into Change of Vitamin D Levels, Depression, and Frailty Among Depressed Older Persons. Int. J. Geriatr. Psychiatry. 2021, 36, 1029\u0026ndash;1036.\u003c/li\u003e\n \u003cli\u003eD\u0026apos;Souza, R.S.; Lin, G.; Oh, T.; Vincent, A.; Orhurhu, V.; Jiang, L.; Mauck, W.D.; Qu, W. Fibromyalgia Symptom Severity and Psychosocial Outcomes in Fibromyalgia Patients with Hypovitaminosis D: A Prospective Questionnaire Study. Pain Med. 2020, 21, 3470\u0026ndash;3478.\u003c/li\u003e\n \u003cli\u003eCoentre, R.; Canelas da Silva, I. Symptomatic Correlates of Vitamin D Deficiency in First-Episode Psychosis. Psychiatry J. 2019, 2019, 7839287.\u003c/li\u003e\n \u003cli\u003eMikola, T.; Marx, W.; Lane, M.M.; Hockey, M.; Loughman, A.; Rajapolvi, S.; Rocks, T.; O\u0026apos;Neil, A.; Mischoulon, D.; Valkonen-Korhonen, M.; Lehto, S.M.; Ruusunen, A. The Effect of Vitamin D Supplementation on Depressive Symptoms in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Crit. Rev. Food Sci. Nutr. 2022, 1\u0026ndash;18.\u003c/li\u003e\n \u003cli\u003eXie, F.; Huang, T.; Lou, D.; Fu, R.; Ni, C.; Hong, J.; Ruan, L. Effect of Vitamin D Supplementation on the Incidence and Prognosis of Depression: An Updated Meta-Analysis Based on Randomized Controlled Trials. Front. Public Health. 2022, 10, 903547.\u003c/li\u003e\n \u003cli\u003eWalsh, J.S.; Bowles, S.; Evans, A.L. Vitamin D in Obesity. Curr. Opin. Endocrinol. Diabetes Obes. 2017, 24, 389\u0026ndash;394.\u003c/li\u003e\n \u003cli\u003eVanlint, S. Vitamin D and Obesity. Nutrients. 2013, 5, 949\u0026ndash;956.\u003c/li\u003e\n \u003cli\u003eGilsanz, V.; Kremer, A.; Mo, A.O.; Wren, T.A.; Kremer, R. Vitamin D Status and Its Relation to Muscle Mass and Muscle Fat in Young Women. J. Clin. Endocrinol. Metab. 2010, 95, 1595\u0026ndash;1601.\u003c/li\u003e\n \u003cli\u003eCrewther, B.; Cook, C.; Fitzgerald, J.; Starczewski, M.; Gorski, M.; Orysiak, J. Vitamin D and Cortisol as Moderators of the Relationship Between Testosterone and Exercise Performance in Adolescent Male Athletes. Pediatr. Exerc. Sci. 2020, 32, 204\u0026ndash;209.\u003c/li\u003e\n \u003cli\u003eDawson-Hughes, B.; Harris, S.S.; Lichtenstein, A.H.; Dolnikowski, G.; Palermo, N.J.; Rasmussen, H. Dietary Fat Increases Vitamin D-3 Absorption. J. Acad. Nutr. Diet. 2015, 115, 225\u0026ndash;230.\u003c/li\u003e\n \u003cli\u003eBouquegneau, A.; Dubois, B.E.; Krzesinski, J.M.; Delanaye, P. Anorexia Nervosa and the Kidney. Am. J. Kidney Dis. 2012, 60, 299\u0026ndash;307.\u003c/li\u003e\n \u003cli\u003eCuntz, U.; Voderholzer, U. Liver Damage Is Related to the Degree of Being Underweight in Anorexia Nervosa and Improves Rapidly with Weight Gain. Nutrients. 2022, 14, 2378.\u003c/li\u003e\n \u003cli\u003eMenculini, G.; Brufani, F.; Del Bello, V.; Moretti, P.; Tortorella, A. Circadian Rhythms Disruptions and Eating Disorders: Clinical Impact and Possible Psychopathological Correlates. Psychiatr. Danub. 2019, 31(Suppl. 3), 497\u0026ndash;502.\u003c/li\u003e\n \u003cli\u003eMehler, P.S.; Blalock, D.V.; Walden, K.; Kaur, S.; McBride, J.; Walsh, K.; Watts, J. Medical Findings in 1,026 Consecutive Adult Inpatient-Residential Eating Disordered Patients. Int. J. Eat. Disord. 2018, 51, 305\u0026ndash;313.\u003c/li\u003e\n \u003cli\u003eGatti, D.; El Ghoch, M.; Viapiana, O.; Ruocco, A.; Chignola, E.; Rossini, M.; Giollo, A.; Idolazzi, L.; Adami, S.; Dalle Grave, R. Strong Relationship Between Vitamin D Status and Bone Mineral Density in Anorexia Nervosa. Bone. 2015, 78, 212\u0026ndash;215.\u003c/li\u003e\n \u003cli\u003eModan-Moses, D.; Levy-Shraga, Y.; Pinhas-Hamiel, O.; Kochavi, B.; Enoch-Levy, A.; Vered, I.; Stein, D. High Prevalence of Vitamin D Deficiency and Insufficiency in Adolescent Inpatients Diagnosed with Eating Disorders. Int. J. Eat. Disord. 2015, 48, 607\u0026ndash;614.\u003c/li\u003e\n \u003cli\u003eVelickovic, K.M.; Makovey, J.; Abraham, S.F. Vitamin D, Bone Mineral Density and Body Mass Index in Eating Disorder Patients. Eat. Behav. 2013, 14, 124\u0026ndash;127.\u003c/li\u003e\n \u003cli\u003eTasegian, A.; Curcio, F.; Dalla Ragione, L.; Rossetti, F.; Cataldi, S.; Codini, M.; Ambesi-Impiombato, F.S.; Beccari, T.; Albi, E. Hypovitaminosis D3, Leukopenia, and Human Serotonin Transporter Polymorphism in Anorexia Nervosa and Bulimia Nervosa. Mediators Inflamm. 2016, 2016, 8046479.\u003c/li\u003e\n \u003cli\u003eF\u0026ouml;cker, M.; Timmesfeld, N.; B\u0026uuml;hlmeier, J.; Zwanziger, D.; F\u0026uuml;hrer, D.; Grasemann, C.; Ehrlich, S.; Egberts, K.; Fleischhaker, C.; Wewetzer, C.; Wessing, I.; Seitz, J.; Herpertz-Dahlmann, B.; Hebebrand, J.; Libuda, L. Vitamin D Level Trajectories of Adolescent Patients with Anorexia Nervosa at Inpatient Admission, During Treatment, and at One Year Follow-Up: Association with Depressive Symptoms. Nutrients. 2021, 13, 2356.\u003c/li\u003e\n \u003cli\u003eLappe, J.M.; Davies, K.M.; Travers-Gustafson, D.; Heaney, R.P. Vitamin D Status in a Rural Postmenopausal Female Population. J. Am. Coll. Nutr. 2006, 25, 395\u0026ndash;402.\u003c/li\u003e\n \u003cli\u003eAmerican Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5; American Psychiatric Publishing: Arlington, VA, USA, 2013.\u003c/li\u003e\n \u003cli\u003eSheehan, D.V.; Lecrubier, Y.; Sheehan, K.H.; Amorim, P.; Janavs, J.; Weiller, E.; Hergueta, T.; Baker, R.; Dunbar, G.C. The Mini-International Neuropsychiatric Interview (M.I.N.I.): The Development and Validation of a Structured Diagnostic Psychiatric Interview for DSM-IV and ICD-10. J. Clin. Psychiatry. 1998, 59(Suppl. 20), 22\u0026ndash;57.\u003c/li\u003e\n \u003cli\u003eFairburn, C.G.; Beglin, S.J. Assessment of Eating Disorders: Interview or Self-Report Questionnaire? Int. J. Eat. Disord. 1994, 16, 363\u0026ndash;370.\u003c/li\u003e\n \u003cli\u003eAlshahrani, F.; Aljohani, N. Vitamin D: Deficiency, Sufficiency and Toxicity. Nutrients. 2013, 5, 3605\u0026ndash;3616.\u003c/li\u003e\n \u003cli\u003eRoss, A.C.; Manson, J.E.; Abrams, S.A.; Aloia, J.F.; Brannon, P.M.; Clinton, S.K.; Durazo-Arvizu, R.A.; Gallagher, J.C.; Gallo, R.L.; Jones, G.; Kovacs, C.S.; Mayne, S.T.; Rosen, C.J.; Shapses, S.A. The 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D from the Institute of Medicine: What Clinicians Need to Know. J. Clin. Endocrinol. Metab. 2011, 96, 53\u0026ndash;58.\u003c/li\u003e\n \u003cli\u003eHolick, M.F.; Binkley, N.C.; Bischoff-Ferrari, H.A.; Gordon, C.M.; Hanley, D.A.; Heaney, R.P.; Murad, M.H.; Weaver, C.M.; Endocrine Society. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 2011, 96, 1911\u0026ndash;1930.\u003c/li\u003e\n \u003cli\u003eAnglin, R.E.; Samaan, Z.; Walter, S.D.; McDonald, S.D. Vitamin D Deficiency and Depression in Adults: Systematic Review and Meta-Analysis. Br. J. Psychiatry. 2013, 202, 100\u0026ndash;107.\u003c/li\u003e\n \u003cli\u003eNagata, J.M.; Grandis, A.; Bojorquez-Ramirez, P.; Nguyen, A.; Downey, A.E.; Ganson, K.T.; Patel, K.P.; Machen, V.I.; Buckelew, S.M.; Garber, A.K. Assessment of Vitamin D Among Male Adolescents and Young Adults Hospitalized with Eating Disorders. J. Eat. Disord. 2022, 10, 104.\u003c/li\u003e\n \u003cli\u003eAraujo, D.M.; Santos, G.F.; Nardi, A.E. Binge Eating Disorder and Depression: A Systematic Review. World J. Biol. Psychiatry. 2010, 11(Pt. 2), 199\u0026ndash;207.\u003c/li\u003e\n \u003cli\u003eCalvo-Rivera, M.P.; Navarrete-P\u0026aacute;ez, M.I.; Bodoano, I.; Guti\u0026eacute;rrez-Rojas, L. Comorbidity Between Anorexia Nervosa and Depressive Disorder: A Narrative Review. Psychiatry Investig. 2022, 19, 155\u0026ndash;163.\u003c/li\u003e\n \u003cli\u003eLebl\u0026eacute;, N.; Radon, L.; Rabot, M.; Godart, N. Depressive Symptoms During Anorexia Nervosa: State of the Art and Consequences for an Appropriate Use of Antidepressants. Encephale. 2017, 43, 62\u0026ndash;68.\u003c/li\u003e\n \u003cli\u003eMelrose, S. Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depress. Res. Treat. 2015, 2015, 178564.\u003c/li\u003e\n \u003cli\u003eKripke, D.F. Light Treatment for Nonseasonal Depression: Speed, Efficacy, and Combined Treatment. J. Affect. Disord. 1998, 49, 109\u0026ndash;117.\u003c/li\u003e\n \u003cli\u003eGermain, A.; Kupfer, D.J. Circadian Rhythm Disturbances in Depression. Hum. Psychopharmacol. 2008, 23, 571\u0026ndash;585.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Description of Sociodemographic, Clinical and Biological Parameters in Patients with Eating Disorders (N=481) and Comparison Between Those With and Without Current Depressive Disorder.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" summary=\"Procedure Report: Detailed and/or summarized report\" width=\"883\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003eCurrent depressive disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003eWhole population\u003c/p\u003e\n \u003cp\u003eN=481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eN=335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eN=146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eGender, Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e449 (93.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e310 (92.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e139 (95.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eAge (years)\u003csup\u003e(1)\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e481\u0026nbsp;; 24.56 (20.32; 33.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e335; 24.27 (20.16; 32.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e146; 25.33 (20.75; 34.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eBody mass index (kg/m\u003csup\u003e2)(1)\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e481\u0026nbsp;; 18.55 (16.58; 22.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e335; 18.60 (16.54; 22.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e146; 18.36 (16.60; 23.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eSmoking status, Current smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e185 (39.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e119 (36.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e66 (45.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eResting energy expenditure (Kcal/day)\u003csup\u003e(1)\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e459; 1236.00 (1075.00; 1402.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e322; 1226.50 (1071.00; 1380.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e137; 1253.00 (1080.00; 1427.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eFatty mass (kg)\u003csup\u003e(1)\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e454; 12.87 (8.36; 19.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e317; 12.48 (8.09; 18.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e137; 13.16 (9.06; 22.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eEating disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Anorexia Nervosa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e267 (55.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e182 (54.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e85 (58.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Bulimia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e115 (23.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e83 (24.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e32 (21.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Binge eating disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e53 (11.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e34 (10.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e19 (13.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Unspecified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e46 (9.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e36 (10.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e10 (6.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eTotal EDE-Q score\u003csup\u003e(1)\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e448; 3.71 (2.27; 4.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e377; 3.31 (1.83; 4.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e71; 4.32 (3.38; 5.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eTotal EDE-Q score, \u0026ge;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e187 (41.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e107 (33.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e80 (60.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eAnxiety disorder, Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e244 (51.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e142 (42.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e102 (70.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026lt; 0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eSuicide attempt, Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e115 (24.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e64 (19.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e51 (34.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eObsessive-compulsive disorder, Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e61 (12.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e35 (10.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e26 (18.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eSubstance use disorder, Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e40 (8.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e22 (6.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e18 (12.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003ePTSD, Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e35 (7.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e10 (3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e25 (17.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026lt; 0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eSeason at time of assessment, High-light\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e265 (55.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e196 (58.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e69 (47.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003eBiological parameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Prothrombin time (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e455; 100.00 (94.00; 100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e315; 100.00 (94.00; 100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e140; 100.00 (93.00; 100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Vitamin B12 (pg/mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e468; 298.50 (217.50; 391.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e328; 299.50 (210.00; 386.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e140; 293.00 (229.00; 402.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;C-reactive protein (mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e452; 0.40 (0.30; 1.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e319; 0.50 (0.30; 1.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e133; 0.40 (0.30; 1.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Haemoglobin (g/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e474; 13.30 (12.70; 14.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e331; 13.40 (12.70; 14.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e143; 13.20 (12.60; 14.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Ferritin (Microg/mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e459; 46.00 (24.00; 83.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e321; 46.00 (25.00; 81.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e138; 45.00 (23.00; 86.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;TSH (mUI/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e442; 1.86 (1.28; 2.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e313; 1.81 (1.25; 2.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e129; 2.00 (1.30; 2.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Albumin (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e443; 46.00 (44.00; 49.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e306; 46.00 (44.00; 49.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e137; 46.00 (44.00; 48.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 237px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Creatinine (\u0026micro;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e475; 68.00 (60.00; 76.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e330; 69.00 (61.00; 76.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e145; 67.00 (59.00; 75.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003csup\u003e(1)\u003c/sup\u003eContinuous variable was expressed as number, median (First quartile; Third quartile).\u003c/p\u003e\n\u003cp\u003eAbbreviations: EDE-Q=Eating Disorder Examination Questionnaire; PTSD=Post-Traumatic Stress Disorder.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Association Between Vitamin D Status and the Presence of Current Depressive Disorder.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" summary=\"Procedure Report: Detailed and/or summarized report\" width=\"1056\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eCurrent depressive disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eWhole population\u003c/p\u003e\n \u003cp\u003eN=481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eN=335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eN=146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 0\u003c/strong\u003e\u003csup\u003e(2)\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1\u003c/strong\u003e\u003csup\u003e(3)\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 2\u003c/strong\u003e\u003csup\u003e(4)\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 3\u003c/strong\u003e\u003csup\u003e(5)\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eOR [95%CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eOR [95%CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eOR [95%CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eOR [95%CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eVitamin D deficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026ge;20 ng/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e405 (84.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e292 (87.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e113 (77.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026lt;20 ng/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e76 (15.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e43 (12.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e33 (22.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1.98 [1.20; 3.28]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1.90 [1.09; 3.29]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e2.03 [1.12; 3.68]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1.89 [1.03; 3.46]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eVitamin D serum\u0026nbsp;\u003c/p\u003e\n \u003cp\u003econcentration (ng/ml)\u003csup\u003e(1)\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eOR for a 20-units decrease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e481; 33.00\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(24.00; 43.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e335; 33.60\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(24.50; 43.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e146; 31.75\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(21.00; 40.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1.33 [1.00; 1.77]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1.30 [0.96; 1.76]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1.24 [0.89; 1.74]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1.18 [0.84; 1.66]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003csup\u003e(1)\u003c/sup\u003eContinuous variable was expressed as number, median (First quartile; Third quartile).\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e(2)\u003c/sup\u003eCrude association.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e(3)\u003c/sup\u003eModel 1 was adjusted for Total EDE-Q score.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e(3)\u003c/sup\u003eModel 2 was adjusted for Total EDE-Q score plus smoking status, anxiety disorders, suicidal attempts, obsessive-compulsive disorder, substance abuse disorders, PTSD.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e(3)\u003c/sup\u003eModel 3 was adjusted for all the covariates in Model 2 plus season at time of assessment.\u003c/p\u003e\n\u003cp\u003eAbbreviations: EDE-Q=Eating Disorder Examination Questionnaire; OR=Odds ratio; CI=Confidence Intervals; PTSD=Post-Traumatic Stress Disorder.\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-eating-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joed","sideBox":"Learn more about [Journal of Eating Disorders](http://jeatdisord.biomedcentral.com)","snPcode":"40337","submissionUrl":"https://submission.nature.com/new-submission/40337/3","title":"Journal of Eating Disorders","twitterHandle":"@JEatDisord","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Eating disorders, vitamin D deficiency, depression, seasonality, eating disorder subtype","lastPublishedDoi":"10.21203/rs.3.rs-9135597/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9135597/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eVitamin D deficiency and depressive disorders are both common in patients with eating disorders (EDs). However, the association between vitamin D status and current depressive disorder (CDD) in ED populations remains insufficiently explored.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional study including 481 outpatients with EDs assessed at a specialized ED unit in Montpellier, France. Psychiatric diagnoses were established using the Mini-International Neuropsychiatric Interview (M.I.N.I.). ED severity was assessed with the Eating Disorder Examination Questionnaire (EDE-Q). Serum 25-hydroxyvitamin D levels were measured as part of routine clinical assessment, and vitamin D deficiency was defined as \u0026lt;\u0026thinsp;20 ng/mL. Odds ratios (ORs) were estimated using logistic regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eVitamin D deficiency was significantly associated with higher odds of CDD (OR 1.98, 95% CI 1.20\u0026ndash;3.28; p\u0026thinsp;=\u0026thinsp;0.008). This association persisted after adjustment for ED severity, psychiatric comorbidities, and season of assessment. No significant interactions were found between vitamin D deficiency and ED subtype, EDE-Q score, or season.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eVitamin D deficiency was associated with the presence of a current depressive disorder in patients with eating disorders, independently of ED subtype, severity, and seasonality. These findings support the clinical relevance of assessing vitamin D status in patients with EDs presenting with depressive symptoms. Longitudinal studies are needed to clarify the direction and clinical implications of this association.\u003c/p\u003e","manuscriptTitle":"The Association of Vitamin D Deficiency with Depressive Disorders in Patients with Eating Disorders: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-06 13:54:24","doi":"10.21203/rs.3.rs-9135597/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-19T23:32:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-19T23:26:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109869872117510089441279397025752303316","date":"2026-04-19T23:19:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-02T09:30:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214085450686586423257086170420501664934","date":"2026-04-02T07:01:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-31T15:47:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-25T04:01:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-25T04:00:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Eating Disorders","date":"2026-03-16T08:57:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-eating-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joed","sideBox":"Learn more about [Journal of Eating Disorders](http://jeatdisord.biomedcentral.com)","snPcode":"40337","submissionUrl":"https://submission.nature.com/new-submission/40337/3","title":"Journal of Eating Disorders","twitterHandle":"@JEatDisord","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5de7fbce-d159-4e6d-af80-64c43f64e0e5","owner":[],"postedDate":"April 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T04:39:44+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-06 13:54:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9135597","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9135597","identity":"rs-9135597","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}