Background. Obese adults are frequently vitamin D deficient before bariatric surgery; whether similar abnormalities exist in morbidly obese adolescents is unknown. Objective. To determine the prevalence of vitamin D deficiency in morbidly obese adolescents. Methods. Cross-sectional study of preoperative laboratory measures from 236 adolescents evaluated for bariatric surgery. Results. The group ( with 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) levels; 76 boys, 143 girls; years; 43% Caucasian, 35% Hispanic, and 15% African American) had mean BMI of ？kg/m2. 25OHD levels were deficient (<20？ng/mL) in 53%; 8% had severe deficiency (<10？ng/mL); only 18% of patients were replete (>30？ng/mL). 25OHD levels were inversely associated with BMI ( , ) and PTH levels ( , ). Race was the strongest predictor of 25OHD ( ); 82% of African Americans, 59% of Hispanics, and 37% of Caucasians were deficient. African American race, BMI, and PTH explained 21% of the variance in 25OHD ( ). Conclusions. Most adolescents presenting for bariatric surgery have suboptimal vitamin D levels, with African Americans and those with higher BMIs at greatest risk for vitamin D deficiency. All morbidly obese adolescents should be screened for vitamin D deficiency before bariatric procedures. 1. Introduction Over the past thirty years, the adolescent obesity rate has more than tripled. It has been estimated that 17% of US children and adolescents meet criteria for overweight (body mass index (BMI) between the 85th–95th percentile for age) and 4% are now considered morbidly obese (BMI > 99th percentile) [1, 2]. Bariatric surgery is widely used in the morbidly obese adult population [3–5]. Since the late 1990s, coincident with the increased prevalence of obesity (BMI > 30？kg/m2) in the adolescent population, bariatric surgery use in adolescents has grown rapidly. It has been estimated that between 1000 and several thousand adolescents undergo bariatric procedures each year [6]. There is increasing evidence suggesting that these procedures may be the most effective treatment for weight loss in the adolescent as well as in the adult [7–12]. Indeed, a recent meta-analysis found that in adolescents, bariatric surgery was associated with permanent weight loss and resolution of concomitant metabolic conditions, including diabetes and hypertension [11]. Data on skeletal and mineral metabolism consequences of morbid obesity and bariatric surgery in adolescents are limited. Prior to surgery, obese adults are often vitamin D deficient, with lowest levels in the most obese individuals [13].
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