Hindawi Publishing Corporation ISRN Obesity Volume 2013, Article ID 284516, 7 pages http://dx.doi.org/10.1155/2013/284516 Clinical Study Vitamin D Deficiency Is Prevalent in Morbidly Obese Adolescents Prior to Bariatric Surgery Marisa Censani, 1 Emily M. Stein, 2 Elizabeth Shane, 2 Sharon E. Oberfield, 1 Donald J. McMahon, 2 Shulamit Lerner, 1 and Ilene Fennoy 1 1 Department of Pediatrics, Columbia University Medical Center, 622 West 168th Street, PH 5E-522, New York, NY 10032, USA 2 Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA Correspondence should be addressed to Ilene Fennoy; if1@columbia.edu Received 10 January 2013; Accepted 29 January 2013 Academic Editors: A. Erkner, S. A. Lear, E. K. Naderali, J. M. Robbins, and S. Straube Copyright © 2013 Marisa Censani et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Obese adults are frequently vitamin D defcient before bariatric surgery; whether similar abnormalities exist in morbidly obese adolescents is unknown. Objective. To determine the prevalence of vitamin D defciency in morbidly obese adolescents. Methods. Cross-sectional study of preoperative laboratory measures from 236 adolescents evaluated for bariatric surgery. Results. Te group ( = 219 with 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) levels; 76 boys, 143 girls; 15.9 ± 1.2 years; 43% Caucasian, 35% Hispanic, and 15% African American) had mean BMI of 47.6 ± 8.1 kg/m 2 . 25OHD levels were defcient (<20 ng/mL) in 53%; 8% had severe defciency (<10 ng/mL); only 18% of patients were replete (>30 ng/mL). 25OHD levels were inversely associated with BMI ( = −0.28,  < 0.0001) and PTH levels ( = −0.24,  = 0.0003). Race was the strongest predictor of 25OHD ( < 0.002); 82% of African Americans, 59% of Hispanics, and 37% of Caucasians were defcient. African American race, BMI, and PTH explained 21% of the variance in 25OHD ( < 0.0001). 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 defciency. All morbidly obese adolescents should be screened for vitamin D defciency 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/m 2 ) in the adolescent population, bariatric surgery use in adolescents has grown rapidly. It has been estimated that between 1000 and several thousand adoles- cents undergo bariatric procedures each year [6]. Tere is increasing evidence suggesting that these procedures may be the most efective 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 ofen vitamin D defcient, with lowest levels in the most obese individuals [13]. Inadequate calcium intake and secondary hyperparathy- roidism are common [13–16]. Te only data available in morbidly obese adolescents (BMI > 35 kg/m 2 ) comes from a small study that did not describe the frequency of vita- min D defciency, although mean vitamin D levels were in the insufcient range [17]. Vitamin D defciency may have important consequences in the adolescent, as vitamin D plays an essential role in calcium absorption from the small intestine and in the development and maintenance of the skeleton. It has been associated with rickets, or the failure of mineralization of developing bone and cartilage,