[OR38-4] Vitamin D Deficiency Is Prevalent in Morbidly Obese Adolescents Prior to Bariatric Surgery

Marisa Censani, Emily M Stein, Sharon Oberfield, Don J McMahon, Shulamit Lerner, Jeffrey Zitsman, Elizabeth Shane, Ilene Fennoy. Columbia University Medical Center, New York, NY; Columbia University Medical Center, New York, NY; Columbia University Medical Center, New York, NY.

Background: Bariatric surgery is a widely used and effective treatment for weight loss in extremely obese adults. Its use in obese adolescents is rapidly increasing with the rise of childhood obesity. Obese adults commonly have vitamin D deficiency, inadequate calcium intake and secondary hyperparathyroidism prior to bariatric surgery. Whether similar metabolic abnormalities exist in morbidly obese adolescents is not known.
Objective: To determine the prevalence of vitamin D deficiency in morbidly obese adolescents evaluated for bariatric surgery
Methods: A retrospective analysis of preoperative laboratory measures from all adolescent patients (n=236) evaluated for bariatric surgery at Columbia University Medical Center between March 2006 and June 2011.
Results: Of 236 patients, 219 patients had 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) levels available for review. The group (76 boys and 143 girls; mean age: 15.9 +/- 1.2 years; 43% Caucasian, 35% Hispanic, 15% African-American) had a mean BMI of 47.5 +/- 8.1 kg/m2. Mean serum 25OHD (20.7 +/- 9.8 ng/ml) was in the insufficient range prior to supplementation, and was inversely associated with BMI (r = -0.28, p <0.0001). 25OHD levels were deficient (<20 ng/ml) in 53% and 8% had severe deficiency (<10 ng/ml) while only 18% of patients were found to be vitamin D replete (>30 ng/ml). Only 11 patients (4.8%) had clear secondary hyperparathyroidism, although PTH levels varied inversely with 25OHD (r= -0.24, p= 0.0003). Findings varied by race, with 82% of African-Americans, 59% of Hispanics, and 37% of Caucasian patients vitamin D deficient. Race was the strongest predictor of 25OHD (p<0.0002). African American race, BMI, and PTH explained 21% of the variance in 25OHD (p < 0.0001).
Conclusion: The vast majority of adolescent patients presenting for bariatric surgery have sub-optimal vitamin D levels, with over half in the frankly deficient range. Severely obese adolescents who are African-American and had higher BMIs were at greatest risk for vitamin D deficiency. These results support screening all morbidly obese adolescents for vitamin D deficiency, and repleting those who are deficient. This is particularly important prior to bariatric surgery where weight loss and decreased calcium and vitamin D absorption in some procedures may place these patients at further risk.

Sources of Research Support: This work is supported by an NIH NIDDK 5T32 DK 06552-07 in Pediatric Endocrinology (PI SE Oberfield).

Nothing to Disclose: MC, EMS, SO, DJM, SL, JZ, ES, IF

Date: Tuesday, June 26, 2012
Session Info: ORAL SESSION: Vitamin D: Supplementation, Metabolism & Function (11:15 AM-12:45 PM)
Presentation Time: 12:00 pm
Room: 332

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