Obesity Surgery

, Volume 18, Issue 2, pp 145–150 | Cite as

Prevalence of Vitamin D Insufficiency and Deficiency in Morbidly Obese Patients: A Comparison with Non-Obese Controls

  • Whitney S. GoldnerEmail author
  • Julie A. Stoner
  • Jon Thompson
  • Karen Taylor
  • Luann Larson
  • Judi Erickson
  • Corrigan McBride
Research Article



Vitamin D deficiency is common in patients after bariatric surgery. However, obesity itself has also been associated with decreased vitamin D. The prevalence of vitamin D deficiency in obese persons has not previously been compared to non-obese controls when controlling for factors that could affect vitamin D status.


We evaluated 25 hydroxy vitamin D, iPTH, calcium, albumin, and creatinine in 41 patients undergoing Roux-en-Y gastric bypass. We then compared them to healthy non-obese controls matched for age, sex, race/ethnicity, and season of vitamin D measurement.


Ninety percent of the pre-bariatric surgery patients had 25-OH-D levels <75 nmol/l, and 61% had 25-OH-D levels <50 nmol/l versus 32 and 12% in controls, respectively. Additionally, 49% of the pre-bariatric surgery patients had secondary hyperparathyroidism versus 2% of controls. These differences persisted after controlling for sunlight exposure and dietary intake of calcium and vitamin D. Mean calcium, corrected for albumin, and creatinine were not significantly different between the groups, but mean albumin levels were significantly lower among surgery patients.


Vitamin D deficiency is common in obese patients at the time of bariatric surgery and is also accompanied by secondary hyperparathyroidism approximately half the time. These findings suggest that vitamin D deficiency after bariatric surgery is multifactorial and in part caused by preoperative vitamin D deficiency rather than postoperative malabsorption alone. In this study, increased vitamin D deficiency in obese persons cannot be explained by a difference in calcium/vitamin D intake or sunlight exposure.


Vitamin D deficiency Vitamin D insufficiency Obesity Bariatric surgery Secondary hyperparathyroidism 



This work was funded by a grant of the Clinical Research Center at the University of Nebraska Medical Center.


  1. 1.
    Holick M. The vitamin D epidemic and its health consequences. J Nutr 2005;135:2739S–48S.PubMedGoogle Scholar
  2. 2.
    Newbury L, Dolan K, Hatzifotis M, et al. Calcium and vitamin D depletion and elevated parathyroid hormone following biliopancreatic diversion. Obes Surg 2003;13(6):893–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Slater GH, Ren CJ, Siegel N, et al. Serum fat-soluble vitamin D deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg 2004;8(1):48–55.PubMedCrossRefGoogle Scholar
  4. 4.
    Ybarra J, Sanchez-Hernancez J, Gich I, et al. Unchanged hypovitaminosis D and secondary hyperparathyroidism in morbid obesity after bariatric surgery. Obes Surg 2005;15:330–5.PubMedGoogle Scholar
  5. 5.
    Johnson J, Maher J, DeMaria E, et al. The long-term effects of gastric bypass on vitamin D metabolism. Ann Surg 2006;243(5):701–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Goldner WS, O’Dorisio TM, Dillon JS, et al. Severe metabolic bone disease as a long-term complication of obesity surgery. Obes Surg 2002;12:685–92.PubMedCrossRefGoogle Scholar
  7. 7.
    Collazo-Clavell ML, Jiminez A, Hodgson SF, et al. Osteomalacia after Roux-en-Y gastric bypass. Endocr Pract 2004;10:195–8.PubMedGoogle Scholar
  8. 8.
    Snijder MB, Van Dam RM, Visser M, et al. Adiposity in relation to vitamin D status and parathyroid hormone levels: a population-based study in older men and women. J Clin Endocrinol Metab 2005;90:4119–23.PubMedCrossRefGoogle Scholar
  9. 9.
    Arunabh S, Pollack S, Yeh J, et al. Body fat content and 25-hydroxyvitamin D levels in healthy women. J Clin Endocrinol Metab 2003;88(1):157–61.PubMedCrossRefGoogle Scholar
  10. 10.
    Buffington C, Walker B, Cowan GS, et al. Vitamin D deficiency in the morbidly obese. Obes Surg 1993;3:421–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Hamoui N, Anthone G, Crookes PF. Calcium metabolism in the morbidly obese. Obes Surg 2004;14:9–12.PubMedCrossRefGoogle Scholar
  12. 12.
    Ybarra J, Snachez-Hernandez J, Gich I, et al. Unchanged hypovitaminosis D and secondary hyperparathyroidism in morbid obesity after bariatric surgery. Obes Surg 2005;15:330–5.PubMedGoogle Scholar
  13. 13.
    Carlin AM, Sudhaker R, Meslemani AM, et al. Prevalence of vitamin D depletion among morbidly obese patients seeking gastric bypass surgery. Surg Obes Relat Diseases 2006;2:98–103.CrossRefGoogle Scholar
  14. 14.
    Dawson-Hughes B, Harris SS, Krall EA, et al. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997;337:670–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 1988;67:373–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Holick MF, Matsuoka LY, Wortsman J. Age, vitamin D, and solar ultraviolet. Lancet 1989;2:1104–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Looker AC, Dawson-Hughes B, Calvo MS, et al. Serum 25-hydoxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 2002;30:771–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Giovannucci E, Mchaud D. The role of obesity and related metabolic disturbances in cancers of the colon, prostate, and pancreas. Gastroenterology 2007;132(6):2208–25.PubMedCrossRefGoogle Scholar
  19. 19.
    Larsson S, Wolk A. Obesity and the risk of gallbladder cancer: a meta-analysis. Br J Cancer 2007;96(9):1457–61.PubMedGoogle Scholar
  20. 20.
    Seewaldt V, Goldenberg V, Jones L, et al. Overweight and obese perimenopausal and postmenopausal women exhibit increased abnormal mammary epithelial cytology. Cancer Epidemiol Biomarkers Prev 2007;16(3):613–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Dawson-Hughes B, Heaney R, Holick M, et al. Estimates of optimal vitamin D status. Osteoporos Int 2005;16:713–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Wortsman J, Matsuoka LY, Chen TC, et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000;72:690–3.PubMedGoogle Scholar
  23. 23.
    Atreja A, Abacan C, Licata A. A 51 year old woman with debilitating cramps 12 years after bariatric surgery. Clev Clin J Med 2003;70:417–26.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Whitney S. Goldner
    • 1
    Email author
  • Julie A. Stoner
    • 2
  • Jon Thompson
    • 3
  • Karen Taylor
    • 3
  • Luann Larson
    • 4
  • Judi Erickson
    • 1
  • Corrigan McBride
    • 3
  1. 1.Department of Internal Medicine, Section of Diabetes, Endocrinology, and MetabolismUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Department of Biostatistics, College of Public HealthUniversity of Nebraska Medical CenterOmahaUSA
  3. 3.Department of SurgeryUniversity of Nebraska Medical CenterOmahaUSA
  4. 4.Department of Internal Medicine, Clinical Research CenterUniversity of Nebraska Medical CenterOmahaUSA

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