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Bariatric surgery ups risk for alcohol abuse
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Symptoms of alcohol abuse significantly increased among patients 2 years after undergoing bariatric surgery when compared with 1 year after the procedure. Roux-en-Y gastric bypass also appeared to double a patient’s likelihood of developing alcohol use disorder symptoms, new data published in JAMA indicate.
“The number of alcoholic drinks consumed on a typical drinking day was significantly higher in the year prior to surgery and in the second postoperative year than in the first postoperative year. Alcohol consumption at a hazardous level was significantly more common prior to surgery than after surgery. However, there was a significant increase between the first and second postoperative years,” researchers said.
Before and after bariatric surgery
Wendy C. King, PhD, of the University of Pittsburgh and colleagues designed the Longitudinal Assessment of bariatric Surgery-2 (LABS-2) study to determine whether the prevalence of alcohol use disorders changed after bariatric surgery.
Patients were categorized as having alcohol use disorder symptoms if they reported at least one symptom of alcohol-related harm or alcohol dependence. Researchers then compared reports of alcohol use disorders at 1 year before with 1 and 2 years after surgery.
The study included 2,458 adults who underwent bariatric surgery at 10 US hospitals. Of those patients, 1,945 (78.8% female; 87% white; median age, 47 years; median BMI, 45.8) completed the preoperative and postoperative Alcohol Use Disorders Identification Test (AUDIT) between 2006 and 2011.
“More than half (62.3%; 95% CI, 53–71.5) of those reporting [alcohol use disorders] at the preoperative assessment continued to have or had recurrent [alcohol use disorders] within the first 2 postoperative years,” the researchers wrote. “In contrast, 7.9% (95% CI, 6.4–9.4) of participants not reporting [alcohol use disorders] at the preoperative assessment had postoperative [alcohol use disorders]. Nonetheless, more than half (60.5%; 95% CI, 53.1–67.9) of postoperative [alcohol use disorders] was reported by those not reporting [alcohol use disorders] at the preoperative assessment.”
The prevalence of alcohol use disorder symptoms did not differ significantly from 1 year before to 1 year after surgery (7.6% vs. 7.3%; P=.98), but rose considerably between the first and second years after surgery (9.6%; P=.01).
Potential predictors
Preoperative variables associated with increased risk for alcohol use disorders after bariatric surgery include:
- male sex (adjusted OR=2.14; 95% CI, 1.51-3.01); smoking (adjusted OR=2.58; 95% CI, 1.19-5.58).
- consumption of at least two alcoholic drinks per week (adjusted OR=6.37; 95% CI, 4.17-9.72).
- alcohol use disorders (e.g., at age 45, adjusted OR=11.14; 95% CI, 7.71-16.1).
- recreational drug use (adjusted OR=2.38; 95% CI, 1.37-4.14).
- lower sense of belonging at the preoperative assessment (adjusted OR=1.09; 95% CI, 1.04-1.15).
- younger age to increased odds for alcohol use disorders after surgery (age per 10 years younger without preoperative alcohol use disorder, adjusted OR=1.95; 95% CI, 1.65-2.3 and age per 10 years younger with preoperative alcohol use disorder, adjusted OR=1.31; 95% CI, 1.03-1.68).
- Roux-en-Y gastric bypass vs. laparoscopic adjustable gastric banding (adjusted OR=2.07; 95% CI, 1.4-3.08).
The researchers said that evidence suggests that bariatric procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy change the pharmacokinetics of alcohol.
Researchers concluded that alcohol screening and referrals should be offered as preoperative and postoperative clinical care. They suggested that further research should examine the long-term effect of bariatric surgery on alcohol use disorders, and the relationship of alcohol use disorders as they relate to postoperative weight control.
For more information:
- King WC. JAMA. 2012;doi:10.1001/jama.2012.6147.
Disclosures:
- Dr. Courcoulas reported receiving grants from Allergan, Pfizer, Covidien, and EndoGastric Solutions; and is a consultant for and serves on the scientific advisory board for Johnson & Johnson’s Ethicon Healthcare System. Dr. Pories reported serving as a consultant to Johnson & Johnson’s Ethicon Endo-Surgery Inc., as well as receiving research grants from Johnson & Johnson’s Ethicon Endo-Surgery Inc. and GlaxoSmithKline.