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Source: DGNews  |  Posted 9 years ago

Weight-Loss Surgery Increases Alcohol Use Disorders Over Time

BETHESDA, Md -- June 18, 2012 -- Adults who had bariatric surgery to lose weight had a significantly higher risk of alcohol use disorders (AUD) 2 years after surgery, according to a study published in the June 20, 2012, print issue of JAMA and being presented at the 2012 Annual Meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS).

Researchers investigated alcohol consumption and alcohol use disorders symptoms in 1,945 participants from the Longitudinal Assessment of Bariatric Surgery (LABS) study -- a prospective study of patients undergoing weight-loss surgery at 1 of 10 hospitals across the US.

Within 30 days before surgery, and again 1 and 2 years after surgery, study participants completed the Alcohol Use Disorders Identification (AUDIT) test. Study participants were categorised as having AUD if they had at least 1 symptom of alcohol dependence (ie, not being able to stop drinking once started) or alcohol-related harm (ie, not being able to remember events), or if their total AUDIT score was at least 8 (out of 40).

About 70% of the study participants had Roux-en-Y (RYGB) gastric bypass surgery, 25% had laparoscopic adjustable gastric banding surgery, and about 5% had other, less common weight-loss surgeries.

Among participants who had the RYGB procedure, 7% reported symptoms of alcohol use disorders prior to surgery. There was no significant increase in AUD 1 year after surgery. However, by the second year after surgery, 10.7% of patients reported symptoms of AUD, a relative increase of more than 50% compared with pre-surgical rates.

One in 8 study participants reported having at least 3 drinks on a typical drinking day the second year after surgery.

“This is concerning, given the negative impact heavy drinking may have on vitamin and mineral status, liver function, and weight loss,” said lead author Wendy King, MD, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.

Although AUD prior to surgery was one of the strongest predictors of AUD after surgery, more than half of study participants with AUD after surgery did not report having the condition during the year before surgery.

Regular alcohol use before surgery -- at least 2 drinks per week -- was also independently related to a higher risk of postoperative AUD. In addition to prior AUD and drinking frequency, patients with less social support or who reported preoperative recreational drug use or smoking before surgery were more likely to report symptoms of AUD after surgery. Men and younger adults were also more likely to develop AUD.

Depressive symptoms, mental health treatment, and binge eating prior to surgery were not independently related to an increased likelihood of AUD after surgery.

“The study results suggest that clinicians should be aware of the importance of monitoring for signs and symptoms of AUD and consider counselling after bariatric surgery,” said Mary Horlick, MD, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, Maryland.

Previous studies suggesting that bariatric surgery may increase the risk for alcohol use disorders were small, retrospective, and used a variety of assessment methods. “This first prospective study of AUD symptoms before and after surgery was done in a large number of people from 10 hospitals across the US using a validated and reliable alcohol use screening method,” said Dr. Horlick.

“These findings show that there is much more to learn about bariatric surgery and how it influences a patient’s health and well-being,” said Griffin P. Rodgers, MD, NIDDK. “It is important that patients and their doctors be fully aware of short- and long-term benefits and risks of bariatric surgery. We hope the LABS results will help researchers identify clinical questions that require further research, including better understanding of the risk of AUD.”

SOURCE: National Institutes of Health

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Add genet43 as a colleague

I suspect that if an Adverse Childhood Event (ACE) history were taken, the increased alcohol use would be correlated to childhood trauma (see Vincent Filetti and the ACE project). Extra weight is often used as a defense after childhood sexual abuse and alcohol will dissolve the feeling of being ashamed. Remove just the weight and the increased alcohol will dissolve the excess shame, at least for a short time. For those with an ACE score of six or more categories, the risk of substance use disorder is 46x (4600%) compared to normal.

Add drorkmd as a colleague

Interesting to hear about alcohol abuse after baritric surgery
Think twice before recommending a person for the surgery

Add drorkmd as a colleague

Interesting to hear about alcohol abuse after baritric surgery
Think twice before recommending a person for the surgery

Add jschulzmn as a colleague

It would also be interesting to evaluate patients in recovery from alcoholism and see if there is a high relapse rate after bariatric surgery.

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