Monday, December 21, 2020

Bariatric Surgery May Increase Risk of Unhealthy Alcohol Use

Adults with no history of unhealthy alcohol use who undergo bariatric surgery to promote weight loss may be more likely to develop unhealthy alcohol use compared with adults who do not receive surgery, according to a study appearing today in JAMA Network Open.

“The clinical implications of these results suggest that patients undergoing bariatric surgical procedures should be cautioned that drinking alcohol can escalate after bariatric surgery, even in patients with no previous evidence of drinking alcohol above recommended limits,” wrote Matthew Maciejewski, Ph.D., of the Durham VA Medical Center and colleagues.

“[N]ot drinking alcohol is the safest option after a bariatric surgical procedure, given that blood alcohol concentration (and therefore the brain’s alcohol exposure) peaks at higher levels after a bariatric operation,” they continued. “Furthermore, all patients who undergo bariatric surgical procedures should be monitored long-term for unhealthy alcohol use.”

Previous controlled studies examining the relationship between bariatric surgery and drinking behaviors have mainly focused on women who have had Roux-en-Y gastric bypass (RYGB), not the laparoscopic sleeve gastrectomy (LSG)—the more popular bariatric surgery in the United States.

The researchers analyzed electronic health record data from 2,608 veterans (75% male) who underwent a bariatric surgical procedure between October 1, 2008, and September 30, 2016. (Since 2004, the U.S. Department of Veterans Affairs health system has required screening of all outpatients using the 3-item Alcohol Use Disorders Identification Test-Consumption, or AUDIT-C.) This sample included 1,684 patients who had had LSG procedures and 924 who had had RYGB procedures. Another 22,284 veterans who had not had bariatric surgery but had similar characteristics as the patients who did were included as matched controls.

The participants were further divided based on their scores on the AUDIT-C: Any veterans who reported AUDIT-C score of ≥3 (females) or ≥4 (males) in the two years prior to surgery were classified as having unhealthy alcohol use. About 92% of the participants had no history of unhealthy alcohol use.

The researchers evaluated alcohol use data collected until the participants’ death, eight years after the surgery, or the end of the study period (December 31, 2019), whichever came first.

The researchers estimated that among veterans without a history of unhealthy alcohol use, 7.9% and 9.2% were at risk of developing unhealthy alcohol use eight years following their LSG or RYGB surgery, respectively, compared with 4.5% and 4.4% of matched controls. Among veterans with a history of unhealthy alcohol use, 39.4% of veterans who received RYGB were at risk of postsurgical unhealthy alcohol use, compared with 25.7% of matched controls. The researchers identified no differences in post-LSG unhealthy alcohol use between veterans with a history of unhealthy alcohol use and matched controls (26.1% versus 28.9%, respectively).

“From these findings, we estimate that for every 21 patients who undergo an RYGB and every 29 patients who undergo an LSG, on average one from each group will develop unhealthy alcohol use,” Maciejewski and colleagues wrote.

To read more on this topic, see the Psychiatric News article “Many At-Risk Bariatric Patients Missed by Alcohol Screening Tools.”

(Image: iStock/toddtaulman)

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