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Popular Weight-loss Surgery Increases Risk of Alcohol Use Disorders, Study Finds

 
PITTSBURGH, June 18, 2012 – People who receive the most popular weight-loss surgical procedure are at increased risk of developing symptoms of alcohol use disorders, University of Pittsburgh Graduate School of Public Health (GSPH) researchers have discovered.
 
The findings, to be published in the Wednesday print edition of the Journal of the American Medical Association, are the first to draw a clear link between Roux-en-Y gastric bypass (RYGB) surgery and symptoms of alcohol use disorders and could have implications for patient screening before surgery, as well as clinical care after surgery. Alcohol use disorders include alcohol abuse and dependence, popularly known as alcoholism.
 
“Patients should be educated about the potential effect of bariatric surgery, in particular RYGB surgery, to increase the risk of alcohol use disorders,” said lead author Wendy King, Ph.D., assistant professor in GSPH’s Department of Epidemiology, who presented the results today at the American Society for Metabolic & Bariatric Surgery’s annual meeting in San Diego. “Alcohol screening should be included in routine pre- and post-operative care.”
 
King and her colleagues investigated alcohol consumption and alcohol use disorder symptoms in the Longitudinal Assessment of Bariatric Surgery study, a prospective study of patients undergoing weight-loss surgery at one of 10 different hospitals across the United States. Within 30 days before surgery and again one and two years after surgery, 1,945 study participants completed the Alcohol Use Disorders Identification Test, developed by the World Health Organization, to identify symptoms of alcohol use disorders.
 
Nearly 70 percent of study participants underwent the popular RYGB surgery, which reduces the size of the stomach and shortens the intestine, limiting food intake and the body’s ability to absorb calories. Another 25 percent of patients had laparoscopic adjustable gastric banding, where the surgeon inserts an adjustable band around the patient’s stomach, lessening the amount of food the stomach can hold. The remaining 5 percent of patients had one of three less-popular weight-loss surgeries.
 
Among participants who had the RYGB procedure, 7.0 percent reported symptoms of alcohol use disorders prior to surgery.  One year after surgery, there was not a significant increase in alcohol use disorders. However, by the second post-operative year, there was greater than a 50 percent relative increase, with 10.7 percent of patients reporting symptoms of alcohol use disorders. In contrast, there was not a significant increase in alcohol use disorders following laparoscopic adjustable gastric banding.
 
“Among RYGB patients, there was a significant decrease in alcohol consumption in the first year after surgery, compared to the year before surgery, but not in the second year. Thus, the increase in alcohol use disorder symptoms following RYGB surgery was likely a result of an increase in alcohol sensitivity following surgery combined with resumption of higher levels of alcohol consumption in the second post-operative year,” King said.
 
Safe levels of alcohol consumption have yet to be established for the post-operative patient. Previous studies on the effect of alcohol following bariatric surgery suggest that after having RYGB, patients feel intoxicated more rapidly and for longer after drinking less.
 
King’s study found that one in eight participants reported consuming at least three drinks per typical drinking day by the second post-operative year. “This is concerning, given the negative impact heavy drinking may have on vitamin and mineral status, liver function and weight loss,” King said.
 
King’s study also found several patient characteristics that could help predict whether a patient is more likely to develop alcohol use disorders following surgery, including a lower sense of interpersonal support (i.e., having people to do things with), smoking, recreational drug use, consumption of alcohol at least two times per week, and prior alcohol use disorders. However, over half of patients with post-operative alcohol use disorders did not report the illness in the year prior to surgery. Men and younger adults also were more likely to develop alcohol use disorders.
 
Depressive symptoms, mental health, binge eating and having received treatment for psychiatric issues prior to surgery were not independently related to an increased likelihood of alcohol use disorders following surgery.
 
Bariatric surgery is the most effective treatment for substantial weight loss in adults with severe obesity. It has also proven to be effective in reversing risk factors for heart disease and, in some cases, reversing type 2 diabetes. King said, “There are risks associated with most medical interventions. While this study highlights a potential risk, it is important that it is considered in conjunction with the benefits of bariatric surgery.”
 
Patients were recruited from East Carolina University in Greenville, N.C.; Columbia University and Weill College of Medicine at Cornell University, both in New York City; Legacy Good Samaritan Hospital and Oregon Health & Science University, both in Portland, Ore.; Neuropsychiatric Research Institution in Fargo, N.D.; UPMC in Pittsburgh; University of Washington and Virginia Mason Hospital, both in Seattle; and Valley Hospital in Ridgewood, N.J.
 
Collaborators on this study include Jia-Yuh Chen, M.S., Anita P. Courcoulas, M.D., M.P.H., and Melissa A. Kalarchian, Ph.D., all of the University of Pittsburgh; Susan Z. Yanovski, M.D., of the National Institute of Diabetes and Digestive and Kidney Diseases; James E. Mitchell, M.D., Kristine J. Steffen, Pharm.D., Ph.D., and Scott G. Engel, Ph.D., all of the Neuropsychiatric Research Institute; and Walter J. Pories, M.D., of East Carolina University.
 
This study was funded by the National Institutes of Health.
 
For a JAMA digital news release including video and radio broadcast, please visit http://digitalnewsrelease.com.

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