The benefits of bariatric surgery must be weighed against the risks of developing alcohol use disorder (AUD), alcohol-related liver disease (ALD) and psychiatric disorders, according to researchers from University of Pittsburgh Medical Center. They emphasised healthcare professionals should exercise caution before performing bariatric surgery in patients who present ALD and/or alcohol misuse.
Previous research from large cohorts suggest that metabolic surgery can increase the risk of AUD and although US clinical guidelines consider current alcohol or drug use disorders as exclusion criteria for bariatric surgery, it is not clear whether a previous metabolic surgery increases the risk of ALD and liver-related events.
As a result, the investigators sought to ascertain whether a prior history of bariatric surgery could increase the risk of developing ALD and psychiatric disorders associated with AUD, and if vitamin D deficiency mediates the alcohol-associated outcomes after surgery.
From a total of 82,750,785 patients 2,197,589 met the study inclusion criteria; 34% had undergone bariatric surgery (bariatric surgery group) and 66% other surgeries (abdominal surgery group). Different types of bariatric surgery included 46.88% of RYGB, 33.76% laparoscopic sleeve gastrectomy (LSG), 10.66% adjustable gastric banding (AGB) and 8.69% others.
After propensity-score matching, the final study cohort included 537,757 patients with bariatric surgery and 537,757 patients with other abdominal surgeries. The two groups (bariatric surgery vs abdominal surgery) had comparable metabolic comorbidities, including diabetes (18.5% vs 19.2%), hypertension (43.4% vs 46.3%), obesity (16.9% vs 19.3%) and renal failure (4.3% vs 5.3%). The prevalence of vitamin D deficiency was significantly higher in the bariatric surgery group (2.41% vs 0.48%; OR: 5.12 [95% CI: 4.91–5.34]; p<0.001).
They found that bariatric patients had a significantly increased risk of AUD (3.32% vs 1.74%; OR: 1.90 [95% CI: 1.85–1.95]; p 0.001) and the prevalence of AUD increased significantly from 2005 to 2015 (Figure 1). The magnitude of the association between AUD and bariatric surgery was stronger in patients without vitamin D deficiency (OR 2.48 in normal vitamin D group vs OR 1.27 in vitamin D deficiency group).
In addition, ALD was significantly higher in the bariatric surgery group and compared to abdominal surgery, bariatric group had a greater risk of ALD (0.71% vs 0.43%, OR: 1.29 [95% CI: 1.22–1.37]; p<0.001). Among patients with AUD, the rate of ALD was higher after bariatric surgery than other abdominal surgeries (3.4% vs 1.4%; OR: 2.47 [95% CI: 2.45–2.50]; p< 0.001). The prevalence of cirrhosis was also significantly higher in the bariatric surgery group (5.34% vs 3.92%, OR: 1.39 [95% CI: 1.37–1.42]; p<0.001). The prevalence of both ALD and cirrhosis showed a significant increase among bariatric surgery cases from 2005 to 2015 (Figure 1).
The prevalence of psychiatric disorders associated with AUD, recreational drug use and depression was also higher in the bariatric surgery group and compared to abdominal surgery, bariatric procedures had a higher risk of developing psychiatric disorders associated with AUD. Bariatric surgery was also more strongly associated with psychiatric disorders in AUD than with alcohol-related liver disease.
“Our data indicate that vitamin D deficiency does not appear to be associated with the risks of AUD, ALD, or psychiatric disorders associated with AUD,” the authors concluded. “Further studies should explore other potential mechanisms underlying the development of these conditions after bariatric surgery.”
The findings were reported in the Paper, ‘Bariatric Surgery Is Associated with Alcohol-Related Liver Disease and Psychiatric Disorders Associated with AUD’, published in Obesity Surgery. To access this paper, please click here