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Original Contribution
June 20, 2012

Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery

Author Affiliations

Author Affiliations: Departments of Epidemiology (Dr King) and Biostatistics (Ms Chen), Graduate School of Public Health, and Department of Psychiatry, School of Medicine (Dr Kalarchian), University of Pittsburgh, Pittsburgh, Pennsylvania; Neuropsychiatric Research Institute, Fargo, North Dakota (Drs Mitchell, Steffen, and Engel); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Courcoulas); Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina (Dr Pories); and Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases (Dr Yanovski).

JAMA. 2012;307(23):2516-2525. doi:10.1001/jama.2012.6147
Abstract

Context Anecdotal reports suggest bariatric surgery may increase the risk of alcohol use disorder (AUD), but prospective data are lacking.

Objective To determine the prevalence of preoperative and postoperative AUD, and independent predictors of postoperative AUD.

Design, Setting, and Participants A prospective cohort study (Longitudinal Assessment of Bariatric Surgery-2) of adults who underwent bariatric surgery at 10 US hospitals. Of 2458 participants, 1945 (78.8% female; 87.0% white; median age, 47 years; median body mass index, 45.8) completed preoperative and postoperative (at 1 year and/or 2 years) assessments between 2006 and 2011.

Main Outcome Measure Past year AUD symptoms determined with the Alcohol Use Disorders Identification Test (indication of alcohol-related harm, alcohol dependence symptoms, or score ≥8).

Results The prevalence of AUD symptoms did not significantly differ from 1 year before to 1 year after bariatric surgery (7.6% vs 7.3%; P = .98), but was significantly higher in the second postoperative year (9.6%; P = .01). The following preoperative variables were independently related to an increased odds of AUD after bariatric surgery: male sex (adjusted odds ratio [AOR], 2.14 [95% CI, 1.51-3.01]; P < .001), younger age (age per 10 years younger with preoperative AUD: AOR, 1.31 [95% CI, 1.03-1.68], P = .03; age per 10 years younger without preoperative AUD: AOR, 1.95 [95% CI, 1.65-2.30], P < .001), smoking (AOR, 2.58 [95% CI, 1.19-5.58]; P = .02), regular alcohol consumption (≥ 2 drinks/week: AOR, 6.37 [95% CI, 4.17-9.72]; P < .001), AUD (eg, at age 45, AOR, 11.14 [95% CI, 7.71-16.10]; P < .001), recreational drug use (AOR, 2.38 [95% CI, 1.37-4.14]; P = .01), lower sense of belonging (12-item Interpersonal Support Evaluation List score per 1 point lower: AOR, 1.09 [95% CI, 1.04-1.15]; P = .01), and undergoing a Roux-en-Y gastric bypass procedure (AOR, 2.07 [95% CI, 1.40-3.08]; P < .001; reference category: laparoscopic adjustable gastric band procedure).

Conclusion In this cohort, the prevalence of AUD was greater in the second postoperative year than the year prior to surgery or in the first postoperative year and was associated with male sex and younger age, numerous preoperative variables (smoking, regular alcohol consumption, AUD, recreational drug use, and lower interpersonal support) and undergoing a Roux-en-Y gastric bypass procedure.

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