Binge drinking at time of bariatric surgery is associated with liver disease, suicides, and increases long-term mortality

Abstract

Binge drinking; Bariatric surgery; Liver disease

Consum excessiu d'alcohol; Cirurgia bariàtrica; Malalties hepàtiques

Consumo excesivo de alcohol; Cirugía bariátrica; Enfermedades hepáticas

Background and Aims: Alcohol use disorder has been reported in patients undergoing bariatric procedures, but the pattern of alcohol consumption has not been evaluated. We investigated the prevalence, risk factors, and impact of binge drinking (BD) at the time of surgery and during follow-up. Methods: A prospective, longitudinal study of subjects undergoing bariatric surgery was included in the LABS-2 registry between 2006 and 2009. Participants with AUDIT questionnaire at the time of surgery and a minimum of 12 months follow-up were included. BD was defined as consuming ≥5 drinks on at least 1 occasion in the previous month. Liver biopsies were obtained during bariatric procedures in not all cases. Survival analysis was performed with the adjusted Cox regression model and competing risk. Results: A total of 2257 subjects were included, with a median follow-up of 79 months. The prevalence of BD at time of surgery was 12%, and it raised up to 23% during follow-up. Patients with BD predominantly had a binge eating disorder (OR=1.35 [95% CI: 1.04–1.76]), regularly consumed fast food [OR=1.4 (95% CI: 1.07–1.85)] and used other drugs (OR=2.65 [95% CI: 1.74–4.04]). Within liver biopsies evaluation, BD showed higher hepatic iron deposits (OR=3.00 [95% CI: 1.25–7.21]). BD at the time of surgery was associated with a higher risk of BD during follow-up (OR=10.49 [95% CI: 7.86–14.00]) and long-term mortality (HR: 3.21 [95% CI: 1.67–6.18]). Specific causes of death in these patients with BD were liver disease (p=0.020), suicide (p=0.015), neoplasms (p=0.034), and respiratory (p=0.025). Conclusions: The prevalence of BD in patients undergoing bariatric surgery is high and increases the risk of postoperative liver disease, suicides, and long-term mortality.

LABS-2 was funded by a cooperative agreement by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Grant numbers: Data Coordinating Center -U01 DK066557; Columbia-Presbyterian—U01-DK66667 (in collaboration with Cornell University Medical Center CTSC, Grant UL1-RR024996); University of Washington—U01-DK66568 (in collaboration with CTRC, Grant M01RR-00037); Neuropsychiatric Research Institute—U01-DK66471; East Carolina University—U01-DK66526; University of Pittsburgh Medical Center—U01 DK66585 (in collaboration with CTRC, Grant UL1-RR024153); Oregon Health & Science University—U01-DK66555. Ramon Bataller received lectures fee from Abbvie and Gilead. Hugo López-Pelayo received funds for training from Lundbeck and for elaborating training materials from Advanz Pharma. Joaquin Cabezas consults, advises, is on the speakers’ bureau, and received grants from Gilead. He is on the speakers’ bureau and received grants from Abbvie. Ramon Bataller is a recipient of NIAAA grants U01AA021908, U01AA020, and NIDDK P30DK120531821. Meritxell Ventura-Cots, Carlos Fernández-Carrillo, Edilmar Alvarado-Tapias, and Ana Clemente are recipients of a scholarship grant for study extension abroad, sponsored by the Spanish Association for the Study of the Liver (AEEH). Meritxell Ventura-Cots is recipient of a Joan Rodes award from the ISCII (JR19/00015) and the PI22/01770 grant from the ISCIII—Fondos Feder. Edilmar Alvarado-Tapias is a recipient of a Joan Rodes award from the ISCII (JR20/00047) and the PI21/01995 grant from the ISCIII- Fondos Feder. David Martí-Aguado is a recipient of the Joan Rodes award ISCIII (JR22/00002) and a scholarship grant for study extension abroad, sponsored by the University of Valencia (UV-RI_MID-1528578). Elisa Pose is a recipient of the PI22/00910 grant from the ISCIII—Fondos Feder. Josepmaria Argemi is a recipient of the PI20/01663 grant from the ISCIII- Fondos Feder and an award from the “Fundación Echebano” (Pamplona, Spain). Hugo López-Pelayo is a recipient of the PI20/00760 grant from the ISCIII—Fondos Feder, 2020I004 grant from Plan Nacional sobre Drogas, and 101045870 from DG Justice-European Commission. The remaining authors have no conflicts to report.