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Kenkre JS, Gesell S, Keller A, Milani RM, Scholtz S, Barley EA. Alcohol Misuse post Metabolic and Bariatric Surgery: A Systematic Review of Longer-term Studies with Focus on new Onset Alcohol use Disorder and Differences Between Surgery Types. Curr Obes Rep 2024; 13:596-616. [PMID: 38850501 PMCID: PMC11306568 DOI: 10.1007/s13679-024-00577-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Evidence suggests an increased risk of alcohol problems post-surgery where no problematic alcohol use was present prior to surgery which may be different across types of surgery. OBJECTIVE To characterise the risk of new onset alcohol misuse post bariatric surgery, differences between surgeries and the impact over time. METHODS All published studies on new and relapsing alcohol use were reviewed. Data were classed as 'subjective' (clinical interview, self-report questionnaires) and 'objective' (hospital admissions, substance misuse programmes) and further categorised by follow up time - 'shorter-term' (one year), 'medium-term' (one year to two years) and 'long-term' (> two years). RESULTS Twenty-three of the forty-two studies included in the review reported new onset data. Nine studies reported on differences between surgery types. In those reporting objective measures, all of which were long term, RYGB carried a higher risk than SG, followed by LAGB. All but one study using subjective measures reported a small but significant number of new onset concerning alcohol use, and comparisons between surgery types had more varied results than the objective measures. Studies of substance abuse programmes found high rates of new onset cases (17-60%). CONCLUSION This systematic review provides support for the consensus guidance suggesting patients should be informed of a small but significant risk of new onset alcohol use following bariatric surgery, with the strongest evidence in the medium- to long-term and in those who have had RYGB followed by SG.
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Affiliation(s)
- Julia S Kenkre
- Section of Endocrinology and Investigative Medicine, Imperial College, London, UK
| | - Sutapa Gesell
- Central and North West London NHS Foundation Trust, London, UK
| | - Annalise Keller
- School of Human and Social Sciences, University of West London, London, UK
| | - Raffaella M Milani
- School of Human and Social Sciences, University of West London, London, UK
| | - Samantha Scholtz
- Section of Endocrinology and Investigative Medicine, Imperial College, London, UK.
- West London NHS Trust, London, UK.
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Owusu S, Osumo B, Slotman GJ. Pre-operative cardiopulmonary, metabolic, abdominal, and somatic variations by race in men with obesity resolve after Laparoscopic Roux-en-Y gastric bypass (LRYGB): Dyslipidemia and psychologicals by race persist. Am J Surg 2022; 224:1388-1392. [PMID: 36273940 DOI: 10.1016/j.amjsurg.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Whether/how LRYGB men vary by race in clinical characteristics/post-operative outcomes is unknown. OBJECTIVE Identify male pre-/post LRYGB clinical/outcomes variations by race. METHODS Data from 17,734 LYRGB BOLD database men were analyzed in five groups: African American (AA, n = 1310), Caucasian (C, n = 14,168), Asian (A, n = 53), Hispanic (H, n = 1519), and Other (O, Pacific Islander, Native American, or more than one race, n = 684). DATA demographics, BMI, and 28 weight-related conditions. RESULTS Pre-LRYGB age, health insurance, unemployment, BMI, and 24/28 obesity related comorbidities varied by race (p < 0.01). Highest pre-LRYGB: AA 4, C 14, A 5, H none, O 1 comorbidity. 12 month BMI and 14 comorbidities varied by race (p < 0.05). 24 months only dyslipidemia, depression, and psychological impairment varied by race (p < 0.05). CONCLUSION Demographics, BMI and 24 obesity comorbidities vary by race in LRYGB men, but only 3 at 24 months. Caucasians have the greatest cardiopulmonary related comorbidities. This advanced knowledge may facilitate peri-operative management.
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Affiliation(s)
- Stephanie Owusu
- Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Bismarck Osumo
- Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Gus J Slotman
- Department of Surgery, Inspira Health Network, Vineland, NJ, USA.
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Beiglböck H, Mörth E, Reichardt B, Stamm T, Itariu B, Harreiter J, Hufgard-Leitner M, Fellinger P, Eichelter J, Prager G, Kautzky A, Kautzky-Willer A, Wolf P, Krebs M. Sex-Specific Differences in Mortality of Patients with a History of Bariatric Surgery: a Nation-Wide Population-Based Study. Obes Surg 2022; 32:8-17. [PMID: 34751909 PMCID: PMC8752554 DOI: 10.1007/s11695-021-05763-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Bariatric surgery reduces mortality in patients with severe obesity and is predominantly performed in women. Therefore, an analysis of sex-specific differences after bariatric surgery in a population-based dataset from Austria was performed. The focus was on deceased patients after bariatric surgery. MATERIALS AND METHODS The Austrian health insurance funds cover about 98% of the Austrian population. Medical health claims data of all Austrians who underwent bariatric surgery from 01/2010 to 12/2018 were analyzed. In total, 19,901 patients with 107,806 observed years postoperative were eligible for this analysis. Comorbidities based on International Classification of Diseases (ICD)-codes and drug intake documented by Anatomical Therapeutical Chemical (ATC)-codes were analyzed in patients deceased and grouped according to clinically relevant obesity-associated comorbidities: diabetes mellitus (DM), cardiovascular disease (CV), psychiatric disorder (PSY), and malignancy (M). RESULTS In total, 367 deaths were observed (1.8%) within the observation period from 01/2010 to 04/2020. The overall mortality rate was 0.34% per year of observation and significantly higher in men compared to women (0.64 vs. 0.24%; p < 0.001(Chi-squared)). Moreover, the 30-day mortality was 0.19% and sixfold higher in men compared to women (0.48 vs. 0.08%; p < 0.001). CV (82%) and PSY (55%) were the most common comorbidities in deceased patients with no sex-specific differences. Diabetes (38%) was more common in men (43 vs. 33%; p = 0.034), whereas malignant diseases (36%) were more frequent in women (30 vs. 41%; p = 0.025). CONCLUSION After bariatric surgery, short-term mortality as well as long-term mortality was higher in men compared to women. In deceased patients, diabetes was more common in men, whereas malignant diseases were more common in women.
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Affiliation(s)
- Hannes Beiglböck
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Eric Mörth
- Department of Informatics, University of Bergen, 5008 Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, 5021 Bergen, Norway
| | | | - Tanja Stamm
- Institute for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090 Austria
| | - Bianca Itariu
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Jürgen Harreiter
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Miriam Hufgard-Leitner
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Paul Fellinger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Jakob Eichelter
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Gerhard Prager
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Division of Social Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alexandra Kautzky-Willer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Peter Wolf
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Lee CWJ, Tuck L, Kumar S, Nye E. Acute Wernicke's encephalopathy in a young female after sleeve gastrectomy. ANZ J Surg 2021; 91:2549. [PMID: 34766690 DOI: 10.1111/ans.17214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lucy Tuck
- Peninsula Health, Frankston, Victoria, Australia
| | - Shanal Kumar
- Peninsula Health, Frankston, Victoria, Australia.,Monash Centre for Health Research and Implementation, Clayton, Victoria, Australia
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Abstract
Half a million bariatric procedures are performed annually worldwide. Our aim was to review the signs and symptoms of Wernicke's encephalopathy (WE) after bariatric surgery. We included 118 WE cases. Descriptions involved gastric bypass (52%), but also newer procedures like the gastric sleeve. Bariatric WE patients were younger (median = 33 years) than those in a recent meta-analysis of medical procedures (mean = 39.5 years), and often presented with vomiting (87.3%), ataxia (84.7%), altered mental status (76.3%), and eye movement disorder (73.7%). Younger age seemed to protect against mental alterations and higher BMI against eye movement disorders. The WE treatment was often insufficient, specifically ignoring low parenteral thiamine levels (77.2%). In case of suspicion, thiamine levels should be tested and treated adequately with parenteral thiamine supplementation.
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Affiliation(s)
- Erik Oudman
- Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands.
- Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, The Netherlands.
| | - Jan W Wijnia
- Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
- Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, The Netherlands
| | - Mirjam van Dam
- Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
- Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, The Netherlands
| | - Laser Ulas Biter
- Department of Bariatric Surgery, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Albert Postma
- Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
- Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, The Netherlands
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Taylor MA, Szczerbinski L, Citko A, Niemira M, Gorska M, Hady HR, Kretowski A. Sex-Specific Glucose Homeostasis and Anthropometric Responses to Sleeve Gastrectomy in Obese Patients. Nutrients 2019; 11:nu11102408. [PMID: 31600929 PMCID: PMC6836106 DOI: 10.3390/nu11102408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/12/2019] [Accepted: 09/19/2019] [Indexed: 11/16/2022] Open
Abstract
Bariatric surgery rapidly and effectively treats obesity and its comorbidities like dysregulated glucose homeostasis. Despite the sex-balanced incidence of obesity in most human populations, women have sought this intervention more frequently than men. However, as the number of bariatric surgeries rapidly rises, it is increasingly urgent to understand how sex-specific differences may emerge in metabolic and anthropometric parameters. Hundred fifty-four obese patients (47% men and 53% women) from the Bialystok Bariatric Surgery Study underwent sleeve gastrectomy and were measured for 25 parameters at baseline (immediately prior to surgery) and at four follow-up visits over one year. We used generalized linear mixed models to detect sex-specific differences in the time series of responses parameters. Unlike most previous studies with older cross-sections of men than women, our cohort was age-matched, and men were less healthy at baseline. Of parameters that showed a significant cohort-wide (across-sex) response, 14 (56%) also showed sex-specific responses with men improving more than women. In particular, men remitted in diabetes symptoms more strongly, rapidly, and durably than women. Taken together, our results indicate that men may benefit more from sleeve gastrectomy and that this difference in improvement may be related to more progressed morbidity prior to surgery independent of age.
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Affiliation(s)
- Mark A Taylor
- School of Medicine, University of California, San Francisco 505 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Lukasz Szczerbinski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland.
| | - Anna Citko
- Clinical Research Centre, Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland.
| | - Magdalena Niemira
- Clinical Research Centre, Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland.
| | - Maria Gorska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland.
| | - Hady Razak Hady
- 1st Clinical Department of General and Endocrine Surgery, Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland.
| | - Adam Kretowski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland.
- Clinical Research Centre, Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland.
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Harreiter J, Kautzky-Willer A. Sex and Gender Differences in Prevention of Type 2 Diabetes. Front Endocrinol (Lausanne) 2018; 9:220. [PMID: 29780358 PMCID: PMC5945816 DOI: 10.3389/fendo.2018.00220] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/18/2018] [Indexed: 12/25/2022] Open
Abstract
Lifestyle intervention programs are effective in the prevention of type 2 diabetes mellitus (T2DM) in high risk populations. However, most studies only give limited information about the influence of sex and/or gender effectiveness of these interventions. So far, similar outcome was reported for diabetes progression and weight loss. Nevertheless, long-term data on cardiovascular outcome are sparse but favoring women regarding all-cause and cardiovascular mortality. In both men and women, sex hormone imbalances and reproductive disorders are associated with a higher risk of T2DM development. Diabetes prevention approaches are reported for polycystic ovary syndrome, gestational diabetes mellitus, and erectile dysfunction and are presented in this review. In the surgical treatment options for morbid obese patients, sex and gender differences are present. Choices and preferences of adherence to lifestyle and pharmacological interventions, expectations, treatment effects, and complications are influenced by sex or gender. In general, bariatric surgery is performed more often in women seeking medical/surgical help to lose weight. Men are older and have higher comorbidities and mortality rates and worse follow-up outcome after bariatric surgery. A more gender-sensitive clinical approach, as well as consideration of ethnicity may improve quality of life and increase health and life expectancy in men and women with a high risk for subsequent progression to T2DM.
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