Background

The prevalence of alcohol use disorder (AUD) is higher in post-bariatric surgery populations. The diagnosis of non-alcoholic steatohepatitis (NASH) requires <20 g daily alcohol intake, however studies show even minor alcohol consumption can exacerbate NASH. This study aimed to evaluate if degree of alcohol use was associated with predicted incidence of NASH in the Longitudinal Assessment of Bariatric Surgery-2 cohort (LABS2).

Methods

A predictive model for NASH (PMN) was previously developed using LABS2. The PMN was used to categorize patients into low, medium, high, and very high-risk groups. Alcohol use disorders identification test (AUDIT) scores were compared with the PMN risk groups at time of surgery (n=1286) as well as at 12-, 24-, and 36-month follow up. A subgroup analysis limited to Roux-en-Y gastric bypass (RYGB) patients evaluated associations of limb length with AUDIT scores.

Results

At all levels of alcohol intake, PMN risk groups improved postoperatively through 36-month follow up (Table 1). Subjects with hazardous drinking or alcohol dependence increased from 2.2% to 6% during follow-up. However, the PMN risk groups improved even in those with higher levels of alcohol intake. There were no clear associations between level of alcohol intake and biliopancreatic, alimentary, or common channel lengths through 84-month follow up.

Conclusions

The predicted incidence of NASH decreases following bariatric surgery even in participants with AUD. Improvement in NASH appears to be independent of alcohol consumption, suggesting that weight loss is critical in NASH treatment. Limb lengths in RYGB do not appear to impact alcoholic intake behavior.