M.A.C. Manoukian; J.A. Harris; A.D. Carr M.D.; M.J. Campbell M.D. Impact of Illicit Drug Use on Nutrient and Hormone Levels in Male Roux-en-Y Surgery Patients M.A.C. Manoukian; J.A. Harris; A.D. Carr M.D.; M.J. Campbell M.D. University of California Davis School of Medicine Introduction Tables Conclusion Patients being evaluated for bariatric surgery often suffer from metabolic and vitamin deficiencies1. Roux-en-y gastric bypass changes the intestinal anatomy of patients possibly leading to further metabolic and vitamin abnormalities2. Illicit drug use has previously been reported to alter metabolism and nutrition levels in non-surgical patients3. Previous studies have illustrated that obese people are more likely to use cannabis, cocaine, and amphetamine than non-obese people4-7. The effect of prior use of illicit drugs on preoperative and post-operative vitamin levels has not been well evaluated. Table 1. Differences in Pre-Operative Nutritional Status in Non-Drug Use vs Any Drug Use Non Drug Users Drug Users P-Value Clinical Diagnosis of Impaired Fasting Glucose 7/28 (25%) 16/24 (66.6%) 4*10-5 Use of Diabetes Medication 13/24(54.2%) 0.001 Elevated HbA1C 7/20 (35%) 17/23 (73.91%) 9*10-5 Vitamin D Deficiency 12/17 (72.2%) 5/21 (23.8%) 3*10-6 Elevated Total Cholesterol 10/26 (38.46%) 3/24 (12.5%) 0.0089 Elevated Low Density Lipoprotein 9/22 (43.48%) 5/24 (20.83%) 0.0455 High Density Lipoprotein < 35 14/24 (58.33%) 10/24 (41.67%) .0977 Preoperative male patients with a prior history of drug use may have increased insulin resistance and diabetes when compared to patients without a history of drug use both before and 1 year after bariatric intervention. Male patients who have a history of illicit drug use have similar weight loss outcomes and hospital readmission rates, when compared to male patients without a history of drug use. Male patients with a history of drug use have higher rates of 1 year follow up than male patients without a history of illicit drug use. Male patients with a prior history of drug use, but who have successfully quit, should still be considered for bariatric surgery Methods A chart review of male patients undergoing Roux-en-Y surgery at UC Davis Medical Center between 2008 and 2011 was conducted. Patients with no history of illicit drug use from 2008 and patients with a history of illicit drug use from 2008-2011 were identified. Continuous data were analyzed utilizing a homoscedastic two tailed T -test. Categorical data were analyzed utilizing a Pearson’s Chi Squared Test. Table 2. Differences in Post-Operative Nutritional Status in Non-Drug Use vs Any Drug Use Non Drug Users Drug Users P-Value Elevated HbA1C 2/14 (14.29%) 5/16 (31.25%) 0.0133 Vitamin D Deficiency 3/16 (18.75%) 0.61 Elevated Total Cholesterol 2/15 (13.33%) 3/18 (16.67%) 0.677 Elevated Low Density Lipoprotein 1/18 (5.56%) 0.3317 High Density Lipoprotein < 35 0/15 (0%) 0/18 (0%) - References Flancbaum L, Belsley S, Drake V, Colarusso T, Tayler E: Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg 2006, 10(7):1033-1037. Silva RA, Malta FM, Correia MF, Burgos MG: Serum Vitamin B12, Iron and Folic Acid Deficiencies in Obese Individuals Submitted to Different Bariatric Techniques. Arq Bras Cir Dig 2016, 29Suppl 1(Suppl 1):62-66. Vescovi PP, Pedrazzoni M, Michelini M, Maninetti L, Bernardelli F, Passeri M: Chronic effects of marihuana smoking on luteinizing hormone, follicle-stimulating hormone and prolactin levels in human males. Drug Alcohol Depend 1992, 30(1):59-63. Donnadieu-Rigole H, Olive L, Nalpas B, Duny Y, Nocca D, Perney P: Prevalence of Psychoactive Substance Consumption in People With Obesity. Subst Use Misuse 2016, 51(12):1649-1654. Virmani A, Binienda ZK, Ali SF, Gaetani F: Metabolic syndrome in drug abuse. Ann N Y Acad Sci 2007, 1122:50-68. Li SX, Yan SY, Bao YP, Lian Z, Qu Z, Wu YP, Liu ZM: Depression and alterations in hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axis function in male abstinent methamphetamine abusers. Hum Psychopharmacol 2013, 28(5):477-483. Malhotra S, Heptulla RA, Homel P, Motaghedi R: Effect of marijuana use on thyroid function and autoimmunity. Thyroid 2016. Results We identified 52 male patients who met our inclusion criteria. 28 (51.85%) patients had no history of illicit drug use. 24 (46.15%) patients had a history of illicit drug use. All patients had stopped drug use prior to surgery. Table 3. Differences in Weight Loss Characteristics, Readmission Rates, and Follow-Up Rates of All Groups Non Drug Users Drug Users P-Value Age at Operation 43.69 ± 12.29 (N=28) 49.30 ± 9.34 (N=24) 0.0735 Pre-Operative BMI 49.14 ± 8.77 (N=28) 48.16 ± 6.36 (N=24) 0.653 Post-Operative BMI 33.39 ± 7.38 (N=14) 33.20 ± 6.58 (N=19) 0.9359 Percent Excess Weight Loss 59.75 ± 16.95 (N=14) 55.67 ± 21.61 (N=19) 0.8771 Incidence of >50% Excess Weight Loss 8/14 (57.14%) 11/19 (57.89%) 0.9472 1-Year All Purpose Readmission Rate 1/28 (3.57%) 1/24 (4.17%) 0.8751 Present at 1 Year Follow Up 14/28 (50%) 19/24 (79.17%) 0.0043