1. 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 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):
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):
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):
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 ± (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 ± (N=14)
55.67 ± (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