{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T04:33:52Z","timestamp":1792211632519,"version":"4.4.0"},"reference-count":212,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Metabolic and bariatric surgery (MBS) has evolved into a highly effective neurohormonal intervention for severe obesity; however, it introduces unique long-term vulnerabilities, particularly regarding alcohol (AUD) and substance use disorders (SUD). This review synthesizes the epidemiological, pharmacokinetic, and neurobiological drivers of postoperative substance misuse. Procedures like Roux-en-Y gastric bypass (RYGB) radically alter ethanol metabolism, eliminating first-pass metabolism and accelerating gastric emptying, while simultaneously recalibrating reward pathways, creating a \u201creward gap\u201d that facilitates addiction transfer. These physiological shifts exacerbate critical micronutrient deficiencies (thiamine, B12, iron), increase the risk of post-bariatric hypoglycemia, and correlate with higher rates of liver cirrhosis and suicide. Furthermore, substance use is a primary driver of suboptimal weight loss trajectories and weight regain. Mitigation requires a lifelong, multidisciplinary framework involving preoperative risk stratification, validated screening (e.g., AUDIT-C), and targeted nutritional supplementation to safeguard the long-term metabolic and psychological benefits of MBS.<\/jats:p>","DOI":"10.3390\/nu18060932","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T14:30:32Z","timestamp":1773671432000},"page":"932","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Alcohol and Substance Use After Bariatric Surgery: Nutritional Risks and Clinical Implications in Long-Term Postoperative Care"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5317-8548","authenticated-orcid":false,"given":"Mart\u00edn","family":"Campuzano-Donoso","sequence":"first","affiliation":[{"name":"Facultad de Ciencias de la Salud y Bienestar Humano, Universidad Tecnol\u00f3gica Indoam\u00e9rica, Ambato 180150, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4234-5524","authenticated-orcid":false,"given":"Claudia","family":"Reytor-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias de la Salud y Bienestar Humano, Universidad Tecnol\u00f3gica Indoam\u00e9rica, Ambato 180150, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1161-0846","authenticated-orcid":false,"given":"Gerardo","family":"Sarno","sequence":"additional","affiliation":[{"name":"San Giovanni di Dio e Ruggi D\u2019Aragona\u201d University Hospital, Scuola Medica Salernitana, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9550-2772","authenticated-orcid":false,"given":"Martha","family":"Montalvan","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Universidad Esp\u00edritu Santo, Samborond\u00f3n 0901952, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9054-456X","authenticated-orcid":false,"given":"Luigi","family":"Barrea","sequence":"additional","affiliation":[{"name":"Department of Psychology and Health Sciences, Universit\u00e0 Telematica Pegaso, Centro Direzionale F2, 80143 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8809-4931","authenticated-orcid":false,"given":"Giovanna","family":"Muscogiuri","sequence":"additional","affiliation":[{"name":"Centro Italiano per la Cura e il Benessere del Paziente con Obesit\u00e0 (C.I.B.O.), Unit\u00e0 di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirugia, Universit\u00e0 degli Studi di Napoli Federico II, 80131 Naples, Italy"},{"name":"Division of Endocrinology, Department of Medicine, The University of Arizona College of Medicine, Tucson, AZ 85724, USA"},{"name":"Dipartimento di Medicina Clinica e Chirurgia, Unit\u00e0 di Endocrinologia, Diabetologia ed Andrologia, Universit\u00e0 degli Studi di Napoli Federico II, 80131 Naples, Italy"},{"name":"Cattedra Unesco \u201cEducazione Alla Salute E Allo Sviluppo Sostenibile\u201d, Universit\u00e0 degli Studi di Napoli Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4583-8283","authenticated-orcid":false,"given":"Ludovica","family":"Verde","sequence":"additional","affiliation":[{"name":"Centro Italiano per la Cura e il Benessere del Paziente con Obesit\u00e0 (C.I.B.O.), Unit\u00e0 di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirugia, Universit\u00e0 degli Studi di Napoli Federico II, 80131 Naples, Italy"},{"name":"Division of Endocrinology, Department of Medicine, The University of Arizona College of Medicine, Tucson, AZ 85724, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1922-662X","authenticated-orcid":false,"given":"Giuseppe","family":"Annunziata","sequence":"additional","affiliation":[{"name":"Department for the Promotion of Human Sciences and Quality of Life, San Raffaele Open University, 00166 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3641-1501","authenticated-orcid":false,"given":"Daniel","family":"Simancas-Racines","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias de la Salud y Bienestar Humano, Universidad Tecnol\u00f3gica Indoam\u00e9rica, Ambato 180150, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Panichella, G., Gentile, F., Nannipieri, M., and Emdin, M. 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