Nutritional status in patients with sustained heavy alcohol use
- Leah Gramlich, MD, FRCPC
Leah Gramlich, MD, FRCPC
- Professor of Medicine
- University of Alberta
- Puneeta Tandon, MD, FRCPC
Puneeta Tandon, MD, FRCPC
- Associate Professor of Medicine
- University of Alberta, Canada
- Adam Rahman, MD, DABIM, FRCPC
Adam Rahman, MD, DABIM, FRCPC
- Assistant Professor of Medicine
- University of Western Ontario
- Section Editor
- Timothy O Lipman, MD
Timothy O Lipman, MD
- Section Editor — Nutrition
- GI-Hepatology-Nutrition Section
- Washington DC Veterans Affairs Medical Center
Excessive alcohol use is highly prevalent and a major cause of nutritional deficiency in developed countries . Alcohol causes nutritional complications from both its primary effects on the intake and metabolism of nutrients and secondary effects of end organ damage (eg, alcohol induced liver disease, pancreatitis) [1-7]. Modest alcohol use may be beneficial for cardiovascular and cerebrovascular risk reduction ; however, heavy alcohol use is associated with significant morbidity and mortality . (See "Overview of the risks and benefits of alcohol consumption" and "Cardiovascular benefits and risks of moderate alcohol consumption" and "Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis".)
Malnutrition results from sustained, heavy alcohol use, including what was described as alcohol dependence in the Diagnostic and Statistical Manual, fourth edition (DSM-IV) . The diagnoses, alcohol abuse and alcohol dependence, were replaced by one diagnosis, alcohol use disorder, in DSM-5 . Although the crosswalk between DSM-IV and DSM-5 disorders is imprecise, alcohol dependence is approximately comparable to the moderate to severe subtype of alcohol use disorder.
This topic addresses the epidemiology, pathogenesis, assessment, and treatment of malnutrition in individuals with sustained heavy alcohol use. Malnutrition in patients with chronic liver disease, from alcohol or other causes, is discussed elsewhere. (See "Nutritional assessment in chronic liver disease".)
EPIDEMIOLOGY OF ALCOHOL-RELATED MALNUTRITION
With the exception of alcoholic steatosis without inflammation, the prevalence of malnutrition varies depending on the presence and degree of cirrhosis and ranges between 20 to 60 percent . Individuals without liver disease may be nutritionally normal, deficient in micronutrients, or have significant protein-calorie malnutrition . In one study, body protein and lean body mass were similarly reduced in alcoholic patients with or without liver disease . There are no reliable predictors of who will develop malnutrition as a result of moderate to heavy alcohol use.
PATHOGENESIS OF MALNUTRITION
Both acute and chronic alcohol consumption can cause malnutrition by decreasing dietary caloric intake, impairing nutrient digestion and absorption, decreasing protein synthesis and secretion, increasing catabolism of gut proteins, and increasing breakdown and excretion of nutrients . The degree of malnutrition depends on the amount of alcohol consumed, the quality of food intake, genetics, and the presence and severity of comorbid illnesses. The risk of developing micro- and macronutrient deficiencies increases significantly when alcohol makes up more than 30 percent of total caloric intake .
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- EPIDEMIOLOGY OF ALCOHOL-RELATED MALNUTRITION
- PATHOGENESIS OF MALNUTRITION
- Effects of alcohol on dietary intake
- Effects of alcohol on absorption and digestion
- Effects of alcohol on energy metabolism
- Effects of alcohol on macronutrient metabolism
- - Protein calorie malnutrition
- NUTRITIONAL ASSESSMENT
- Approach in patients with alcohol use disorder
- Physical examination
- Laboratory findings
- Fat-soluble vitamins
- - Vitamins A, D, E, and K
- Water-soluble vitamins
- - Vitamin B1 (thiamine)
- - Vitamin B2 (riboflavin)
- - Vitamin B6 (pyridoxine)
- - Folate
- - Vitamin B12 (cobalamin)
- - Vitamin C
- Minerals and trace elements
- - Calcium, magnesium, and phosphorus
- - Iron
- Water and electrolytes
- SUMMARY AND RECOMMENDATIONS