Nutritional considerations in alcoholic liver disease

Abstract

Alcohol is a cumulative and direct toxin which the liver is obliged to metabolize causing a variety of metabolic effects (James, 1989). Alcohol is a direct hepatic toxin, impairs glucose synthesis by the liver, accentuates glycogen breakdown and exhausts muscle glycogen. Alcohol provides empty calories, suppresses appetite and increases sensitivity to drugs. Patients with alcoholic cirrhosis appear to develop state of starvation more rapidly. Nutrient abnormalities and malnutrition with multiple causes are common in the alcoholic. There are many reasons why alcoholics become malnourished (Morgan, 1982). The severity of malnutrition may be related to the degree of liver damage and clinical manifestations (Mendenhall et al., 1986). One of the major reasons is inadequate food intake and poor choice of meals predominating in carbohydrates, with inadequate protein and vitamin content. Malabsorption and maldigestion occur directly. as a result of ethanol toxicity causing pancreatic insufficiency. Hyperexcretion and malutilization of nutrients may occur - metabolism of nutrients especially fat-soluble vitamins is severely impaired while protein synthesis and amino acid metabolism are deranged. Nutrient requirements may be increased, especially for vitamin-dependant metabolic reactions.