Nutrition in alcohol-related liver disease: Physiopathology and management

Table 1 Effect of alcohol on nutrients

Nutrients	Effect of alcohol intake		Results
Carbohydrate	Acute alcohol intake	Inhibits gluconeogenesis; stimulates hepatic glycogenolysis	Hypoglycaemic; hyperglycaemic
	Chronic alcohol intake	Inhibits lactate stimulated gluconeogenesis; carbohydrate rich food taken with alcohol	Hyperlactatemia; delayed paradoxical hypoglycaemic state
Proteins	Acute and chronic alcohol intake	Increases nitrogen excretion; imbalance between protein growth and breakdown	Muscle wasting and myopathy
Lipids	Acute and chronic alcohol intake	Inhibits β-oxidation and increases esterification of fatty acids	Increased accumulation of triglycerides in the hepatocytesFibrosis
Thiamine	Chronic alcohol intake	Inadequate nutritional intake Decreased absorption	Wernicke Korsakoff syndrome
Folate	Chronic alcohol intake	Reduced dietary intake; intestinal malabsorption; reduced liver uptake, storage; increased urinary excretion	Macrocytic anaemia; muscle dysfunction
Vitamin A	Chronic alcohol intake	Inhibit the cleavage of β-carotene, a dietary pro-vitamin A carotenoid	Xerophthalmia and night blindness
Vitamin C	Chronic alcohol intake	Intestinal malabsorption; hepatotoxicity inhibits hepatic transformation to their active metabolites	Scurvy and poor wound healing
Zinc	Chronic alcohol intake	Disrupts gut permeability; decreases ileal -zinc concentration; increased accumulation of reactive oxygen species and plasma endotoxin levels	Acrodermatitis; anorexia; hypogonadism; altered immune function; poor wound healing; impaired night vision; diarrhoea; impaired mental function and portal systemic encephalopathy
Magnesium	Chronic alcohol intake	Increases the urinary excretion of magnesium	Cardiovascular: Hypertension, stroke and myocardial infarction; Neurological: Seizure, depression and neuromuscular abnormalities