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长期大量饮酒患者的营养状况

Authors
Leah Gramlich, MD, FRCPC
Puneeta Tandon, MD, FRCPC
Adam Rahman, MD, DABIM, FRCPC
Section Editor
Timothy O Lipman, MD
Deputy Editors
Anne C Travis, MD, MSc, FACG, AGAF
Richard Hermann, MD

引言

过量饮酒在发达国家相当普遍，并且是营养缺乏的主要病因[1]。酒精通过其对营养素的摄取和代谢的原发效应和损伤终末器官(如酒精诱导性肝病和胰腺炎)的继发效应引起营养性并发症[1-7]。适度饮酒可能有益于降低患心脑血管疾病风险[2]；但是大量饮酒与显著的并发症发病率和死亡率有关[3]。  (参见“饮酒的风险与益处概述”和“适量饮酒对心血管的益处及风险”和“酒精使用障碍：流行病学、发病机制、临床表现、不良后果和诊断”)

长期大量饮酒[包括《诊断与统计手册》第四版(Diagnostic and Statistical Manual, DSM-Ⅳ)中所述的酒精依赖]会造成营养不良[8]。DSM-5中，酒精滥用和酒精依赖的诊断被替换为单一诊断，即酒精使用障碍[9]。尽管DSM-Ⅳ与DSM-5界定的疾病并不能完全对应，但酒精依赖大约相当于酒精使用障碍的中至重度亚型。

本专题将讨论长期大量饮酒个体的营养不良的流行病学、发病机制、评估和治疗。因酒精或其他原因导致慢性肝病患者的营养不良将在别处讨论。 (参见“慢性肝病的营养评估”)

酒精相关营养不良的流行病学

除不伴炎症的酒精性脂肪变外，营养不良的患病率介于20%-60%之间，具体取决于是否存在肝硬化及其严重程度[10]。无肝病的个体可能营养上正常、微量营养素缺乏或伴有严重蛋白质-热量营养不良(protein-calorie malnutrition, PCM)[11]。在一项研究中，伴或不伴肝病的酗酒患者的身体蛋白质和瘦体重的减少相似[12]。关于哪些患者会因中度至大量饮酒引起营养不良并没有可靠的预测标志。

营养不良的发病机制

急性和慢性饮酒都可因降低膳食热量摄取、造成营养素的消化和吸收障碍、减少蛋白质的合成和分泌、增加肠道蛋白质的分解代谢及增加营养素的分解和排泄导致营养不良[13]。营养不良的程度取决于饮酒量、摄入食物的质量、遗传因素及有无共存疾病及其严重程度。若酒精占总热量摄取的30%以上，出现微量营养素和宏量营养素缺乏的风险显著升高[13]。

                         

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-26.
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