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Nutritional status in patients with sustained heavy alcohol use

Leah Gramlich, MD, FRCPC
Puneeta Tandon, MD, FRCPC
Adam Rahman, MD, DABIM, FRCPC
Section Editor
Timothy O Lipman, MD
Deputy Editors
Shilpa Grover, MD, MPH, AGAF
Richard Hermann, MD


Excessive alcohol use is highly prevalent and a major cause of nutritional deficiency in developed countries [1]. 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 [2]; however, heavy alcohol use is associated with significant morbidity and mortality [3]. (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) [8]. The diagnoses, alcohol abuse and alcohol dependence, were replaced by one diagnosis, alcohol use disorder, in DSM-5 [9]. 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".)


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 [10]. Individuals without liver disease may be nutritionally normal, deficient in micronutrients, or have significant protein-calorie malnutrition [11]. In one study, body protein and lean body mass were similarly reduced in alcoholic patients with or without liver disease [12]. There are no reliable predictors of who will develop malnutrition as a result of moderate to heavy alcohol use.


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 [13]. 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 [13].

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Literature review current through: Nov 2017. | This topic last updated: Jan 26, 2017.
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