Skip to main content

Advertisement

Log in

The Role of Nutrition in the Pathogenesis and Treatment of Alcohol-Related Liver Disease

  • Nutrition in Patients with Chronic Liver Disease (E Tapper, Section Editor)
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

Abstract

Malnutrition is increasingly being recognized as a poor prognostic factor in the realm of chronic liver disease, particularly among those individuals with end-stage liver disease undergoing transplant evaluation.

Purpose of Review

The purpose of this review is to demonstrate how nutrition contributes to disease pathogenesis and whether improvements in nutrition can alter disease pathogenesis.

Recent Findings

Recent findings reveal that the role of nutrition is multifaceted, primarily due to alterations in gut microbiota and cytokine release. Additionally, there is increasing data demonstrating that those with gastric bypass are more susceptible to developing end-stage liver disease with lesser amounts of alcohol use.

Summary

The role of nutrition as relates to liver disease is complex and involves not only global calorie replacement but also management of micronutrient deficiencies. Future research should focus on further tools to assess for malnutrition and prevention of sarcopenia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Antonow DR McClain CJ. Nutrition and alcoholism. Alcohol and the Brain 1985:pp. 81–120.

  2. Guthrie GD, Myers KJ, Gesser EJ, White GW, Koehl JR. Alcohol as a nutrient: interactions between ethanol and carbohydrate. Alcohol Clin Exp Res. 1990;14:17–22.

    Article  CAS  Google Scholar 

  3. Lin HZ, Yang SQ, Zeldin G, Diehl AM. Chronic ethanol consumption induces the production of tumor necrosis factor-alpha and related cytokines in liver and adipose tissue. Alcohol Clin Exp Res. 1998;22:231S–7S.

    Article  CAS  Google Scholar 

  4. Campillo B, Sherman E, Richardet JP, Bories PN. Serum leptin levels in alcoholic liver cirrhosis: relationship with gender, nutritional status, liver function and energy metabolism. Eur J Clin Nutr. 2001;55:980–8.

    Article  CAS  Google Scholar 

  5. Thursz MR, Richardson P, Allison M, et al. Prednisolone or pentoxifylline for alcoholic hepatitis. N Engl J Med. 2015;372:1619–28.

    Article  CAS  Google Scholar 

  6. •• Moreno C, Deltenre P, Senterre C, et al. Intensive enteral nutrition is ineffective for patients with severe alcoholic hepatitis treated with corticosteroids. Gastroenterology. 2016;150:903–10 e8. This reference is important because it refuted nutrition replacement alone as a therapy for severe alcoholic hepatitis.

    Article  CAS  Google Scholar 

  7. •• Kirpich IA, Petrosino J, Ajami N, et al. Saturated and unsaturated dietary fats differentially modulate ethanol-induced changes in gut microbiome and metabolome in a mouse model of alcoholic liver disease. Am J Pathol. 2016;186:765–76. This reference is relevant due to the revelation that not all nutrients provide benefit.

    Article  CAS  Google Scholar 

  8. •• Song M, Chen T, Prough RA, Cave MC, McClain CJ. Chronic alcohol consumption causes liver injury in high-fructose-fed male mice through enhanced hepatic inflammatory response. Alcohol Clin Exp Res. 2016;40:518–28. This reference is relevant due to a plausible explanation for alcohol liver disease and non-alcohol-related liver disease overlap.

    Article  CAS  Google Scholar 

  9. • Hartmann P, Hochrath K, Horvath A, et al. Modulation of the intestinal bile acid/farnesoid X receptor/fibroblast growth factor 15 axis improves alcoholic liver disease in mice. Hepatology. 2018;67:2150–66. This reference is relevant due to a revelation of mechanism of action.

    Article  CAS  Google Scholar 

  10. Mutlu E, Keshavarzian A, Engen P, Forsyth CB, Sikaroodi M, Gillevet P. Intestinal dysbiosis: a possible mechanism of alcohol-induced endotoxemia and alcoholic steatohepatitis in rats. Alcohol Clin Exp Res. 2009;33:1836–46.

    Article  CAS  Google Scholar 

  11. Chen YL, Yang SS, Peng HC, Hsieh YC, Chen JR, Yang SC. Folate and vitamin B12 improved alcohol-induced hyperhomocysteinemia in rats. Nutrition. 2011;27:1034–9.

    Article  CAS  Google Scholar 

  12. Leo MA, Lieber CS. Alcohol, vitamin A, and beta-carotene: adverse interactions, including hepatotoxicity and carcinogenicity. Am J Clin Nutr. 1999;69:1071–85.

    Article  CAS  Google Scholar 

  13. Hanje AJ, Fortune B, Song M, Hill D, McClain C. The use of selected nutrition supplements and complementary and alternative medicine in liver disease. Nutr Clin Pract. 2006;21:255–72.

    Article  Google Scholar 

  14. Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM, et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 2010;362:1675–85.

    Article  CAS  Google Scholar 

  15. Mezey E, Potter JJ, Rennie-Tankersley L, Caballeria J, Pares A. A randomized placebo controlled trial of vitamin E for alcoholic hepatitis. J Hepatol. 2004;40:40–6.

    Article  CAS  Google Scholar 

  16. Ghorbani Z, Hajizadeh M, Hekmatdoost A. Dietary supplementation in patients with alcoholic liver disease: a review on current evidence. Hepatobiliary Pancreat Dis Int. 2016;15:348–60.

    Article  Google Scholar 

  17. Mohammad MD, Falker KC, Song M, et al. Low dose zinc sulfate (220 mg) supplementation for three months normalizes zinc levels, endotoxemia, pro-inflammatory biomarkers and improves clinical parameters in alcoholic cirrhosis- a double blind placebo controlled- (ZAC) clinical trial. Hepatology 2015; 62:851A

  18. •• Nishikawa H, Enomoto H, Yoh K, et al. Serum Zinc Concentration and Sarcopenia: A Close Linkage in Chronic Liver Diseases. J Clin Med. 2019;11:8(3). This reference outlines the role of micronutrients and sarcopenia.

  19. Zinc Supplementation in Alcoholic Cirrhosis. https://www.clinicaltrialsgov/ct2/show/NCT02072746. Accessed November 6, 2019.

  20. • Trial of Anakinra (Plus Zinc), G-CSF, or Prednisone in Patients With Severe Alcoholic Hepatitis (AlcHepNet). https://www.clinicaltrialsgov/ct2/show/NCT04072822. Accessed on November 6, 2019. This reference describes the role of micronutrient replacement as a treatment for alcoholic hepatitis.

  21. • Kalafateli M, Mantzoukis K, Choi Yau Y, et al. Malnutrition and sarcopenia predict post-liver transplantation outcomes independently of the model for end-stage liver disease score. J Cachexia Sarcopenia Muscle. 2017;8:113–21. This reference highlights the impact of malnutrition as relates to transplant.

    Article  Google Scholar 

  22. Sinclair M, Gow PJ, Grossmann M, Angus PW. Review article: sarcopenia in cirrhosis--aetiology, implications and potential therapeutic interventions. Aliment Pharmacol Ther. 2016;43:765–77.

    Article  CAS  Google Scholar 

  23. Dasarathy J, McCullough AJ, Dasarathy S. Sarcopenia in alcoholic liver disease: clinical and molecular advances. Alcohol Clin Exp Res. 2017;41:1419–31.

    Article  CAS  Google Scholar 

  24. Cuellar RE, Tarter R, Hays A, Van Thiel DH. The possible occurrence of “alcoholic hepatitis” in a patient with bulimia in the absence of diagnosable alcoholism. Hepatology. 1987;7:878–83.

    Article  CAS  Google Scholar 

  25. Platis IE, Carpenter LL, Vojvoda D, Bowers MB Jr, Mazure CM. Possible acceleration of alcoholic cirrhosis in a patient with bulimia. Int J Eat Disord. 1996;20:439–42.

    Article  CAS  Google Scholar 

  26. Vidot H, Kline K, Cheng R, et al. The Relationship of Obesity, Nutritional Status and Muscle Wasting in Patients Assessed for Liver Transplantation. Nutrients. 2019;4:11(9)

  27. •• Cherla DV, Rodriguez NA, Vangoitsenhoven R. Impact of sleeve gastrectomy and Roux-en_y gastric bypass on biopsy-proven non-alcoholic fatty liver disease. Surg Endosc. 2019;29. This reference highlights recent observations in patients with gastric bypass being susceptible to alcohol-related liver disease.

  28. •• Garg SK SS, Bazerbachi F, et al. Bariatric surgery is associated with increased risk of alcoholic hepatitis: analysis from National Inpatient Database. Presented at AASLD, 2018, San Francisco, CA 2018. This reference highlights recent observations in patients with gastric bypass being susceptible to alcohol-related liver disease.

  29. Sharma R, Gentry RT, Lim RT Jr, Lieber CS. First-pass metabolism of alcohol. Absence of diurnal variation and its inhibition by cimetidine after evening meal. Dig Dis Sci. 1995;40:2091–7.

    Article  CAS  Google Scholar 

  30. Klockhoff H, Naslund I, Jones AW. Faster absorption of ethanol and higher peak concentration in women after gastric bypass surgery. Br J Clin Pharmacol. 2002;54:587–91.

    Article  CAS  Google Scholar 

  31. Ivezaj V, Stoeckel LE, Avena NM, Benoit SC, Conason A, Davis JF, et al. Obesity and addiction: can a complication of surgery help us understand the connection? Obes Rev. 2017;18:765–75.

    Article  CAS  Google Scholar 

  32. Cabre E, Rodriguez-Iglesias P, Caballeria J, et al. Short- and long-term outcome of severe alcohol-induced hepatitis treated with steroids or enteral nutrition: a multicenter randomized trial. Hepatology. 2000;32:36–42.

    Article  CAS  Google Scholar 

  33. Mendenhall CLAS, Weesner RE, et al. Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans administration cooperative study group on alcoholic hepatitis. Am J Med. 1984;76:211–22.

    Article  CAS  Google Scholar 

  34. Singal AK, Kamath PS, Francisco Ziller N, DiCecco S, Shoreibah M, Kremers W, et al. Nutritional status of patients with alcoholic cirrhosis undergoing liver transplantation: time trends and impact on survival. Transpl Int. 2013;26:788–94.

    Article  Google Scholar 

  35. Huynh DK, Selvanderan SP, Harley HA, Holloway RH, Nguyen NQ. Nutritional care in hospitalized patients with chronic liver disease. World J Gastroenterol. 2015;21:12835–42.

    Article  CAS  Google Scholar 

  36. Plauth M, Cabre E, Riggio O, et al. ESPEN guidelines on enteral nutrition: liver disease. Clin Nutr. 2006;25:285–94.

    Article  CAS  Google Scholar 

  37. Morgan MY, Madden AM, Soulsby CT, Morris RW. Derivation and validation of a new global method for assessing nutritional status in patients with cirrhosis. Hepatology. 2006;44:823–35.

    Article  Google Scholar 

  38. Alvares-da-Silva MR, Reverbel da Silveira T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition. 2005;21:113–7.

    Article  Google Scholar 

  39. Plauth M, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, et al. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr. 2019;38:485–521.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Haripriya Maddur.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Nutrition in Patients with Chronic Liver Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maddur, H., Shah, V.H. The Role of Nutrition in the Pathogenesis and Treatment of Alcohol-Related Liver Disease. Curr Hepatology Rep 19, 7–12 (2020). https://doi.org/10.1007/s11901-020-00504-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11901-020-00504-2

Keywords

Navigation