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Alcoholism pp 237-251 | Cite as

Chronic Alcoholism, Malnutrition, and Folate Deficiency

  • Charles H. Halsted
Part of the NATO ASI Series book series (NSSA, volume 206)

Abstract

The association between chronic alcoholism and malnutrition, long a matter of controversy, depends upon the population under study. Thus, surveys of alcoholic patients admitted to US Veterans Administration hospitals indicated a high prevalence of protein-calorie malnutrition, associated with consumption of protein-deficient diets and/or with alcoholic liver disease (Patek et al, 1975; Mendenhall et al., 1984; Mezey et al., 1988). On the other hand, studies of economically self-sufficient chronic alcoholics suggested a low incidence of malnutrition (Neville et al., 1968; Hurt et al., 1979; Morgan and Levine, 1988), often associated with deficiency of a single nutrient (Camilo et al., 1981). Studies of derelict alcoholics admitted to municipal hospitals in the USA demonstrated a high prevalence of vitamin deficiencies, in particular those of folate, thiamin, and pyridoxine (Leevy et al., 1970), and hepatic levels of these vitamins appeared to decrease in proportion to severity of alcoholic liver disease (Baker et al., 1964). More recent studies indicate that vitamin A deficiency is predictable in alcoholic liver disease, as reflected by serum and hepatic levels that decrease according to severity of the histopathology (Leo and Lieber, 1982).

Keywords

Alcoholic Liver Disease Folate Deficiency Alcoholic Hepatitis Alcoholic Patient Chronic Alcoholism 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Baker, H., Frank, O., Ziffer, H., Goldfarb, S., Leevy, C. M., and Sobotka, H., 1964, Effect of hepatic disease on liver B-complex vitamin titers, Am. J. Clin. Nutr., 14:1–6.PubMedGoogle Scholar
  2. Baraona, E., Pirola, R. C. and Lieber, C. S., 1974, Small intestinal damage and changes in cell population produced by ethanol ingestion in the rat, Gastroenterology 66:226–34.Google Scholar
  3. Bianchi, A., Chipman, D. W., Dreskia, A. and Rosensweig, N., 1970, Nutritional folic acid deficiency with megaloblastic changes in the small bowel epithelium, N. Engl. J. Med., 282:859–61.PubMedCrossRefGoogle Scholar
  4. Camilo, M. D., Morgan, M. Y. and Sherlock, S., 1981, Erythrocyte transketolase activity in alcoholic liver disease, Scand. J. Gastroenterol., 16:273–9.Google Scholar
  5. Cunningham, C. C. and Spach, P. I., 1987, The effect of chronic ethanol consumption on the lipids in liver mitochondria, Ann. N. Y. Acad. Sci., 492:181–91.PubMedCrossRefGoogle Scholar
  6. Darby, W. J., 1979, The nutrient contributions of fermented beverages, In: “Fermented Food Beverages in Nutrition,” C. F. Gastineau, W. J. Darby, and T. B. Turner, eds., pp. 61–79, Academic Press, New York.Google Scholar
  7. Eichner, E. R. and Hillman, R. S., 1971, The evolution of anemia in alcoholic patients, Am. J. Med., 50:218–32.PubMedCrossRefGoogle Scholar
  8. Eichner, E. R. and Hillman, R. S., 1973, Effect of alcohol on serum folate level, J. Clin. Invest., 52:584–91.PubMedCrossRefGoogle Scholar
  9. Eichner, E. R., Pierce, H. I. and Hillman, R. S., 1971, Folate balance in dietary induced megaloblastic anemia, N. Engl. J. Med., 284:933–8.PubMedCrossRefGoogle Scholar
  10. Goetsch, C. A. and Klipstein, F. A., 1977, Effect of folate deficiency of the intestinal mucosa on jejunal transport in the rat, J. Lab. Clin. Med., 89:1002–8.PubMedGoogle Scholar
  11. Halliwell, B., 1987, Oxidants and human disease: Some new concepts, FASEB J., 1:358–64.PubMedGoogle Scholar
  12. Halsted, C. H., 1990, Intestinal absorption of dietary folates, In: “Folic Acid Metabolism in Health and Disease,” M. F. Picciano, E. L. R. Stokstad, and J. F. Gregory, III, eds., pp. 23–45, Wiley-Liss, New York.Google Scholar
  13. Halsted, C. H. and Keen, C. L., 1990, Alcohol and micronutrient metabolism and deficiencies, Eur. J. Gastroenterol. Hepatol., 2:399–405.Google Scholar
  14. Halsted, C. H. and Tamura T., 1978, Folate deficiency in liver disease, In: “Problems in Liver Disease,” C. S. Davidson, ed., pp. 91–100, Stratton Intercontinental Medical Book, New York.Google Scholar
  15. Halsted, C. H., Griggs, R. C. and Harris, J. W., 1967, The effect of alcoholism on the absorption of folic acid (H3-PGA) evaluated by plasma levels and urine excretion, J. Lab. Clin. Med., 69:116–31.PubMedGoogle Scholar
  16. Halsted, C. H., Robles, E. A. and Mezey, E., 1971, Decreased jejunal uptake of labelled folic acid (3H-PGA) in alcoholic patients: Roles of alcohol and malnutrition, N. Engl. J. Med., 285:701–6.PubMedCrossRefGoogle Scholar
  17. Halsted, C. H., Robles, E. A. and Mezey, E., 1973a, Distribution of ethanol in the human gastrointestinal tract, Am. J. Clin. Nutr., 26:831–4.Google Scholar
  18. Halsted, C. H., Robles, E. A. and Mezey, E., 1973b, Intestinal malabsorption in folate-deficient alcoholics, Gastroenterology, 64:526–32.Google Scholar
  19. Harris, R. A., Burnett, R., McQuilkin, S., McClard, A. and Simon, F. R., 1987, Effects of ethanol on membrane order: Fluorescent studies, Ann. N. Y. Acad. Sci., 492:125–33.PubMedCrossRefGoogle Scholar
  20. Herbert, V., 1962, Experimental nutritional folate deficiency in man, Trans. Assoc. Am. Phys., 75:307–20.PubMedGoogle Scholar
  21. Herbert, V., 1971, Predicting nutrient deficiency by formula, N. Engl. J. Med., 284:976–7.PubMedCrossRefGoogle Scholar
  22. Herbert, V., 1990, Development of human folate deficiency, In: “Folic Acid Metabolism in Health and Disease,” M. F. Picciano, E. L. R. Stokstad, and J. F. Gregory, III, eds., pp. 195–210, Wiley-Liss, New York.Google Scholar
  23. Herbert, V., Zalusky, R. and Davidson, C. S., 1963, Correlates of folate deficiency with alcoholism and associated macrocytosis, anemia, and liver disease, Ann. Intern. Med., 58:977–88.PubMedGoogle Scholar
  24. Hermos, J. A., Adams, W. H., Lin, Y. K. and Trier, J., 1972, Mucosa of the small intestine in folate deficient alcoholics, Ann. Intern. Med., 76:951–75.Google Scholar
  25. Hillman, R. S., McGuffin, R. and Campbell, C., 1977, Alcohol interference with the folate enterohepatic cycle. Trans. Assoc. Am. Phys., 90:145–56.PubMedGoogle Scholar
  26. Hines, J. D. and Cowan, D. H., 1974, Anemia in alcoholism, In: “Drugs and Hematopoietic Reactions,” N. V. Dimitrov and J. H. Nodine, eds., pp. 141–53, Crune and Stratton, New York.Google Scholar
  27. Horne, D. W., Briggs, W. T. and Wagner, C., 1979, Studies on the transport mechanism of 5-methyltetrahydrofolic acid in freshly isolated hepatocytes: Effect of ethanol, Arch. Biochem. Biophys., 196:557–65.PubMedCrossRefGoogle Scholar
  28. Hunter, C. L., Treanor, L. L., Gray, J. B., Halter, S. A., Hoyumpa, A. and Wilson, F. A., 1983, Effects of ethanol in vitro on rat intestinal brush-border membranes, Biochim. Biophys. Acta, 732:256–65.PubMedCrossRefGoogle Scholar
  29. Hurt, R. D., Nelson, R. A., Dickson, E. R., Higgins, J. A. and Morse, R. M., 1979, Nutritional status of alcoholics before and after admission to an alcoholism treatment unit, In: “Fermented Food Beverages in Nutrition,” C. F. Gastineau, W. J. Darby, and T. B. Turner, eds., pp. 397–408, Academic Press, New York.Google Scholar
  30. Israel, Y., Valenzuela, J. E., Salazar, I. and Ugarte, G., 1969, Alcohol and amino acid transport in the human small intestine, J. Nutr., 98:222–4.PubMedGoogle Scholar
  31. Jandl, J. H., and Lear, A. A., 1956, The metabolism of folic acid in cirrhosis, Ann. Intern. Med., 45:1027–44.PubMedGoogle Scholar
  32. Kabadi, V. M., Eisenstein, A. B. and Konda, J., 1985, Elevated plasma ammonia levels in hepatic cirrhosis: Role of glucagon, Gastroenterology, 88:750–6.PubMedGoogle Scholar
  33. Kawase, T., Kato, S. and Lieber, C. S., 1989, Lipid peroxidation and antioxidant defense system in rat liver after chronic ethanol feeding, Hepatology, 10:815–21.PubMedCrossRefGoogle Scholar
  34. Keating, J. N., Weir, D. G. and Scott, J. M., 1985, The effect of ethanol consumption on folate polyglutamate biosynthesis in the rat, Biochem. Pharmacol., 34:1913–6.Google Scholar
  35. Keen, C. L., Tamura, T., Lonnerdal, B., Hurley, L. S. and Halsted, C. H., 1985, Changes in hepatic superoxide dismutase activity in alcoholic monkeys, Am. J. Clin. Nutr., 41:929–32.PubMedGoogle Scholar
  36. Kelly, D., Reed, B., Weir, D. and Scott, J., 1981, Effect of acute and chronic alcohol ingestion on the rate of folate catabolism and hepatic enzyme induction in mice, Clin. Sci., 60:221–4.PubMedGoogle Scholar
  37. Kim, C., Leo, M. A., Lowe, N. and Lieber, C. S., 1988, Effects of vitamin A and ethanol on liver plasma membrane fluidity, Hepatology, 8:735–41.PubMedCrossRefGoogle Scholar
  38. Klipstein, F. A., Lipton, S. D. and Schenk, E. A., 1973, Folate deficiency of the intestinal mucosa, Am. J. Clin. Nutr., 26:728–37.PubMedGoogle Scholar
  39. Leevy, C. M., 1966, Abnormalities of hepatic DNA synthesis in man, Medicine, 45:423–33.PubMedCrossRefGoogle Scholar
  40. Leevy, C. M., Thomson, A. and Baker, H., 1970, Vitamins and liver injury, Am. J. Clin. Nutr., 23:493–8.PubMedGoogle Scholar
  41. Leo, M. A. and Lieber, C. S., 1982, Hepatic vitamin A depletion in alcoholic liver injury, N. Engl. J. Med., 307:597–601.PubMedCrossRefGoogle Scholar
  42. Leo, M. A. and Lieber, C. S., 1985, New pathway for retinol metabolism in liver microsomes, J. Biol. Chem., 260:5228–31.PubMedGoogle Scholar
  43. Lieber, C. S., 1988, Biochemical and molecular forms of alcohol-induced injury to liver and other tissue, N. Engl. J. Med., 319:1639–50.PubMedCrossRefGoogle Scholar
  44. Lieber, C. S. and DeCarli, L. M., 1972, An experimental model of alcohol feeding and liver injury in the baboon, J. Med. Primatol., 3:153–63.Google Scholar
  45. Lelbach, W. K., 1975, Cirrhosis in the alcoholic and its relation to the volume of alcohol abuse, Ann. N. Y. Acad. Sci., 252:85–105.PubMedCrossRefGoogle Scholar
  46. Lindenbaum, J. and Lieber, C. S., 1975, Effect of chronic ethanol administration on intestinal absorption in man in the absence of nutritional deficiency, Ann. N. Y. Acad. Sci., 252:228–34.PubMedCrossRefGoogle Scholar
  47. Lindenbaum, J., Healton, E. B., Savage, D. G., Brust J. C. M., Garrett T. J., Podell, E. R., Marcell, P. D., Stabler, S. P. and Allen R. H., 1988, Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis, N. Engl. J. Med., 318:1720–8.PubMedCrossRefGoogle Scholar
  48. Linscheer, W. G., 1970, Malabsorption in cirrhosis, Am. J. Clin. Nutr., 23:488–92.PubMedGoogle Scholar
  49. Lumeng, L., 1978, The role of acetaldehyde in mediating the deleterious effect of ethanol in pyridoxal 5’-phosphate metabolism, J. Clin. Invest., 62:286–93.PubMedCrossRefGoogle Scholar
  50. Mak, K. M., Leo, M. A. and Lieber, C. S., 1984, Alcoholic liver injury in baboons: transformation of lipocytes to transitional cells, Gastroenterology, 87:188–200.PubMedGoogle Scholar
  51. Marchesini G., Zoli, M., Angiolina, A., Dondi, C., Bianchi, F. B. and Pisi, E., 1981, Muscle protein breakdown in liver cirrhosis and the role of altered carbohydrate metabolism, Hepatology, 1:294–9.PubMedCrossRefGoogle Scholar
  52. Mason, J. B., 1990, Intestinal transport of monoglutamyl folates in mammalian systems, In: “Folic Acid Metabolism in Health and Disease,” M. F. Picciano, E. L. R. Stokstad, and J. F. Gregory, III, eds., pp. 47–63, Wiley-Liss, New York.Google Scholar
  53. McMartin, K. E. and Collins, T. D., 1983, Relationship of alcohol metabolism to folate deficiency produced by ethanol in the rat, Pharmacol. Biochem. Behay., 18:257–62.CrossRefGoogle Scholar
  54. McMartin, K. E., Collins, T. D., Shiao, C. Q., Vidrine, L. and Redefski, H. M., 1986, Study of dose-dependence and urinary folate excretion produced by ethanol in humans and rats, Alcoholism, 10:419–24.PubMedGoogle Scholar
  55. Mekhjian, H. S. and May, E.S., 1977, Acute and chronic effects of ethanol on fluid transport in the human small intestine, Gastroenterology 72:1280–6.PubMedGoogle Scholar
  56. Mendenhall, C. L., Anderson, S., Weesner, R. E., Goldberg, S. J. and Crolic, K. A., 1984, Protein-calorie malnutrition associated with alcoholic hepatitis, Am. J. Med., 76:211–22.PubMedCrossRefGoogle Scholar
  57. Mezey, E., Jow, E., Slavin, R. E. and Tobon, F., 1970, Pancreatic function and intestinal absorption in chronic alcoholism, Gastroenterology, 59:657–64.PubMedGoogle Scholar
  58. Mezey, E., Kolman, C. J., Diehl, A. M., Mitchell, M. and Herlong, H. F., 1988, Alcohol and dietary intake in the development of chronic pancreatitis and liver disease in alcoholism, Am. J. Clin. Nutr., 48:148–51.PubMedGoogle Scholar
  59. Morgan, M. Y. and Levine, J. A., 1988, Alcohol and nutrition, Proc. Nutr. Soc., 47:85–98.PubMedCrossRefGoogle Scholar
  60. Morgan, M. Y., Marshall, A. W., Milstrom, J. P. and Sherlock, S., 1982, Plasma amino acid patterns in liver disease, Gut, 23:363–70.Google Scholar
  61. Naughton, C. A., Chandler, C. J., Duplantier, R. B. and Halsted, C. H., 1989, Folate absorption in alcoholic pigs: in vitro hydrolysis and transport at the intestinal brush border membrane, Am. J. Clin. Nutr., 50:1436–41.PubMedGoogle Scholar
  62. Neville, J., Eagles, J. A., Samson, G. and Olson, R. E., 1968, Nutritional status of alcoholics, Am. J. Clin. Nutr., 21:1329–40.PubMedGoogle Scholar
  63. Owen, O. E., Trapp, V. E., Reichard, G. A., Mozzoli, M. A., Moctezuma, J., Paul, P., Skutcher, C. C. and Boden, G., 1983, Nature and quality of fuels consumed in patients with alcoholic cirrhosis, J. Clin. Invest., 72:1821–32.PubMedCrossRefGoogle Scholar
  64. Patek, A. J., Toth, I. G., Saunders, M. G., Castro, G. A. M. and Engel, J. J., 1975, Alcohol and dietary factors in cirrhosis, Arch. Intern. Med., 135:1053–7.PubMedCrossRefGoogle Scholar
  65. Perlow, W., Baraona, E. and Lieber, C. S., 1977, Symptomatic intestinal disaccharidase deficiency in alcoholics, Gastroenterology, 77:680–4.Google Scholar
  66. Pirola, R. C. and Lieber, C. S., 1972, The energy cost of the metabolism of drugs, including ethanol, Pharmacology, 7:185–96.PubMedCrossRefGoogle Scholar
  67. Pratt, R. F. and Cooper, B. A., 1971, Folates in plasma and bile of man after feeding [3H] folic acid and 5-formyltetrahydrofolate (folinic acid), J. Clin. Invest., 50:455–62.PubMedCrossRefGoogle Scholar
  68. Reisenauer, A. M., 1990, Affinity labelling of the folate-binding protein in pig intestine, Biochem. J., 267:249–52.PubMedGoogle Scholar
  69. Reisenauer, A. M., Chandler, C. J. and Halsted, C. H., 1986, Folate binding and hydrolysis by pig intestinal brush border membranes, Am. J. Physiol., 251:G481–6.PubMedGoogle Scholar
  70. Reisenauer, A. M., Buffington, C. A. T., Villanueva, J. A. and Halsted, C. H., 1989, Folate absorption in alcoholic pigs: in vivo intestinal perfusion studies, Am. J. Clin. Nutr., 50:1429–35.PubMedGoogle Scholar
  71. Robles, C. A., Mezey, E., Halsted, C. H. and Schuster, M. M., 1974, Effect of ethanol on motility of the small intestine, Johns Hopkins Med. J., 135:17–24.PubMedGoogle Scholar
  72. Roggin, C. M., Iber, F. L. and Linscheer, W. G., 1972, Intraluminal fat digestion in the chronic alcoholic, Gut, 13:107–11.PubMedCrossRefGoogle Scholar
  73. Romero, J. J., Tamura, T. and Halsted, C. H., 1981, Intestinal absorption of [3H] folic acid in the chronic alcoholic monkey, Gastroenterology, 80:99–102.PubMedGoogle Scholar
  74. Rothschild, M. A., Oratz, M. and Schrieber, S., 1987, Effects of ethanol on protein synthesis, Ann. N. Y. Acad. Sci., 492:233–43.PubMedCrossRefGoogle Scholar
  75. Rubin, E., Ryback, B. J., Lindenbaum, J., Gerson, C. D., Walker, G. and Lieber, C. S., 1972, Ultrastructural changes in the small intestine induced by ethanol, Gastroenterology, 63:801–14.PubMedGoogle Scholar
  76. Ruder, J. B., Girard, D. E. and Cooney, T. G., 1985, Wernicke’s encephalopathy, N. Engl. J. Med., 312:1035–9.CrossRefGoogle Scholar
  77. Russell, R. M., Rosenberg, I. M., Wilson, P. D., Iber, F. L., Oaks, E. V., Giovetti, A. C., Otradovec, C. L., Karwoski, P. A. and Press, A. W., 1983, Increased urinary excretion and prolonged turnover time of folic acid during ethanol ingestion, Am. J. Clin. Nutr., 38:64–70.PubMedGoogle Scholar
  78. Savage, D. and Lindenbaum, J., 1986, Anemia in alcoholics, Medicine (Baltimore), 65:322–8.Google Scholar
  79. Shaw, S., Jayatilleke, E., Herbert, V. and Colman, N., 1989, Cleavage of folates during ethanol metabolism. Role of xanthine oxidase-generated superoxide dismutase, Biochem. J., 257:277–80.PubMedGoogle Scholar
  80. Shaw, S., Jayatilleke, E., Ross, A., Gordon, E. R. and Lieber, C. S., 1981, Ethanol induced lipid peroxidation: Potentiation by long-term alcohol feeding and attenuation by methionine, J. Lab. Clin. Med., 98:417–24.PubMedGoogle Scholar
  81. Soberon, S., Pauley, M. P., Duplantier, R., Fan, A. and Halsted, C. H., 1987, Metabolic effects of enteral formula feeding in alcoholic hepatitis, Hepatology, 7:1204–9.PubMedCrossRefGoogle Scholar
  82. Steinberg, S. E., Campbell, C. L. and Hillman, R. S., 1979, Kinetics of the normal folate enterohepatic cycle, J. Clin. Invest., 64:83–8.CrossRefGoogle Scholar
  83. Sullivan, L. W. and Herbert, V., 1964, Suppression of hematopoiesis by ethanol, J. Clin. Invest. 43:2048–62.PubMedCrossRefGoogle Scholar
  84. Swanson, V. L. and Thomassen, R. W., 1965, Pathology of the jejunal mucosa in tropical sprue, Am. J. Pathol., 46:511–51.PubMedGoogle Scholar
  85. Taber, M. M. and Lakshmaiah, N., 1987, Studies on hydroperoxide-dependent folic acid degradation by hemin, Arch. Biochem. Biophys., 257:100–6.CrossRefGoogle Scholar
  86. Tamura, T. and Halsted, C. H., 1983, Folate turnover in chronically alcoholic monkeys, J. Lab. Clin. Med., 101:623–8.PubMedGoogle Scholar
  87. Tamura, T., Romero, J. J., Watson, J. E., Gong, E. J. and Halsted, C. H., 1981, Hepatic folate metabolism in the chronic alcoholic monkey, J. Lab. Clin. Med., 97:65–461.Google Scholar
  88. Thomson, A. L., Baker, H. and Leevy, C. M., 1970, Patterns of 35S-thiamine hydrochloride absorption in the malnourished alcoholic patient, J. Lab. Clin. Med., 76:34–45.PubMedGoogle Scholar
  89. Wagner, C., 1982, Cellular folate binding proteins; function and significance, Ann. Rev. Nutr., 2:229–48.CrossRefGoogle Scholar
  90. Wang, D. L. and Reitz, R. C., 1983, Ethanol ingestion and polyunsaturated fatty acids: Effects on the acyl-CoA desaturases, Alcoholism, 7:220–6.PubMedGoogle Scholar
  91. Waring, A. J., Rottenberg, H., Ohnishi, T. and Rubin, E., 1981, Membranes and phospholipide of liver mitochondria from chronic alcoholic rats are resistant to membrane disordering by alcohol, Proc. Natl. Acad. Sci. USA, 78:2582–6.PubMedCrossRefGoogle Scholar
  92. Weber, F. L., Jr. and Reiser, B.J., 1982, Relationship of plasma amino acids to nitrogen balance and portal systemic encephalopathy in alcoholic liver disease, Dig. Dis. Sci., 27:103–10.PubMedCrossRefGoogle Scholar
  93. Weber, F. L., Jr., Bagby, B. S., Licate, L. and Kelson, S., 1990, Effects of branched-chain amino acids on nitrogen metabolism in patients with cirrhosis, Hepatology, 11:942–50.PubMedCrossRefGoogle Scholar
  94. Wilkinson, J. and Shane, B., 1982, Folate metabolism in the ethanol-fed rat, J. Nutr., 112:604–9.PubMedGoogle Scholar
  95. Williams, W. M. and Hueng, K. C., 1982, Renal tubular transport of folic acid and methotrexate in the monkey. Am. J. Physiol., 242:F484–90.PubMedGoogle Scholar
  96. Zidenberg-Cherr, S., Halsted, C. H., Olin, K. L., Reisenauer, A. M. and Keen, C. L., 1990, The effect of chronic alcohol ingestion on free-radical defense in the miniature pig, J. Nutr., 120:213–7.PubMedGoogle Scholar

Copyright information

© Plenum Press, New York 1991

Authors and Affiliations

  • Charles H. Halsted
    • 1
  1. 1.Division of Clinical Nutrition Department of Internal MedicineUniversity of CaliforniaDavisUSA

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