Malnutrition and the role of nutritional support in alcoholic liver disease

Malnutrition adversely effects hepatic function and structure. In certain instances, histological changes indistinguishable from alcoholic liver disease may be seen. Alcohol is clearly a direct hepatic toxin and its results are not prevented by normal nutritional intake. The majority of patients admitted to the hospital with alcoholic liver disease are moderately to severely malnourished but find it difficult or impossible to resume an intake sufficient to repair and maintain a normal nutritional state. Malnutrition may be considered a complication of alcohol abuse which occurs simultaneously with liver damage. Repair of both nutrition and hepatic histology requires considerable time, more for the latter. Here we review the data which both incriminates and separates the effects of malnutrition and of alcohol on the liver, and review the current literature on the effect of intravenous or enteral protein-calorie supplementation on acute alcoholic liver disease. While the data suggest that improvement in conventional liver tests are accelerated somewhat by such treatment, there have been no major confirmed differences noted between treatment and control groups at 3 to 4 wk. More precise measures of liver function, as opposed to conventional tests of liver status, and longer follow-up periods will be required to substantiate the suggested beneficial effects of iv or enteral protein-calorie supplementation in acute alcoholic hepatitis.