Explain why malnutrition is prominent in a patient with alcoholism or alcoholic hepatitis.
What will be an ideal response?
Alcohol often replaces food in the diet. Though it is possible to meet maintenance energy needs from the energy in the alcohol consumed, malnourishment results because of an inadequate intake of nutrients; though high in calories, alcohol contains no protein, vitamins, or minerals. Alcohol is also preferentially metabolized over whatever nutrients are obtained through food. Alcohol causes inflammation of the stomach, pancreas, and intestine, interfering with the normal processes of digestion and absorption and resulting in secondary malnutrition. The subsequent decrease in pancreatic enzyme secretion, intestinal transporters, and micelle formation results in altered absorption of fat-soluble vitamins, thiamin, and folic acid. The metabolism of alcohol increases the need for certain nutrients, particularly the B vitamins and magnesium. Alcohol causes increased urinary excretion of folate and pyridoxine (B6) as well as increased retinoid metabolism.
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