Alcohol, malnutrition, and alcoholic cirrhosis1

The relative importance of malnutrition and alcohol toxicity in the pathogenesis of cirrhosis has been controversiaL In epidemiological studies the incidence of cirrhosis can be correlated with the duration and amount of alcohol imbibed. The importance of nutrition has been discounted. In these studies few analyses of dietary intake were included. Diets of patients with alcoholic cirrhosis characteristically are poor. Furthermore, alcohol toxicity impairs nutrition by interfering with absorption, transport, and utilization of essential nutrients. Patients with cirrhosis respond favorably to nutritious diets despite the concurrent intake of alcohol, although in lesser amount than their usual intakes. In long-term studies highly nutritious diets have protected rats against cirrhosis from alcohoL However, in acute experiments with “loading” doses there was evidence of direct hepatotoxicity in animals and man. Recently, cirrhosis has been produced in baboons with alcohol and a diet considered adequate. The findings are important, but there is some question whether dietary factors (imbalance) may have played a role. Also of recent interest has been the occurrence of lesions simulating alcoholic hepatitis and cirrhosis after jejunoileal bypass surgery. The evidence suggests that malnutrition may have been a major factor in this disease. The roles of alcohol toxicity and of malnutrition in the pathogenesis of cirrhosis are not fully understood, Further studies are needed to clarify these relationships. Am. I. Clin. Nuir. 32: 1304-1312, 1979. The relative importance of malnutrition and alcohol toxicity in the pathogenesis of alcoholic cirrhosis has been a source of interest and controversy for some years. As data accumulate it becomes evident that both factors are involved. The interrelation of alcoholism and malnutrition was brought into focus by observations on alcoholic pellagra (1) and alcoholic polyneuritis (2) in the 1930’s. These diseases were shown to be similar to the endemic forms both in symptoms and response to treatment. With specific therapy patients with alcoholic polyneuritis and pellagra recovered despite the concurrent administration of alcohol under controlled conditions. The association of alcoholism with deficiency diseases and the frequency of cirrhosis in countries where malnutrition and enteric diseases were prevalent (3-5) suggested that alcoholic cirrhosis might be a conditioned nutritional deficiency disease, analogous to alcoholic pellagra and polyneuritis. Based upon this concept patients with alcoholic cirrhosis were treated with diets rich in protein and vitamin B complex. The response to therapy exceeded chance expectations (6, 7).