Nutritional, Gut and Liver Disease Related to Alcohol Use Disorder

Vitamin Deficiencies 

Alcohol use can alter the intake, absorption and utilisation of nutrients. Thiamine deficiency should alert clinicians to the possibility of other vitamin deficiency particularly in the setting of neuropathy. Notably, nicotinic acid, vitamin B2, vitamin B6, vitamin B12, folate or vitamin E) deficiencies lead to clinical problems including anorexia, diarrhoea, skin changes (erythematous and/or hyperkeratotic dermatitis, cheilosis, glossitis, keratoconjunctivitis and dermatitis), mental changes in pellagra and myelopathy.  

Protein-Energy Malnutrition  

Protein-energy malnutrition is commonly seen in those with severe alcohol dependence and particularly with cirrhosis and liver injury. Clinically, protein-energy malnutrition may be present as loss of muscle tissue, and evident symptomatically as weakness and loss of muscle bulk in the upper arm and thigh. 


Alcohol use increases the risk of impaired bone mineral density in a dose-dependent manner. In the setting of alcohol-related liver disease, there is a two-fold increase in the risk of bone fracture. For patients with AUD, rigorous assement for osteoporosis and vitamin D deficiency is suggested to optimise bone health. Consideration of vitamin D supplementation and bisphosphonates for osteoporosis based on assessments and risk.  

Assessment and Management of Alcohol-Related Malnutrition 

Patients presenting with moderate to severe AUD should undergo a complete nutritional assessment looking for symptoms of undernutrition including weight loss, fatigue, decrease in muscle strength, oedema, gastrointestinal symptoms, and dietary history; physical examination for decreased body mass index, muscle mass, and subcutaneous fat; and laboratory findings. Consider supplemental thiamine and/or a multi-vitamin for all individuals with alcohol misuse. In patients malnutrition may require supplemental feeding of both protein and calories as well as vitamin supplements with a multi-vitamin and thiamine. Patients with loss of muscle mass and frailty may benefit from allied health assessment and intervention with occupational therapy and physiotherapy. Early recognition of malnutrition, sarcopenia and frailty is important to offset its significant social and individual health impacts.