Alcoholic liver disease (ALD) evolves through various stages, and malnutrition correlates with the severity of ALD. Poor nutrition is caused both by the substitution of calories from alcohol for calories from food and by the malabsorption and maldigestion of various nutrients attributed to ALD. The only established therapy for ALD consists of abstinence from alcohol. Sufficient nutritional repletion coupled with appropriate supportive treatment modalities may be effective in reducing complications associated with ALD—particularly infection. Nutrition makes a significant positive contribution in the treatment of ALD, especially in selected malnourished patients.

Indeed, in a large study of hospitalized patients with varying severity of ALD, malnutrition (especially the type caused by deficient protein and calories) was closely associated (although not necessarily causal) with the severity of liver injury (Mendenhall et al. 1984).

All patients with clinical evidence of ALD (regardless of severity) exhibited some features of malnutrition. With regard to the possible value of nutritional therapy, it would seem logical that patients with more severe deficits would benefit more, although convincing proof of this, to our knowledge, is not available.

This article reviews the various forms of liver injury; the basis for and role of malnutrition in ALD, including the harmful effects of the products of alcohol metabolism; evidence for the benefits of nutrition; and special considerations for nutritional therapy in ALD.