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Re: Alcoholism and Micronutrients

Dear Editor,
This artice from A Shenkin [1] is timely and very informative on micronutients in health and their role in preventing disease. As mentioned in the article, pre-existing nutritional deprivation has consistently been shown in studies as a very good indication for micronutrient replacement. [2] Detsky's subjective global assessment tool is well validated and to be used when nutritional intervention in adults in indicated. For clinicians, the better marker for nutritional intervention in adults is unintentional weight loss. There have been various meta-analyses evaluating protein energy supplementations in adults, though results are inconsistent. The review by the American Gastroenterology Association [3]supports the use of these supplements, especially in patients with short bowel syndrome. There is evidence to suggest benefit of micronutrient supplementation in patients with alcoholic liver disease [4], coeliac disease, and some evidence in non-alcoholic steatohepatitis. [5] However, this benefit might be due to associated malnutrition, overtly seen in alcoholics and symtomatic coeliacs. There is evidence to show that selenium deficiency is seen in alcoholics and has effect on mood changes.[6] Also, the use of micronutrients in critically ill patients is established and multivitamin and trace element preparations suitable for most patients requiring parenteral nutrition are widely available, but concerns regarding individual patients requiring additional supplements or smaller amounts of certain micronutrients have to be kept in mind. [7] Hence, in clinical practice, especially in alcoholics, stress for prevention of malnutrition is crucial to health rather than disease.

References
1. A Shenkin, Micronutrients in health and disease Postgrad Med J 2006; 82: 559-567

2. Souba, WW. Nutritional support. N Engl J Med 1997; 336:41.

3. Koretz, RL, Lipman, TO, Klein, S. AGA Technical Review on Parenteral Nutrition. Gastroenterology 2001; 121:970.

4. Halsted CH, Nutrition and alcoholic liver disease. Semin Liver Dis. 2004 Aug;24(3):289-304.

5. Miele L, Gabrieli ML, Forgione A, et al. Oxidative stress in metabolic syndrome and nonalcoholic steatohepatitis. Is it possible a role for vitamins in clinical practice? Recenti Prog Med. 2006 Jan;97(1):1-5.

6. Role of selenium depletion in the etiopathogenesis of depression in patients with alcoholism [corrected]. Med Hypotheses. 2002 Sep;59(3):330-3. Review. Erratum in: Med Hypotheses. 2003 Sep;61(3):416.

7. Nutrition and alcoholic liver disease.Semin Liver Dis. 2004 Aug;24(3):289-304.