Comprehensive research shows that although the caloric intake and BMI of people with alcohol use disorders often appear normal, poor diet quality, hidden deficiencies, and flawed assessment tools can undermine recovery and long-term health.

study: Dietary intake, quality, and assessment tools in problem alcohol users: A scoping review and meta-analysis. Image credit: Ingrid Balabanova / Shutterstock.com

In a recent study published in translational psychiatryresearchers are comparing dietary intake, diet quality, and dietary assessment methods in individuals with alcohol use disorder (AUD) and related problematic alcohol use.

The important role of nutrition in the Australian dollar

Nutrition plays an important role in the proper functioning of the brain and immune system, and in recovery from chronic disease. However, its role in relation to AUD progression, treatment response, and recovery outcomes has not been widely studied.

Excessive alcohol intake prevents proper nutrient uptake and absorption, inhibits metabolism, increases the excretion of essential nutrients, and increases the risk of malnutrition. Many patients with AUD are diagnosed with coexisting hepatic, cardiovascular, and metabolic diseases, and these symptoms are often exacerbated by nutrient malabsorption and metabolic dysfunction.

Medical nutritional therapy involves developing individualized dietary and lifestyle plans based on specific medical conditions and symptoms and may support improved health in people with AUD. Due to the limitations of traditional methods used to assess dietary quality and behavior, the relationship between nutritional status, dietary behavior, and AUD, and how these factors interact to influence patient outcomes, remains unclear. It is poorly characterized.

Multi-database review of Australian dollar meals

The researchers performed a comprehensive search in databases including PubMed/MEDLINE, Scopus, and Web of Science using a combination of keywords and medical subject headings (MeSH) related to alcohol consumption, diet, nutrition, and dietary assessment.

Studies providing quantitative dietary data for adults diagnosed with AUD or alcohol-related disorders, as defined in the Diagnostic and Statistical Manual of Mental Disorders, were included in the analysis. Both active drinking and abstinence periods were included.

Title and abstract screening followed by full-text review and structured data extraction was performed by multiple reviewers. Dietary intake data were consistent with the study and separated based on drinking status.

Alcohol calories make up the majority of your intake, but they don’t replace food

A total of 41 studies published in 16 countries from 1968 to 2022 were included in the analysis, involving 2,727 Australian dollar individuals. Most study participants were men between the ages of 38 and 54, with an average body mass index (BMI) of 24.4 kg/m2.

People who are actively drinking consume an average of 2,900 kcal per day, with more than 1,500 kcal coming from alcohol alone, the equivalent of about 15 standard drinks. Despite active drinkers having higher caloric intake from alcohol, abstainers evaluated primarily in inpatient or residential treatment settings reported an average daily energy intake of 2,384 kcal/day, suggesting that alcohol calories are consumed in addition to food and nonalcoholic beverage intake during periods of active drinking.

Compared to the general U.S. population, carbohydrates accounted for a lower proportion of total energy, while protein and fat intakes were generally comparable to population reference values. Total protein intake was generally sufficient to meet recommended dietary allowances.

One study used the Healthy Eating Index 2015 to find that people receiving inpatient care consumed a slightly higher quality diet than the general U.S. population. This may be due to the structured eating environment. By comparison, another study using the Nova classification system reported increased intake of ultra-processed foods during active drinking, a pattern that has been associated in a wide range of literature with worse metabolic and mental health.

Dietary fiber intake was underreported and highly variable, as studies varied and some reported levels were below recommended values. In contrast, dietary fiber intake abstinence It was higher in single inpatient studies, likely reflecting the provision of structured meals. Fiber is essential for maintaining optimal gastrointestinal health, regulating blood sugar levels, and supporting cardiovascular health. Therefore, it will be important for future studies to characterize the daily fiber intake of patients with AUD and determine the potential health benefits of increasing intake of fiber-rich foods in this patient population.

The most common dietary tool used in studies was a dietary history interview, followed by a 24-hour dietary recall and dietary record. Importantly, none of these assessment tools have been validated for use with AUD patients, increasing the potential for recall bias.

A normal BMI hides nutritional deficiencies

Study results show that weighted averages of reported intakes suggest that many people diagnosed with AUD have caloric intakes, macronutrient distributions, and BMI values ​​within typical population ranges. However, these findings coexist with a high prevalence of micronutrient deficiencies and substantial methodological limitations, such as underreporting, impaired nutrient absorption, and metabolic disorders associated with chronic alcohol exposure.

Importantly, standard dietary guidelines were developed for the general American population and, as a result, may not be appropriate for individuals with AUD, highlighting the need to develop AUD-specific nutritional guidance and intake standards.

Poor quality of diet can worsen symptoms inflammationAlthough cognitive dysfunction, and comorbidities are common in patients with AUD, improved nutritional intake, especially a diet rich in fiber, micronutrients, and balanced macronutrients, may support physiological healing, psychological health, and recovery.