Review Article

The Role of Nutrition in Alcohol-associated Liver Disease

Indira Bhavsar-Burke; Claire L. Jansson-Knodell; Ashley C. Gilmore; David W. Crabb


Aliment Pharmacol Ther. 2021;53(12):1268-1276. 

In This Article

Abstract and Introduction


Background: Malnutrition is a commonly encountered issue in patients with alcohol-associated liver disease. The role of nutritional supplementation in the management of alcohol-associated liver disease is integral to patient outcomes—it has been shown to decrease rates of hepatic encephalopathy, improve outcomes post-liver transplant, reduce 90-day hospital readmissions and lower mortality. Despite these benefits, many studies have shown nutritional support to be an underutilised tool in the care of patients with alcohol-associated liver disease.

Aims: To review the epidemiology, pathophysiology, recommendations for nutritional assessment and supplementation, as well as future directions for research of the relationship between nutrition and alcohol-associated liver disease.

Methods: A literature search was conducted via PubMed using MeSH terms to inform this narrative review.

Results: Decreased dietary intake, socioeconomic status, impaired absorption of nutrients and increased free radical species are implicated in the pathophysiology of malnutrition in alcohol-associated liver disease.

Conclusions: Malnutrition is common in alcohol-associated liver disease, and physicians should be aware of its association with poor clinical outcomes. Routine nutritional assessment, involvement of a dietician and nutritional supplementation are recommended to improve clinical outcomes in patients with alcohol-associated liver disease.


As alcohol consumption increases globally, so too does the disease burden of alcohol-associated liver disease (ALD). ALD refers to a spectrum of disease states including asymptomatic steatosis, alcoholic hepatitis and cirrhosis.[1] Progression across stages depends not only on alcohol consumption but additional risk factors such as genetic susceptibility, sex, presence of other concurrent liver disease and diet.[1] ALD accounts for a substantial portion of the worldwide cirrhosis burden and is one of the leading indications for liver transplant. Patients with ALD are at increased risk for malnutrition, which has long been associated with poor clinical outcomes.[2] This article will review the epidemiology, pathophysiology, nutritional assessment and supplementation recommendations for nutrition in the setting of ALD. A literature search was conducted via PubMed using MeSH terms to inform this narrative review.