Nicoll Ruairidh, Gerasimidis Konstantinos, Forrest Ewan
Department of Gastroenterology, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK.
Department of Human Nutrition, School of Medicine, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow G31 2ER, UK.
Alcohol Alcohol. 2022 May 10;57(3):275-282. doi: 10.1093/alcalc/agab060.
Chronic alcohol consumption may result in liver injury and chronic liver disease, but other factors are likely to influence disease progression. Malnutrition, specifically micronutrient deficiency, is frequently associated with both alcohol use disorder and chronic liver disease. We hypothesize that micronutrient deficiencies may affect the progression of liver disease in this population.
Systematic integrative review of the medical literature; electronic search of MEDLINE 1950-2021; studies investigating role of any micronutrient in the acceleration of alcohol-related liver injury in humans or animals. Studies which specifically related to alcoholic hepatitis were excluded. Outcomes were extracted and recorded in tabulated form and discussed narratively.
We identified 46 studies investigating the role of micronutrient deficiencies in the pathogenesis of alcohol-related liver disease. Specific micronutrients which were identified included folic acid or related B vitamins (n = 9 studies), Vitamin D (n = 9 studies), magnesium (n = 8 studies), zinc (n = 8 studies) and selenium (n = 12 including one systematic review). Observational evidence suggests a potential role of magnesium deficiency in accelerating alcohol-related liver injury with weak or negative evidence for other micronutrients.
Magnesium deficiency may increase the risk of alcohol-related liver injury and adverse liver outcomes. However, currently, there is insufficient evidence to support magnesium supplementation except for clinically relevant magnesium deficiency. Long-term prospective cohort studies assessing the impact of micronutrients on liver disease progression in patients with alcohol use disorder are lacking and may help determine whether there is a causal role for micronutrient deficiencies in alcohol-related liver injury.
长期饮酒可能导致肝损伤和慢性肝病，但其他因素可能会影响疾病进展。营养不良，尤其是微量营养素缺乏，常与酒精使用障碍和慢性肝病相关。我们推测微量营养素缺乏可能会影响该人群肝病的进展。
对医学文献进行系统综合评价；对1950 - 2021年的MEDLINE进行电子检索；研究任何微量营养素在加速人类或动物酒精性肝损伤中的作用。排除与酒精性肝炎具体相关的研究。提取结果并以表格形式记录，进行叙述性讨论。
我们确定了46项研究微量营养素缺乏在酒精性肝病发病机制中作用的研究。确定的特定微量营养素包括叶酸或相关B族维生素（9项研究）、维生素D（9项研究）、镁（8项研究）、锌（8项研究）和硒（12项研究，包括1项系统评价）。观察性证据表明镁缺乏在加速酒精性肝损伤中可能起作用，而其他微量营养素的证据较弱或为阴性。
镁缺乏可能会增加酒精性肝损伤和不良肝脏结局的风险。然而，目前除了临床相关的镁缺乏外，没有足够的证据支持补充镁。缺乏评估微量营养素对酒精使用障碍患者肝病进展影响的长期前瞻性队列研究，这些研究可能有助于确定微量营养素缺乏在酒精性肝损伤中是否存在因果作用。
