1987 Henry Baker lecture. Nutrition, alcohol, and the liver.

Alcohol is hepatotoxic in both established alcoholics and normal volunteers. Good nutrition does not protect against this effect. Those who are admitted to the hospital with evidence of alcoholic liver disease are uniformly malnourished. The malnourished sick, including those with alcoholic liver disease, do not fare as well with their disease as do the well-nourished sick. The data are compatible with the concept that malnutrition is a complication of alcoholism and interferes with rapid repair of alcoholic liver injury. Only in this important sense does poor protein intake contribute to the hepatic injury of alcohol abuse. Correction of kwashiorkor allows the inherent repair mechanisms to operate in reversing the reversible. Therefore, for the sicker alcoholics who have a reversible component to their liver disease, but who cannot consume adequate diets, enteral or parenteral caloric supplements are indicated. This is, after all, not so different from other diseases. 'Tis better to have one ailment at a time. If one wishes to alter the overall impression or picture of the play, remove one of the significant actors.