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Thakurdesai A, Jha SK, Erinkitola I, Said A, Joshi T, Schwandt ML, Parajuli D, Singal AK, Kong M, Cave MC, Vatsalya V. The gut-immune-liver axis in patients with alcohol use disorder and clinically low serum zinc levels. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 39095327 DOI: 10.1111/acer.15408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/21/2024] [Accepted: 06/29/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Alcohol use disorder (AUD) with chronic and heavy alcohol consumption causes alcohol-associated liver disease (ALD). Early-stage ALD exhibits dyshomeostasis of zinc. We investigated the role of zinc deficiency in gut-barrier dysfunction, proinflammatory response, hepatocyte injury, and death, as well as potential sex differences in AUD patients. METHODS Thirty-nine male and female AUD patients were grouped by normal [≥71 μg/dL (Group 1, number (n) = 26)] and low [<71 μg/dL (Group 2, n = 13)] serum zinc levels. Demographics, alcohol intake markers [Lifetime Drinking History (LTDH), heavy drinking days in the past 90-days (HDD90), total drinks in the past 90-days (TD90), number of drinking days in the past 90-days (NDD90), average drinks per day in the past 90 days (AvgDPD90)] were collected. Blood samples were tested for complete blood count (CBC), comprehensive metabolic panel (CMP), coagulation markers, gut-barrier dysfunction markers, cytokines, and hepatocyte death markers. RESULTS Group 2 females exhibited lower LTDH than Group 2 males (p = 0.028), but higher recent drinking. Aspartate transaminase: alanine transaminase (AST:ALT) ratio was higher (p = 0.049) in Group 2 males compared to Group 1 males. Overall, Group 2 showed threefold higher interleukin 8 (IL-8) levels than Group 1 (p = 0.92); these were sevenfold higher in Group 2 females than Group 1 females. Group 2 females also had higher K18M65, but lower K18M30 than Group 1 females. Necrotic type of cell death (K18M65) was well-described only in Group 2 by the arrangement of lipopolysaccharide (LPS), soluble cluster of differentiation 14 (sCD14), and tumor necrosis factor alpha (TNF-α) (R2 = 0.633, p = 0.037). CONCLUSION Our findings demonstrated the role of the gut-immune-liver axis in describing hepatocyte injury and death in zinc-deficient AUD patients. These patients represented an arrangement of gut-barrier dysfunction and an exacerbated immune response. Shift in the cell-death mechanism from apoptosis in zinc-replete females to necrosis in zinc-deficient females suggests a subclinical to clinical transition of ALD associated with zinc status.
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Affiliation(s)
- Aishwarya Thakurdesai
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Clinical Laboratory for the Intervention Development of AUD and Organ-Severity, University of Louisville, Louisville, Kentucky, USA
| | - Suman K Jha
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Clinical Laboratory for the Intervention Development of AUD and Organ-Severity, University of Louisville, Louisville, Kentucky, USA
| | - Iyabo Erinkitola
- Clinical Laboratory for the Intervention Development of AUD and Organ-Severity, University of Louisville, Louisville, Kentucky, USA
| | - Aula Said
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Clinical Laboratory for the Intervention Development of AUD and Organ-Severity, University of Louisville, Louisville, Kentucky, USA
| | - Thwisha Joshi
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Clinical Laboratory for the Intervention Development of AUD and Organ-Severity, University of Louisville, Louisville, Kentucky, USA
| | - Melanie L Schwandt
- National Institute on Alcohol Abuse and Alcoholism, NIAAA, NIH, Bethesda, Maryland, USA
| | - Dipendra Parajuli
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Louisville, Louisville, Kentucky, USA
- Robley Rex VA Medical Center, Louisville, Kentucky, USA
| | - Ashwani K Singal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Louisville, Louisville, Kentucky, USA
- VA Medical Center, Sioux Falls, South Dakota, USA
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, School of Public Health, University of Louisville, Louisville, Kentucky, USA
| | - Matthew C Cave
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Louisville, Louisville, Kentucky, USA
- Robley Rex VA Medical Center, Louisville, Kentucky, USA
| | - Vatsalya Vatsalya
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Clinical Laboratory for the Intervention Development of AUD and Organ-Severity, University of Louisville, Louisville, Kentucky, USA
- National Institute on Alcohol Abuse and Alcoholism, NIAAA, NIH, Bethesda, Maryland, USA
- Robley Rex VA Medical Center, Louisville, Kentucky, USA
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Jophlin L, Liu TY, McClain CJ. Nutritional deficiencies in alcohol use disorder/alcohol-associated liver disease. Curr Opin Gastroenterol 2024; 40:112-117. [PMID: 38193343 DOI: 10.1097/mog.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW To delineate common and uncommon dietary and nutritional deficiencies in individuals with chronic heavy alcohol use and alcohol use disorder and to highlight important advances in the nutrition field in patients ranging from those with alcohol use disorder (AUD) and no liver disease to those with decompensated alcohol-associated liver disease (ALD). RECENT FINDINGS Patients with AUD may have nutritional deficiencies, especially isolated nutrient deficiencies, such as thiamine or zinc deficiencies. This should not be surprising, as alcohol is a major source of "empty calories." It is devoid of critical macronutrients, such as protein, and micronutrients including important vitamins and minerals. Patients with AUD frequently drink much more than often appreciated (10-20 drinks a day). Patients with AUD and early ALD often begin to develop more apparent nutritional deficiencies. Healthcare providers need to be aware of the presenting features of individual nutrient deficiencies, such as thiamine deficiency, and to provide prompt treatment. In patients with more advanced liver disease, malnutrition correlates with severity of liver disease. It is important to understand the value of nutritional support throughout the spectrum of AUD. SUMMARY We review nutritional deficiencies in the spectrum of patients with AUD and ALD and highlight new information and recommendations.
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Affiliation(s)
- Loretta Jophlin
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Tzu-Yu Liu
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Craig J McClain
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
- Robley Rex VAMC, Louisville KY, USA
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