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Similar to Alcohol-ADVI (1).pptx. Ethanol is rapidly oxidised by the body to carbon dioxide and water, with no cumulative effect.
Similar to Alcohol-ADVI (1).pptx. Ethanol is rapidly oxidised by the body to carbon dioxide and water, with no cumulative effect. (20)
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Alcohol-ADVI (1).pptx. Ethanol is rapidly oxidised by the body to carbon dioxide and water, with no cumulative effect.
- 1. ETHANOL
- 2. ETHANOL • US Drinking Population • ~51% of women • ~72% of men • ~5% of total en intake • Heavy drinkers • 3% of women • 14% of men • Up to 50% of total en intake
- 3. ETHANOL • Energy Content of • 7.1 kcal/g • 29.7 kJ/g • 1 drink = • 12 g ethanol • ~9 oz beer (270 ml) • 100 mL wine (12 % by volume) • 30 mL liquor (40% by volume) • ~85.2 kcal from ethanol
- 4. THE PROOF IS IN THE ALCOHOL • Proof = 2x % alcohol • 100 proof is 50% alcohol • Whiskey, gin, rum, vodka are 80 proof or 40 % alcohol • Wine = 8 –14% alcohol • Beer = 4 –9% alcohol
- 5. ETHANOL • Nutrient • Drug • Toxin
- 6. ETHANOL METABOLISM • Priority • Toxic • Not stored • Therefore, ingestion effects metabolism
- 7. ETHANOL METABOLISM • Absorbed • Stomach • Small amount metabolized • Men> women • Decreases with aging • Aspirin decreases metabolism • Jejunum
- 8. ETHANOL METABOLISM • 3 enzyme systems • Alcohol dehydrogenase • Light intake • Microsomal ethanol oxidizing system • Inducible • Higher levels • Catalase • in presence of hydrogen peroxide • < 2 %
- 9. ETHYL ALCOHOL: METABOLISM AND BIOCHEMICAL IMPACT
- 10. ALCOHOL DEHYDROGENASE • Ethanol to acetaldehyde to acetate to acetyl CoA • Uses NAD + forms NADH • Liver primarily • Gastric mucosal cells • Males> females • CH3CHOH + NAD+ CH3CH + NADH + O • CH3CH + NAD+ + H2O CH3 CO- + 2H+ + NADH O • NADH increases in cytosol and mitochondria ethanol acetaldehyde acetaldehyde acetate ALDH2 Occurs in mitochondria
- 11. MEOS-CYTOCHROME P450 2E1 Metabolizes up to 20% of ethanol Inducible by ethanol and other substances increasing tolerance to ethanol or increasing metabolism of some substances (vitamin A, some drugs)
- 12. ALCOHOL TOXICITY • Acetaldehyde Toxicity • Can attach to proteins impairing the protein function • Damage to hepatocytes can lead to fibrosis and cirrhosis • High NADH: NAD+ ratio • Increase formation of lactate ( LDH) • Slows Krebs cycle so acetyl CoA pushed toward fatty acid synthesis • Glycerol -3-P increased TAG synthesis • Impaired gluconeogenesis
- 14. ETHANOL METABOLISM • Changes redox potential in liver cells • Suppresses Krebs cycle • Increases lactate formation from pyruvate • Impairs gluconeogenesis • Hypoglycemia • Increased fatty acid synthesis • Decreased urate excretion • Hyperuricemia
- 15. METABOLIC CHANGES • Toxicity • Changes in membrane fluidity • Changes in redox potential • Acetaldehyde toxicity • Increased free radical production • Lipid peroxidation • Inhibits protein synthesis • Effects vitamin metabolism
- 16. METABOLIC CHANGES • Affected by • Dose • Duration of ingestion • Genotype • ADH variant • increases ethanol metabolism • ALDH variant • Low activity common in Asians • Facial flushing • Headaches
- 20. CAUSES OF MALNUTRITION IN ASH • Anorexia • Alterd taste/smell • Malabsorption • Poor food quality • Metabolic disterbances • Cytokine • Complications of liverdisease • Unpalatable diet • Fasting for proceedures
- 21. ALCOHOL AND NUTRITIONAL STATUS • Reduced Dietary Intake • Poverty • Displaces regular food • Anorexia • Problems eating
- 22. ALCOHOL AND NUTRITIONAL STATUS • Impaired Digestion • Alcoholic gastritis • Reduced secretions • Bile • Pancreatic enzymes • Mucosal damage
- 23. ALCOHOL AND NUTRITIONAL STATUS • Malabsorption • Mucosal damage • Indirect damage • Folate deficiency • Motility changes • Faster transit times in SI • Pancreatic insufficiency
- 24. ALCOHOL AND NUTRITIONAL STATUS • Impaired transport of nutrients • Liver damage • Decreased Storage • Liver damage • Alcoholic myopathy
- 25. ALCOHOL AND NUTRITIONAL STATUS • Increased losses • Excretion • Bile • Urine • Increased requirements • From other changes • Increased metabolic rate
- 26. ALCOHOL & ENERGY METABOLISM • ~ 96 g or 25 en% • Substituted increases EE ~ 4% • Adding increases ~7% • 20-25 % thermic effect of food (~12 % mixed meal) • Moderate consumption • 15-20% thermic effect of food
- 27. LIPIDS • Suppresses lipid oxidation ~ 1/3 • Acetate used by peripheral tissues instead of FA • + fat balance • Increases FA intake by liver • Fatty liver
- 28. LIPIDS • Increased TG • Increased VLDL formation • Decreased lipoprotein lipase • Increased HDL-C • Decreased lipoprotein (a)
- 29. CARBOHYDRATE • No effect with moderate intake by healthy individuals • Excessive ETOH • Increased acetate • Increased NADH and NADPH • Decreases gluconeogenesis • If diet poor, low glycogen stores leads to hypoglycemia • exacerbated by • oral glycemic agents • insulin
- 30. CARBOHYDRATE • Alters epinephrine and GH secretion • May mask hypoglycemia • Inhibits glycogen storage • Light – moderate alcohol • Lower insulin levels
- 31. VITAMINS •May lower plasma vit A •Increased degradation •Decreased RBP •Vit E levels reduced with chronic ingestion •Heavy drinkers •Lower intake vit D •Lower absorption vit D •Decreased activation vit D •Increased risk of bone fractures
- 32. VITAMINS •Several vit def often with heavy drinkers •Vit B6 •> 50% alcoholics have low levels •Multiple causes •Folate •<50% heavy drinkers low levels •Multiple causes •Riboflavin •Low intake •Decreased bioavailability
- 33. VITAMINS •Thiamin def •80% of heavy drinkers •Poor intake •Malabsorption •Alcohol interferes with active transport •Reduced active form •Increased urinary loss •Reduced storage capacity
- 34. THIAMIN DEF CONTINUED •Wernicke-Korsakoff syndrome •Ataxia, psychosis, altered consciousness •Treated immediately with parenteral thiamin •Alcoholics Supplemented •Thiamin and magnesium •B vits
- 35. MINERALS •Magnesium •Low levels •More prevalent if liver disease present •Def may exacerbate alcohols effects •Increase organ damage •Membrane changes •Supplement in heavy drinkers
- 36. ZINC Decrease levels Associated with liver disease Causes Low intake Reduced absorption Urinary losses Changes in distribution
- 37. ZINC • Clinical signs def • Altered taste & smell • Hypogonadism • Infertility • Impaired dark adaptation
- 38. ETHANOL AND MORTALITY • J shaped curve • Low levels decreased morbidity & mortality • Decreased CAD • Gallstones • High levels and abstinence increased • Morbidity • Mortality • Nadir • US men- 69.9 g/w • US women- 26.1 g/w
- 39. ALCOHOL CONSUMPTION, HEAVY DRINKING, AND MORTALITY: RETHINKING THE J‐SHAPED CURVE Alcoholism: Clinical and Experimental Research 27 AUG 2013 DOI: 10.1111/acer.12250 http://onlinelibrary.wiley.com/doi/10.1111/acer.12250/full#acer12250-fig-0001 Figure 1. Mortality risk by frequency of heavy (5+ drinks; dark line) and nonheavy (<5 drinks; light line) drinking occasions per week. Hazard ratio, with 95% CI, is plotted separately for the frequency of each behavior. Data are based on the 1997 to 2001 waves of the National Health Interview Survey. Reflects an interaction model; results are for those respondents who did not indicate they were in poor health.
- 40. ETHANOL AND MORTALITY • Linear relationship between frequency of consuming >5 drinks during one day and mortality. • So dose matters!
- 41. ETHANOL AND MORTALITY • J shaped curve • Increased morbidity and mortality • Cancers • Alcoholic liver disease • 11.1-4.6/100,000 age-adjusted death rate from cirrhosis of the liver • CVD including arrhythmias • Alcoholic cardiomyopathy • Hypertension • Stroke • 1/3 fatal car wrecks alcohol related
- 42. Figure 1. Associations of usual alcohol consumption with all-cause mortality and the aggregate of cardiovascular disease in current drinkers. Cardiovascular disease was defined as an aggregate of myocardial infarction, coronary heart disease, and stroke. A M Wood, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies LANCET, Volume 391, Issue 10129, 2018, 1513–1523 http://dx.doi.org/10.1016/S0140-6736(18)30134-X
- 43. Figure 2. Associations of usual alcohol consumption with cardiovascular subtypes in alcohol drinkers Hazard ratios are adjusted for age, smoking, and history of diabetes, and stratified by sex and EPIC centre. The reference category is the lowest baseline alcohol... Angela M Wood, et al Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies Lancet Volume 391, Issue 10129, 2018, 1513–1523 http://dx.doi.org/10.1016/S0140-6736(18)30134-X
- 44. Figure 3. Hazard ratios for subtypes of cardiovascular outcomes in current drinkers, per 100 g per week higher usual alcohol consumption. Hazard ratios are adjusted for age, smoking, and history of diabetes, and stratified by sex and centre A M Wood, et al Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies Volume 391, Issue 10129, 2018, 1513–1523 http://dx.doi.org/10.1016/S0140-6736(18)30134-X
- 45. Figure 4. Estimated future years of life lost by extent of reported baseline alcohol consumption compared with those who reported consuming >0–≤100 g per week. The estimates of cumulative survival from 40 years of age onwards in the alcohol-drinking groups. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies A M Wood et al. Lancet, Volume 391, Issue 10129, 2018, 1513–1523 http://dx.doi.org/10.1016/S0140-6736(18)30134-X
- 46. CANCER • Increased risk breast cancer • moderate intake • 30- <60g/d • RR = 1.41 • Oropharyngeal • Esophageal • Colorectal • Causes • Acetalaldehyde effects • Methyl metabolism
- 47. BONE • Heavy drinkers • Low intake Ca • Malabsorption Ca • Increased urinary Ca • Impaired Vit D • Increased fractures This Photo by Unknown Author is licensed under CC BY-SA- NC
- 48. FETAL ALCOHOL SYNDROME • Heavy alcohol ingestion during pregnancy • 1 in 8 women at risk via drinking • > 7 drinks/w • >5 drinks/occasion • Growth retardation • Facial changes • Neurobehavioral changes • Cognitive impairment • Learning disabilities
- 49. CARDIOVASCULAR DISEASE • Lipids • Increase HDL • Decrease size etc. LDL • Decrease lipoprotein (a) • Effects LDL receptor • Coagulation • Coagulation factors • Thrombosis • fibrinolysis
- 50. CVD • Endocrine • Metabolism • Insulin • Estrogen • Steroid • Polyphenols etc. • Red wine • Other sources
- 51. CVD • Psychological • Anti-anxiety • Stress • Modulate type A behavior • Other • Vasoreactivity • Membrane