Systematic review of nutritional interventions for people admitted to hospital for alcohol withdrawal

Abstract

Aim: The aim of this review is to describe the nature of nutritional interventions for people admitted to hospital for alcohol withdrawal reported in the scientific literature and the health outcomes achieved. Methods: The review protocol was registered with PROSPERO (CRD42 017081884). The following databases were systematically searched following the PRISMA protocol: CINAHL, MEDLINE, PsycARTICLES, PsycINFO, Scopus and Web of Science. Eligible studies were those published in English, in a hospital inpatient setting with the primary reason for admission being alcohol withdrawal. Studies of patient populations with the diagnosis of pancreatitis or liver cirrhosis were excluded. Studies were screened for eligibility, and data were extracted and descriptively analysed. Identified articles were assessed using the Quality Criteria Checklist for Primary Research produced by the Academy of Nutrition and Dietetics. Results: Fourteen studies met the inclusion criteria. Given the heterogeneity of studies, only a descriptive analysis of interventions could be achieved. Nutrition interventions included supplementation with thiamine, multivitamins, amino acids, antioxidant compounds, probiotics, magnesium or were educational interventions.Outcome measures included memory function, biochemical and anthropometrical indices, withdrawal symptoms, bowel flora levels and nutrition knowledge. However, the overall body of evidence was limited, particularly as there was a wide variation in participant age, study designs and duration of interventions.Conclusions: A wide range of nutrition interventions were identified, mostly involving nutrient supplements ameliorating inadequacies. Future research might also consider total dietary interventions as well as studies on the perspectives of people undergoing alcohol withdrawal. K E Y W O R D Salcohol related disorders, alcoholism, malnutrition, nutrition therapy, outcome assessment (health care), thiamine

Efficacy of dietary interventions in individuals with substance use disorders for illicit substances or illicit use of pharmaceutical substances: A systematic review

“…At this point, individuals may be more receptive to interventions focusing on nutrition education and behaviour change. 7 Prior to that or in the initial stages of rehabilitation, addressing the nutritional deficiencies should be the priority; for example, by nutrient supplementation, as seen in the review by McLean et al 5 for alcohol withdrawal interventions in the hospital setting. The necessary content of education and behaviour change interventions should also be explored, including consulting with individuals with substance use disorders, to ensure that it meets their needs and preferences.…”

“…This is despite the strong evidence for the need for dietary intervention to be part of substance use rehabilitation as a result of the poor nutritional state of individuals with substance use disorders. 4,5,28,38 The poor dietary intake of participants in the studies in this review only adds to this evidence. Among the included studies, a limited range of dietary intake outcomes were assessed, mostly focusing on fruit and vegetable intake.…”

“…2 Participants with a substance use disorder for alcohol or tobacco only were excluded because of the aim to focus on illicit substances or illicit use of pharmaceutical substances and as a result of existing systematic reviews of dietary interventions in alcohol and tobacco use. [5][6][7] However, in the case of individuals having multiple comorbid substance use disorders (i.e., an illicit substance plus alcohol or tobacco), studies were included providing that the primary/predominant substance use disorder related to an illicit substance or illicit use of a pharmaceutical substance. If the primary/predominant substance used was unclear, studies where participants had multiple comorbid substance use disorders including any illicit substance or illicit use of any pharmaceutical substance were included.…”

Alcohol and the Brain

“…However, individuals with alcoholism require levels of thiamine supplementation much higher than that required from the average diet, so control of dietary intake alone is not the whole story [61]. In addition to thiamine deficiency AUD is associated with other malnutrition and other micronutrient deficiencies which are comprehensively reviewed by McLean et al [65].…”

A time of change

“…In the clinical setting, the review of Fleurke et al examines the role of the dietitian in the management of malnutrition in older adults. McLean et al have synthesised the evidence for nutritional interventions for people admitted to hospital for alcohol withdrawal. The identification and synthesis of the effects of nutritional interventions on markers of sarcopenia in hospitalised patients aged 65 years and above are the focus of the review of Rus et al, while MacKenzie‐Shalders et al highlights outcomes that have arisen from implementation of electronic bedside meal ordering systems into hospital foodservice.…”