Dietary fiber deficiency as a component of malnutrition associated with psychological alterations in alcohol use disorder

Abstract

Background & aims: Chronic alcohol consumption can cause malnutrition that may contribute to alcoholinduced organ injury and psychological disorders. We evaluated the link between nutrient intake, especially dietary fibers (DF) and different parameters reflecting mental health and well being, namely anxiety, depression, alcohol craving, sociability, fatigue and intestinal comfort in alcohol use disorder (AUD) patients. Methods: Cross-sectional data from 50 AUD patients, hospitalized for a 3-week detoxification program were used. Three 24-h recalls allowed to calculate dietary habits and nutrient intakes, that was also assessed in healthy subjects (HS). Diet quality was measured using the NOVA score. Psychological factors and intestinal discomfort were evaluated using validated self-administered questionnaires. Results: Energy intake (excluding alcoholic beverage), total fat, monounsaturated and polyunsaturated fatty acids, protein and DF intakes were lower in AUD subjects compared to HS. Ninety percent of patients had a DF intake below the recommendation. AUD patients consumed more than twice as much ultra-processed food than HS. Fructan intake was negatively associated with anxiety (p ¼ 0.04) adjusted for main confounders. Total DF, insoluble, soluble DF and galacto-oligosaccharide intakes were associated with higher sociability score. Soluble DF intake was associated with better satisfaction of bowel function (p ¼ 0.02) and a lower intestinal discomfort (p ¼ 0.04). Conclusions: This study reveals that insufficient DF intake is part of AUD-related malnutrition syndrome, and is associated with higher anxiety, lower sociability score and intestinal discomfort. Our results suggest that an adequate intake of DF might be beneficial for recovery from AUD. Trial registration: NCT03803709, https://clinicaltrials.gov/ct2/show/NCT03803709.

Restoring an adequate dietary fiber intake by inulin supplementation: a pilot study showing an impact on gut microbiota and sociability in alcohol use disorder patients

“…We have already shown in a previous study that fiber intake was very low in actively drinking AUD patients. 18 During the second week of the program, at home, the two groups increased significantly their TDF intake to reach, on average, 19 g per day (Table S3). Twenty-eight percent of patients in the placebo group had an intake of more than 25 g/d during the second week of the program (Figure S2 A-B).…”

“…Gastrointestinal symptoms were measured using a French version of a self-reported questionnaire initially used to evaluate the symptoms of irritable bowel syndrome developed by gastroenterologists at the St-Luc hospital as described before. 18 , 73 Patients completed this questionnaire at baseline and then every other day after the beginning of supplementation.…”

“…On Day 2 of alcohol withdrawal, all participants were interviewed using three nonconsecutive 24-h dietary recall (related to the week before hospitalization: week 0) by a trained dietician as previously described. 18 During the second week of the program (week 2: at home) patients were asked to complete a food diary in which they registered all the food and drinks consumed during 3 defined days (two weekdays and one weekend day). The participants were instructed to specify all ingredients per eating moment: breakfast, morning snack, lunch, afternoon snack, dinner, and evening snack.…”

“… 17 AUD patients have reduced carbohydrate, protein and fat intakes, and their dietary fiber (DF) intake is also well below the recommended value. 18–20 Among DF, inulin-type fructans are interesting as they go along with the definition of prebiotics: “substrates that are selectively used by host microorganisms conferring a health benefit” meaning that they promote the growth of some specific bacteria. 21 Inulin-type fructans are natural components present in several fruits and vegetables including wheat, onion, banana, garlic, jerusalem artichoke, chirory and leek.…”

“… 23 , 25 , 26 We have also shown that DF deficiency in AUD patients is associated with gastrointestinal discomfort and psychological alterations. 18 Therefore, inulin supplementation could be an interesting approach to increase dietary fiber intake and to modulate the gut microbiota in order to improve psychological symptoms of AUD patients.…”