The loss of metabolic control on alcohol drinking in heavy drinking alcohol-dependent subjects.
BACKGROUND
Most physiological studies interested in alcohol-dependence examined ethanol as a pharmacological agent rather than a nutrient. We conducted two studies, which assessed the metabolic and endocrine factors involved in the regulation of alcohol and nutrient intake in alcohol-dependent (AD) subjects. We also examined the potential role of a disruption in energy balance in alcohol-dependence.


RESULTS
In Study-1, quantitative dietetic interviews of eating and drinking habits were conducted with 97 AD subjects. The population was split around a median alcohol intake value of 12.5 kcal/kg/day. The results showed that the "low alcohol" drinking AD subjects had high Body Mass Index (BMI) and Fat Mass (FM) and alcohol intake was compensated for by a decrease in non-alcoholic intakes. "High alcohol" drinking AD subjects, on the other hand, had low BMI and FM and the total caloric intakes were largely above norms. In Study-2, 24 AD inpatients were submitted to dietetic interviews, calorimetry and blood samplings for the measurement of biomarkers of the regulation of metabolism and satiety, on day 2, 5 and 16 of abstinence. These patients were compared with 20 controls matched for age and gender. We observed in AD patients an increase in cortisol, leptin and PYY plasma levels and a decrease in ghrelin, which might explain the observed decrease in non-alcoholic intakes. However, alcoholic and non-alcoholic intakes correlated positively with basal metabolism and negatively with leptin and leptin/BMI.


CONCLUSIONS
For individuals consuming below 12.5 kcal/kg/day of alcohol, alcohol intake is compensated for by a decrease in non-alcoholic nutrient intakes, probably due to changes in metabolic and satiety factors. For individuals consuming above 12.5 kcal/kg/day of alcohol, alcohol accelerates metabolism and decreases fat mass and leptin levels, and the total caloric intake largely exceeds norms. A dual model for regulation of energy intake in AD subjects is proposed.
Department of Adult Psychiatry, Saint-Luc Academic Hospital and Psychological Development Research Unit, Institute of Neuroscience and Institute of Psychology, Catholic University of Louvain, Brussels, Belgium. Philippe.detimary@uclouvain.be
Philippe
P
de Timary
Patrice D
PD
Cani
Julie
J
Duchemin
Audrey M
AM
Neyrinck
Dominique
D
Gihousse
Pierre-François
PF
Laterre
Abdenor
A
Badaoui
Sophie
S
Leclercq
Nathalie M
NM
Delzenne
Peter
P
Stärkel
D000328:Adult; D000428:Alcohol Drinking / Q000097:blood*; D000437:Alcoholism / Q000097:blood* / Q000503:physiopathology; D001481:Basal Metabolism; D001823:Body Composition; D015992:Body Mass Index; D002151:Calorimetry; D004435:Eating; D002149:Energy Intake; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D020738:Leptin / Q000097:blood; D008297:Male; D008875:Middle Aged; D019894:Peptide YY / Q000097:blood; D012527:Satiation; D011795:Surveys and Questionnaires; D013695:Temperance
D020738:Leptin; D019894:Peptide YY; D006854:Hydrocortisone