**5. Ethanol and malnutrition**

Ethanol consumption has an effect on person's nutritional status. Many people who consume one to two glasses or less of alcoholic beverages per day consider those beverages a part of their normal diet and acquire a certain number of calories from them. When consumed in excess, ethanol can interfere with the nutritional status of the consumer. Ethanol can alter the intake, absorption and utilization of various nutrients [23, 24]. The primary constituents of alcoholic beverages are water, ethanol (alcohol), sugars (carbohydrates) and negligible amounts of other nutrients like proteins, vitamins and minerals. Because alcoholic beverages provide almost no nutrients, they are considered as "empty calories". Any calories provided by alcoholic beverages are derived from the carbohydrates and alcohol they contain. Ethanol has a caloric value of 7.1 kcal/g.

Many consumers of alcoholic beverages suffer from various degrees of malnutrition (both primary and secondary malnutrition). A situation where alcohol replaces other nutrients in the diet resulting in overall reduced nutrient intake is known as primary malnutrition while secondary malnutrition occurs when alcoholics consumes adequate nutrients but alcohol interferes with the absorption of those nutrients from the intestine so they are not available to the body [25]. The risk of developing micro- and macronutrient deficiencies increases significantly when alcohol makes up more than 30% of total caloric intake [26]. Heavy alcohol consumption not only influences the drinker's diet but also affects the metabolism of those nutrients that are consumed. Even if the drinker ingests sufficient proteins, fats, vitamins, and minerals, deficiencies may develop if those nutrients are not adequately absorbed from the gastrointestinal tract into the blood, are not broken down properly, and/or are not used effectively by the body's cells.

Proteins are essential nutrients for the human body that help maintain the cell's structure, act as enzymes that mediate almost all biochemical processes/reactions occurring in the body and transport certain substances in the body. Amino acids are building blocks of proteins and proteins are composed of 20 different amino acids. Some of these amino acids can be made by the body itself (non-essential amino acids) from various precursors or are recycled when proteins that are damaged or are no longer needed are broken down or degraded. Other amino acids cannot be produced by the body and must be obtained through diet (essential amino acids). Heavy alcohol consumption can interfere with the production and uptake of these non-essential and essential amino acids. Vitamins are micronutrients present in food essential for normal metabolism and insufficient levels of vitamin in the body can lead to serious health consequences. Alcoholics tends to have deficiencies in certain vitamins particularly thiamine (vitamin B1), riboflavin (vitamin B2), pyridoxine (vitamin B6), ascorbic acid (vitamin C) and folic acid.
