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Alcoholics are especially susceptible to deficiencies of thiamine, folate, B vitamins, and ascorbic acid. Alcohol intake leads to negative nitrogen balance, increased protein turnover, and inhibition of lipolysis (Bunout, 1999). Deficiencies in folate, vitamin B6, and vitamin B12 play a role in elevated levels of homocysteine, which in turn promotes atherosclerosis and thrombosis formation (Cravo & Camilo, 2000). Ethanol can suppress appetite through its effect on the CNS. Gastric, hepatic, and pancreatic disease my further decrease enteral intake and contribute to maldigestion or malabsorption. Signs of malnutrition include thinning of the hair, ecchymosis, glossitis, abdominal distention, peripheral edema, hypocalcemic tetany, and neuropathy. Nutritional management consists of abstinence and institution of a well-balanced diet and multivitamins, plus thiamine and vitamin B supplements when indicated.

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