Background In healthy subjects, alcohol decreases lipid oxidation favouring fat deposition.
However, individuals who chronically abuse alcohol are not obese. To investigate this
paradox, we measured energy expenditure (EE) and fuel utilization in chronic alcohol
abusers in relation to their drinking behaviour.
Methods Resting and postprandial EE and nonprotein respiratory quotient (NPRQ) were
measured using indirect calorimetry, in 36 alcohol abusers [mean (6SE) age 4262 years;
weight 6762 kg; 21 with steatosis, eight with hepatitis; seven with cirrhosis] and in 36
gender-, age- and weight-matched healthy controls. Alcoholic patients were re-evaluated
either after 14 days (n.14) or on days 2, 4, 6, 8, 14 and 42 (n.6) after abstinence.
Results When alcoholics were compared to healthy controls, mean energy intake was
greater, 1561MJ dayÿ1 (3862% from alcohol) cf. 961MJ dayÿ1 (P < 0´001), resting
EE increased, 8262 cf. 6562W (P < 0´001) and NPRQ decreased, 0´7560´02 cf.
0´8260´01 (P < 0´001). The postprandial increases in EE and NPRQ were of similar
magnitude in both groups. Abstinence from alcohol for 14 days was accompanied by
reduced energy intake, 1661 cf. 1161 MJ dayÿ1 (P < 0´005) and decreased resting EE,
8465 cf. 7364W(P < 0´05). The decrease in resting EE consistently occurred 4 days after
abstinence from alcohol.
Conclusions Chronic alcohol abuse is associated with energy wasting and inhibition of
adipose tissue accumulation. This may explain why alcoholics are not obese despite high
total energy intakes.