Alcoholism impacts negatively on health outcomes of abusers, heavy alcohol intakes may also adversely affect the diet and nutrient status of the individual, increasing the risk of malnutrition 1. Heavy alcohol use may cause primary malnutrition whereby alcohol displaces other nutrients and secondary malnutrition resulting from alcohol interfering with the digestion, absorption, metabolism and utilization of some nutrients 2. Alcohol intoxication also damages two major organs involved in metabolism and nutrition: the liver and the pancreas. The liver removes toxins from harmful substances. The pancreas regulates blood sugar and the absorption of fat 3. Damage to these two organs results in an imbalance of fluids, calories, protein, and electrolytes. Many alcoholics present severe malnutrition, as alcohol’s metabolic process prevents the body from proper absorption, digestion, and use of essential nutrients. Alcoholics’ dietary intake patterns are adversely being influenced by the changing environmental-factors leading to alarming rates of underweight, obesity, higher metabolic risk factors causing diabetes, hypertension, other chronic diseases and hindering effective rehabilitation from alcoholism 4. Dietary intake patterns of alcoholics undergoing rehabilitation in Kenya’s rehabilitation centers have been reported to be inclusive of higher energy dense 5, poor nutrient dense 6, lack of dairy products 7, inadequate fruit and vegetable intake 8, snacking 10, spread of fast food chains 9 and other restaurants (eating out). In general, their diets are higher in fats, cholesterol and refined carbohydrates (increase of energy and fat intake), and low in dietary fibers and polyunsaturated fatty acids per capita 4. The consumption of fruits, vegetables and complex carbohydrates has decreased due to the harsh economic conditions over the last few decades 10. Sub-optimal dietary intake patterns amongst alcoholics have resulted in the deficiency of essential nutrients especially during their rehabilitation; with 32% of alcoholics being undernourished and 61% either overweight or obese 11. This hinders effective rehabilitation from alcoholism and also becomes a threat to the health status of recuperating alcoholics. Both under-nutrition and over-nutrition are prevalent amongst alcoholics which are related to practice of poor dietary intake patterns as a result of diverse and interrelated factors 10. The objective of this study was, therefore, to assess dietary intake patterns of recuperating alcoholics by understanding their diet intake with regard to commonly consumed foods groups.

In this study, we present findings on the main food categories and dietary patterns practiced by alcoholics’ in Kenya. Eleven main food categories consumed by the study respondents were derived from high calorie, composite and low calorie foods that formed the dietary patterns. The consumption of these food categories was further explored by dividing the respondents into three groups referring to three dietary patterns adopted based on the food categories. Identified dietary patterns in our study were relatively similar to those reported in other studies on alcoholics 3. According to Mathew 10 three dietary patterns were identified; these were mainly the western, prudent, and traditional, as well as alcohol dietary patterns. Azadbakht 13 showed that alcoholics adopted four similar patterns: fast food and meat, refined grains and cereals, traditional, and alcohol 15. Furthermore, similar patterns were found among alcoholics in other countries, where “vegetable,” “fruit,” “sweet/salty snack foods,” and “starchy foods” were reported 1, whereas “western,” “traditional,” and “mixed” diets were found 4. These differences in identified patterns between different studies and settings may be due to numerous environmental-factors including the availability, affordability and access to certain types of foods in addition to the nutrition transition status which requires further research. The dietary patterns we found were adopted differently by alcoholics. Thus these significantly impacts on the alcoholism status and rehabilitation of the respective alcoholic. High and low calorie dietary patterns have been associated with persistent alcohol cravings, increased risk of relapsing after rehabilitation and likelihood of developing chronic diseases 131416. Because alcoholics frequently have poor nutritional status, which is further exacerbated by alcohol’s effects on the body’s metabolism, nutritional approaches are useful in the treatment of recuperating alcoholic 17. However optimal dietary intake should include a diet that is balanced, varied and sufficiently compensates for deficits in nutrients, as well as counteracts the alcohol-induced increase in oxidative stress 1. Several limitations could, however, be stated for this study: reporting bias is possible given that food consumption frequencies were self-reported by respondents. Food consumption may be differentially reported since there is a well-established evidence of underreporting of dietary intakes among females and over-reporting of dietary intakes among males, which may lead to an additional reporting bias 18. The relationship between dietary patterns and the nutritional status of alcoholics, in addition to other nutritional parameters, remains to be established by appropriate prospective studies 4.

Nutrition promotion programs and evidence-based educational interventions are needed to promote healthy eating amongst alcoholics in an effort to limit related co-morbidities and improve alcohol rehabilitation. Further-more, more importance should be given to exploring dietary patterns rather than the intake of individual nutrients and foods in relation to health of a particular alcoholic. Further research is needed to explore determinants of dietary patterns among alcoholics more importantly, the association between identified dietary patterns and health outcomes.

All authors were involved with the drafting of the research paper, critically reviewed the manuscript and approved the final version submitted for publication.

The authors sincerely thank participants who shared their experiences, and contributed needed information to the study. All those contributed to the success of this study in one way or another are also recognized