Dietary Intakes of Patients with Alcohol Use Disorder During a 4-Week Protocol on an Inpatient Treatment Unit Found to Meet Dietary Reference Intakes for Macronutrients, but Have Variability in Energy Balance and Adequacy of Micronutrient Intake



      Despite literature supporting the importance of diet during rehabilitation, minimal research quantifies dietary intake during treatment for alcohol use disorder (AUD).


      The aim was to quantify dietary intake and energy balance of patients with AUD during inpatient treatment.


      This was a secondary analysis of data from a 4-week observational protocol. Participants self-selected food from a room service menu. Dietary intake was recorded by patients and reviewed by nutrition staff. To quantify nutrient and food group intake, data were coded into Nutrition Data Systems for Research software, versions 2016 and 2017. Daily average intake was calculated for all dietary variables.


      Participants (n = 22) were adults seeking treatment for AUD at the National Institutes of Health Clinical Center (Bethesda, MD) between September 2016 and September 2017 and who were enrolled in a study examining the microbiome during AUD rehabilitation. Four participants discontinued protocol participation before study week 4 and were not included in analyses examining change over time.

      Main outcome measures

      Weight change, daily energy, and macronutrient and select micronutrient intakes were the main outcome measures included.

      Statistical analyses performed

      Mean differences in intake and weight were assessed using nonparametric tests.


      Sixty-four percent of participants were male; mean ± SD age was 46.3 ± 13.0 years, mean ± SD body mass index (calculated as kg/m2) was 23.9 ± 2.5, and mean intake was 2,665 kcal/d (consisting of 45.9% carbohydrate, 34.9% fat, and 19.1% protein). Eighty percent or more of this sample met the Estimated Average Requirement for 10 of 16 micronutrients assessed. Male participants consumed more energy than estimated needs (P = .003) and gained a mean ± SD of 2.67 ± 1.84 kg (P = .006) when an outlier with weight loss and acute pancreatitis was removed from analysis. Female participants did not gain weight or consume more than estimated energy needs.


      Overall macronutrient intake was within recommended ranges, but intake of other dietary components and weight gain were variable, supporting the need for individualized nutrition care during AUD treatment.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Understanding Alcohol Use Disorder. National Institute on Alcohol Abuse and Alcoholism.
        • American Psychiatric Association
        Substance-related and addictive disorders.
        in: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association, 2013
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        4th ed. American Psychiatric Association, 1994
        • 2020 National Survey on Drug Use and Health
        Table 5.4A-Alcohol Use Disorder in Past Year among Persons Aged 12 or Older, by Age Group and Demographic Characteristics: Numbers in Thousands, 2019 and 2020. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality.
        • GBD 2016 Alcohol Collaborators
        Alcohol use and burden for 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016.
        Lancet. 2018; 392: 1015-1035
        • Lieber C.
        Alcohol: Its metabolism and interaction with nutrients.
        Annu Rev Nutr. 2000; 20: 395-430
        • American Dietetic Association
        Position of the American Dietetic Association: Nutrition intervention in treatment and recovery from chemical dependency.
        J Am Diet Assoc. 1990; 90: 1274-1277
        • Schroeder R.D.
        • Higgins G.E.
        You are what you eat: The impact of nutrition on alcohol and drug use.
        Subst Use Misuse. 2017; 52: 10-24
        • Grant L.
        • Haughton B.
        • Sachan D.
        Nutrition education is positively associated with substance abuse treatment program outcomes.
        J Am Diet Assoc. 2004; 104: 604-610
        • Barbadoro P.
        • Ponzio E.
        • Pertosa M.
        • et al.
        The effects of educational intervention on nutritional behaviour in alcohol-dependent patients.
        Alcohol. 2011; 46: 77-79
        • Jadhav K.S.
        • Peterson V.L.
        • Halfon O.
        • et al.
        Gut microbiome correlates with altered striatal dopamine receptor expression in a model of compulsive alcohol seeking.
        Neuropharmacology. 2018; 141: 249-259
        • Cowan J.
        • Devine C.
        Food, eating, and weight concerns of men in recovery from substance addiction.
        Appetite. 2008; 50: 33-42
        • Jaynes K.D.
        • Gibson E.L.
        The importance of nutrition in aiding recovery from substance use disorders: A review.
        Drug and Alcohol Depend. 2017; 179: 229-239
        • Alves D.
        • Costa A.F.
        • Custódio D.
        • Natário L.
        • Ferro-Lebres V.
        • Andrade F.
        Housing and employment situation, body mass index and dietary habits of heroin addicts in methadone maintenance treatment.
        Heroin Addict Relat Clinl Probl. 2011; 13: 11-14
        • Neale J.
        • Nettleton S.
        • Pickering L.
        • Fischer J.
        Eating patterns among heroin users: A qualitative study with implications for nutritional interventions.
        Addiction. 2012; 107: 635-641
        • Wall-Bassett E.D.
        • Robinson M.A.
        • Knight S.
        “Moving Toward Healthy”: Insights into food choices of mothers in residential recovery.
        Glob Qual Nurs Res. 2016; 3: 1-11
        • Kampov-Polevoy A.
        • Garbutt J.C.
        • Janowsky D.
        Evidence of preference for a high-concentration sucrose solution in alcoholic men.
        Am J Psychiatry. 1997; 154: 269-270
        • Emerson M.H.
        • Glovsky E.
        • Amaro H.
        • Nieves R.
        Unhealthy weight gain during treatment for alcohol and drug use in four residential programs for Latina and African American women.
        Subst Use Misuse. 2009; 44: 1553-1565
        • Wilkens Knudsen A.
        • Jensen J.E.
        • Nordgaard-Lassen I.
        • Almdal T.
        • Kondrup J.
        • Becker U.
        Nutritional intake and status in persons with alcohol dependency: Data from an outpatient treatment programme.
        Eur J Nutr. 2014; 53: 1483-1492
        • Ames N.J.
        • Barb J.J.
        • Schuebel K.
        • et al.
        Longitudinal gut microbiome changes in alcohol use disorder are influenced by abstinence and drinking quantity.
        Gut Microbes. 2020; 11: 1608-1631
        • Mejldal A.
        • Andersen K.
        • Bilberg R.
        • et al.
        The Alcohol Dependence Scale and DSM-5 alcohol use disorder: Severity ratings correspond insufficiently in older patients.
        Int J Methods Psychiatr Res. 2020; 29: e1811
      2. Foodservice Suite [computer program]. Version 11.7.100. The CBORD Group, Inc, 2015
      3. Dietary Assessment Primer, Instrument Profiles, Food Records: Validation. National Cancer Institute.
      4. Nutrition Data Systems for Research [computer program]. Version 2016. University of Minnesota, 2016
      5. Nutrition Data Systems for Research [computer program]. Version 2017. University of Minnesota, 2017
        • Krebs-Smith S.M.
        • Pannucci T.E.
        • Subar A.F.
        • et al.
        Update of the Healthy Eating Index: HEI-2015.
        J Acad Nutr Diet. 2018; 118: 1591-1602
      6. 2015-2020 Dietary Guidelines for Americans. 8th ed. US Department of Health and Human Services, US Department of Agriculture. Published December 2015. Accessed January 20, 2022.

        • Murphy S.P.
        • Poos M.I.
        Dietary Reference Intakes: Summary of applications in dietary assessment.
        Public Health Nutr. 2002; 5: 843-849
        • Mifflin M.D.
        • St Jeor S.T.
        • Hill L.A.
        • Scott B.J.
        • Daugherty S.A.
        • Koh Y.O.
        A new predictive equation for resting energy expenditure in healthy individuals.
        Am J Clin Nutr. 1990; 51: 241-247
      7. JMP Data Discovery Statistical Software [computer program]. Version 14. JMP Statistical Discovery, 2018
      8. HEI scores for Americans. US Department of Agriculture, Food and Nutrition Service.
        • National Academies of Sciences, Engineering and Medicine
        Dietary Reference Intakes for Sodium and Potassium.
        The National Academies Press, 2019
        • Institute of Medicine
        Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids.
        The National Academies Press, 2005
        • Zaragoza-Jordana M.
        • Closa-Monasterolo R.
        • Luque V.
        • et al.
        Micronutrient intake adequacy in children from birth to 8 years. Data from the Childhood Obesity Project.
        Clin Nutr. 2018; 37: 630-637
        • Eicher-Miller H.A.
        • Boushey C.A.
        How often and how much? Differences in dietary intake by frequency and energy contribution vary among U.S. adults in NHANES 2007-2012.
        Nutrients. 2017; 9: 86
        • O’Neil C.E.
        • Keast D.R.
        • Fulgoni III, V.L.
        • Nickas T.A.
        Food sources of energy and nutrients among adults in the US: NHANES 2003-2006.
        Nutrients. 2012; 4: 2097-2120
        • Bachman J.L.
        • Reedy J.
        • Subar A.F.
        • Krebs-Smith S.M.
        Sources of food group intakes among the US population, 2001-2002.
        J Am Diet Assoc. 2008; 108: 804-814
        • Kiefer I.
        • Rathmanner T.
        • Kunze M.
        Eating and dieting differences in men and women.
        J Mens Health Gend. 2005; 2: 194-201
        • Kruseman M.
        • Berchtold A.
        • Sangin C.
        • et al.
        Eating behaviors, body composition and risk of relapse among persons withdrawing from substance abuse: A 3-months follow up study.
        J Addict Res Ther. 2014; S10: 001


      S. Yang is a metabolic clinical research dietitian, Nutrition Department, Clinical Center, National Institutes of Health, Bethesda, MD.


      K. Ratteree is a metabolic quality assurance dietitian, Nutrition Department, Clinical Center, National Institutes of Health, Bethesda, MD.


      S. A. Turner is a metabolic clinical research dietitian, Nutrition Department, Clinical Center, National Institutes of Health, Bethesda, MD.


      R. T. Tuason is a research nurse specialist, Clinical Center, National Institutes of Health, Bethesda, MD.


      A. Brooks is a scientific review officer, Center for Scientific Review, National Institutes of Health, Bethesda, MD. At the time of the study, she was a scientific program specialist, Clinical Center, National Institutes of Health, Bethesda, MD.


      G. R. Wallen is chief of the Translational Biobehavioral and Health Disparities Branch, Clinical Center, National Institutes of Health, Bethesda, MD.


      J. J. Barb is a bioinformatics scientist, Clinical Center, National Institutes of Health, Bethesda, MD.