The role of nutrition in the development of alcohol-related cognitive dysfunction, within a life cycle approach, is reviewed in this chapter. From prenatal exposure to alcohol, underage drinking, binge drinking in adolescents and adults and drinking problems in older people, the interaction of alcohol and poor nutrition can have an adverse effect on cognitive performance. These brain-related effects occurring across the life span can have a significant impact on the process of ageing and the development of dementia. The progression of chronic alcohol misuse includes:

• Changes in dietary selection and eating behavior • Impaired metabolism, including:

° decreased efficiency of the liver

° impaired absorption of nutrients via the gut

° increased vulnerability to diabetes • Damage to tissues and organs due to oxidative stress • Cognitive impairment • Use of alcohol to self-medicate for anxiety, depression and other mental health

problems • Disruption of sleep and other circadian rhythms

Alcohol and nutrition

From a socio-economic perspective, health inequalities are increased in people abusing alcohol who are often consuming as much as 50 per cent of their daily calories from alcohol (Lieber, 2003 ). The consequences of chronic alcohol abuse and dependence result in a wide range of pathological indications found in muscle, bone and major organ systems, including the brain, cardiovascular system, digestive system and the liver (Albano, 2006 ). In populations using alcohol to excess, a wide range

of health problems have been attributed to poor diet and heavy alcohol consumption. Morbidity and mortality result from heavy alcohol use, and disproportionately affect people of lower socio-economic status (Makela, 1999 ). Households with higher incomes are more likely to have better-quality diets, consuming more fruit and vegetables (Darmon and Drewnowski 2008 ; Johansson et al ., 1999 ). Lower socio-economic status and income have been linked to poorer overall health, negative health behaviors, such as smoking and alcohol misuse, and to shorter life expectancy. Individuals living in less deprived areas of the UK can expect to live ten years longer than those in more deprived areas, and to spend more life-years free of chronic illness and disabilities (van Oers et al ., 1999 ). Lifestyle factors such as diet and alcohol consumption may partly explain such health differentials. Socioeconomic differences in nutrition are evident in that families who are less affluent, less educated or employed in less prestigious jobs have diets that are least concordant with official recommendations, both in general and specifically in relation to fruit and vegetable consumption in Europe and in the UK (Billson, Pryer and Nichols, 1999 ; Lindstrom et al ., 2001 ). It is well established that the consumption of alcohol is implicated in both the cause and progression of chronic liver disease. Increased consumption of alcohol over the lifetime, the amount consumed on any one occasion and the frequency of drinking all contribute to health risks more or less in a linear pattern for both men and women. This conclusion, from a major European review conducted within the Addictions and Lifestyles in Contemporary Europe: Reframing Addictions Project (ALICE-RAP Consortium, 2012 ), provides strong support for the idea that there is no drinking level without risk. The frequency of high-risk drinking is related directly to both risk and the severity of alcohol dependence, as shown in large-scale, general population-based studies.