ABSTRACT
I. Introduction .................................................................................................. 430 II. Folate De ciency in Chronic Alcoholism .................................................... 430
A. Incidence .................................................................................................. 430 B. Clinical Manifestations of Folate De ciency in Patients with Chronic Alcoholism ................................................................................. 430
1. Anemia................................................................................................. 430 2. Hyperhomocysteinemia ....................................................................... 431 3. Colorectal Cancer and Folate De ciency in Patients with Chronic Alcoholism ........................................................................................... 431
III. Etiologies of Folate De ciency in People with Chronic Alcoholism ........... 432 A. Dietary Insuf ciency ............................................................................... 432 B. Intestinal Malabsorption .......................................................................... 433 C. Hepatic Uptake and Metabolism of Folate .............................................. 435 D. Increased Renal Excretion of Folate ........................................................ 436 E. Oxidative Destruction of Folate ............................................................... 436
IV. Hepatic Folate-Dependent Methionine Metabolism and Interactions with Ethanol Exposure ............................................................. 436 A. Normal Interactions of Folate and Methionine Metabolism ................... 437 B. Clinical Observations on Effects of Ethanol on the Methionine Cycle ............................................................................... 438 C. Effects of Ethanol Exposure on Methionine Metabolism and Interactions with Alcoholic Liver Disease ............................................... 438
V. Ethanol-Induced Aberrant Methionine Metabolism in the Pathogenesis of Alcoholic Liver Disease......................................................440
VI. Potential Epigenetic Effects of Ethanol and Folate De ciency on Development of Alcoholic Liver Disease ..................................................... 441
VII. Summary and Future Research Needs .........................................................442 References ..................................................................................................... 443
