Table 1.

Trace elements and vitamins imbalance in ALD.

	Status in Liver Disease	Physiological Role	Potential Role in Liver Disease
Zinc	↓	Neurotransmitter functions, intracellular signaling transduction, inflammatory response, ROS production, immune regulation, wound healing, gene expression	Mitochondrial dysfunction, oxidative injury, glutathione depletion [29]
Iron	↑	Transportation of oxygen, DNA and ATP synthesis	HSCs activation, liver fibrosis promotion, ferroptosis, increased risk of infections, ROS increased production [29]
Copper	↓/↑	Bone marrow and CNS homeostasis; co-factor of antioxidant enzymes	Interaction with other trace elements [29]
Vitamin B group	↓	Pleiotropic co-enzymatic activity, direct precursor for metabolic substrates, antioxidant response	Vitamin B6: limitation of glutathione synthesis affecting antioxidant capability of the liver [30,31,32]
Vitamin D	↓	Calcium homeostasis immuno-modulating activity	Vitamin D deficiency is associated with poor prognosis and complications of portal hypertension in cirrhosis [33]
Vitamin E	↓	Antioxidant immuno-modulating activity	Deficiency could increase oxidative stress, modifying the composition of gut microbiota [34] in addition to anti-inflammatory and antioxidant effects and signal transduction of P53, NFkB and Cyclin D1 pathways [35]

Note: ↑—means increased; ↓—means reduced.