The Bayesian Alcoholism Test had better diagnostic properties for confirming diagnosis of hazardous and harmful alcohol use

OBJECTIVE: Conventional tests for alcoholism fail to confirm hazardous and harmful alcohol use (HHAU) accurately and objectively. We validated a Bayesian Alcoholism Test (BAT) for confirming the diagnosis of HHAU. STUDY DESIGN AND SETTING: BAT is based on studies on the prevalence of HHAU and other diseases causing similar abnormalities, and on conditional probabilities of these disorders and associated biochemical markers and clinical signs. BAT was compared to carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) in treatment-seeking alcoholics, non-treatment-seeking heavy drinkers, and controls. Main outcome measures were test sensitivity and specificity, likelihood ratios, and receiver-operating characteristic (ROC) curves. RESULTS: Comparing alcoholics and controls, sensitivity of BAT (94%) was significantly higher than CDT (63%) and GGT (73%). The area under the ROC curve for BAT (.989) was significantly higher than the area under the curve for CDT (.909) and area under the curve for GGT (.902). Using pooled data of all 182 subjects included in the study, the amount of drinking had a significant better correlation coefficient with BAT (.795) than with CDT (.657), and GGT (.604). CONCLUSION: BAT has better diagnostic properties than CDT and GGT for confirming HHAU.     

Carbohydrate-deficient transferrin for detection and monitoring of sustained heavy drinking. What have we learned? Where do we go from here?

Carbohydrate-deficient transferrin (CDT) has been widely investigated as a biological marker of heavy alcohol consumption. In general, it has been found to be at least as sensitive and probably more specific than gamma-glutamyltransferase (GGT). Because the two analytes are not highly correlated, their use in parallel enhances the sensitivity of detection of heavy alcohol consumption, especially in clinical populations. Women as a group produce more CDT under natural conditions and may produce less CDT in response to heavy drinking. Carbohydrate-deficient transferrin has found a place in the monitoring of alcoholics during treatment. Changes in CDT levels from individualized baseline values seem to be more sensitive to lower level relapse drinking than is the use of raw cut-off values. There are some conditions such as severe liver disease in which higher than normal levels of CDT are produced, thereby reducing the specificity of this marker for detecting heavy drinking under certain conditions. Future directions for the use of CDT include standardization and automation of measurement technology, evaluation of how to use it wisely in myriad medical and institutional settings, understanding more thoroughly the gender issues in its production, and greater evaluation of its performance as a monitoring tool during treatment and follow-up situations. How to combine CDT with both verbal tools of alcohol assessment and newer biological markers will also need more extensive evaluation.     

Measurement of carbohydrate-deficient transferrin by isoelectric focusing/western blotting and by micro anion-exchange chromatography/radioimmunoassay: comparison of diagnostic accuracy.

At present, the most reliable marker of recent and heavy alcohol intake is carbohydrate-deficient transferrin (CDT). While most CDT quantitation methods (including immunofixation and micro anion-exchange chromatography [MAEC] combined with radioimmunoassay [RIA]) either lack the precision required for diagnostic usage or are not commercially available, we recently described an isoelectric focusing/Western blotting (IEF/WB) procedure that provides sensitive and specific assessment of serum CDT content. However, a modified MAEC/RIA kit, supposedly more reliable than the original, is also being advanced as suitable for widespread clinical application. Therefore, we compared this modified MAEC/RIA procedure to the IEF/WB method of CDT quantitation in the following 108 subjects; 53 alcoholics undergoing detoxification without clinical or histological evidence of liver disease, 24 recently drinking alcoholics with biopsy-proven liver disease, eight alcoholics abstinent for more than 30 days with biopsy-proven liver disease, seven non-drinking patients with non-alcoholic liver disease, and 16 healthy controls. Although CDT measurements by the two methods were correlated (r = 0.60, P < 0.01), serum CDT values obtained with IEF/WB were nearly five-fold higher than those obtained with MAEC/RIA (e.g. 140.0 +/- 58 versus 28.5 +/- 16 mg/l among the active drinkers). Of the two methods, IEF/WB exhibited significantly greater sensitivity than MAEC/RIA for detecting recent, heavy drinking (75% versus 61%, P < 0.05) and generated no false positives whereas MAEC/RIA gave falsely elevated CDT levels in 37% of the abstinent alcoholics.(ABSTRACT TRUNCATED AT 250 WORDS)     

Blood alcohol is the best indicator of hazardous alcohol drinking in young adults and working-age patients with trauma

AIMS: To determine the most effective marker of hazardous alcohol drinking in trauma patients. METHODS: A prospective study of 349 trauma patients aged 16-49 years admitted into a general hospital trauma centre. Information on the amount and pattern of alcohol drinking was obtained by interview. Blood or breath alcohol concentration (BAC), serum gammaglutamyl transferase (GGT), aspartate aminotransferase (AST), carbohydrate-deficient transferrin (CDT) and the mean corpuscular volume (MCV) of erythrocytes were measured as markers of alcohol consumption. RESULTS: In this series, 8% of all trauma patients were found to be dependent drinkers, while 61% were frequent binge drinkers, 17% infrequent binge drinkers, 8% light-to-moderate drinkers and 6% nondrinkers. On admission, the BAC test was positive in 68% of the hazardous drinkers (i.e. dependent drinkers or frequent binge drinkers). Using a cut-off level of >0 mg/dl, the sensitivity and specificity of the BAC test for identifying hazardous drinking were 68% (95% confidence intervals [CI], 61-73%) and 94% (95% CI, 87-97%), respectively, and the positive predictive value was 96% (95% CI, 92-98%). GGT, MCV, CDT and AST were less accurate indicators of hazardous drinking. BAC was the least expensive marker. CONCLUSIONS: Two-thirds of trauma patients were hazardous drinkers, and blood alcohol on admission was an accurate indicator of this. BAC should be systematically used in trauma centres if patients are to be selected for an alcohol intervention.     

Method-dependent characteristics of carbohydrate-deficient transferrin measurements in the follow-up of alcoholics

AIMS: There are only limited data comparing the diagnostic characteristics of carbohydrate-deficient transferrin (CDT) measurements in assays for excessive alcohol consumption under controlled conditions. METHODS: We compared different CDT assays and the conventional laboratory markers of ethanol consumption, gamma-glutamyl transferase (gamma-GT) aspartate aminotransferase (AST) and mean corpuscular volume (MCV) in the assessment and follow-up of 36 alcoholics (31 men, five women, mean age 44 years), who were admitted for detoxification. Detailed interviews to assess the amount of alcohol consumption were carried out for each patient. A hospital follow-up with supervised abstinence for 8 +/- 4 days (range 5-19 days) was carried out for 17 patients. Controls were 30 apparently healthy individuals (22 men, eight women, mean age 49 years), who had no history of hazardous drinking. RESULTS: At the time of admission, the %CDT method, which excludes the trisialotransferrin isoform from the measurement, yielded elevated values in 69% of the patients, compared to 61% for CDTect. The corresponding sensitivities for gamma-GT, AST and MCV were 61, 56 and 47%, respectively. The self-reported alcohol consumption for a period of 1 month prior to admission showed a stronger correlation with the %CDT results (r = 0.59, P = 0.0003) than with the CDTect results (r = 0.36, P = 0.04), GT (r = 0.40, P = 0.02) or AST (r = 0.35, P = 0.05). During follow-up with supervised abstinence the mean %CDT values were found to show a slower rate to normalization (mean 14 +/- 4 days) than the CDT values measured with the CDTect method (mean 10 +/- 5 days) (P < 0.05). CONCLUSIONS: The data indicate distinct differences and method-dependent rates of normalization in CDT assays, possibly reflecting different degrees of transferrin desialylation in the alcoholics. The present findings should be considered in studies on alcohol markers for monitoring abstinence.     

Drinking pattern and alcohol-related medical disorders.

Although heavy alcohol intake is known to be one of the most common causative factors of liver disease, pancreatitis, upper gastrointestinal and neurological disorders, the influence of the drinking pattern is largely unknown. The study investigated the relationship of alcohol-related medical disorders in alcoholics and their drinking pattern. Two hundred and forty-one chronic alcoholics were referred consecutively for detoxification and their drinking pattern was sufficient for them to be included in this study. History of alcohol abuse as well as drinking behaviour in the last 6 months were assessed by a semi-structured interview. Findings included intensive clinical examination with abdominal ultrasound in most subjects. Heavy drinking with frequent inebriation was most often found in our sample (44.4%), whereas continuous heavy alcohol consumption without intoxication (33.6%), and an episodic drinking style (22.0%) were less frequent. The heavy drinkers suffered more often from pancreatitis, oesophageal varices, polyneuropathy or erectile dysfunction than episodic drinkers. They also showed more upper gastrointestinal disorders, although the estimated life-time alcohol intake was comparable to continuous drinkers. No difference relating to withdrawal delirium or seizures could be found between the groups of alcoholics. Frequent heavy drinkers showed a trend to more alcohol-related medical disorders than alcoholics with a different drinking pattern, although they were younger and their estimated life-time alcohol intake was comparable to that of continuous drinkers. Thus, the drinking pattern, particularly frequent inebriation, has an influence on the occurrence of alcohol-related disorders.     

Comparison of the combined marker GGT-CDT and the conventional laboratory markers of alcohol abuse in heavy drinkers, moderate drinkers and abstainers

AIMS: A combined index based on gamma-glutamyltransferase (GGT) and carbohydrate-deficient transferrin (CDT) measurements (GGT-CDT) has been recently suggested to improve the detection of excessive ethanol consumption. The aim of this work was to compare GGT-CDT with the conventional markers of alcohol abuse in individuals with a wide variety of alcohol consumption. METHODS: A cross-sectional and follow-up analysis was conducted in a sample of 165 heavy drinkers, consuming 40-540 g of ethanol per day, and 86 reference individuals who were either moderate drinkers (n = 51) or abstainers (n = 35). RESULTS: GGT-CDT (5.35 +/- 1.08) in the heavy drinkers was significantly higher than in the reference individuals (3.30 +/- 0.37). The sensitivity of GGT-CDT (90%) in correctly classifying heavy drinkers exceeded that of CDT (63%), GGT (58%), mean corpuscular volume (MCV) (45%), aspartate aminotransferase (AST) (47%), and alanine aminotransferase (ALT) (50%), being also essentially similar for alcoholics with (93%) or without (88%) liver disease. When comparing the data using either moderate drinkers or abstainers as reference population, the sensitivity of GGT-CDT, CDT, and ALT remained unchanged whereas the sensitivity of GGT, MCV, and AST was found to show variation. CONCLUSIONS: GGT-CDT improves the sensitivity of detecting excessive ethanol consumption as compared with the traditional markers of ethanol consumption. These findings should be considered in the assessment of patients with alcohol use disorders.     

CDT: a biological marker of alcohol abuse

BACKGROUND: Laboratory tests may be useful tools in the identification of heavy drinkers, in identifying the etiological role of alcohol in the onset of the disease, and in monitoring changes in alcohol intake. OBJECTIVES: An ideal diagnostic marker of alcohol abuse should: be characterized by high specificity and sensitivity; show an high specific correlation with alcohol metabolism; be dependent on alcohol intake and have a relatively short half-life (t1/2) so as to be able to monitor abstinence periods. CONCLUSIONS: CDT (Carbohydrate-Deficient-Transferrin) meets all these requirements and offers the physician a significant tool as a marker of chronic alcohol abuse. CDT can reveal a daily alcohol consumption of 50-80 g of ethanol, corresponding to a bottle of 11 degrees-13 degrees wine, for two consecutive weeks, with normalization after two weeks of abstinence (t1/2 of CDT is 15 days). Compared with other more common alcohol abuse markers, such as GGT or MCK CDT is more specific and provides more detailed information.     

Treated and treatment-naive alcoholics come from different populations.

In most research on alcoholism, convenience samples of individuals who have been in some type of treatment are used. Berkson's fallacy results when the associations found in studies of select samples are incorrectly presumed to apply to all alcoholics (i.e., including untreated alcoholics in the general population). In the current study, we examined whether treated and untreated alcoholics have similar early alcohol use histories by comparing abstinent alcoholics (treated and sober at least 6 months) with treatment-naive alcoholics (active drinkers). We studied 14 pairs of women and 25 pairs of men matched on the age at which they first met criteria for heavy alcohol use (women, 80 drinks per month; men, 100 drinks per month). The timeline follow-back interview method was used to gather retrospective alcohol use information. Alcohol dose and duration of use were subsequently computed for two intervals: (1) time between the person's first drink and date at which the person met criteria for heavy drinking and (2) period between when criteria for heavy drinking were met and current age of the treatment-naive person from each pair. During the period before the matching "heavy drinking" criteria were met, alcohol dose did not differ between groups. In the period after criteria for heavy alcohol use were met, in comparison with treatment-naive alcoholics, the treated alcoholics had higher average and peak alcohol doses. We rejected the hypothesis that the treatment-naive alcoholics and the treated alcoholics have similar alcohol use trajectories over time, with the treatment-naive sample simply being observed earlier in its alcohol use histories. Instead, we concluded that the two groups come from different populations with regard to alcohol use. In fact, the treated alcoholics had alcohol doses more than 50% higher than those of treatment-naive alcoholics in the years just after they began drinking heavily. This finding supports the suggestion that results from studies of alcoholics in treatment or after treatment (i.e., most studies of alcoholics) cannot be generalized to untreated individuals (who make up the majority of alcoholics).     

Assessment of alcohol consumption by mailed questionnaire in epidemiological studies: evaluation of misclassification using a dietary history interview and biochemical markers

Background: Self-reported information on alcohol from questionnaires is generally assumed to introduce misclassification of consumption, mainly in the direction of underestimation. The aim of this study was to evaluate self-reported information on alcohol consumption from a mailed questionnaire by comparing to a dietary history interview and biochemical markers of alcohol intake. Subjects and Methods: For 76 male twin pairs of the Finnish Twin Cohort Study aged 40–70 years information on self-reported alcohol consumption was collected through mailed questionnaire and dietary history interview. Carbohydrate-deficient transferrin (CDT), Gamma-glutamyltransferase (Gamma-GT) and mean corpuscular volume (MCV) were determined from blood samples. Results: Mean levels of CDT, gamma-GT and MCV showed a rise with increased self-reported alcohol consumption already at low levels of reported consumption (<20 g alcohol/day). There was a positive correlation between reported amount alcohol intake per day and levels of CDT (r = 0.46), gamma-GT (r = 0.32) and MCV (r = 0.36) but within the high consumption group ( 30 g/day) there was no such correlation. The questionnaire had sensitivity of 28–43% and specificity of 89% for identification of high consumers of alcohol using the biochemical markers as reference and sensitivity 41% and specificity 94% using the dietary history interview as reference. Sensitivity was improved when information on binge drinking (82%) or possible drinking problems (73%) was considered. Conclusion: Comparison to dietary history interview as well as to biochemical markers indicate that self-reported information on alcohol consumption from a mailed questionnaire may be used to distinguish between groups with different levels of alcohol consumption. The suggested misclassification of high consumers implies that only strong associations between high alcohol intake and disease are likely to be detected in studies based on questionnaire data.     

Treated and treatment-naive alcoholics come from different populations.

In most research on alcoholism, convenience samples of individuals who have been in some type of treatment are used. Berkson's fallacy results when the associations found in studies of select samples are incorrectly presumed to apply to all alcoholics (i.e., including untreated alcoholics in the general population). In the current study, we examined whether treated and untreated alcoholics have similar early alcohol use histories by comparing abstinent alcoholics (treated and sober at least 6 months) with treatment-naive alcoholics (active drinkers). We studied 14 pairs of women and 25 pairs of men matched on the age at which they first met criteria for heavy alcohol use (women, 80 drinks per month; men, 100 drinks per month). The timeline follow-back interview method was used to gather retrospective alcohol use information. Alcohol dose and duration of use were subsequently computed for two intervals: (1) time between the person's first drink and date at which the person met criteria for heavy drinking and (2) period between when criteria for heavy drinking were met and current age of the treatment-naive person from each pair. During the period before the matching "heavy drinking" criteria were met, alcohol dose did not differ between groups. In the period after criteria for heavy alcohol use were met, in comparison with treatment-naive alcoholics, the treated alcoholics had higher average and peak alcohol doses. We rejected the hypothesis that the treatment-naive alcoholics and the treated alcoholics have similar alcohol use trajectories over time, with the treatment-naive sample simply being observed earlier in its alcohol use histories. Instead, we concluded that the two groups come from different populations with regard to alcohol use. In fact, the treated alcoholics had alcohol doses more than 50% higher than those of treatment-naive alcoholics in the years just after they began drinking heavily. This finding supports the suggestion that results from studies of alcoholics in treatment or after treatment (i.e., most studies of alcoholics) cannot be generalized to untreated individuals (who make up the majority of alcoholics).     

Serum apolipoprotein A-II as a marker of change in alcohol intake in male drinkers

The relative usefulness of high-density lipoprotein cholesterol (HDL-C) and the HDL components, apolipoproteins A-I and A-II (Apo A-I and Apo A-II), as prospective markers of change in alcohol intake was compared to gamma-glutamyl transferase (gamma GT) and erythrocyte mean corpuscular volume (MCV) in a controlled crossover trial of 46 moderate male drinkers whose alcohol intake was reduced by approximately 80% for six weeks by the substitution of their normal drinking habits for a low alcohol content beer only. Only serum Apo A-II levels correlated significantly with self-reported alcohol intake at the commencement of the study (r = 0.46; P less than 0.001). All five indices fell significantly with reduction of alcohol intake. The change in these indices between normal and low alcohol intake periods correlated directly with change in alcohol intake, the highest correlation being with delta Apo A-II (r = 0.72; P less than 0.001). Using discriminant analysis this variable was found to achieve an accuracy of 96% in classifying subjects into the correct drinking category (either normal or low alcohol intake). The relative percentages for the other variables were delta Apo A-I 78%, delta HDL-C 82%, delta gamma GT 78% and delta MCV 76%. We conclude that Apo A-II may prove a valuable marker of alcohol intake in cross-sectional epidemiological studies, while delta Apo A-II may be a sensitive marker of change in alcohol intake in the prospective management of the heavy drinker.     

The combined use of the early detection of alcohol consumption (EDAC) test and carbohydrate-deficient transferrin to identify heavy drinking behaviour in males

The aim of this study was to determine the efficacy of the combined use of carbohydrate-deficient transferrin (CDT) and the Early Detection of Alcohol Consumption (EDAC) test to assess heavy drinking in a population of males (n = 187) drinking an average of 20 drinks per day. Heavy drinkers (n = 138) and light drinkers (n = 49) were analysed in three ways: using the EDAC test alone, using the CDT test alone and using the EDAC and CDT tests combined. The EDAC method uses linear discriminant function to analyse a battery of routine laboratory tests that generate a score for each subject and its associated probability value. This translates into the likelihood of each individual being a heavy or a light drinker. CDT uses ion-exchange chromatography to extract CDT in the serum and quantifies it by radioimmunoassay. The EDAC alone showed 88% (122/138) sensitivity rate when identifying heavy drinking males and 98% (48/49) specificity rate when assessing light drinkers. The CDT test alone showed a sensitivity rate of 58% (80/138) and a corresponding specificity rate of 96% (47/49). When analysed in parallel, 92% (127/138) of heavy drinkers showed abnormal EDAC and/or CDT tests and 94% (46/49) of light drinkers were negative for both tests. When analysed sequentially, the CDT test confirmed 61% (75/122) of the heavy drinkers identified by the EDAC test. Specificity rate for this testing strategy was 100%, because the only false positives for EDAC tested negative for CDT. This preliminary study shows that EDAC and CDT may react independently to alcohol intake and can be combined for maximum diagnostic accuracy.     

Profile of drinking behaviour and comparison of self-report with the CAGE questionnaire and carbohydrate-deficient transferrin in a rural Lesotho community

This paper aims to: (1) profile the drinking behaviour of a rural Lesotho community facing relocation; (2) compare the following measures of hazardous drinking in this community: quantity/frequency self-report, the CAGE questionnaire and carbohydrate-deficient transferrin (CDT) levels; (3) describe community awareness of, and attitude towards, treatment services. As part of a larger baseline survey of community health status, households in 29 villages in Lesotho were randomly sampled. Consenting adults (n = 348) participated in a face-to-face interview about alcohol use, which included the CAGE. Blood was taken from participants for CDT determination. Fifty-three per cent of men (37/69) and 19% of women (53/279) reported drinking alcohol. Thirty-six per cent of men (25/69) and 9% of women (25/279) were classified as hazardous drinkers defined as drinking 350 g (males) or 225 g (females) of alcohol/week, or 'engaged in bouts of heavy drinking 1 to 2 days a month or more during the past 12 months'. Hazardous drinkers were significantly more likely to be male and older, but did not differ from the rest of the sample on marital status. Using hazardous drinking as the standard, CAGE (score > or = 2) had a positive predictive value (PPV) of 75% for men and 62% for women. The parameters for CDT must be interpreted with caution as the cut-offs for hazardous drinking, especially for women's drinking, were lower than the usual cut-offs in published CDT studies. However, the high specificities for CDT in men (100%; 19/19) and in women (77%; 110/142) are consistent with other studies, but the low PPV of 14% (5/37) for men and women combined suggests that CDT is not effective as a predictor of hazardous drinking in this population. There was high awareness of available treatment services among participants, and most believed treatment to be beneficial. Overall, the study provides a comprehensive baseline profile of drinking behaviour in this community, but did not show the CAGE questionnaire or CDT profile to be useful in in this community.     

LONGITUDINAL COMPARISON OF CARBOHYDRATE-DEFICIENT TRANSFERRIN AND GAMMA-GLUTAMYL TRANSFERASE: COMPLEMENTARY MARKERS OF EXCESSIVE ALCOHOL CONSUMPTION

The utility of carbohydrate-deficient transferrin (CDT) andgamma-glutamyl transferase (GGT) as biochemical markers of excessivealcohol consumption was studied in alcohol-dependent subjects.Serum samples were collected once weekly from 10 male out-patientsundergoing a 6-month alcohol treatment programme. Frequencyof relapse into drinking (defined as any intake of alcoholicbeverage) was assessed by self-reports during patient interviewsthree times per week and by daily determination of the 5-hydroxytryptophollevel in urine. A marked decrease in mean CDT and GGT valueswas observed during the initial month. Only one patient remainedtotally abstinent throughout the observation period, while fourhad sporadic relapses (2–5 days with alcohol consumption).Both CDT and GGT remained below the respective reference limitsin those patients. The other five patients drank more frequently(range 22–57 days) and increased their mean levels ofCDT and GGT after the initial decrease. As determined from thevalues at admission and during the course of the study, CDTappeared to be the most sensitive marker in six out of the 10patients. In one patient, both markers were affected in a parallelway, whereas two of those with frequent relapses responded toalcohol consumption with a marked increase in GGT, but withno or only a slight increase in CDT. One patient did not showany abnormal CDT or GGT values. In 54 female and 60 male serumsamples collected at random from patients during admission atan alcohol detoxification unit, 35% and 58% of the CDT valuesexceeded the reference limits for females and males, respectively.For GGT, 59% of the female and 67% of the male values were abovecut-off. Carbohydrate-deficient transferrin and GGT were notsignificantly correlated. Taken together, the present resultsindicate that measurement of both CDT and GGT will increasethe possibility of identifying excessive alcohol consumption.By following changes in CDT and GGT values during a period ofalcohol withdrawal, the most sensitive individual marker canbe determined. This in turn allows for improved detection ofrelapse into heavy drinking dunng long-term monitoring of out-patients.     

Concentration of fatty acid ethyl esters in hair of alcoholics: comparison to other biological state markers and self reported-ethanol intake

AIMS: In a variety of clinical and forensic situations long term use of alcohol must be monitored. In this project we explore the utility of fatty acid ethyl esters (FAEE) in this regard. Additionally, we propose a cut-off value of FAEE to distinguish teetotallers/moderate/social drinkers from alcoholics or individuals drinking at harmful levels. PATIENTS AND METHODS: FAEE levels from 18 alcohol-dependent patients in detoxification were contrasted with those of 10 social drinkers and 10 teetotallers. FAEE in hair were determined, using headspace solid phase microextraction and gas chromatography mass spectrometry. C(FAEE), as sum of the concentrations of four esters, was compared to a major FAEE, ethyl palmitate. PEth was measured in heparinized whole blood with a high pressure liquid chromatography (HPLC) method. Drinking validation criteria include self reports, phosphatidyl ethanol (PEth) in whole blood as well as the traditional markers of heavy drinking, gamma glutamyl transpeptidase (GGT), mean corpuscular volume (MCV) and carbohydrate deficient transferrin (CDT). RESULTS: Receiver-operating characteristic (ROC) curve analysis for C(FAEE), indicated a sensitivity of 100% and a specificity of 90% for a cut-off of 0.29 ng/mg. By using a cut-off of 0.4 ng/mg, C(FAEE) identified 94.4% correctly. C(FAEE) and ethyl palmitate were significantly associated (r = 0.945; P < 0.001) as were C(FAEE) and PEth (r = 0.527; P = 0.025). No significant correlation was found between C(FAEE) and total grams of ethanol consumed last month, blood-alcohol concentration at admission to the hospital, CDT, MCV, or GGT. Among the serum and blood markers, %CDT identified 47.1%, MCV 38.8% and GGT 72.2% of patients with chronic intake of higher amounts of ethanol correctly, whereas PEth achieved 100% accuracy. CONCLUSIONS: The data suggest that C(FAEE) is a potentially valuable marker of chronic intake of high quantities of ethanol. Furthermore, the results indicate that a reasonable and provisional FAEE cut-off to distinguish between social/moderate and heavy drinking/alcoholism in hair is 0.4 ng/mg.     

Prospective study of alcohol consumption and metabolic syndrome

BACKGROUND: Alcohol consumption is related to the prevalent metabolic syndrome. Few studies have evaluated the effects of alcohol consumption on the development of metabolic syndrome. OBJECTIVE: We examined the association between alcohol consumption and incident metabolic syndrome. DESIGN: This was a prospective cohort study of 3833 male and female Koreans aged 40-69 y and free of the metabolic syndrome at baseline. Information on alcohol consumption was obtained periodically from interviewer-administered questionnaires. Incident cases of the metabolic syndrome were identified by biennial health examinations during 4 y of follow-up between 2003 and 2006. RESULTS: Compared with nondrinkers, the multivariate relative risk [RR (95% CI)] of the metabolic syndrome for very light drinkers consuming 0.1 to 5 g of alcohol per day (g/d) was 1.06 (0.71, 1.58), that for light drinkers consuming 5.1 to 15 g/d was 1.13 (0.69, 1.83), that for moderate drinkers consuming 15.1 to 30 g/d was 1.25 (0.75, 2.09), and that for heavy drinkers consuming >30 g/d was 1.63 (1.02, 2.62). All individual components of the metabolic syndrome were significantly associated with heavy drinking, particularly among heavy liquor drinkers. CONCLUSIONS: Heavy drinking, in particular among liquor drinkers, is associated with an increased risk of the metabolic syndrome by influencing its components. Further data are warranted to clarify the association between drinking minimal alcohol and the metabolic syndrome as well as the beverage-specific association for drinking beer or wine.     

Alcohol use in pregnancy, craniofacial features, and fetal growth.

STUDY OBJECTIVE--The aim was to study the relationship between the level of alcohol consumption in pregnancy and craniofacial characteristics of the neonate. DESIGN--This was a prospective survey of a sample of pregnant women, stratified on prepregnancy level of alcohol consumption. SETTING--The study was carried out at the public antenatal clinic of Roubaix maternity hospital. PARTICIPANTS--During an eight month period, 684 women (89% of those eligible) were interviewed in a standardised way at their first antenatal clinic visit. Of these, all who were suspected of being alcoholic or heavy drinkers (at least 21 drinks per week) were selected for follow up, as was a subsample of light (0-6 drinks per week) and moderate (7-20 drinks per week) drinkers. Of 347 women selected in this way, 202 had their infants assessed by a standardised morphological examination. MEASUREMENTS AND AND MAIN RESULTS--Suggestive craniofacial characteristics of the infants, present either in isolation or in association with growth retardation ("fetal alcohol effects"), were compared in relation to maternal alcohol consumption (alcoholic 12%; heavy drinking 24%; moderate drinking 28%; light drinking 36%). No differences were found between light and moderate drinkers. Infants born to alcoholics had a greater number of craniofacial characteristics and the proportion with features compatible with fetal alcohol effects was higher. There was a similar trend for infants of heavy drinkers. Infants of heavy drinkers who had decreased their alcohol consumption during pregnancy had fewer craniofacial features. Infants of heavy smokers were also found to have increased numbers of craniofacial characteristics. CONCLUSIONS--Craniofacial morphology could be a sensitive indicator of alcohol exposure in utero. Altered morphology is usually considered specific for alcohol exposure, but the relation observed with smoking needs further exploration.     

Alcohol consumption profile by time in middle-aged men: a longitudinal study based on three different diagnostic instruments

This longitudinal study aimed at comparing aggregate measures of heavy or problem drinking and their variations across time among the same subjects. We examined middle-aged men participating in a health survey over a 5-year interval. Of the 133 consecutive men in the whole age group interviewed as 40-year-olds in 1989, 114 were reached and re-interviewed in 1994. Alcohol consumption was measured by self-report, Malmo-modified Michigan Alcoholism Screening Test (Mm-MAST), and serum carbohydrate-deficient transferrin (CDT). Self-reported alcohol consumption decreased with years (142 vs 105 g/week, P = 0.01), as did CDT (16.9 vs 14.4 U/l, P = 0.02), but there was no change in the Mm-MAST results. There was no significant difference in the number of heavy drinkers (either Mm-MAST score > or = 3, or by self-reported alcohol consumption > or = 280 g/week, or by CDT > or = 20 U/l) at 40 and 45 years of age (37 and 47% respectively). At the individual level, alcohol consumption both increased and decreased with age. At 45 years of age 5/114 (4%) of the men reported that they had increased their alcohol consumption by more than 80 g/week and 25/114 (22%) said that they had reduced their drinking by the same amount. The remaining 84 (74%) reported drinking the same amount as 5 years earlier (+/- 80 g/week). This indicates that alcohol drinking habits are not stable in middle age. Most heavy drinkers in both age groups were detected by Mm-MAST and this proportion increased with age while the proportion of positive self-reports and CDTs decreased. Thus, the social consequences, measured here by the Mm-MAST, may be more readily experienced with years even at smaller consumption levels.     

Amount and Frequency of Alcohol Consumption and All-Cause Mortality in a Japanese Population: The JMS Cohort Study

Background

Lower mortality has been reported in light-to-moderate alcohol drinkers. We examined the association between the amount and frequency of alcohol consumption and all-cause mortality in a Japanese population.

Methods

We conducted a prospective cohort study among 8934 Japanese people (3444 men and 5490 women) who completed a baseline survey between 1992 and 1995. We confirmed the date and cause of death by referring to death certificates. The Cox proportional hazards model was used to evaluate the effect of alcohol consumption on risk for all-cause mortality, after adjustment for potential confounding factors.

Results

We identified 637 (397 men and 240 women) deaths during the 12.0 years of mean follow-up. Among men, as compared with non-drinkers, the relative risk was higher in ex-drinkers (hazard ratio [HR], 1.18), lower in light drinkers (HR, 0.95) and moderate drinkers (HR, 0.91), and significantly higher in heavy drinkers (HR, 1.67; 95% confidence interval, 1.10–2.55). Among women, light, moderate, and heavy drinkers were grouped into current drinkers. The relative risk was slightly higher in current drinkers (HR, 1.23), and that in ex-drinkers was near 1.0 (HR, 0.97). In stratified analysis, the harmful effects of heavy drinking were more severe among male smokers and younger men. In terms of frequency, men who drank only on special occasions had the highest mortality (HR, 1.28), regardless of alcohol intake per drinking session.

Conclusions

In men, a near J-shaped association was identified between alcohol consumption and all-cause mortality. Both the amount and frequency of alcohol consumption were related to mortality.Key words: cohort studies, alcohol drinking, mortality, Japan