Alcoholism ranks as one of the main current threats to the health and safety of people in most Western countries. Therefore, a high priority should be given to aims at reducing its prevalence through more effective diagnosis and early intervention. The need for objective methods for revealing alcohol abuse in its early phase has also been widely acknowledged. It is postulated here that the diagnosis of alcohol use disorders could be markedly improved by a more systematic use of specific questionnaires and laboratory tests, including blood ethanol, serum gamma-glutamyltransferase (GGT), carbohydrate-deficient transferrin (CDT), and mean corpuscular volume of erythrocytes (MCV). Recent research has provided new insights into the relationships between ethanol intake, biomarkers, and factors affecting their diagnostic validation, including gender, age, and the effects of moderate drinking and obesity. It appears that the concept of reference intervals for several ethanol-sensitive parameters in laboratory medicine needs to be revisited. CDT is currently the most specific marker of alcohol abuse, and when combined with GGT using a mathematically formulated equation a high sensitivity is reached without loss of assay specificity. Possible new biomarkers include minor ethanol metabolites (protein-acetaldehyde condensates and associated autoimmune responses, ethylglucuronide, and phosphatidylethanolamine), 5-hydroxytryptophol, and genetic markers although so far their routine applications have been limited.
"Considering that serum -GTP enzyme activity is a generally known biomarker of excessive alcohol consumption and liver dysfunction (Niemelä, 2007), our results raise the possibility that excessive consumption of alcohol influences blood heavy metal status through the impairment of liver function. Moreover, subjects with high scores for the alcohol and noodle dietary pattern showed higher levels of blood glucose, total cholesterol and triglyceride before and after adjustment. "
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to evaluate the associations between dietary patterns and blood levels of lead and mercury in Korean adults. A total of 858 Korean adults (⩾20 years) who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) V-1 2010 were included in this study. Data of biochemical measurements including blood lead and mercury levels, nutrients intakes and anthropometric measurements were acquired. 'Balanced diet', 'Grain and kimchi', and 'Alcohol and noodle' dietary patterns were derived from a factor analysis, and the subjects were divided into tertiles by each dietary pattern score. A logistic multiple regression analysis showed that the balanced diet pattern was negatively associated with blood levels of lead before and after adjustment. On the other hand, the alcohol and noodle pattern was positively associated with blood lead and mercury levels. These results indicate that the alcohol and noodle dietary pattern characterized by high alcohol consumption and lack of various foods, and the balanced dietary pattern, including vegetable, fish, meat and milk intake, was associated with the blood concentrations of heavy metals in Korean adults.
Food and chemical toxicology: an international journal published for the British Industrial Biological Research Association 10/2013; 62. DOI:10.1016/j.fct.2013.09.034 · 2.90 Impact Factor
"While sex differences in %CDT appear to exist, more sophisticated newer and standardized assays and methods (Bergstrom and Helander, 2008, Helander et al., 2010) have overcome this issue with the current test for the percent disialo isoform of CDT (%dCDT). The sensitivity of %CDT and %dCDT is frequently low (Niemela, 2007) but may be increased in combination with GGT (Hietala et al., 2006). However, GGT may be elevated and therefore not valid for use in those infected with HIV and/or HBV. "
[Show abstract][Hide abstract] ABSTRACT: Alcohol is heavily consumed in sub-Saharan Africa and affects HIV transmission and treatment and is difficult to measure. Our goal was to examine the test characteristics of a direct metabolite of alcohol consumption, phosphatidylethanol (PEth).
Persons infected with HIV were recruited from a large HIV clinic in southwestern Uganda. We conducted surveys and breath alcohol concentration (BRAC) testing at 21 daily home or drinking establishment visits, and blood was collected on day 21 (n = 77). PEth in whole blood was compared with prior 7-, 14-, and 21-day alcohol consumption.
(i) The receiver operator characteristic area under the curve (ROC-AUC) was highest for PEth versus any consumption over the prior 21 days (0.92; 95% confidence interval [CI]: 0.86 to 0.97). The sensitivity for any detectable PEth was 88.0% (95% CI: 76.0 to 95.6) and the specificity was 88.5% (95% CI: 69.8 to 97.6). (ii) The ROC-AUC of PEth versus any 21-day alcohol consumption did not vary with age, body mass index, CD4 cell count, hepatitis B virus infection, and antiretroviral therapy status, but was higher for men compared with women (p = 0.03). (iii) PEth measurements were correlated with several measures of alcohol consumption, including number of drinking days in the prior 21 days (Spearman r = 0.74, p < 0.001) and BRAC (r = 0.75, p < 0.001).
The data add support to the body of evidence for PEth as a useful marker of alcohol consumption with high ROC-AUC, sensitivity, and specificity. Future studies should further address the period and level of alcohol consumption for which PEth is detectable.
Alcoholism Clinical and Experimental Research 12/2011; 36(5):854-62. DOI:10.1111/j.1530-0277.2011.01669.x · 3.21 Impact Factor
"In this respect, systematic questioning, breath alcohol tests, or biological markers of excessive alcohol consumption are of limited use. Measures of biological markers are only outside the normal range if at least 60 g of alcohol is consumed per day for at least 2 weeks (Niemela, 2007). This limitation makes it difficult to identify and characterize patients who really remain abstinent during treatment, reinforces patients in their efforts to trivialize their lapses, and biases evaluation of therapeutic outcome. "
[Show abstract][Hide abstract] ABSTRACT: Urine ethyl glucuronide (EtG) was screened in 75 patients during a hospital-based treatment for an alcohol use disorder. During follow-up, EtG was detected in 35 (14.6%) of the 239 urine samples. Positive screens were found in 22 patients (29%), of whom nine were outpatients (39.1% of all outpatients) and 13 inpatients (25.0% of all inpatients). Of the 22 patients with positive EtG, five (22%) also gave a positive breath alcohol test and 10 (45.5%) reported recent alcohol consumption; 12 (54.5%) gave a negative breath alcohol test and declared no alcohol lapse. Ethyl glucuronide has been found useful in detecting covered lapses.
Journal of Addiction Medicine 08/2011; 6(1):35-8. DOI:10.1097/ADM.0b013e3182249b93 · 1.76 Impact Factor
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