Moderate and heavy alcohol consumption have no favorable effect on lipid values.

Moderate alcohol consumption has been reported to provide protection against coronary heart disease. We studied serum lipid values in 380 men, including 184 controls (37 teetotalers and 147 moderate drinkers), 90 heavy drinkers, and 106 alcoholics. Total cholesterol values were significantly lower among alcoholics than controls (mean +/- SEM, 5.43 +/- 0.15 mmol/L [210 +/- 5.8 mg/dL] vs 6.01 +/- 0.08 mmol/L [232 +/- 3.1 mg/dL]), but their high-density lipoprotein (HDL) cholesterol values were higher (1.66 +/- 0.07 mmol/L [64 +/- 2.7 mg/dL] vs 1.14 +/- 0.02 mmol/L [44 +/- 0.8 mg/dL]). Accordingly, there was a highly significant difference in the HDL/total cholesterol ratio (0.32 +/- 0.13 vs 0.19 +/- 0.01). Heavy drinkers had significantly higher total cholesterol values than controls (6.30 +/- 0.13 mmol/L [244 +/- 5.0 mg/dL] vs 6.01 +/- 0.08 mmol/L [232 +/- 3.1 mg/dL]); the same was true of HDL cholesterol values (1.25 +/- 0.07 mmol/L [48 +/- 2.7 mg/dL] vs 1.14 +/- 0.02 mmol/L [44 +/- 0.8 mg/dL]). No significant difference was found in the HDL/total cholesterol ratio between controls and heavy drinkers or between teetotalers and moderate drinkers. Therefore, moderate alcohol intake apparently does not change HDL/total cholesterol ratio; if moderate drinking is protective against coronary heart disease, the mechanism is probably not via lipids.

Binge drinking and ambulatory blood pressure.

-The effect of alcohol drinking in raising blood pressure (BP) is rapidly reversible. However, there is only limited information on the effect of binge drinking on BP values. In this study, 20 healthy men who were all social drinkers drank alcohol (2.2 g/kg) in controlled circumstances on a Saturday evening. Ambulatory BP measurement (ABPM) values were compared with ABPM values of the same subjects during the previous sober Saturday, separately throughout 6 hours of intoxication, throughout 6 hours when blood alcohol levels decreased, and throughout 6 hangover hours. During the intoxication period, both mean systolic BP and mean diastolic BP were 5 mm Hg higher (P=0.0183 and P=0.0529, respectively) and the pulse was 18 beats per minute faster (P=0.0001) compared with the corresponding sober period during the previous weekend. While blood alcohol levels decreased after drinking, mean systolic BP was 4 mm Hg lower (P=0. 0331), diastolic BP was 5 mm Hg lower (P=0.0058), and pulse was 15 bpm faster (P=0.0001) than during the sober weekend. No statistically significant difference was found between the weekends in BP values during the hangover period. Drinking seems to increase both systolic and diastolic BP during intoxication but not during hangover. During the period when blood alcohol levels are decreasing, usually at night, both pressure levels fall to less than the basic level. These major and rapid changes in BP values might increase the likelihood of strokes, which are seen in increased numbers among young adults, especially during weekends and holidays.

Alcohol consumption and its relation to lipid-based cardiovascular risk factors among middle-aged women: the role of HDL(3) cholesterol.

To study the association of alcohol consumption and lipid-based cardiovascular risk factors among middle-age women, cross-sectional analysis among 274 middle-aged healthy women with different drinking habits and a follow-up analysis of alcoholic women during abstinence was performed. Serum total cholesterol, low and high-density lipoprotein cholesterol (LDL and HDL cholesterol), triglycerides (TG), apolipoproteins A1 (Apo A1) and B (Apo B), and HDL-cholesterol subfractions 2 (HDL(2)) and 3 (HDL(3)) were measured. All lipid values except LDL cholesterol positively correlated with self-reported alcohol consumption. When alcoholics were excluded the correlation was significant only for HDL cholesterol, HDL(3), and Apo A1. The increasing trend of HDL cholesterol, HDL(3) and Apo A1 were clearly seen first in women consuming >20-40 g/day of absolute alcohol. Alcohol consumption >40 g/day increased all lipid values except LDL cholesterol. Abstinence for 2 weeks caused a significant decrease in HDL(3) cholesterol, and an increase in LDL cholesterol and Apo B. The results indicate that among middle-aged women the Apo A1 and HDL cholesterol via its HDL(3) but not HDL(2) subfraction might play a role in the beneficial coronary consequences associated with moderate alcohol consumption. However, the increasing beneficial trend first appears when daily drinking exceeds 20 g/day.

Association of serum MMP-9 with autoantibodies against oxidized LDL.

Monocyte-derived macrophages in atherosclerotic plaques secrete matrix metalloproteinases (MMPs), which may contribute to plaque rupture. There has been much speculation as to which factors precipitate in the arterial inflammation. Oxidized low density lipoprotein (oxLDL) has been suggested to have proinflammatory properties, and it has been shown to increase matrix metalloproteinase-9 (MMP-9) secretion by macrophages in vitro. We determined serum MMP-9 concentration and autoantibodies against oxLDL by ELISA in men with angina pectoris (n=243) and age-matched controls (n=238). The association between serum MMP-9 concentration and autoantibodies against oxLDL was evaluated. Autoantibody level against oxLDL, expressed in optical density units, was significantly higher in subjects with angina pectoris compared to controls (0.100+/-0.064 versus 0.088+/-0.051, respectively, P=0.030), but serum levels of MMP-9 did not differ significantly between these groups (54.2+/-29.9 versus 50.6+/-23.1 microg/l). However, autoantibodies against oxLDL correlated positively with serum MMP-9 (r=0.21, P<0.001). In a multiple regression model (including age, diastolic blood pressure, cholesterol, HDL cholesterol, triglycerides, BMI, smoking and MMP-9) serum MMP-9 (beta=0.200, P<0.001) and smoking (beta=0.179, P<0.001) were significantly associated with autoantibodies against oxLDL. In conclusion, autoantibodies against oxLDL were positively associated with angina pectoris and serum MMP-9. Since autoantibody level against oxLDL could be expected to reflect the degree of oxLDL in the vessel wall, our results suggest that oxLDL is associated with MMP-9 in vivo.

Association of carbohydrate-deficient transferrin (CDT) and gamma-glutamyl-transferase (GGT) with serum lipid profile in the Finnish population.

BACKGROUND: Moderate consumption of alcohol may reduce mortality from vascular diseases. The beneficial effects of alcohol may partly be mediated by its effects on lipoprotein metabolism. We studied the connection between alcohol consumption and the serum lipid profile from a well-documented national health program study. METHODS AND RESULTS: Carbohydrate-deficient transferrin (CDT) and gamma-glutamyl-transferase (GGT) were used as biochemical markers for alcohol consumption. The laboratory analyses were carried out on 5675 subjects (3097 males and 2578 females). The subjects were divided into quartiles on the basis of CDT or GGT value. The highest CDT quartile and the lowest GGT quartile seemed to be associated with a favorable lipid profile and the lowest CDT quartile and the highest GGT quartile were associated with an unfavorable lipid profile. Serum high density lipoprotein (HDL) cholesterol values were significantly higher and triglycerides lower with increasing serum CDT concentrations for both men and women. Increasing serum GGT was associated with higher serum total cholesterol and higher triglycerides in both men and women and lower HDL cholesterol in men. CONCLUSIONS: CDT and GGT seem to detect different populations of subjects in regard to lipid metabolism. These observations may lead to a better understanding of the effects of alcohol consumption on lipids as well as mechanisms behind favorable and detrimental effects of alcohol on vascular diseases. CONDENSED ABSTRACT: Carbohydrate-deficient transferrin (CDT) and gamma-glutamyl-transferase (GGT) were used as biochemical markers for alcohol consumption. A total of 3097 males and 2578 females were divided into quartiles on the basis of their CDT or GGT values. The highest CDT quartiles had higher HDL and lower triglycerides, whereas the highest GGT quartiles appeared to be associated with higher total cholesterol and triglycerides in both genders and lower HDL in men. CDT and GGT seem to detect different populations of subjects in regard to lipid metabolism. These observations may have important clinical and public health implications.

Women have a larger and less atherogenic low density lipoprotein particle size than men.

Some epidemiological studies have shown that serum total cholesterol increases with age. especially in women. On the other hand, the risk of coronary artery disease is smaller in women than in men. Earlier studies have shown that a small dense low density lipoprotein (LDL) is more atherogenic than a large LDL. We studied LDL size and apolipoprotein E (apo E) phenotypes in premenopausal and postmenopausal women and in men at the same age. In this study 342 subjects participating in a health screening study were examined. There were four subgroups: 40-year-old men (n = 85), 40-year-old women (n = 80), 70-year old men (n = 88) and 70-year-old women (n = 89). In the present study LDL size was larger (P < 0.01) in women (26.39 +/- 0.07 nm) than in men (25.95 +/- 0.07 nm). We found that LDL size correlated highly positively (r = 0.606; P < 0.001) with serum high density lipoprotein (HDL) concentration and inversely with serum triglyceride concentration (r = -0.627; P < 0.001). Measuring serum HDL cholesterol and triglycerides in health screening studies gives information indirectly about LDL size and its atherogenicity. Apo E phenotype was not significantly associated with serum triglycerides, but was associated with LDL size, LDL cholesterol, total cholesterol and HDL cholesterol. In our sample LDL size decreased and LDL cholesterol and total cholesterol increased according to the most prevalent apo E phenotypes in the order E2/3, E3/3, E3/4 and E4/4. Subjects with phenotype apo E4/4 had the smallest LDL size (25.70 +/- 0.19 nm), the highest total cholesterol (6.53 +/- 0.35 mmol/l) and the lowest HDL cholesterol values (1.28 +/- 0.04 mmol/l). We conclude that there was a significant interaction between sex and age in serum total cholesterol which was highest in older women. However, their LDL size was larger and their LDL is less atherogenic. Apo E phenotype had a significant influence on LDL size.

A human Lactobacillus strain (Lactobacillus casei sp strain GG) promotes recovery from acute diarrhea in children.

To determine the effect of a human Lactobacillus strain (Lactobacillus casei sp strain GG, Gefilac) on recovery from acute diarrhea (82% rotavirus), 71 well-nourished children between 4 and 45 months of age were studied. After oral rehydration, the patients randomly received either Lactobacillus GG-fermented milk product, 125 g (10(10-11) colony-forming units) twice daily (group 1); Lactobacillus GG freeze-dried powder, one dose (10(10-11) colony-forming units) twice daily (group 2); or a placebo, a pasteurized yogurt (group 3) 125 g twice daily; each diet was given for 5 days, in addition to normal full diet otherwise free of fermented dairy products. The mean (SD) duration of diarrhea after commencing the therapy was significantly shorter in group 1 (1.4 [0.8] days) and in group 2 (1.4 [0.8] days) than in group 3 (2.4 [1.1] days); F = 8.70, P less than 0.001. After rehydration, each dietary group maintained a positive weight trend. The urinary lactulose-mannitol recovery ratios (means [95% confidence intervals]) on admission were 0.09 (0.03, 0.24) in group 1, 0.12 (0.07, 0.22) in group 2, and 0.08 (0.04, 0.18) in group 3; no significant alterations in intestinal permeability were observed at retesting after 2 days of realimentation. The result indicates that early nutritional repletion after rehydration causes no mucosal disruption and is beneficial for recovery from diarrhea. It is further suggested that Lactobacillus GG in the form of fermented milk or freeze-dried powder is effective in shortening the course of acute diarrhea.

Drinking pattern and blood pressure.

Large amounts of alcohol are known to increase blood pressure. There is little evidence about the effect of binge drinking of alcohol on blood pressure, although this is the dominant style of alcohol drinking in several countries. The purpose of the present study was to examine the relationship between binge drinking and blood pressure using daily heavy drinkers as a reference group. We examined 260 consecutive nonalcoholic 40- and 45-year-old men participating in a health screening. There were 37 teetotalers, 147 social drinkers, 62 weekend heavy drinkers attending the health screening 2 to 7 days after binge drinking, and 14 men who drank heavily every day. Group division was made using self-reported alcohol consumption and a structured alcohol questionnaire. Blood pressure was measured manually by a mercury manometer. BMDP statistical software was used in the statistical analysis of the material. The diastolic blood pressure of weekend heavy drinkers (mean intake during the weekend, 289 g) did not differ from that found in teetotalers but systolic blood pressure was slightly higher (5 mm Hg, P = .04). In contrast, daily heavy drinkers (mean intake during the weekend [Friday to Saturday], 151 g) had significantly higher systolic (8 mm Hg, P = .04) and diastolic (6 mm Hg, P = .05) blood pressure values than teetotalers. We conclude that different drinking habits seem to have different effects on blood pressure, those of daily heavy drinking being more prominent than those of weekend heavy drinking.

Dose-dependent suppression by ethanol of transient auditory 40-Hz response.

RATIONALE: Acute alcohol (ethanol) challenge is known to induce various cognitive disturbances, yet the neural basis of the effect is poorly known. The auditory transient evoked gamma-band (40-Hz) oscillatory responses have been suggested to be associated with various perceptual and cognitive functions in humans; however, alcohol effects on auditory 40-Hz responses have not been investigated to date. OBJECTIVES: The objective of the study was to test the dose-related impact of alcohol on auditory transient evoked 40-Hz responses during a selective-attention task. METHODS: Ten healthy social drinkers ingested, in four separate sessions, 0.00, 0. 25, 0.50, or 0.75 g/kg of 10% (v/v) alcohol solution. The order of the sessions was randomized and a double-blind procedure was employed. During a selective attention task, 300-Hz standard and 330-Hz deviant tones were presented to the left ear, and 1000-Hz standards and 1100-Hz deviants to the right ear of the subjects (P=0. 425 for each standard, P=0.075 for each deviant). The subjects attended to a designated ear, and were to detect the deviants therein while ignoring tones to the other ear. RESULTS: The auditory transient evoked 40-Hz responses elicited by both the attended and unattended standard tones were significantly suppressed by the 0.50 and 0.75 g/kg alcohol doses. CONCLUSIONS: Alcohol suppresses auditory transient evoked 40-Hz oscillations already with moderate blood alcohol concentrations. Given the putative role of gamma-band oscillations in cognition, this finding could be associated with certain alcohol-induced cognitive deficits.

Amount of alcohol is an important determinant of the severity of acute alcoholic pancreatitis.

BACKGROUND: Does the amount of recently consumed alcohol correlate with the severity of acute alcoholic pancreatitis? METHODS: One hundred one consecutive episodes of acute pancreatitis (AP) were prospectively studied. Seventy-three were alcoholic AP episodes; 40 patients had their first alcoholic AP episode. A standard personal interview was used to determine the alcohol consumption during 2 months and during 1 week before AP. The severity of AP was evaluated according to the Ranson criteria, the serum C-reactive protein (CRP) concentration measured 24 to 48 hours after admission, the length of the hospital stay, the development of complications, and the mortality rate. RESULTS: In the 40 patients having their first alcoholic AP episode, the reported 2-month alcohol consumption correlated significantly with the number of positive Ranson criteria (correlation coefficient r = 0.44, p < 0.01), serum CRP concentration (r = 0.51, p < 0.001), and the length of the hospital stay (r = 0.45, p < 0.01). Complications occurred in eight of 14 patients with 2-month alcohol consumption of more than 5000 gm as compared with one of 14 patients with consumption of less than 2000 gm (p < 0.05). In the same 40 patients the 1-week alcohol consumption correlated with the number of positive Ranson criteria (r = 0.40, p < 0.05) and serum CRP concentration (r = 0.37, p < 0.05). Of the 12 patients who had consumed more than 1000 gm alcohol during the last week before admission, two died and complications developed in six (50%), as compared with none (p < 0.05) and six (21%), respectively, of those who had consumed less than 1000 gm. No significant correlations were observed between the reported alcohol consumption and any of the severity parameters in the 33 patients with recurrent episodes of alcoholic AP. CONCLUSIONS: The amount of alcohol consumed may be an important determinant of the severity of the first alcoholic AP episode but not of recurrent alcoholic AP.

Adenosine A1/A2a receptors mediate suppression of mismatch negativity by ethanol in humans.

Acute alcohol challenge suppresses the mismatch negativity (MMN) component of the auditory event-related potential (ERP), however, the transmitter systems underlying MMN generation/mediating this effect have remained vague. To test adenosinergic contribution, 12 healthy social drinkers participated in four sessions, ingesting: (1) placebo pill and placebo beverage; (2) caffeine (100 mg) and placebo beverage; (3) placebo pill and alcohol (0.55 g/kg in 10% (v/v) solution); or (4) both caffeine and alcohol. ERP measured during a dichotic-listening task disclosed increased MMN and P3b peak latencies, and diminished amplitude of processing negativity (PN) with alcohol, however, only the increase in MMN peak latency was significantly antagonized by caffeine. The results suggest that A1 and A2a receptors play a role in the generation of, and mediate partly the suppressant effect of ethanol on, the MMN.

Global field power of auditory N1 correlates with impaired verbal-memory performance in human alcoholics.

First weeks after alcohol withdrawal, associated with profound changes in neural transmission, constitute the critical period for relapse prevention and pharmacological intervention in alcoholism. Here, 20 male alcoholics with 1-6 weeks of abstinence and 20 age-matched healthy controls were studied using auditory event-related potentials (ERP), measured with a 32-channel electroencephalogram, and neuropsychological tests of auditory-verbal memory. Global field power maximum of ERP during 80-150 ms period after presentation of unattended tones (binaural 700 Hz pure tones, inter-stimulus interval 2.5 s) was significantly (P<0.01) larger in the alcoholics than controls. This effect, reflecting augmented N1 generation, significantly correlated (r=0.5) with impaired memory performance in the alcoholics. The profound change in pre-attentive auditory processing, predicting impaired memory performance, might reflect impaired cerebral inhibitory transmission in alcoholics.

Post-withdrawal changes in middle-latency auditory evoked potentials in abstinent human alcoholics.

We investigated the effects of chronic alcoholism on middle-latency auditory evoked potentials (MAEP) in 14 male alcoholics with 1-6 weeks of abstinence (without other severe disorders) and 13 age-matched male social-drinker controls. The peak amplitude of a positive deflection (Pa) of the MAEP, peaking at about 30 ms post-stimulus, was significantly larger in the alcoholics than in the controls (P < 0.01), and notably, a significant negative correlation (r = -0.65) was observed between the Pa amplitude and duration of abstinence in the alcoholics. The present results suggest that the post-withdrawal brain hyperexcitability in the alcoholic brain, gradually recovering with abstinence, could be objectively and non-invasively studied with the MAEP.

Benzodiazepine temazepam suppresses the transient auditory 40-Hz response amplitude in humans.

To discern the role of the GABA(A) receptors in the generation and attentive modulation of the transient auditory 40-Hz response, the effects of the benzodiazepine temazepam (10 mg) were studied in 10 healthy social drinkers, using a double-blind placebo-controlled design. Three hundred Hertz standard and 330 Hz rare deviant tones were presented to the left, and 1000 Hz standards and 1100 Hz deviants to the right ear of the subjects. Subjects attended to a designated ear and were to detect deviants therein while ignoring tones to the other. Temazepam significantly suppressed the amplitude of the 40-Hz response, the effect being equal for attended and non-attended tone responses. This suggests involvement of GABA(A) receptors in transient auditory 40-Hz response generation, however, not in the attentive modulation of the 40-Hz response.

Drinking habits and prevalence of heavy drinking among primary health care outpatients and general population.

AIMS: To identify the target group for brief alcohol intervention in primary health care and to compare the prevalence of heavy drinking in two different primary health care populations and the general population in the same geographical area. DESIGN: Drinking data were collected from outpatients of primary health care by a questionnaire containing the CAGE test and quantity-frequency alcohol consumption questions and from a sample of the general population by a telephone survey, including the CAGE. The index of heavy drinking was for men three, and for women two, affirmative answers in CAGE which though not specifically a consumption questionnaire is a good marker of heavy drinking. SETTING: Two different primary health care populations (primary health care clinic and occupational health care clinic) and the general population in a Finnish health care area. PARTICIPANTS: Consecutive 1861 primary health care clinic and 2942 occupational health care clinic outpatients and 544 randomly selected adults in the general population, contacted by telephone. FINDINGS: The primary health care clinic patients drank significantly more per occasion than the patients of the occupational health care clinic (75 vs. 66 g. in men; 33 vs. 27 g. in women) and fewer times per week (0.8 vs. 0.9 in men; 0.5 vs. 0.6 in women). The patients in the primary health care clinic also reported drinking more per week (76 vs. 67 g. in men; 23 vs. 19 g. in women); among women the difference was significant. Among men the prevalences of heavy drinking in the primary health care clinic, occupational health care clinic and general population were 20%, 17% and 16%, respectively (p > or = 0.05). Among women the corresponding figures were 9%, 6% and 13% (p < 0.05). CONCLUSIONS: The high prevalence of heavy drinking found in the study confirms the importance of brief intervention by general practitioners. The study also indicates that prevalence and drinking habits depend on the type of clinic and heavy drinkers in general may not be over-represented in primary health care. This study raises the question, especially among women, of how to reach and to provide health advice to those heavy drinkers who do not attend primary health care facilities.

Determination of fetal hemoglobin by cation exchange liquid chromatography.

A sensitive liquid chromatographic method for the analysis of the major component of fetal hemoglobin (HbF0) in blood using high-resolution strong cation exchange column is described. The imprecision of the method was assessed in 20 repeated assays of blood samples containing 0.67%, 0.97%, 2.2% and 3.3% of HbF0. Within-assay CVs were 5.0%, 2.8%, 1.8% and 1.5% and between-assay CVs 5.8%, 3.7%, 1.9% and 2.7%, respectively. The HbF0 concentration was stable in EDTA blood for at least 20 days at +8 degrees C and 3 days at +22 degrees C. Blood HbF0 levels (mean +/- S.D.) were 0.41 +/- 0.20% for 21 healthy males, and 0.48 +/- 0.19% for 22 healthy non-pregnant females. The method is simple and reproducible, and allows the sensitive determination of blood HbF0.

Semi-automatic method for determination of different isoforms of carbohydrate-deficient transferrin.

Carbohydrate deficient transferrin (CDT) has been reported to be one of the best biochemical markers of alcohol abuse. However, a need still exists for a simple and practical method for widespread laboratory use. A semi-automatic (SA) isoelectric focusing (IEF) assay for CDT (SA-IEF-CDT) by a Phast System is introduced here. Different isoforms of transferrin were separated by IEF on polyacrylamide gels (pI 4.0-6.5) and located by immunofixation with an anti-transferrin serum. The precipitation bands were stained with Coomassie Brilliant Blue and quantitated densitometrically. The present method gave a picture of the relative amounts of 10 different transferrin isoforms. The percentage of CDT with pI > or = 5.7 (representing di-, mono- and asialotransferrin) was calculated. For comparisons transferrin bands with pI > or = 5.6 (tri-, di-, mono-, and asialotransferrin), pI > or = 5.8 (mono- and asialotransferrin) and pI > or = 5.9 (asialotransferrin) as well as GGT, ASAT and ALAT were calculated. The method showed good linearity and it identified different isoforms in concentrations of < 10 mg/l of transferrin. The correlation of the present method with a commercially available method employing anion exchange followed by double antibody RIA (AE-RIA-CDT) was good (n = 38, r = 0.924). In 19/20 (95%) of healthy controls, the CDT value was below 4.4% (mean + 2 S.D.) of total transferrin, while higher values were observed in all 20 (100%) alcoholics. In conclusion, the developed semi-automatic method is a practical and reliable alternative for determination of different transferrin isoforms.

Mismatch negativity subcomponents and ethyl alcohol.

Effects of ethanol (0.55 and 0.85 g/kg) on event-related potentials were investigated by presenting 50-ms standard and 25-ms deviant pure tones to 9 social drinkers during a reading task, in a single-blind, placebo-controlled paradigm. Whereas the lower ethanol dose had no impact on ERPs with an 0.8-s inter-stimulus interval (ISI), it attenuated the N1, P2, and mismatch negativity (MMN) amplitudes with a longer ISI of 2.4 s. The higher alcohol dose increased the N1 peak latency with both ISIs. It also suppressed the N1 and MMN amplitudes with the longer ISI. The MMN suppression did not, however, occur at scalp sites below the Sylvian fissure, thus suggesting that ethanol affected only the frontal MMN subgenerator. Moreover, the different dose responses of the N1, P2, and MMN (subcomponents) to ethanol may indicate that the neurotransmitter systems underlying their generation are, to some extent, different.

The diagnostic value of a discriminant score in the detection of alcohol abuse.

To detect alcoholism and alcohol consumption in its early phase, the diagnostic values of a discriminant score and a combination of laboratory tests were examined. Seventy-eight men with a well-documented history of chronic alcoholism, 76 male heavy drinkers, and 165 male controls were classified according to self-reported alcohol consumption and the Malmö-modified Michigan Alcoholism Screening Test. The present study documented the efficiency of the acetaldehyde-induced hemoglobin fraction, ie, HbA1ach in heavy drinkers, aspartate aminotransferase in alcoholics, and, additionally, mean corpuscular volume and gamma-glutamyltransferase in both groups of alcohol abusers. The discriminant score, formed from gamma-glutamyltransferase, HbA1ach, and the mean corpuscular volume, gave a sensitivity of 72% and a specificity of 73% in detecting heavy drinkers as compared with the best single discriminant, ie, mean corpuscular volume, with a sensitivity of 60% and a specificity of 69%. The best discriminant score values for alcoholics were the result of the combination of aspartate aminotransferase, mean corpuscular volume, high-density lipoprotein cholesterol, triglycerides, and alkaline phosphatase, giving a sensitivity of 91% and a specificity of 96%. In conclusion, I recommend the use of a discriminant score for the detection of alcohol abuse in clinical settings and especially in its early phase. The results of this study also confirm the assumption that alcohol abuse in all phases, like alcoholism and heavy drinking, may not be detected optimally with the use of only one marker or even combinations of them.

Effect of acetaldehyde on hemoglobin: HbA1ach as a potential marker of heavy drinking.

The appearance of a new acetaldehyde-induced hemoglobin fraction, HbA1ach, and the effect of alcohol consumption on it and on the ratio of HbA1ach and glycated hemoglobin, HbA1c, were studied in vivo by cation exchange liquid chromatography. The mean +/- SEM of blood HbA1ach level was 171 +/- 13.10(-3)% of total hemoglobin as measured in 34 male teetotallers. Blood HbA1ach levels of 127 social drinkers (182 +/- 6.10(-3)%) were compared with those of 72 heavy drinkers (213 +/- 8.10(-3)%, p less than 0.01), 79 alcoholics (209 +/- 6.10(-3)%, p less than 0.01) and 16 diabetics (419 +/- 28.10(-3)%, p less than 0.001). HbA1ach correlated positively with HbA1c (p less than 0.001) and negatively with HbAo (p less than 0.001). The ratio of HbA1ach/HbA1c was effective in detecting the alcohol-induced increase in the HbA1ach fraction because the ratio reduced the disturbing effect of glucose. The sensitivity of the HbA1ach/HbA1c ratio was 33% in the heavy drinker group as compared to 40% of gamma-glutamyltransferase and 24% of mean corpuscular volume. The HbA1ach fraction and the HbA1ach/HbA1c ratio seem to be valuable in detecting excessive alcohol consumption in its early phase.