Biochemical detection and monitoring of alcohol abuse and abstinence

Abstract

The merits and limitations of traditional and new markers for alcohol abuse (and abstinence) are critically examined for detection and monitoring of alcoholics, hazardous drinkers and binge drinkers. The traditional markers discussed include g-glutamyltransferase (GGT), aspartate and alanine aminotransaminases (AST, ALT) and mean corpuscular volume (MCV); new markers include mitochondrial AST, carbohydrate-de®cient transferrin (CDT), serum/urine 5hydroxytryptophol, b-hexosaminidase and acetaldehyde adducts. The strengths and weaknesses of several of the self-reporting screening questionnaires are also explored. No laboratory test is reliable enough on its own to support a diagnosis of alcoholism. Sensitivities and speci®cities vary considerably and depend on the population concerned. GGT continues to remain the test that combines greatest convenience and sensitivity; its diagnostic accuracy can be enhanced by combination with other traditional markers (AST, ALT, MCV). None of the newer markers offers signi®cant advantage, although CDT seems to be better at monitoring patients for increased alcohol consumption or progress towards abstinence.

Comparison of assessment methods for self-reported alcohol consumption in health interview surveys

“…Biochemical markers have the advantage that they are precise and reliable and cannot be biased by recall or a respondent's motivation to report socially improper behaviour (Babor et al, 2000). However, some disadvantages with biochemical markers are the costs and that the raised levels may result from other causes than heavy drinking (e.g., use of prescribed drugs, smoking, obesity, pregnancy and liver disorders of nonalcoholic origin) (Sharpe, 2001). Examples of limitations in using collateral informants are that they often are hard to recruit and that they often lack detailed information concerning the quantity and frequency of drinking (Babor et al, 2000).…”

Les marqueurs biologiques de la consommation d'alcool

“…Toutefois, cette augmentation peut aussi apparaître dans des pathologies hépatiques non liées à l'alcool, des hémolyses, des myélodysplasies, des déficiences en folates et en vitamines B12, dans l'hypothyroïdie, des chimiothérapies ou d'autres thérapeutiques. La normalisation du VGM s'effectue en 40 jours et donc, n'est pas très sensible aux changements significatifs de la conduite d'alcoolisation (9). Cependant bien que ce paramètre ait une sensibilité faible, comme seul marqueur biologique de l'alcoolisme, il a une valeur accrue, quand il est associé à d'autres marqueurs (9).…”

“…La normalisation du VGM s'effectue en 40 jours et donc, n'est pas très sensible aux changements significatifs de la conduite d'alcoolisation (9). Cependant bien que ce paramètre ait une sensibilité faible, comme seul marqueur biologique de l'alcoolisme, il a une valeur accrue, quand il est associé à d'autres marqueurs (9).…”

What are the Factors Affecting GGT Elevation in Patients with Severe Alcohol Use Disorders in Albanian Population?

“…But it can elevate even in obesity, dyslipidemia, hypertension or diabetes [11]. Even if several studies report a positive correlation between ethanol intake and serum GGT in abstainer, moderate or heavy drinkers, notable variation in GGT values are seen even between heavy drinkers [12,13]. Many studies highlight the possible agerelated or amount related effects on serum GGT activities in heavy drinkers [14,15].…”