Quantifying Alcohol Consumption in the General Population by Analysing Phosphatidylethanol Concentrations in Whole Blood: Results from 24,574 Subjects Included in the HUNT4 Study

Abstract

Aims To evaluate the association between self-reported alcohol consumption and phosphatidylethanol (PEth) concentrations in blood in a large general population study, and discuss optimal cut-off PEth concentrations for defined levels of alcohol consumption. Methods Population based, longitudinal cohort study including 24,574 adults from The Trøndelag Health Study 4 (HUNT4) conducted in Trøndelag County, Norway. Data included PEth concentration, self-reported alcohol consumption and CAGE score. Results PEth levels in whole blood increased with the number of alcohol units consumed, the frequency of alcohol consumption, the frequency of binge drinking and the CAGE score (lifetime, i.e. ‘have you ever’). The cut-off concentrations with highest combined sensitivity and specificity were 0.057 μmol/l (40 ng/ml) for identification of those consuming >1 alcohol unit per day (sensitivity 86%, specificity 76%), 0.087 μmol/l (61 ng/ml) for consuming >2 units per day (sensitivity 87%, specificity 81%) and 0.122 μmol/l (86 ng/ml) for consuming >3 alcohol units per day (sensitivity 80%, specificity 86%). By defining a CAGE score ≥ 2 as potentially harmful consumption, a cut-off of 0.100 μmol/l (70 ng/ml) identified 52% of all those subjects. Conclusions Cut-off limits of PEth concentrations should take into account the indication for sampling. Using cut-offs for the PEth concentrations of about 0.05 μmol/l (35 ng/ml) and 0.08 μmol/l (56 ng/ml) would identify about 90% of the subjects consuming more than 1 and 2 alcohol units per day, respectively. Concentrations above these cut-offs should lead to a more detailed interview related to alcohol use.

Phosphatidylethanol vs Transdermal Alcohol Monitoring for Detecting Alcohol Consumption Among Adults

“…The optimal PEth cutoff of 18.5 ng/mL is lower than cutoffs proposed based on comparisons with self-reported alcohol use in a population-based study in Norway, which found that 40 ng/mL was the optimal cutoff for detecting drinking more than 1 drink per day, which would meet criteria for heavy alcohol consumption in women, and 61 ng/mL for detecting drinking more than 2 drinks per day, which would meet criteria for heavy alcohol consumption for men . A likely explanation of the lower PEth cutoffs for heavy alcohol consumption in our study is that the mean age in our study was 66 years and all participants had a history of AF, compared with a mean age of 55 years in volunteers in the study conducted in Norway . While age was not associated with the sensitivity of PEth for unhealthy alcohol use in an individual-participant data meta-analysis (with median age of 38), a recent study that purposefully enrolled persons over age 60 years found that PEth values were negatively correlated with age …”

“…21 A likely explanation of the lower PEth cutoffs for heavy alcohol consumption in our study is that the mean age in our study was 66 years and all participants had a history of AF, compared with a mean age of 55 years in volunteers in the study conducted in Norway. 21 While age was not associated with the sensitivity of PEth for unhealthy alcohol use in an individual-participant data meta-analysis (with median age of 38), 15 a recent study that purposefully enrolled persons over age 60 years found that PEth values were negatively correlated with age. 31 Our optimal cutoff was quite near the proposed consensus cutoff for general populations of 20 ng/mL for detecting alcohol use greater than low consumption or abstinence 32 ; this cutoff was also suggested in a review of the literature.…”

“…For PEth to be useful to detect heavy alcohol use in clinical settings, appropriate cutoffs are needed . Some researchers have proposed a variety of PEth cutoffs for heavy alcohol consumption, ranging from 20 to 80 ng/mL; however, these cutoffs were derived from studies that relied on retrospective self-report of alcohol use, which themselves may be subject to recall bias and inaccurate reporting . Thus there is a need to derive PEth cutoffs most indicative of heavy alcohol consumption.…”

Association of liver fibrosis with extrahepatic cancer in steatotic liver disease patients with PNPLA3 I148M GG genotype

“…FibroScan was carried out using an M or XL probe (for patients with BMI ≥ 30 kg/m 2 ). All the enrolled subjects were given questionnaires that included questions about the frequency of any consumption of alcohol, the amount of alcohol usually consumed per week (specified as number of glasses or volumes of beer, wine, and liquor) and the frequency of binge drinking 22 . The level of alcohol intake was then quantified as 10–60 g/week 3 .…”

“…All the enrolled subjects were given questionnaires that included questions about the frequency of any consumption of alcohol, the amount of alcohol usually consumed per week (specified as number of glasses or volumes of beer, wine, and liquor) and the frequency of binge drinking. 22 The level of alcohol intake was then quantified as 10-60 g/week. 3 Longterm alcohol consumption was defined as >40 g alcohol consumption daily for women or >60 g alcohol consumption daily for men for ≥6 months.…”