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Hammarberg A, Ingesson Hammarberg S, Redegren Cuellar S, Guterstam J. Phosphatidylethanol as an outcome measure in treatment aimed at controlled drinking. Alcohol Alcohol 2024; 59:agae070. [PMID: 39367532 DOI: 10.1093/alcalc/agae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 09/12/2024] [Accepted: 09/16/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND Phosphatidylethanol (PEth) is a specific marker of alcohol intake, used both as a screening method for hazardous use and as an outcome measure in the treatment of alcohol use disorder (AUD). However, what cut-off values to apply for hazardous use in a treatment setting is still unclear. We aimed to investigate the correlation between PEth and self-reported drinking and identify the optimal cut-off for hazardous use, for patients with AUD and a stated goal of controlled drinking. METHODS We used data from a randomized controlled trial of two different psychological treatments aiming for controlled drinking, conducted within specialized addiction care in Stockholm, Sweden. A total of 181 patients left samples that could be included in the current analysis. Outcomes were measured at five different time points over 2 years of follow-up. PEth 16:0/18:1 values were correlated with subjective reports of recent drinking based on the Timeline Follow-Back Method. RESULTS The correlation between PEth and self-reported alcohol intake increased significantly over time, with the weakest correlation found at baseline (Spearman's ρ = 0.42) and the strongest at the 104-week follow-up (ρ = 0.69). When used to indicate hazardous drinking according to Swedish guidelines (≥10 units per week), receiver operating characteristic analysis revealed PEth ≥ 0.22 μmol/l to be the optimal cut-off. CONCLUSIONS PEth is a useful outcome measure that can be used to validate subjective reports of current drinking. In a treatment setting aimed at controlled drinking, the accuracy of patients' self-report measures seems to improve over time. In this context, a PEth value of ≥0.22 μmol/l is a sensitive and specific indicator of hazardous drinking.
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Affiliation(s)
- Anders Hammarberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Norra Stationsgatan 69, 7th Floor, 113 64 Stockholm, Sweden
| | - Stina Ingesson Hammarberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Norra Stationsgatan 69, 7th Floor, 113 64 Stockholm, Sweden
| | - Susanna Redegren Cuellar
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Norra Stationsgatan 69, 7th Floor, 113 64 Stockholm, Sweden
| | - Joar Guterstam
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Norra Stationsgatan 69, 7th Floor, 113 64 Stockholm, Sweden
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Tevik K, Skråstad RB, Benth JŠ, Selbæk G, Bergh S, Eldholm RS, Krokstad S, Helvik AS. Prevalence and change in alcohol consumption in older adults over time, assessed with self-report and Phosphatidylethanol 16:0/18:1 -The HUNT Study. PLoS One 2024; 19:e0304714. [PMID: 38820445 PMCID: PMC11142565 DOI: 10.1371/journal.pone.0304714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/16/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Changes in alcohol consumption may affect older adults' health. We examined prevalence and changes in the alcohol consumption of older women and men (≥65 years) in Norway over a 24-year period. METHODS Data from three population-based health surveys (The Trøndelag Health Study-HUNT2 1995-97, HUNT3 2006-08, HUNT4 2017-19) were used. Alcohol consumption was measured using self-reported measures and an objective measure of alcohol consumption (Phosphatidylethanol 16:0/18:1, PEth). Self-reported lifetime abstinence, former drinking, current drinking, frequent drinking (≥4 times/week), and risk drinking (≥8 units/week) were measured. The PEth concentrations were stratified: <0.03 μmol/l (abstinence/very low level of alcohol consumption); >0.06 μmol/l (indicating >1 unit/day); >0.10 μmol/l (indicating >3 units/day), and >0.30 μmol/l (heavy alcohol consumption). RESULTS In HUNT4, the prevalence of self-reported lifetime abstinence, frequent drinking, and risk drinking was 5.2%, 4.4%, and 5.6%, respectively, while prevalence of PEth <0.03 μmol/l was 68.1% and PEth >0.06 μmol/l was 21.2%. Over the course of the three surveys, the prevalence of self-reported lifetime abstinence decreased, while the prevalence of frequent drinking and risk drinking increased. Men were less often abstainers and more often frequent and risky drinkers than women in all three surveys. Gender differences for abstinence and current drinking reduced with time. From HUNT3 to HUNT4, the prevalence of PEth <0.03 μmol/l decreased, while the prevalence of PEth >0.06 μmol/l increased. Men compared to women, had less often PEth <0.03 μmol/l and more often PEth >0.06 and >0.10 μmol/l in HUNT3 and HUNT4. Women and men ≥75 years were just as likely to have PEth >0.30 μmol/l in HUNT4. The gender differences in PEth concentrations were reduced in HUNT4 among those aged 70-74 years or ≥75 years. CONCLUSION Alcohol consumption has increased among Norwegian older adults over a 24-year period, but at a slower pace during the last decade.
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Affiliation(s)
- Kjerstin Tevik
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ragnhild Bergene Skråstad
- Department of Clinical Pharmacology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Geir Selbæk
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sverre Bergh
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Rannveig Sakshaug Eldholm
- Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Anne-Sofie Helvik
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Finanger T, Melby K, Spigset O, Andreassen TN, Lydersen S, Skråstad RB. Relationship between alcohol intake based on daily smartphone-reported consumption and PEth concentrations in healthy volunteers. Alcohol Alcohol 2024; 59:agae040. [PMID: 38881524 PMCID: PMC11180986 DOI: 10.1093/alcalc/agae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 06/18/2024] Open
Abstract
AIMS To investigate the association between alcohol consumption registered daily with a digital smartphone-based diary and concentration of phosphatidylethanol (PEth) 16:0/18:1 in a population without a known alcohol use disorder (AUD), and evaluate whether prospective registration of alcohol consumption is better than retrospective registration and if the association between alcohol intake and PEth was affected by sex or body mass index (BMI). METHODS A total of 41 women and 21 men without AUD-diagnosis registered their alcohol consumption prospectively with a digital diary for 14 days, and retrospectively with the Timeline Followback method in the same time interval. PEth was measured before and after the registration period. RESULTS The correlation between alcohol consumption and PEth varied from 0.65 to 0.87. It did not depend significantly on the reporting method, and was not influenced by sex or BMI. Based on the regression coefficient, a reduction of alcohol consumption by two alcohol units (26 g of pure ethanol) per day would lead to a reduction of the PEth concentration of about 0.1 μmol/l, and vice versa. CONCLUSIONS There was a good correlation between PEth concentration and alcohol consumption, both when alcohol consumption was reported prospectively and retrospectively. The preferred cut-off for PEth should be adjusted to the level of alcohol consumption considered harmful and a purposeful trade-off between sensitivity and specificity. In order to identify persons with a daily alcohol consumption of more than two or three units of alcohol with a sensitivity of 80% or 90%, we suggest a cut-off of around 0.1 μmol/l.
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Affiliation(s)
- Trine Finanger
- Clinic of Substance Use and Addiction Medicine, St. Olav University Hospital, 7030 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Katrine Melby
- Clinic of Blue Cross Lade Addiction Treatment Centre, 7041 Trondheim, Norway
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, 7030 Norway
| | - Olav Spigset
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7030 Trondheim, Norway
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, 7030 Norway
| | - Trine N Andreassen
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, 7030 Norway
| | - Stian Lydersen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, 7030 Norway
| | - Ragnhild Bergene Skråstad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7030 Trondheim, Norway
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, 7030 Norway
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Podéus H, Simonsson C, Nasr P, Ekstedt M, Kechagias S, Lundberg P, Lövfors W, Cedersund G. A physiologically-based digital twin for alcohol consumption-predicting real-life drinking responses and long-term plasma PEth. NPJ Digit Med 2024; 7:112. [PMID: 38702474 PMCID: PMC11068902 DOI: 10.1038/s41746-024-01089-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/29/2024] [Indexed: 05/06/2024] Open
Abstract
Alcohol consumption is associated with a wide variety of preventable health complications and is a major risk factor for all-cause mortality in the age group 15-47 years. To reduce dangerous drinking behavior, eHealth applications have shown promise. A particularly interesting potential lies in the combination of eHealth apps with mathematical models. However, existing mathematical models do not consider real-life situations, such as combined intake of meals and beverages, and do not connect drinking to clinical markers, such as phosphatidylethanol (PEth). Herein, we present such a model which can simulate real-life situations and connect drinking to long-term markers. The new model can accurately describe both estimation data according to a χ2 -test (187.0 < Tχ2 = 226.4) and independent validation data (70.8 < Tχ2 = 93.5). The model can also be personalized using anthropometric data from a specific individual and can thus be used as a physiologically-based digital twin. This twin is also able to connect short-term consumption of alcohol to the long-term dynamics of PEth levels in the blood, a clinical biomarker of alcohol consumption. Here we illustrate how connecting short-term consumption to long-term markers allows for a new way to determine patient alcohol consumption from measured PEth levels. An additional use case of the twin could include the combined evaluation of patient-reported AUDIT forms and measured PEth levels. Finally, we integrated the new model into an eHealth application, which could help guide individual users or clinicians to help reduce dangerous drinking.
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Affiliation(s)
- Henrik Podéus
- Department of Biomedical Engineering (IMT), Linköping University, Linköping, Sweden
| | - Christian Simonsson
- Department of Biomedical Engineering (IMT), Linköping University, Linköping, Sweden
- Center for Medicine Imaging and Visualization Science (CMIV), Linköping University, Linköping, Sweden
| | - Patrik Nasr
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
- Wallenberg Center for Molecular Medicine, Linköping University, Linköping, Sweden
| | - Mattias Ekstedt
- Center for Medicine Imaging and Visualization Science (CMIV), Linköping University, Linköping, Sweden
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Stergios Kechagias
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Center for Medicine Imaging and Visualization Science (CMIV), Linköping University, Linköping, Sweden
- Department of Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - William Lövfors
- Department of Biomedical Engineering (IMT), Linköping University, Linköping, Sweden
- School of Medical Sciences and Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gunnar Cedersund
- Department of Biomedical Engineering (IMT), Linköping University, Linköping, Sweden.
- Center for Medicine Imaging and Visualization Science (CMIV), Linköping University, Linköping, Sweden.
- School of Medical Sciences and Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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Nasr P, Wester A, Ekstedt M, Strandberg R, Kechagias S, Shang Y, Widman L, Hagström H. Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis. Clin Gastroenterol Hepatol 2024; 22:1048-1057.e2. [PMID: 38237695 DOI: 10.1016/j.cgh.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND & AIMS Alcohol overconsumption is a risk factor for disease progression in patients with presumed metabolic dysfunction-associated steatotic liver disease (MASLD). How commonly this occurs and how it affects progression to major adverse liver outcomes (MALOs) is not well known. METHODS We did a register-based cohort study, including all patients with a diagnosis of MASLD in Sweden between 1987 and 2020. Patients were stratified on co-occurrence of diagnoses of alcohol-related liver disease (ALD) or alcohol use disorder (AUD) prior to MASLD diagnosis. Incident MALOs were derived from national registers. Cox regression was used to calculate hazard ratios (HRs) for incident MALO. RESULTS A total of 15,107 patients with MASLD were identified. The median age was 55 years, and 52% were female. Of the patients, 1843 (12%) had a prior diagnosis of ALD or AUD. During follow-up, a further 787 patients (5.2%) received a diagnosis of ALD or AUD. Patients with previous ALD or AUD diagnoses at or before baseline had considerably higher rates of MALOs compared with patients without (19.5% vs 7.8%; adjusted HR, 3.12; 95% confidence interval, 2.74-3.55). Acquiring an ALD or AUD diagnosis after MASLD diagnosis was associated with higher rates of MALOs (adjusted HR, 5.81; 95% confidence interval, 4.90-6.88). CONCLUSIONS ALD or AUD is commonly diagnosed prior to or after MASLD diagnosis. Such patients have considerably higher rates of progression to MALOs. Correctly separating between MASLD and ALD is vital to assess prognosis.
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Affiliation(s)
- Patrik Nasr
- Division of Diagnostics and Specialist Medicine, Department of Health, and Caring Sciences, Linköping University, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Axel Wester
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Ekstedt
- Division of Diagnostics and Specialist Medicine, Department of Health, and Caring Sciences, Linköping University, Sweden
| | - Rickard Strandberg
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Stergios Kechagias
- Division of Diagnostics and Specialist Medicine, Department of Health, and Caring Sciences, Linköping University, Sweden
| | - Ying Shang
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Linnea Widman
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Hannes Hagström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden; Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden.
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de Bejczy A. Phosphatidylethanol (B-PEth) and other direct and indirect biomarkers of alcohol consumption. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 175:313-344. [PMID: 38555120 DOI: 10.1016/bs.irn.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
When identifying, preventing and treating alcohol use disorder, a correct estimation of alcohol intake is essential. An objective marker is preferred as self-reported alcohol intake suffers from bias, and the use of alcohol biomarkers is increasing globally. An easy-to-use blood biomarker to correctly assess alcohol consumption is an invaluable asset in alcohol treatment strategies, as well as in alcohol research studies. The specific, cumulative, biomarker phosphatidylethanol, mirroring the past two weeks of consumption, has shown superiority over traditional biomarkers and is an attractive choice of proxy for alcohol intake.
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Affiliation(s)
- Andrea de Bejczy
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Jørgenrud BM, Bråthen CC, Steinson Stenehjem J, Kristiansen T, Rosseland LA, Bogstrand ST. Identifying excessive chronic alcohol use with phosphatidylethanol in patients with suspected severe injury-results from the IDART study. Alcohol Alcohol 2024; 59:agae014. [PMID: 38497164 PMCID: PMC10945293 DOI: 10.1093/alcalc/agae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Acute and chronic alcohol use are well-known risk factors for accidents and injuries, and concurrent psychoactive drug use can increase injury risk further. Phosphatidylethanol (PEth) 16:0/18:1 is a biomarker used to determine alcohol consumption the previous 3-4 weeks. The aim was to investigate the prevalence of chronic alcohol use in trauma patients, as determined by PEth 16:0/18:1 concentrations, and how excessive chronic alcohol use relate to demographic variables, injury mechanisms and drug use. SETTING Patients received at Norwegian trauma hospitals from March 2019 to February 2020. The study is part of the Impairing Drugs and Alcohol as Risk factors for Traumatic Injuries study. METHODS All patients aged ≥ 16 years received with trauma team were included in the study. Data on injury date and mechanism, gender and age was registered. Blood samples were analyzed for 22 psychoactive medicinal and illicit drugs, ethanol and phosphatidylethanol 16:0/18:1. Regression analyses were conducted to assess associations between alcohol use and gender, age, injury mechanism and drug use. RESULTS AND CONCLUSION Of the 4845 patients included in the study, 10% had PEth 16:0/18:1 concentration ≥ 600 nM (~430 ng/mL), indicative of excessive chronic alcohol use. Being male, between 44-61 years old, involved in violence, and testing positive for medicinal drugs was associated with excessive chronic alcohol use.Excessive chronic alcohol use was common among males, middle-aged, patients with violence as injury mechanism and those with medicinal drug use. These findings emphasize the need to detect and treat excessive chronic alcohol use among trauma patients.
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Affiliation(s)
- Benedicte M Jørgenrud
- Section of Drug Abuse Research, Department of Forensic Science, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Camilla C Bråthen
- Division of Elverum-Hamar, Department of Acute Medicine, Innlandet Hospital Trust, P.O. Box 104, N-2381 Brumunddal, Norway
- Institute of Clinical Medicine, Department of Anesthesia and Intensive Care medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
| | - Jo Steinson Stenehjem
- Institute of Clinical Medicine, Department of Anesthesia and Intensive Care medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
| | - Thomas Kristiansen
- Institute of Clinical Medicine, Department of Anesthesia and Intensive Care medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital, P.O. Box 4950, N-0424 Oslo, Norway
| | - Leiv Arne Rosseland
- Institute of Clinical Medicine, Department of Anesthesia and Intensive Care medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
- Division of Emergencies and Critical Care, Department of Research & Development, Oslo University Hospital, P.O. Box 4950, N-0424 Oslo, Norway
| | - Stig Tore Bogstrand
- Section of Drug Abuse Research, Department of Forensic Science, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Acute and Critical Illness, Oslo Metropolitan University, P.O. Box 4 St Olavs plass, N-0130 Oslo, Norway
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1089 Blindern, 0318 Oslo, Norway
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Dagne K, Myers B, Mihretu A, Teferra S. Scoping review of assessment tools for, magnitudes of and factors associated with problem drinking in population-based studies. BMJ Open 2024; 14:e080657. [PMID: 38458797 PMCID: PMC10928735 DOI: 10.1136/bmjopen-2023-080657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/09/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND The term "problem drinking" includes a spectrum of alcohol problems ranging from excessive or heavy drinking to alcohol use disorder. Problem drinking is a leading risk factor for death and disability globally. It has been measured and conceptualised in different ways, which has made it difficult to identify common risk factors for problem alcohol use. This scoping review aims to synthesise what is known about the assessment of problem drinking, its magnitude and associated factors. METHODS Four databases (PubMed, Embase, PsycINFO, Global Index Medicus) and Google Scholar were searched from inception to 25 November 2023. Studies were eligible if they focused on people aged 15 and above, were population-based studies reporting problem alcohol use and published in the English language. This review was reported based on guidelines from the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist'. Critical appraisal was done using the Newcastle-Ottawa Scale. RESULTS From the 14 296 records identified, 10 749 underwent title/abstract screening, of which 352 full-text articles were assessed, and 81 articles were included for data extraction. Included studies assessed alcohol use with self-report quantity/frequency questionnaires, criteria to determine risky single occasion drinking, validated screening tools, or structured clinical and diagnostic interviews. The most widely used screening tool was the Alcohol Use Disorder Identification Test. Studies defined problem drinking in various ways, including excessive/heavy drinking, binge drinking, alcohol use disorder, alcohol abuse and alcohol dependence. Across studies, the prevalence of heavy drinking ranged from <1.0% to 53.0%, binge drinking from 2.7% to 48.2%, alcohol abuse from 4.0% to 19.0%, alcohol dependence from 0.1% to 39.0% and alcohol use disorder from 2.0% to 66.6%. Factors associated with problem drinking varied across studies. These included sociodemographic and economic factors (age, sex, relationship status, education, employment, income level, religion, race, location and alcohol outlet density) and clinical factors (like medical problems, mental disorders, other substance use and quality of life). CONCLUSIONS Due to differences in measurement, study designs and assessed risk factors, the prevalence of and factors associated with problem drinking varied widely across studies and settings. The alcohol field would benefit from harmonised measurements of alcohol use and problem drinking as this would allow for comparisons to be made across countries and for meta-analyses to be conducted. TRIAL REGISTRATION NUMBER Open Science Framework ID: https://osf.io/2anj3.
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Affiliation(s)
- Kefyalew Dagne
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, College of Health Sciences and Medicine, Debre Berhan University, Debre Berhan, Ethiopia
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Alcohol, Tobacco and Other Drug Research Institute, South African Medical Research Council, Cape Town, South Africa
| | - Awoke Mihretu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Hagström H, Hegmar H, Moreno C. Interactions between the metabolic syndrome and alcohol consumption increases the risk of liver disease. United European Gastroenterol J 2024; 12:168-176. [PMID: 38381115 PMCID: PMC10954435 DOI: 10.1002/ueg2.12524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/06/2023] [Indexed: 02/22/2024] Open
Abstract
Alcohol-related liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD, recently renamed metabolic dysfunction-associated steatotic liver disease [MASLD]) share many features, including certain pathophysiological mechanisms, susceptibility genes, and histological lesions. However, the natural history of the two diseases, studied separately, is significantly different, with ALD being associated with a higher risk of cirrhosis and liver-related mortality. Moreover, evidence suggests an interactive effect between ALD and metabolic risk factors that are associated with NAFLD on the risk of progressive fibrosis and development of cirrhosis. Patients with both a high consumption of alcohol and metabolic risk factors, such as obesity or diabetes, should therefore be considered a particularly high-risk group for cirrhosis. Additional studies regarding the efficacy of screening for advanced liver fibrosis or cirrhosis in these risk groups are needed. The most effective and established method for reducing the risk of progression in ALD is alcohol abstinence, whereas weight loss is effective in NAFLD. In this narrative review, we introduce the reader to the literature of the field and present key studies showing this interactive effect.
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Affiliation(s)
- Hannes Hagström
- Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Hannes Hegmar
- Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Christophe Moreno
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
- Faculté de Médecine, Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium
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Desalegn H, Diaz LA, Rehm J, Arab JP. Impact of alcohol use on liver disease outcomes. Clin Liver Dis (Hoboken) 2024; 23:e0192. [PMID: 38860129 PMCID: PMC11164003 DOI: 10.1097/cld.0000000000000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/01/2024] [Indexed: 06/12/2024] Open
Affiliation(s)
- Hailemichael Desalegn
- Division of Gastroenterology, Department of Medicine, Western University, London Health Sciences Center, London, Ontario, Canada
- Alimentiv, London, Ontario, Canada
| | - Luis Antonio Diaz
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, World Health Organization/Pan American Health Organization Collaborating Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
- Program on Substance Abuse & WHO Collaborating Center on Substance Use, Noncommunicable Diseases, and Policy Impact Public Health Agency of Catalonia, Barcelona Spain
| | - Juan Pablo Arab
- Division of Gastroenterology, Department of Medicine, Western University, London Health Sciences Center, London, Ontario, Canada
- Alimentiv, London, Ontario, Canada
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada
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11
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Thurfjell Å, Sandlund C, Adami J, Hasselström J, Hagströmer M, Lundh L. GPs' experiences of phosphatidylethanol in treatment of hypertension: a qualitative study. BJGP Open 2023; 7:BJGPO.2023.0037. [PMID: 37463721 PMCID: PMC11176691 DOI: 10.3399/bjgpo.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/15/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Hazardous alcohol use increases the risk of hypertension but is underdetected in primary healthcare (PHC) patients. Use of the biomarker phosphatidylethanol (PEth), which reflects the last 2-3 weeks of alcohol consumption, is increasing in Swedish PHC, but studies exploring its use for hypertension are scarce or missing. AIM To explore GPs' experiences of using PEth to identify hazardous alcohol use in the context of managing hypertension. DESIGN & SETTING A qualitative study of GPs (n = 12) experienced in using PEth in hypertension management who were recruited at Swedish primary healthcare centres (PHCC) in 2021. METHOD The GPs participated in five focus group interviews. A questioning route was used. The interviews were audio-recorded, transcribed verbatim, and analysed with inductive qualitative content analysis. RESULTS 'I don't hesitate anymore' was the overall theme, which reflected both the disappearance of GPs' fear that the PEth result might upset the patient, as this rarely occurred, and that the positive effects of PEth predominated in the findings. The theme is underpinned by the following four sub-themes: serving as an eye-opener; improving the dialogue; using with care; and learning by doing. CONCLUSION PEth is a useful tool that changed GPs' routines for addressing alcohol and identifying hazardous alcohol use in patients with hypertension managed in PHC. The GPs advocated adopting PEth as a routine test in the treatment of hypertension. However, PEth needs to be used with care to maximise benefit and minimise harm.
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Affiliation(s)
- Åsa Thurfjell
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Christina Sandlund
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | - Jan Hasselström
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Maria Hagströmer
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Sophiahemmet University, Stockholm, Sweden
| | - Lena Lundh
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
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12
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Hahn JA, Fatch R, Barnett NP, Marcus GM. Phosphatidylethanol vs Transdermal Alcohol Monitoring for Detecting Alcohol Consumption Among Adults. JAMA Netw Open 2023; 6:e2333182. [PMID: 37698861 PMCID: PMC10498325 DOI: 10.1001/jamanetworkopen.2023.33182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/02/2023] [Indexed: 09/13/2023] Open
Abstract
Importance Alcohol biomarkers can improve detection of heavy alcohol use in clinical care, yet cutoffs for phosphatidylethanol (PEth), a blood biomarker, have not been established. Objective To determine the optimal cutoff for PEth for heavy alcohol consumption in a study of middle-age and older adults. Design, Setting, and Participants This was a 4-week diagnostic study of adults with paroxysmal atrial fibrillation (AF) and current alcohol consumption, recruited from general cardiology and cardiac electrophysiology outpatient clinics from September 2014 to September 2019. Data were analyzed from October 2021 to March 2022. Main Outcomes and Measures The main aim was to determine the optimal PEth cutoff for heavy alcohol consumption, using the Secure Continuous Remote Alcohol Monitor (SCRAM) to measure transdermal alcohol. Area under the curve (AUC) for PEth-detected compared with SCRAM-detected heavy alcohol consumption in any week over the prior 4 weeks (ie, ≥3 [women] and ≥4 [men] episodes) or any estimated breath alcohol of 0.08% or greater in any week, and the PEth cutoff was calculated using the Youden J statistic. Similar analyses were conducted comparing PEth with individual drinks reported by pressing an event monitor, retrospective self-report via the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), and using 2-week look-backs. Results In this diagnostic study of 64 patients with both PEth and SCRAM measures over 4 weeks (54 [84.4%] men; mean age, 65.5 [95% CI, 62.6-68.5] years; 51 [79.7%] White), 31 (48.4%) had any SCRAM-detected heavy alcohol consumption over the 4 weeks, and the median (IQR) PEth at 4 weeks was 23 ng/mL ( Conclusions and Relevance In a predominately middle-age and older White male population, PEth compared well with SCRAM. A PEth cutoff of 18.5 ng/mL (or rounded to 20 ng/mL, a recommended PEth cutoff for significant alcohol consumption) can be used in clinical care to detect heavy alcohol consumption in middle-age and older men.
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Affiliation(s)
- Judith A. Hahn
- Department of Medicine, University of California, San Francisco
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco
| | - Nancy P. Barnett
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
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13
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Lahr RG, Sharma P, Maus A, Langman LJ, Jannetto PJ. Development of an LC-MS/MS assay with automated sample preparation for phosphatidylethanol (PEth)- Not your typical clinical marker. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1229:123886. [PMID: 37714050 DOI: 10.1016/j.jchromb.2023.123886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023]
Abstract
Phosphatidylethanol (PEth) is a group of phospholipids formed exclusively in the presence of ethanol on the erythrocyte membrane, making it a direct biomarker for long-term ethanol consumption for which a clinical reference interval has been established. Here, we describe an assay for quantitation for two most abundant PEth homologues, PEth 16:0/18:1 and PEth 16:0/18:2, from human whole blood, and present challenges overcome throughout the development process. Since PEth is localized within erythrocyte membranes, a reliable sample preparation technique is an important aspect of PEth analysis. Therefore, various erythrocyte lysing agents for recovery of exogenously spiked standards and controls were evaluated to identify one that performed comparably to the recovery of endogenous analytes found in authentic samples. A supported liquid extraction (SLE) technique was employed for sample cleanup and enrichment which together with liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis enabled automated sample preparation, appropriate chromatographic resolution, and minimal system carryover. This resulted in a laboratory developed test with an analytical measurement range (AMR) of 10-1000 ng/mL (slope = 0.9902-1.0138, R2 = 0.9958-0.9972), that was precise (intra-day precision: 3.4-4.1%; inter-day precision: 4.4-8.2% over the AMR), accurate when compared with an available external laboratory test (slope = 0.9943-1.0206, R2 = 0.9635-0.9678, no lower decision point interpretation changes), with effective analyte recovery (77.2-83.5%), and established stability characteristics, while chromatographically separating the analytes to ensure no additive effects due to the isotopic distribution of the opposing analyte.
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Affiliation(s)
- Richard G Lahr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Pragya Sharma
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Anthony Maus
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Loralie J Langman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Paul J Jannetto
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
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14
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Olsson Y, Hodzic K, Wass C, Lidö H, Stangl BL, O'Connor S, Plawecki MH, Ramchandani VA, Söderpalm B, Jerlhag E. Free-access intravenous alcohol self-administration in social drinkers and individuals with alcohol use disorder: Evaluation of relationships with phosphatidylethanol and self-reported alcohol consumption. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1453-1466. [PMID: 37331818 DOI: 10.1111/acer.15132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/08/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND The free-access (FA) intravenous alcohol self-administration (IV-ASA) paradigm is an experimental approach that can identify modulators of alcohol consumption in humans. Moreover, the outcome measures of IV-ASA paradigms are associated with self-reported alcohol intake using the timeline follow-back method (TLFB). To evaluate how FA IV-ASA reflects drinking in real life, we examined the relationship between an objective marker of recent alcohol intake, phosphatidylethanol in blood (B-PEth), and TLFB and measures obtained during IV-ASA in individuals with alcohol use disorder (AUD) and social drinkers (SD). We also explored the associations between these measures and gut-brain peptides involved in AUD pathophysiology. METHODS Thirty-eight participants completed a laboratory session in which they self-administered alcohol intravenously. The safety limit was 200 mg%, and main outcomes were mean and peak breath alcohol concentrations (BrAC). Blood samples were drawn prior to IV-ASA and subjective alcohol effects were rated during the experiment. RESULTS The study sample comprised 24 SD and 14 participants with DSM-5 mild AUD. Although BrACs were not associated with B-PEth or TLFB in the full sample or AUD subgroup, there was an association with TLFB in SD. In both subgroups, BrACs were associated with alcohol craving but with differential timing. Total ghrelin levels were higher in AUD participants than in SD. CONCLUSIONS No associations between B-PEth levels and achieved BrACs were observed in the mild AUD group, the SD group, or the full sample. The ability for FA IV-ASA to reflect recent drinking was confirmed only for TLFB in SD, whereas there were no associations within the smaller subsample of participants with mild AUD or in the full sample. Further studies that include a larger AUD sample are warranted. The association of BrACs with craving for alcohol suggests that the IV-ASA method may be useful for assessing interventions that target craving. This could be explored by using the FA IV-ASA model to evaluate the effects on craving of approved pharmacotherapies for AUD.
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Affiliation(s)
- Yasmin Olsson
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Beroendekliniken, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kenan Hodzic
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Caroline Wass
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helga Lidö
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Beroendekliniken, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bethany L Stangl
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, Maryland, USA
| | - Sean O'Connor
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Martin H Plawecki
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Vijay A Ramchandani
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, Maryland, USA
| | - Bo Söderpalm
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Beroendekliniken, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabet Jerlhag
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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15
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Perilli M, Toselli F, Franceschetto L, Cinquetti A, Ceretta A, Cecchetto G, Viel G. Phosphatidylethanol (PEth) in Blood as a Marker of Unhealthy Alcohol Use: A Systematic Review with Novel Molecular Insights. Int J Mol Sci 2023; 24:12175. [PMID: 37569551 PMCID: PMC10418704 DOI: 10.3390/ijms241512175] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The Alcohol Use Disorders Identification Test (AUDIT) and its short form, the AUDIT-C, the main clinical instruments used to identify unhealthy drinking behaviors, are influenced by memory bias and under-reporting. In recent years, phosphatidylethanol (PEth) in blood has emerged as a marker of unhealthy alcohol use. This systematic review aims to investigate the molecular characteristics of PEth and summarize the last ten years of published literature and its use compared to structured questionnaires. A systematic search was performed, adhering to PRISMA guidelines, through "MeSH" and "free-text" protocols in the databases PubMed, SCOPUS, and Web of Science. The inclusion criteria were as follows: PEth was used for detecting unhealthy alcohol consumption in the general population and quantified in blood through liquid chromatography coupled to mass spectrometry, with full texts in the English language. Quality assessment was performed using the JBI critical appraisal checklist. Twelve papers were included (0.79% of total retrieved records), comprising nine cross-sectional studies and three cohort studies. All studies stratified alcohol exposure and quantified PEth 16:0/18:1 through liquid chromatography coupled to mass spectrometry (LC-MS) in liquid blood or dried blood spots (DBS) with lower limits of quantitation (LLOQ) ranging from 1.7 ng/mL to 20 ng/mL. A correlation between blood PEth level and the amount of alcohol ingested in the previous two weeks was generally observed. PEth interpretative cut-offs varied greatly among the included records, ranging from 4.2 ng/mL to 250 ng/mL, with sensitivity and specificity in the ranges of 58-100% and 64-100%, respectively. Although the biomarker seems promising, further research elucidating the variability in PEth formation and degradation, as well as the molecular mechanisms behind that variability, are necessary.
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Affiliation(s)
| | | | | | | | | | | | - Guido Viel
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy; (M.P.); (F.T.); (L.F.); (A.C.); (A.C.); (G.C.)
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16
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Salah LM, Bushman LR, Brooks KM, Anderson PL, Kiser JJ. Development and validation of an LC-MS/MS method to quantify the alcohol biomarker phosphatidylethanol 16:0/18:1 in dried blood spots for clinical research purposes. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1223:123725. [PMID: 37120963 PMCID: PMC10335920 DOI: 10.1016/j.jchromb.2023.123725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
Phosphatidylethanol (PEth) is a group of phospholipids detectable in red blood cells exclusively following ethanol consumption. The primary PEth analog, PEth 16:0/18:1, has an extended half-life in red cells, providing a long window of detection and tremendous potential for the quantification of cumulative alcohol consumption. We developed and validated an LC/MS-MS method to quantify PEth 16:0/18:1 in dried blood spots (DBS) for clinical research purposes. Method development and validation followed FDA guidance but expanded on prior published methods through the evaluation of additional DBS-specific factors such as sample hematocrit, punch location, and spot volume. This method was applied to the quantification of PEth in participant samples.
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Affiliation(s)
- Lana M Salah
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, 12850 E Montview Blvd, MS C238-V20-4410, Aurora, CO 80045, USA.
| | - Lane R Bushman
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, 12850 E Montview Blvd, MS C238-V20-4410, Aurora, CO 80045, USA.
| | - Kristina M Brooks
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, 12850 E Montview Blvd, MS C238-V20-4410, Aurora, CO 80045, USA.
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, 12850 E Montview Blvd, MS C238-V20-4410, Aurora, CO 80045, USA.
| | - Jennifer J Kiser
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, 12850 E Montview Blvd, MS C238-V20-4410, Aurora, CO 80045, USA.
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17
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Yan C, Hu W, Tu J, Li J, Liang Q, Han S. Pathogenic mechanisms and regulatory factors involved in alcoholic liver disease. J Transl Med 2023; 21:300. [PMID: 37143126 PMCID: PMC10158301 DOI: 10.1186/s12967-023-04166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/27/2023] [Indexed: 05/06/2023] Open
Abstract
Alcoholism is a widespread and damaging behaviour of people throughout the world. Long-term alcohol consumption has resulted in alcoholic liver disease (ALD) being the leading cause of chronic liver disease. Many metabolic enzymes, including alcohol dehydrogenases such as ADH, CYP2E1, and CATacetaldehyde dehydrogenases ALDHsand nonoxidative metabolizing enzymes such as SULT, UGT, and FAEES, are involved in the metabolism of ethanol, the main component in alcoholic beverages. Ethanol consumption changes the functional or expression profiles of various regulatory factors, such as kinases, transcription factors, and microRNAs. Therefore, the underlying mechanisms of ALD are complex, involving inflammation, mitochondrial damage, endoplasmic reticulum stress, nitrification, and oxidative stress. Moreover, recent evidence has demonstrated that the gut-liver axis plays a critical role in ALD pathogenesis. For example, ethanol damages the intestinal barrier, resulting in the release of endotoxins and alterations in intestinal flora content and bile acid metabolism. However, ALD therapies show low effectiveness. Therefore, this review summarizes ethanol metabolism pathways and highly influential pathogenic mechanisms and regulatory factors involved in ALD pathology with the aim of new therapeutic insights.
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Affiliation(s)
- Chuyun Yan
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Wanting Hu
- MOE Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, Key Lab of Microanalytical Methods & Instrumentation, Department of Chemistry, Center for Synthetic and Systems Biology, Tsinghua University, Beijing, 100084, China
| | - Jinqi Tu
- The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College of Wuhu, Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Jinyao Li
- Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, 830046, China
| | - Qionglin Liang
- MOE Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, Key Lab of Microanalytical Methods & Instrumentation, Department of Chemistry, Center for Synthetic and Systems Biology, Tsinghua University, Beijing, 100084, China
| | - Shuxin Han
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China.
- Xinjiang Key Laboratory of Biological Resources and Genetic Engineering, College of Life Science and Technology, Xinjiang University, Urumqi, 830046, China.
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18
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Trius-Soler M, Praticò G, Gürdeniz G, Garcia-Aloy M, Canali R, Fausta N, Brouwer-Brolsma EM, Andrés-Lacueva C, Dragsted LO. Biomarkers of moderate alcohol intake and alcoholic beverages: a systematic literature review. GENES & NUTRITION 2023; 18:7. [PMID: 37076809 PMCID: PMC10114415 DOI: 10.1186/s12263-023-00726-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
The predominant source of alcohol in the diet is alcoholic beverages, including beer, wine, spirits and liquors, sweet wine, and ciders. Self-reported alcohol intakes are likely to be influenced by measurement error, thus affecting the accuracy and precision of currently established epidemiological associations between alcohol itself, alcoholic beverage consumption, and health or disease. Therefore, a more objective assessment of alcohol intake would be very valuable, which may be established through biomarkers of food intake (BFIs). Several direct and indirect alcohol intake biomarkers have been proposed in forensic and clinical contexts to assess recent or longer-term intakes. Protocols for performing systematic reviews in this field, as well as for assessing the validity of candidate BFIs, have been developed within the Food Biomarker Alliance (FoodBAll) project. The aim of this systematic review is to list and validate biomarkers of ethanol intake per se excluding markers of abuse, but including biomarkers related to common categories of alcoholic beverages. Validation of the proposed candidate biomarker(s) for alcohol itself and for each alcoholic beverage was done according to the published guideline for biomarker reviews. In conclusion, common biomarkers of alcohol intake, e.g., as ethyl glucuronide, ethyl sulfate, fatty acid ethyl esters, and phosphatidyl ethanol, show considerable inter-individual response, especially at low to moderate intakes, and need further development and improved validation, while BFIs for beer and wine are highly promising and may help in more accurate intake assessments for these specific beverages.
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Affiliation(s)
- Marta Trius-Soler
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958, Frederiksberg C, Denmark
- Polyphenol Research Laboratory, Department of Nutrition, Food Sciences and Gastronomy, XIA School of Pharmacy and Food Sciences, University of Barcelona, 08028, Barcelona, Spain
- INSA-UB, Nutrition and Food Safety Research Institute, University of Barcelona, 08921, Santa Coloma de Gramanet, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Giulia Praticò
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958, Frederiksberg C, Denmark
| | - Gözde Gürdeniz
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958, Frederiksberg C, Denmark
| | - Mar Garcia-Aloy
- Biomarker & Nutrimetabolomics Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028, Barcelona, Spain
- Metabolomics Unit, Research and Innovation Centre, Fondazione Edmund Mach, San Michele All'Adige, Italy
| | - Raffaella Canali
- Consiglio Per La Ricerca in Agricoltura E L'analisi Dell'economia Agraria (CREA) Research Centre for Food and Nutrition, Rome, Italy
| | - Natella Fausta
- Consiglio Per La Ricerca in Agricoltura E L'analisi Dell'economia Agraria (CREA) Research Centre for Food and Nutrition, Rome, Italy
| | - Elske M Brouwer-Brolsma
- Division of Human Nutrition and Health, Department Agrotechnology and Food Sciences, Wageningen University and Research, P.O. Box 17, 6700 AA, Wageningen, The Netherlands
| | - Cristina Andrés-Lacueva
- INSA-UB, Nutrition and Food Safety Research Institute, University of Barcelona, 08921, Santa Coloma de Gramanet, Spain
- Biomarker & Nutrimetabolomics Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad Y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Lars Ove Dragsted
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958, Frederiksberg C, Denmark.
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19
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Miller-Matero LR, Adkins E, Zohr SJ, Martens KM, Hamann A, Snodgrass M, Maye M, Braciszewski JM, Szymanski W, Green S, Genaw J, Carlin AM. Utility of phosphatidylethanol testing as an objective measure of alcohol use during the preoperative evaluation for bariatric surgery. Surg Obes Relat Dis 2023; 19:158-164. [PMID: 36443213 DOI: 10.1016/j.soard.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/11/2022] [Accepted: 10/21/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The risk of alcohol use disorder increases after bariatric surgery. Preoperative alcohol use is a risk factor, and this is evaluated during the routine preoperative psychosocial evaluation. However, it is not clear whether patients accurately report their alcohol use. OBJECTIVE To determine whether an objective measure of alcohol use, phosphatidylethanol (PEth) testing, offers utility beyond self-reported alcohol use during the preoperative evaluation for bariatric surgery. SETTING Single healthcare system. METHODS PEth testing was included as part of the routine laboratory work for 139 patients undergoing evaluation for bariatric surgery. PEth testing results were compared with self-reported alcohol use and scores on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) questionnaire obtained during the preoperative psychosocial evaluation. PEth testing results were categorized into abstinent, light use, moderate use, or heavy use. There were 85 patients who completed both PEth testing and a preoperative psychosocial evaluation. RESULTS There were 25 participants (29.4%) who had a positive PEth test; about half had moderate or heavy use values (15.3% of the total sample). The majority of participants with a positive PEth test (82.6%) denied recent alcohol use. Of those with PEth values indicating moderate or heavy use, 61.5% did not have an elevated AUDIT-C score. CONCLUSIONS Patients appeared to underreport their alcohol use during the preoperative psychosocial evaluation. There appears to be utility for routine PEth testing as part of the evaluation process to identify those with risky drinking patterns. Patients with preoperative risky drinking could be educated about their risk and/or referred to programs to mitigate the development of preoperative alcohol misuse.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan.
| | - Elise Adkins
- Behavioral Health, Henry Ford Health, Detroit, Michigan
| | | | - Kellie M Martens
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Department of Surgery, Henry Ford Health, Detroit, Michigan
| | - Aaron Hamann
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Department of Surgery, Henry Ford Health, Detroit, Michigan
| | - Maunda Snodgrass
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Department of Surgery, Henry Ford Health, Detroit, Michigan
| | - Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | - Sally Green
- Department of Surgery, Henry Ford Health, Detroit, Michigan
| | - Jeffrey Genaw
- Department of Surgery, Henry Ford Health, Detroit, Michigan
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20
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Considerations in the search for under-reported alcohol consumption in NAFLD. J Hepatol 2023; 78:e66-e67. [PMID: 35863490 DOI: 10.1016/j.jhep.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/09/2022] [Indexed: 01/24/2023]
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21
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Reisfield GM, Teitelbaum SA, Jones JT, Mason D, Bleiweis M, Lewis B. Blood Phosphatidylethanol (PEth) Concentrations following Intensive Use of an Alcohol-based Hand Sanitizer. J Anal Toxicol 2023; 46:979-990. [PMID: 34748012 DOI: 10.1093/jat/bkab115] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 01/26/2023] Open
Abstract
Alcohol use disorders are prevalent in the USA and throughout the world. Monitoring for alcohol abstinence is useful in several clinical and forensic contexts. The direct alcohol biomarkers have the requisite sensitivity and specificity for abstinence monitoring. The relatively new direct biomarker phosphatidylethanol (PEth), measured in blood, is gaining increasing acceptance in monitoring abstinence from beverage alcohol consumption, but there remains little research addressing the potential for PEth formation consequent to incidental alcohol exposures. In the midst of the coronavirus disease 2019 pandemic, high-alcohol content hand sanitizer is a particularly important source of nonbeverage alcohol exposure. To assess the extent of alcohol absorption and subsequent formation of blood PEth related to intensive use of high alcohol content hand sanitizer, we recruited 15 participants to use a 70% ethyl alcohol-based hand sanitizer 24-100 times daily, for 12-13 consecutive days. Blood was analyzed for PEth 16:0/18:1 by liquid chromatography--tandem mass spectrometry. Our hypothesis that blood PEth concentrations would fail to reach a 20 ng/mL threshold was confirmed. This work adds to the nascent literature on the effects of incidental alcohol exposures on blood PEth formation.
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Affiliation(s)
- Gary M Reisfield
- UF Health Springhill, University of Florida College of Medicine, 4037 NW 86th Terrace, Gainesville, FL 32606, USA
| | - Scott A Teitelbaum
- University of Florida College of Medicine, 1600 Sw Archer Road, Gainesville, FL 32610, USA
| | - Joseph T Jones
- United States Drug Testing Laboratories, Inc., 1700 S Mount Prospect Road, Des Plaines, IL 60018, USA
| | - Dana Mason
- University of Florida College of Medicine, 1600 Sw Archer Road, Gainesville, FL 32610, USA
| | - Max Bleiweis
- University of Florida College of Medicine, 1600 Sw Archer Road, Gainesville, FL 32610, USA
| | - Ben Lewis
- University of Florida College of Medicine, 1600 Sw Archer Road, Gainesville, FL 32610, USA
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22
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Stöth F, Kotzerke E, Thierauf-Emberger A, Weinmann W, Schuldis D. Can PEth be Detected with a Cutoff of 20 ng/mL after Single Alcohol Consumption? J Anal Toxicol 2023; 46:e232-e238. [PMID: 36107736 DOI: 10.1093/jat/bkac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/15/2022] [Accepted: 09/13/2022] [Indexed: 01/26/2023] Open
Abstract
Phosphatidylethanol (PEth) can be determined in capillary blood collected as dried blood spots (DBS) and is a promising direct alcohol biomarker for the determination of drinking habits. Its use for abstinence monitoring needs to be evaluated. Studies with patients undergoing alcohol withdrawal have shown that the elimination of PEth can take up to 2 months. For the determination of PEth 16:0/18:1, a cutoff of 20 ng/mL has been agreed upon in the major US laboratories. However, it is not yet clear what minimum blood alcohol concentrations (BACs) have to be achieved by a single drinking episode to result in PEth concentrations above this cutoff after previous long-term abstinence. To determine whether low drinking amounts can result in a positive PEth concentration above 20 ng/mL, we recruited 12 participants ('social' drinkers). After 4 weeks of abstinence, alcohol was consumed at two separate drinking events with target BACs of 0.5 and 0.3 g/kg, resulting in maximum BACs in the ranges of 0.30-0.63 g/kg and 0.10-0.28 g/kg, respectively. Capillary blood was collected at different time points of the drinking experiment, and PEth was extracted from DBS and analyzed by liquid chromatography-tandem mass spectrometry. Despite drinking doses up to 0.58 g ethanol per kg body weight and reaching BACs of up to 0.63 g/kg, PEth 16:0/18:1 and PEth 16:0/18:2 could not be detected at or above the 20 ng/mL cutoff in any participant at any time after the drinking events. We conclude that after long-term abstinence the cutoff of 20 ng/mL for single alcohol consumption leading to BACs up to 0.63 g/kg is not exceeded.
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Affiliation(s)
- Frederike Stöth
- Institute of Forensic Medicine, Forensic Toxicology and Chemistry, University of Bern, Murtenstrasse 26, 3008 Bern, Switzerland
| | - Ephraim Kotzerke
- Institute of Forensic Medicine, Medical Center, University of Freiburg, Albertstraße 9, 79104 Freiburg, Germany
| | - Annette Thierauf-Emberger
- Institute of Forensic Medicine, Medical Center, University of Freiburg, Albertstraße 9, 79104 Freiburg, Germany
| | - Wolfgang Weinmann
- Institute of Forensic Medicine, Forensic Toxicology and Chemistry, University of Bern, Murtenstrasse 26, 3008 Bern, Switzerland
| | - Dominik Schuldis
- Institute of Forensic Medicine, Medical Center, University of Freiburg, Albertstraße 9, 79104 Freiburg, Germany
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23
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Aboutara N, Jungen H, Szewczyk A, Müller A, Iwersen-Bergmann S. PEth 16:0/18:1 and 16:0/18:2 after consumption of low doses of alcohol-A contribution to cutoff discussion. Drug Test Anal 2023; 15:104-114. [PMID: 36181234 DOI: 10.1002/dta.3376] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 01/26/2023]
Abstract
Phosphatidylethanol in blood has gained recognition as a direct alcohol biomarker. Although different cutoffs have been suggested, there is no consensus for differentiating abstinence from alcohol consumption. In this study, 75 participants (72% female) consumed 20 g of ethanol on three consecutive evenings. Blood was sampled on each following day and PEth 16:0/18:1 and 16:0/18:2 were determined. PEth 16:0/18:1 ranged from 8.9-21.5, 8.7-19.3, and 8.8-42.3 ng/ml and PEth 16:0/18:2 from 8.7-31.7, 9.0-39.3, and 9.4-43.0 ng/ml after the respective days of ethanol consumption. PEth 16:0/18:1 yielded a sensitivity of 25%, 45%, and 49% and PEth 16:0/18:2 of 40%, 61%, and 68% for the consumption days, respectively (cutoff 10 ng/ml). PEth 16:0/18:1 reached >20 ng/ml in five samples overall. Sensitivity of PEth 16:0/18:2 > 20 ng/ml was better with 35% after the three drinking days. Overall, PEth 16:0/18:1 was >35 ng/ml in one sample and PEth 16:0/18:2 in three samples. Significantly, more women had PEth 16:0/18:1 > 10 ng/ml after the third day of consuming 20 g of alcohol (p = 0.02) and PEth 16:0/18:2 > 10 ng/ml after the second (p = 0.023) and the third (p = 0.002) consumption, which can be led back to the higher blood alcohol concentration women reach after consuming the same alcohol amount as men. Although the response rates of PEth to alcohol uptake are subject to strong interindividual differences, results suggest that PEth cutoff should be lowered for better detection of consumption of low to medium amounts of alcohol. Furthermore, it is advantageous to analyze both PEth 16:0/18:2 and 16:0/18:1.
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Affiliation(s)
- Nadine Aboutara
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hilke Jungen
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Szewczyk
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Müller
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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24
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Finanger T, Vaaler AE, Spigset O, Aamo TO, Andreassen TN, Gråwe RW, Skråstad RB. Identification of unhealthy alcohol use by self-report and phosphatidylethanol (PEth) blood concentrations in an acute psychiatric department. BMC Psychiatry 2022; 22:286. [PMID: 35449039 PMCID: PMC9026645 DOI: 10.1186/s12888-022-03934-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of standard screening methods could improve the detection rate of unhealthy alcohol use in patients admitted to psychiatric acute and emergency departments. The aim of the present study was to investigate the ability of the alcohol biomarker phosphatidylethanol (PEth) to identify patients with high levels of alcohol consumption prior to admission. METHODS The data were prospectively collected at admittance to an acute psychiatric department in the period January 2016 to June 2017. A blood sample for the analysis of PEth was available from 177 patients. We compared the PEth concentrations with the Alcohol Use Disorders Identification Test (AUDIT) scores during the hospital stay, and psychiatric diagnoses at discharge. RESULTS A total of 45.8% of the patients had a PEth concentration ≥ 0.03 μmol/L, indicating significant alcohol consumption. AUDIT scores consistent with unhealthy alcohol use were present in 51.7%. There was a significant positive correlation between PEth concentrations and AUDIT scores (r = 0.631, p < 0.001). PEth was above the detection limit of 0.03 μmol/L in 19% of those reporting an average daily intake of zero alcohol units per day during the last week before admission. PEth concentrations were significantly higher among those with an alcohol diagnosis than among those without such a diagnosis (0.82 μmol/L vs. 0.09 μmol/L, p = 0.001). CONCLUSION PEth provides supplementary information on recent alcohol consumption in a psychiatric population and would be particularly helpful in patients unable or unwilling to give such information at admission.
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Affiliation(s)
- Trine Finanger
- Clinic of Substance Use and Addiction Medicine, St. Olav University Hospital, Klostergata 48, 7030, Trondheim, Norway. .,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.
| | - Arne Einar Vaaler
- grid.52522.320000 0004 0627 3560Department of Acute Psychiatry, Division of Mental Health, St. Olav University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology – NTNU, Trondheim, Norway
| | - Olav Spigset
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology – NTNU, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Trond Oskar Aamo
- grid.52522.320000 0004 0627 3560Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Trine Naalsund Andreassen
- grid.52522.320000 0004 0627 3560Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Rolf Wilhelm Gråwe
- grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology – NTNU, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Research and Development, Division of Mental Health, St. Olav University Hospital, Trondheim, Norway
| | - Ragnhild Bergene Skråstad
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology – NTNU, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
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25
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White D, O'Halloran S, Salman S, MacQuillan G, Joyce DA. Validation of a liquid chromatography tandem mass spectrometry (LC-MS/MS) method for erythrocyte phosphatidylethanol revealing critical considerations for its use as a clinical biomarker. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1192:123134. [DOI: 10.1016/j.jchromb.2022.123134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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26
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DiBattista A, Ogrel S, MacKenzie AE, Chakraborty P. Quantitation of phosphatidylethanols in dried blood spots to determine rates of prenatal alcohol exposure in Ontario. Alcohol Clin Exp Res 2021; 46:243-251. [PMID: 34939205 DOI: 10.1111/acer.14766] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/04/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Estimating rates of prenatal alcohol exposure (PAE) in a population is necessary to ensure that proper medical and social supports and interventions are in place. This study sought to estimate PAE in Ontario, Canada by quantifying phosphatidylethanol (PEth) homologues in over 2000 residual neonatal dried blood spots (DBS). METHODS A random selection of 2011 residual DBS collected over a 1-week time period were anonymized and extracted. A targeted liquid chromatography-mass spectrometry method was used to quantify 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphoethanol (PEth (16:0/18:1) or POPEth), the clinically accepted biomarker, and six additional PEth homologues. A POPEth level above the United States Drug Testing Laboratories (USDTL) cutoff up to 4 weeks predelivery was indicative of PAE. All PEth homologues were correlated to one another and logistic regression was used to determine the association between PAE status and infant characteristics. RESULTS The estimated rate of PAE in Ontario, up to the last 4 weeks of gestation, was 15.5% (POPEth >28.5 nM). Most PEth homologues were moderately to strongly correlated to one another. A low birth weight and preterm birth were both associated with PAE, while being small for gestational age had lower odds of PAE. CONCLUSIONS The results of this study suggest that PAE may be more prevalent in Ontario than previous estimates by self-report or meconium testing. These findings support the need to consider the effectiveness of current interventions and the design of new interventions to address this significant public health issue.
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Affiliation(s)
- Alicia DiBattista
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Svetlana Ogrel
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Alex E MacKenzie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Pranesh Chakraborty
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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27
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Aboutara N, Müller A, Jungen H, Szewczyk A, van Rüth V, Bertram F, Püschel K, Heinrich F, Iwersen-Bergmann S. Investigating the use of PEth, CDT and MCV to evaluate alcohol consumption in a cohort of homeless individuals- A comparison of different alcohol biomarkers. Forensic Sci Int 2021; 331:111147. [PMID: 34920332 DOI: 10.1016/j.forsciint.2021.111147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/28/2022]
Abstract
In a cohort including individuals with suspected high alcohol consumption, the concentrations of the indirect alcohol biomarkers carbohydrate-deficient transferrin (CDT) and mean corpuscular volume (MCV) and the direct alcohol biomarker phosphatidylethanol (PEth) were investigated. Blood alcohol concentration (BAC) was analysed as a marker for acute alcohol ingestion. In addition to questions about subjective alcohol consumption behaviour, 147 homeless persons underwent a physical examination with blood sampling. BAC, PEth, CDT and MCV were determined in the blood samples. Special focus was on the comparison of PEth and CDT for indicating excessive alcohol consumption. BAC was measured above 0.1‰ in 39 blood samples (0.1-2.5‰, median 0.75‰). PEth was detected in all of them. Overall, PEth was positive (≥10 ng/ml) in 104 samples (71%) (11-5687 ng/ml, median 650 ng/ml) with 68 (46%) being above the cut-off for excessive alcohol consumption (210 ng/ml). In 26 subjects PEth was the only positive alcohol biomarker. CDT was ≥ 1.7% in 66 cases (47%) (1.8-22.2%, median 4.4%) and ≥ 2.5% in 52 (35%) cases. MCV was elevated (≥95 fl) in 58 subjects (39%). CDT and PEth concentrations showed a significant positive correlation (spearman's correlation coefficient ρ = 0.77, p < 0.001). PEth concentrations were significantly higher in samples that were also CDT positive than solely PEth positive (p = 0.004). PEth did not indicate excessive alcohol consumption (< 210 ng/ml) in eight and two cases in which CDT was ≥ 1.7% and ≥ 2.5%, respectively. On the other hand, CDT was< 1.7% and< 2.5% in ten and 18 cases, respectively, in which PEth was above cut-off for excessive alcohol consumption. Taking the self-reports of the participants into consideration, PEth's sensitivity for detecting excessive alcohol consumption was 100% (10 ng/ml) and 94% (210 ng/ml) and CDT's was 88% (1.7%) and 75% (2.5%). In individuals of the investigated cohort unusually high concentrations of the alcohol consumption markers PEth and CDT were quantified, which proves the assumption of chronic excessive alcohol consumption in parts of the cohort. PEth was the marker that was positive most often and was more sensitive for excessive alcohol consumption than CDT.
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Affiliation(s)
- Nadine Aboutara
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany.
| | - Alexander Müller
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Hilke Jungen
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Anne Szewczyk
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Victoria van Rüth
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Franziska Bertram
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Fabian Heinrich
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Stefanie Iwersen-Bergmann
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
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28
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Reisfield GM, Teitelbaum SA, Jones JT, Mason D, Bleiweis M, Lewis B. Blood Phosphatidylethanol Concentrations Following Regular Exposure to an Alcohol-Based Mouthwash. J Anal Toxicol 2021; 45:950-956. [PMID: 33024993 DOI: 10.1093/jat/bkaa147] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/04/2020] [Accepted: 10/02/2020] [Indexed: 02/06/2023] Open
Abstract
Direct biomarkers of ethanol are used to monitor individuals who are required to abstain from ethanol consumption. In recent years, blood phosphatidylethanol (PEth) has gained acceptance in clinical and forensic contexts as an abstinence marker. Its elimination half-life of several days provides a window of detection of days to weeks. However, there is no research addressing the extent of PEth formation related to extraneous ethanol exposures. To assess the degree of ethanol absorption and subsequent formation of blood PEth related a common extraneous exposure, regular use of an ethanol-containing mouthwash, we recruited 16 participants to gargle with an alcohol-based mouthwash (21.6% ethanol) 4 times daily, for 12 consecutive days. Blood was analyzed for PEth 16:0/18:1 by liquid chromatography-tandem mass spectrometry. Our hypothesis that blood PEth concentrations would not equal or exceed 20 ng/mL was confirmed. Although the data suggest that regular use of mouthwash is unlikely to result in suprathreshold PEth concentrations, this work highlights the importance of considering extraneous ethanol exposures in clinical decision-making and in future research.
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Affiliation(s)
- Gary M Reisfield
- University of Florida College of Medicine, Department of Psychiatry, UF Health Springhill 1, 4037 NW 86th Terrace, Gainesville, FL 32606, USA
| | - Scott A Teitelbaum
- University of Florida College of Medicine, Department of Psychiatry, Florida Recovery Center, 4001 SW 13th St., Gainesville, FL 32605, USA
| | - Joseph T Jones
- United States Drug Testing Laboratories, Inc., 1700 S. Mt. Prospect Rd., Des Plaines, IL 60018, USA
| | - Dana Mason
- University of Florida College of Medicine, Department of Psychiatry, UF Health Springhill 1, 4037 NW 86th Terrace, Gainesville, FL 32606, USA
| | - Max Bleiweis
- University of Florida College of Medicine, Department of Psychiatry, UF Health Springhill 1, 4037 NW 86th Terrace, Gainesville, FL 32606, USA
| | - Ben Lewis
- University of Florida College of Medicine, Department of Psychiatry, Florida Recovery Center, 4001 SW 13th St., Gainesville, FL 32605, USA
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29
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Høiseth G, Hilberg T, Trydal T, Husa A, Vindenes V, Bogstrand ST. The alcohol marker phosphatidylethanol is closely related to AST, GGT, ferritin and HDL-C. Basic Clin Pharmacol Toxicol 2021; 130:182-190. [PMID: 34591374 DOI: 10.1111/bcpt.13662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the quantitative relation between common clinical chemical analyses and ethanol use, measured by a combination of the two alcohol markers phosphatidylethanol (PEth) and carbohydrate-deficient transferrin (CDT). METHODS Results of PEth and CDT in whole blood and serum, respectively, were included, together with information on 10 different commonly measured clinical chemical analytes, as well as age and sex. PEth was analysed by UPC2 -MS/MS and CDT was measured by capillary electrophoresis. RESULTS Samples from 4873 patients were included. The strongest relation to alcohol consumption as measured by PEth, when correcting for age and sex, was found for HDL-C (standardized β = 0.472, p < 0.001), AST (standardized β = 0.372, p < 0.001), ferritin (standardized β = 0.332, p < 0.001) and GGT (standardized β = 0.325, p < 0.001). The relation to PEth was weak for total cholesterol, TG and ALP. No relation was found for Hb and LDL-C. CONCLUSIONS When using PEth as a marker for alcohol consumption, this study demonstrated the quantitative relation to commonly used test as AST or GGT, but also an important relation to ferritin or HDL-C. In clinical practice, elevated levels of these clinical chemical analytes should initiate further work-up on possibly harmful alcohol use.
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Affiliation(s)
- Gudrun Høiseth
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.,Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | - Vigdis Vindenes
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stig Tore Bogstrand
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
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30
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Letter to the Editor (RE. J Addict Med 2021; 16:e66. [DOI: 10.1097/adm.0000000000000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Hahn JA, Murnane PM, Vittinghoff E, Muyindike WR, Emenyonu NI, Fatch R, Chamie G, Haberer JE, Francis JM, Kapiga S, Jacobson K, Myers B, Couture MC, DiClemente RJ, Brown JL, So-Armah K, Sulkowski M, Marcus GM, Woolf-King S, Cook RL, Richards VL, Molina P, Ferguson T, Welsh D, Piano MR, Phillips SA, Stewart S, Afshar M, Page K, McGinnis K, Fiellin DA, Justice AC, Bryant K, Saitz R. Factors associated with phosphatidylethanol (PEth) sensitivity for detecting unhealthy alcohol use: An individual patient data meta-analysis. Alcohol Clin Exp Res 2021; 45:1166-1187. [PMID: 33837975 PMCID: PMC8254773 DOI: 10.1111/acer.14611] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Objective measurement of alcohol consumption is important for clinical care and research. Adjusting for self-reported alcohol use, we conducted an individual participant data (IPD) meta-analysis to examine factors associated with the sensitivity of phosphatidylethanol (PEth), an alcohol metabolite, among persons self-reporting unhealthy alcohol consumption. METHODS We identified 21 eligible studies and obtained 4073 observations from 3085 participants with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) positive scores (≥3 for women and ≥4 for men) and PEth measurements. We conducted 1-step IPD meta-analysis using mixed effects models with random intercepts for study site. We examined the associations between demographic (sex, race/ethnicity, and age) and biologic (body mass index-BMI, hemoglobin, HIV status, liver fibrosis, and venous versus finger-prick blood collection) variables with PEth sensitivity (PEth≥8 ng/ml), adjusting for the level of self-reported alcohol use using the AUDIT-C score. RESULTS One third (31%) of participants were women, 32% were African, 28% African American, 28% White, and 12% other race/ethnicity. PEth sensitivity (i.e., ≥8 ng/ml) was 81.8%. After adjusting for AUDIT-C, we found no associations of sex, age, race/ethnicity, or method of blood collection with PEth sensitivity. In models that additionally included biologic variables, those with higher hemoglobin and indeterminate and advanced liver fibrosis had significantly higher odds of PEth sensitivity; those with higher BMI and those living with HIV had significantly lower odds of PEth sensitivity. African Americans and Africans had higher odds of PEth sensitivity than whites in models that included biologic variables. CONCLUSIONS Among people reporting unhealthy alcohol use, several biological factors (hemoglobin, BMI, liver fibrosis, and HIV status) were associated with PEth sensitivity. Race/ethnicity was associated with PEth sensitivity in some models but age, sex, and method of blood collection were not. Clinicians should be aware of these factors, and researchers should consider adjusting analyses for these characteristics where possible.
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Affiliation(s)
- Judith A Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Pamela M Murnane
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Winnie R Muyindike
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nneka I Emenyonu
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gabriel Chamie
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Joel M Francis
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Department of Family Medicine and Primary Care, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Saidi Kapiga
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Karen Jacobson
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York, NY, USA
| | - Jennifer L Brown
- Department of Psychology and Psychiatry and Behavioral Neuroscience, Center for Addiction Research, University of Cincinnati, Cincinnati, OH, USA
| | - Kaku So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Mark Sulkowski
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gregory M Marcus
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah Woolf-King
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | | | - Patricia Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Tekeda Ferguson
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - David Welsh
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Internal Medicine, Department of Microbiology, Immunology, & Parasitology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Mariann R Piano
- Center for Research Development and Scholarship, Vanderbilt University, Nashville, TN, USA
| | | | - Scott Stewart
- Department of Family Medicine, Division of Addiction Medicine, University at Buffalo, Buffalo, NY, USA
| | - Majid Afshar
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Kathleen McGinnis
- West Haven VA Healthcare System, United States Department of Veterans Affairs, West Haven, CT, USA
| | - David A Fiellin
- Yale School of Medicine, New Haven, CT, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Amy C Justice
- West Haven VA Healthcare System, United States Department of Veterans Affairs, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Kendall Bryant
- National Institutes of Health, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Grayken Center on Addiction, Boston Medical Center, Boston, MA, USA
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He X, Cao H, Li X, Li Y, Yu Y. MG@PD@TiO 2 nanocomposite based magnetic solid phase extraction coupled with LC-MS/MS for determination of lysophosphatidylcholines biomarkers of plasma in psoriasis patients. J Pharm Biomed Anal 2021; 201:114101. [PMID: 33984829 DOI: 10.1016/j.jpba.2021.114101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/18/2021] [Accepted: 04/22/2021] [Indexed: 12/14/2022]
Abstract
Lysophosphatidylcholine (LPC) was commonly known as a class of significant differential metabolites of high relevance with many diseases including psoriasis, of which the accurate determination is of great importance to diagnosis or prediction to many diseases. However, it is challenging and complicated because of the enormous biological sample complexity and impurities interference. In this study, we synthesized a magnetic nanocomposite MG@PD@TiO2 and took advantage of the interactions of Lewis acid-base between the phosphate groups in LPCs and Ti ions on MG@PD@TiO2 nanomaterials for selective separation and enrichment of LPCs from complex biological matrix. The solid-phase extraction sample pretreatment process by means of MG@PD@TiO2 nanomaterials coupled with LC-MS/MS method was then applied to actual determination of six typical LPCs (LPC 10:0, 14:0, 16:0, 18:0, 18:1, 22:0) in human plasma. The extraction conditions were scientifically optimized by single-factor test (adsorbent amount, adsorption and desorption time, elution solvent type, eluant volume). Under the optimal conditions, the detection limits (LOD, S/N = 3) and quantification limits (LOQ, S/N = 10) were 1 and 5 ng/mL for LPC 10:0 and LPC 14:0, 0.02 and 0.1 ng/mL for LPC 16:0 and LPC 18:1, 0.05 and 0.2 ng/mL LPC 18:0 and LPC 22:0, respectively. The intra- and inter-day precisions were 3.82-12.60 % (n = 6) and 3.29-13.50 % (n = 6) respectively, the recoveries were in the range of 91.92-113.69 % and the stability of the analytes in the matrix performed well with RSDs≤15.51 %. Finally, the developed method was successfully applied to the accurate determination of six LPCs biomarkers of plasma in patients with psoriasis (n = 10) and control groups (n = 10).
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Affiliation(s)
- Xinying He
- Pharmaceutical Analysis Department, School of Pharmacy, Fudan University, Shanghai 201203, Pudong, China
| | - Han Cao
- Pharmaceutical Analysis Department, School of Pharmacy, Fudan University, Shanghai 201203, Pudong, China
| | - Xia Li
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, Pudong, China
| | - Yan Li
- Pharmaceutical Analysis Department, School of Pharmacy, Fudan University, Shanghai 201203, Pudong, China; Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai 201399, China.
| | - Yunqiu Yu
- Pharmaceutical Analysis Department, School of Pharmacy, Fudan University, Shanghai 201203, Pudong, China.
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Skråstad RB, Spigset O, Aamo TO, Andreassen TN. Stability of Phosphatidylethanol 16:0/18:1 in Freshly Drawn, Authentic Samples from Healthy Volunteers. J Anal Toxicol 2021; 45:417-421. [PMID: 32754728 PMCID: PMC8040374 DOI: 10.1093/jat/bkaa082] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/12/2020] [Accepted: 05/29/2020] [Indexed: 11/14/2022] Open
Abstract
Due to its specificity, phosphatidylethanol (PEth) 16:0/18:1 has gained increased popularity as a marker for high alcohol consumption in recent years. As conflicting results regarding the stability of PEth 16:0/18:1 in whole blood have been published, there are still uncertainties related to optimum handling, transport and storage of blood samples for the analysis of PEth 16:0/18:1. A stability study where whole blood samples were drawn from healthy volunteers, who had ingested alcohol, is presented. The samples were collected in tubes with ethylenediamine tetraacetic acid (EDTA) and heparin as additives and stored under standardized conditions within 1 h of blood sampling. Storage times were 28 days in ambient temperature and at 4-8°C, and 90 days at -20°C and -80°C. All samples were analyzed regularly during the storage periods. PEth 16:0/18:1 concentrations were stable (defined as < 15% decrease compared with baseline values) at all temperatures up to 28 days, independent of additive. After 90 days of storage at -20°C, the mean concentrations had decreased by 18.8% in EDTA tubes and by 13.8% in heparin tubes. At -80°C, the concentrations were stable throughout the 90-day period. The present study shows that in samples containing PEth formed in vivo, PEth 16:0/18:1 is stable for 28 days irrespective of storage temperature. During long-term storage, samples should be stored at -80°C.
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Affiliation(s)
- Ragnhild Bergene Skråstad
- Department of Clinical Pharmacology, St. Olavs Hospital, 7006 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Olav Spigset
- Department of Clinical Pharmacology, St. Olavs Hospital, 7006 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Trond Oskar Aamo
- Department of Clinical Pharmacology, St. Olavs Hospital, 7006 Trondheim, Norway
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Finanger T, Spigset O, Gråwe RW, Andreassen TN, Løkken TN, Aamo TO, Bratt GE, Tømmervik K, Langaas VS, Finserås K, Salvesen KÅB, Skråstad RB. Phosphatidylethanol as Blood Biomarker of Alcohol Consumption in Early Pregnancy: An Observational Study in 4,067 Pregnant Women. Alcohol Clin Exp Res 2021; 45:886-892. [PMID: 33586791 DOI: 10.1111/acer.14577] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The teratogenic effects of alcohol are well documented, but there is a lack of screening methods to detect alcohol use during pregnancy. Phosphatidylethanol 16:0/18:1 (PEth) is a specific and sensitive biomarker reflecting alcohol intake up to several weeks after consumption. The aim of this study was to investigate the prevalence of positive PEth values as an indicator of early prenatal alcohol exposure in a general population of pregnant women. METHODS Rhesus typing is routinely performed in Norway in all pregnancies around gestational week 12. Rhesus-negative women have an additional test taken around week 24. Blood samples submitted to St. Olav University Hospital in Trøndelag, Norway, for Rhesus typing during the period September 2017 to October 2018 were collected. A total of 4,533 whole blood samples from 4,067 women were analyzed for PEth (limit of quantification of 0.003 µM). RESULTS Fifty-eight women had a positive PEth sample. Of these, 50 women were positive around gestational week 12, 3 women were positive around week 24, and in 5 cases, the timing was unknown. There were no significant differences in proportions of women with positive PEth values related to age, or rural versus urban residency. CONCLUSION In an unselected pregnant population in Norway, 1.4% had a positive PEth sample around gestational week 12, whereas 0.4% had a positive sample around week 24. The use of PEth as an alcohol biomarker should be further investigated as a diagnostic tool in the antenatal setting.
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Affiliation(s)
- Trine Finanger
- Clinic of Substance Use and Addiction Medicine, St. Olav University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology - NTNU, Trondheim, Norway
| | - Olav Spigset
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.,Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Rolf W Gråwe
- Department of Research and Development, Division of Mental Health, St. Olav University Hospital, Trondheim, Norway.,Department of Mental Health, Norwegian University of Science and Technology - NTNU, Trondheim, Norway
| | - Trine N Andreassen
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Trine N Løkken
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Trond O Aamo
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Guro E Bratt
- Clinic of Laboratory Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Kristin Tømmervik
- Clinic of Substance Use and Addiction Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Vibeke S Langaas
- Department of Immunology and Transfusion Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Kristin Finserås
- Department of Immunology and Transfusion Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Kjell Å B Salvesen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.,Department of Obstetrics and Gynecology, St. Olav University Hospital, Trondheim, Norway
| | - Ragnhild B Skråstad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.,Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
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Cherrier MM, Shireman LM, Wicklander K, Yeung W, Kooner P, Saxon AJ, Simpson T, Terman G, Shen D. Relationship of Phosphatidylethanol Biomarker to Self-Reported Alcohol Drinking Patterns in Older and Middle-Age Adults. Alcohol Clin Exp Res 2020; 44:2449-2456. [PMID: 33038267 PMCID: PMC8476046 DOI: 10.1111/acer.14475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Risky alcohol consumption is on the rise among older adults. Biomarkers such as phosphatidylethanol (PEth) have been used to evaluate the correspondence between an objective, laboratory-based biomarker and self-report of alcohol consumption. This study examined the relationship between PEth, self-report of alcohol consumption, and health indices in a sample of community-dwelling older to middle-age adults (aged 35 to 89) with healthy and risky levels of alcohol consumption. METHODS Self-reports of alcohol consumption were collected using the Alcohol Use Disorders Identification Test (AUDIT) and Form 30. In addition, indices of health along with a blood sample to determine PEth values were collected (N = 183). RESULTS PEth was correlated with age, AUDIT-C, AUDIT total, alcohol consumption, mood, and liver function measures but not with medical comorbidity or body mass index (J Gerontol B Psychol Sci Soc Sci 73, 2018, 633). Alcohol consumption over the past 30 days measured with Form 30 was the strongest predictor of PEth levels for both middle-age and older adults, with age a small contributing predictor. General alcohol consumption patterns for amount of alcohol consumed over a 30-day period revealed middle-age adults consumed larger amounts of alcohol compared with older adults, but older adults consumed alcohol on more days than middle-age adults. Middle-age participants evidenced higher PEth levels than older adults at comparable drinking rates. CONCLUSIONS Overall, findings suggest a strong relationship between alcohol consumption and PEth levels with age a small but contributing factor to predicting PEth levels.
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Affiliation(s)
- Monique M Cherrier
- From the, Department of Psychiatry and Behavioral Sciences, (MMC, KW, WY, AJS, TS), School of Medicine University of Washington, Seattle, Washington
| | - Laura M Shireman
- Department of Pharmaceutics, (LMS, DS), School of Pharmacy, University of Washington, Seattle, Washington
| | - Katie Wicklander
- From the, Department of Psychiatry and Behavioral Sciences, (MMC, KW, WY, AJS, TS), School of Medicine University of Washington, Seattle, Washington
| | - Winnie Yeung
- From the, Department of Psychiatry and Behavioral Sciences, (MMC, KW, WY, AJS, TS), School of Medicine University of Washington, Seattle, Washington
| | - Preetma Kooner
- Department of Anesthesiology and Pain Medicine, (PK, GT), School of Medicine, University of Washington, Seattle, Washington
| | - Andrew J Saxon
- From the, Department of Psychiatry and Behavioral Sciences, (MMC, KW, WY, AJS, TS), School of Medicine University of Washington, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education VA Puget Sound Health Care System, (AJS, TS), Seattle, Washington
| | - Tracy Simpson
- From the, Department of Psychiatry and Behavioral Sciences, (MMC, KW, WY, AJS, TS), School of Medicine University of Washington, Seattle, Washington
- Center of Excellence in Substance Addiction Treatment and Education VA Puget Sound Health Care System, (AJS, TS), Seattle, Washington
| | - Greg Terman
- Department of Anesthesiology and Pain Medicine, (PK, GT), School of Medicine, University of Washington, Seattle, Washington
| | - Danny Shen
- Department of Pharmaceutics, (LMS, DS), School of Pharmacy, University of Washington, Seattle, Washington
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Årving A, Høiseth G, Hilberg T, Trydal T, Husa A, Djordjevic A, Kabashi S, Vindenes V, Bogstrand ST. Comparison of the Diagnostic Value of Phosphatidylethanol and Carbohydrate‐Deficient Transferrin as Biomarkers of Alcohol Consumption. Alcohol Clin Exp Res 2020; 45:153-162. [DOI: 10.1111/acer.14503] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Alexander Årving
- From the Department of Forensic Sciences (AÅ, GH, SK, VV, STB) Oslo University Hospital Oslo Norway
| | - Gudrun Høiseth
- From the Department of Forensic Sciences (AÅ, GH, SK, VV, STB) Oslo University Hospital Oslo Norway
- Faculty of Medicine (GH, SK, VV) Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Thor Hilberg
- Fürst Medisinsk Laboratorium (TH, TT, AH, AD) Oslo Norway
| | - Torleif Trydal
- Fürst Medisinsk Laboratorium (TH, TT, AH, AD) Oslo Norway
| | - Asgeir Husa
- Fürst Medisinsk Laboratorium (TH, TT, AH, AD) Oslo Norway
| | | | - Saranda Kabashi
- From the Department of Forensic Sciences (AÅ, GH, SK, VV, STB) Oslo University Hospital Oslo Norway
- Faculty of Medicine (GH, SK, VV) Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Vigdis Vindenes
- From the Department of Forensic Sciences (AÅ, GH, SK, VV, STB) Oslo University Hospital Oslo Norway
- Faculty of Medicine (GH, SK, VV) Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Stig Tore Bogstrand
- From the Department of Forensic Sciences (AÅ, GH, SK, VV, STB) Oslo University Hospital Oslo Norway
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Richards VL, Sajdeya R, Villalba K, Wang Y, Bryant V, Brumback B, Bryant K, Hahn JA, Cook RL. Secondary Analysis of a Randomized Clinical Trial of Naltrexone Among Women Living With HIV: Correlations Between Reductions in Self-Reported Alcohol Use and Changes in Phosphatidylethanol. Alcohol Clin Exp Res 2020; 45:174-180. [PMID: 33190242 DOI: 10.1111/acer.14515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Direct biomarkers such as phosphatidylethanol (PEth) have the capability to detect heavy alcohol use, but it is unclear how strongly self-reported reduction in alcohol use correlates with reduction in PEth. We sought to explore the strength of correlation between reductions in self-reported alcohol use and change in PEth among a sample of women living with HIV (WLWH) who participated in a clinical trial to reduce heavy alcohol use. We also sought to determine whether this correlation was stronger in women with lower body mass index (BMI) and women without an alcohol use disorder (AUD). METHODS 81 WLWH (mean age = 48.7, 80% Black) engaging in a randomized trial of naltrexone versus placebo with a positive baseline PEth (≥8 ng/ml), and alcohol use data at baseline, 2, and 7 months were included in this analysis. Spearman correlation coefficients were compared to measure the correlation between baseline PEth and number of drinks per week by demographic, biological, and alcohol use factors. Mini-International Neuropsychiatric Interview was used to screen for AUD. Further analyses were stratified by BMI and AUD. Spearman correlation coefficients were calculated for the change in PEth and the change in number of drinks per week over 7 months, including 3 time-points: baseline, 2, and 7 months. RESULTS At baseline, the correlation between baseline PEth and the number of drinks per week was significantly stronger for those with a BMI ≤25 compared to those with a BMI > 25 (r = 0.66; r = 0.26, respectively). Similarly, the correlation between baseline PEth and number of drinks was stronger for those who did not screen positive for AUD compared with those who did (r = 0.66; r = 0.25, respectively). When stratifying by BMI, a low-to-moderate correlation (r = 0.32, p = 0.02) was present for persons with a BMI > 25; when stratifying by AUD, a moderate correlation (r = 0.50, p < 0.01) was present for persons without an AUD between 0 and 2 months only. CONCLUSIONS In this sample of WLWH, BMI and AUD affected the strength of correlation between PEth and drinks per week. Future work examining changes in PEth over time in broader populations is needed, particularly to understand the sex differences in PEth levels.
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Affiliation(s)
- Veronica L Richards
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
| | - Ruba Sajdeya
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
| | - Karina Villalba
- Robert Stempel College of Public Health and Social Work, (KV), Florida International University, Miami, Florida
| | - Yan Wang
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
| | - Vaughn Bryant
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
| | - Babette Brumback
- Department of Biostatistics, (BB), University of Florida, Gainesville, Florida
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, (KB), Bethesda, Maryland
| | - Judith A Hahn
- Department of Medicine, (JAH), University of California, San Francisco, California
| | - Robert L Cook
- From the, Department of Epidemiology, (VLR, RS, YW, VB, RLC), University of Florida, Gainesville, Florida
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Tsanaclis L, Davies M, Bevan S, Nutt J, Bagley K, Wicks J. Testing venous carbohydrate-deficient transferrin or capillary phosphatidylethanol with concurrent ethyl glucuronide and ethyl palmitate hair tests to assess historical and recent alcohol use. Drug Test Anal 2020; 13:203-207. [PMID: 33025638 DOI: 10.1002/dta.2939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 11/07/2022]
Abstract
Hair biomarkers, ethyl glucuronide (EtG) and ethyl palmitate (EtPa), together with blood biomarker tests, carbohydrate-deficient transferrin (CDT) or phosphatidylethanol (PEth), are commonly used in identifying patterns of alcohol consumption as they possess different windows of detection. The detection of EtG in hair samples is mainly used in combination with EtPa when hair cosmetic treatments such as hair colouring and bleaching affect EtG levels. The main purpose of our study was to investigate the differences in frequency distribution of positive CDT and PEth results indicating alcohol had been used, when EtG and EtPa were not detected, where evidence of abstinence is paramount. Of the total 602 cases, for 179 (29.7%), neither EtG nor EtPa markers were detected. Of these, 0.5% of the cases produced positive CDT. However, 18.6% produced positive PEth, a significantly higher proportion. A similar pattern emerges when results are evaluated according to whether hair had been either cosmetically treated or untreated. When hair was untreated, one case produced positive CDT, and 19.3% were positive for PEth (median of 51 ng/ml). No cases of positive CDT results, but 20.8% of PEth were positive (median of 106.5 ng/ml) when hair samples had been cosmetically treated. Whether EtG or EtPa markers were detected or not, significantly higher proportions of PEth than CDT were seen. The results of this study substantiate the case for using hair EtG in conjunction with a PEth test, rather than CDT test, for efficient monitoring of recent and historical alcohol consumption.
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Affiliation(s)
- Lolita Tsanaclis
- Cansford Laboratories Limited, 1A Pentwyn Business Centre, Cardiff, UK
| | - Marie Davies
- Cansford Laboratories Limited, 1A Pentwyn Business Centre, Cardiff, UK
| | - Sian Bevan
- Cansford Laboratories Limited, 1A Pentwyn Business Centre, Cardiff, UK
| | - James Nutt
- Cansford Laboratories Limited, 1A Pentwyn Business Centre, Cardiff, UK
| | - Kim Bagley
- Cansford Laboratories Limited, 1A Pentwyn Business Centre, Cardiff, UK
| | - John Wicks
- Cansford Laboratories Limited, 1A Pentwyn Business Centre, Cardiff, UK
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Gerbase FE, Tegner M, Krutzmann ME, Muller VV, Alff JDA, da Silva VB, Sagrilo OP, Linden R, Antunes MV. Blood phosphatidyl ethanol levels as a tool to detect alcohol misuse in trauma patients. Clin Toxicol (Phila) 2020; 59:418-425. [PMID: 33021410 DOI: 10.1080/15563650.2020.1822531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION There is a strong need for a reliable marker of harmful alcohol consumption to identify injured patients that can benefit from alcohol interventions, and blood phosphatidyl ethanol (PEth) has not previously been tested on this population. This study aims to compare the performance of blood PEth concentration, blood alcohol concentration (BAC) and the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) for the screening of alcohol misuse in trauma patients. METHODS Prospective cross-sectional study of 238 adult patients presenting in the emergency department with any type of trauma. PEth concentration was determined in whole blood by high-performance liquid chromatography with tandem mass spectrometry. Consent, AUDIT-C score and demographic data were obtained. RESULTS The sample consisted of majority male (67.6%), single (46.2%) and employed (66%) patients. The most common type of trauma was traffic collision (63.9%). The mean age was 41.7 years. We found a significant correlation between PEth levels with AUDIT-C score (Spearman's r = 0.654; p < .0001). PEth had an area under the ROC curve of 0.885 to detect hazardous alcohol consumption (AUDIT-C score ≥ 6) and PEth ≥23.9 ng/mL cutoff point provided 91.2% of sensitivity and 78.4% of specificity. Twelve patients reported alcohol abstinence, but had quantifiable levels of PEth. CONCLUSIONS PEth levels and AUDIT-C score had a moderate correlation in our population. PEth was useful to identify 12 cases of underreporting of alcohol consumption habits. PEth shows promising results, but more research is needed to identify the best screening tool for alcohol misuse in trauma patients.
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Affiliation(s)
- Fernando Engel Gerbase
- Postgraduate Program on Toxicology and Analytical Toxicology, Universidade Feevale, Novo Hamburgo, Brazil.,Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil.,Emergency Department, Novo Hamburgo Municipal Hospital, Novo Hamburgo, Brazil
| | - Mariane Tegner
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Maria Eduarda Krutzmann
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Victória Vendramini Muller
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Jonatan de Andrade Alff
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Vanessa Becher da Silva
- Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | | | - Rafael Linden
- Postgraduate Program on Toxicology and Analytical Toxicology, Universidade Feevale, Novo Hamburgo, Brazil.,Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
| | - Marina Venzon Antunes
- Postgraduate Program on Toxicology and Analytical Toxicology, Universidade Feevale, Novo Hamburgo, Brazil.,Laboratory of Analytical Toxicology, Institute of Health Sciences, Universidade Feevale, Novo Hamburgo, Brazil
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40
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Reisfield GM, Teitelbaum SA, Opie SO, Jones J, Morrison DG, Lewis B. The roles of phosphatidylethanol, ethyl glucuronide, and ethyl sulfate in identifying alcohol consumption among participants in professionals health programs. Drug Test Anal 2020; 12:1102-1108. [PMID: 32309913 DOI: 10.1002/dta.2809] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/11/2022]
Abstract
Direct alcohol biomarkers, including urinary ethyl glucuronide (EtG), urinary ethyl sulfate (EtS), and blood phosphatidylethanol (PEth), are used to monitor alcohol abstinence in individuals who are mandated to abstain. In this consecutive case series study, we examined 1000 forensic reports of participants enrolled in a professionals health program who were contractually obligated to abstain from alcohol and who underwent recovery status evaluations. We identified 52 evaluations in which urinary EtG, EtS, and blood PEth were measured and which produced a positive result for at least one of these analytes. PEth, at a cutoff concentration of 20 ng/mL, revealed alcohol use more frequently than EtG or EtS at our laboratory's cutoff concentrations of 100 and 25 ng/mL, respectively. This was true, as well, at alternative EtG/EtS cutoff concentrations of 200/50, 300/75, and 400/100 ng/mL. PEth was more likely than EtG/EtS to be positive in participants previously diagnosed with alcohol use disorders (AUD), whereas EtG/EtS was more likely than PEth to be positive in participants without AUD. In this study, blood PEth was the most sensitive biomarker for evidencing alcohol use.
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Affiliation(s)
- Gary M Reisfield
- Division of Addiction Medicine, Department of Psychiatry, University of Florida College of Medicine, 4037 NW 86th Terrace, Gainesville, Florida, FL 32606, USA
| | - Scott A Teitelbaum
- Division of Addiction Medicine, Department of Psychiatry, University of Florida College of Medicine, 4037 NW 86th Terrace, Gainesville, Florida, FL 32606, USA
| | - Shannon O Opie
- Florida Intervention Project for Nurses, Jacksonville Beach, Florida, FL 32240, USA
| | - Joseph Jones
- United States Drug Testing Laboratories, Des Plaines, Illinois, USA
| | - Deborah G Morrison
- Division of Addiction Medicine, Department of Psychiatry, University of Florida College of Medicine, 4037 NW 86th Terrace, Gainesville, Florida, FL 32606, USA
| | - Ben Lewis
- Division of Addiction Medicine, Department of Psychiatry, University of Florida College of Medicine, 4037 NW 86th Terrace, Gainesville, Florida, FL 32606, USA
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Abstract
BACKGROUND Alcohol is consumed by over 2 billion people worldwide. It is a common substance of abuse and its use can lead to more than 200 disorders including hypertension. Alcohol has both acute and chronic effects on blood pressure. This review aimed to quantify the acute effects of different doses of alcohol over time on blood pressure and heart rate in an adult population. OBJECTIVES Primary objective To determine short-term dose-related effects of alcohol versus placebo on systolic blood pressure and diastolic blood pressure in healthy and hypertensive adults over 18 years of age. Secondary objective To determine short-term dose-related effects of alcohol versus placebo on heart rate in healthy and hypertensive adults over 18 years of age. SEARCH METHODS The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to March 2019: the Cochrane Hypertension Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 2), in the Cochrane Library; MEDLINE (from 1946); Embase (from 1974); the World Health Organization International Clinical Trials Registry Platform; and ClinicalTrials.gov. We also contacted authors of relevant articles regarding further published and unpublished work. These searches had no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing effects of a single dose of alcohol versus placebo on blood pressure (BP) or heart rate (HR) in adults (≥ 18 years of age). DATA COLLECTION AND ANALYSIS Two review authors (ST and CT) independently extracted data and assessed the quality of included studies. We also contacted trial authors for missing or unclear information. Mean difference (MD) from placebo with 95% confidence interval (CI) was the outcome measure, and a fixed-effect model was used to combine effect sizes across studies. MAIN RESULTS: We included 32 RCTs involving 767 participants. Most of the study participants were male (N = 642) and were healthy. The mean age of participants was 33 years, and mean body weight was 78 kilograms. Low-dose alcohol (< 14 g) within six hours (2 RCTs, N = 28) did not affect BP but did increase HR by 5.1 bpm (95% CI 1.9 to 8.2) (moderate-certainty evidence). Medium-dose alcohol (14 to 28 g) within six hours (10 RCTs, N = 149) decreased systolic blood pressure (SBP) by 5.6 mmHg (95% CI -8.3 to -3.0) and diastolic blood pressure (DBP) by 4.0 mmHg (95% CI -6.0 to -2.0) and increased HR by 4.6 bpm (95% CI 3.1 to 6.1) (moderate-certainty evidence for all). Medium-dose alcohol within 7 to 12 hours (4 RCTs, N = 54) did not affect BP or HR. Medium-dose alcohol > 13 hours after consumption (4 RCTs, N = 66) did not affect BP or HR. High-dose alcohol (> 30 g) within six hours (16 RCTs, N = 418) decreased SBP by 3.5 mmHg (95% CI -6.0 to -1.0), decreased DBP by 1.9 mmHg (95% CI-3.9 to 0.04), and increased HR by 5.8 bpm (95% CI 4.0 to 7.5). The certainty of evidence was moderate for SBP and HR, and was low for DBP. High-dose alcohol within 7 to 12 hours of consumption (3 RCTs, N = 54) decreased SBP by 3.7 mmHg (95% CI -7.0 to -0.5) and DBP by 1.7 mmHg (95% CI -4.6 to 1.8) and increased HR by 6.2 bpm (95% CI 3.0 to 9.3). The certainty of evidence was moderate for SBP and HR, and low for DBP. High-dose alcohol ≥ 13 hours after consumption (4 RCTs, N = 154) increased SBP by 3.7 mmHg (95% CI 2.3 to 5.1), DBP by 2.4 mmHg (95% CI 0.2 to 4.5), and HR by 2.7 bpm (95% CI 0.8 to 4.6) (moderate-certainty evidence for all). AUTHORS' CONCLUSIONS: High-dose alcohol has a biphasic effect on BP; it decreases BP up to 12 hours after consumption and increases BP > 13 hours after consumption. High-dose alcohol increases HR at all times up to 24 hours. Findings of this review are relevant mainly to healthy males, as only small numbers of women were included in the included trials.
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Affiliation(s)
- Sara Tasnim
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Chantel Tang
- Faculty of Health Sciences, McGill University, Montreal, Canada
| | - Vijaya M Musini
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - James M Wright
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
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42
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Ferguson TF, Theall KP, Brashear M, Maffei V, Beauchamp A, Siggins RW, Simon L, Mercante D, Nelson S, Welsh DA, Molina PE. Comprehensive Assessment of Alcohol Consumption in People Living with HIV (PLWH): The New Orleans Alcohol Use in HIV Study. Alcohol Clin Exp Res 2020; 44:1261-1272. [PMID: 32441814 DOI: 10.1111/acer.14336] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND High frequency of alcohol use among people living with HIV (PLWH) warrants careful assessment and screening to better understand its impact on HIV disease progression and development of comorbidities. Due to the limitations of the tools used to measure alcohol use, the links to health consequences are not fully understood. METHODS We completed a cross-sectional analysis to examine the prevalence of alcohol consumption using multiple alcohol assessment tools and their correlation and consistency in a cohort of PLWH (N = 365) enrolled in the New Orleans Alcohol Use in HIV (NOAH) Study. Alcohol use was assessed with the Alcohol Use Disorders Identification Test (AUDIT), timeline followback (TLFB) Calendar, lifetime drinking history, Alcohol and Drug Addiction Severity Index, and blood levels of phosphatidylethanol (PEth). Spearman's correlations were estimated for continuous measures of alcohol consumption; Wilcoxon rank-sum tests were used to compare means; and logistic regression was used to estimate odds of alcohol use by demographic characteristics. RESULTS Self-report of current alcohol use varied from 58.9 to 73.7% depending on the assessment. All the self-reported alcohol measures showed statistically significant correlations with the biological marker PEth. The highest correlation was with TLFB grams (r = 0.67, p < 0.001). Using TLFB, 73.7% of the cohort reported using alcohol in the last 30 days, and 61.6% had a positive PEth value. The prevalence of risky drinkers, meeting the TLFB > 3 (women) or >4 (men) drinks/day or>7 (women) or>14 (men) drinks/week, was 49.0%. Medium-risk drinking defined as an AUDIT score ≥ 8 was reported in 40.3%, and high-risk drinkers/probable AUD (AUDIT score ≥ 16) was met by 17.0% of the cohort. CONCLUSIONS Our results demonstrate the importance of comprehensive assessments for alcohol use, including self-report via multiple assessment tools administered by trained staff, as well as the addition of biomarkers for improved classification of subjects into different drinking categories.
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Affiliation(s)
- Tekeda F Ferguson
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Katherine P Theall
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Meghan Brashear
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Vincent Maffei
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Microbiology, Immunology, & Parasitology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans,, Louisiana
| | - Alaina Beauchamp
- Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Robert W Siggins
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Liz Simon
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Donald Mercante
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Steve Nelson
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Pulmonology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - David A Welsh
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Pulmonology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Patricia E Molina
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Neumann J, Beck O, Helander A, Böttcher M. Performance of PEth Compared With Other Alcohol Biomarkers in Subjects Presenting For Occupational and Pre-Employment Medical Examination. Alcohol Alcohol 2020; 55:401-408. [PMID: 32363383 PMCID: PMC7338721 DOI: 10.1093/alcalc/agaa027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 01/16/2023] Open
Abstract
Aims To compare the performance of short- and long-term alcohol biomarkers for the evaluation of alcohol drinking in employment-related health controls. Methods The 519 blood samples originated from 509 patients (80% men) presenting at occupational health units and medical centers at employment agencies for the evaluation of risky drinking. The laboratory investigation comprised the measurement of phosphatidylethanol (PEth 16:0/18:1), carbohydrate-deficient transferrin (CDT; % disialotransferrin), gamma-glutamyl transferase (GGT), mean corpuscular volume (MCV), ethanol and ethyl glucuronide (EtG). Results Many samples tested positive for acute (57%) and chronic (69%) alcohol biomarkers. PEth was the single most positive biomarker (64%; cut-off 0.05 μmol/l or 35 μg/l) and the only positive chronic biomarker in 100 cases. The highest PEth concentrations were seen in samples positive for all chronic biomarkers, followed by those also being CDT positive (cut-off 2.0%). All 126 CDT-positive samples were positive for PEth using the lower reporting limit (≥0.05 μmol/l) and for 114 cases (90%) also using the higher limit (≥0.30 μmol/l or 210 μg/l). In the CDT-positive cases, the PEth median concentration was 1.71 μmol/l, compared with 0.45 μmol/l for the CDT-negative cases (P < 0.0001). PEth and CDT values were correlated significantly (r = 0.63, P < 0.0001). Among the EtG-positive cases (≥1.0 ng/ml), 95% were also PEth positive, and all ethanol-positive cases (≥0.10 g/l) were also PEth positive. Conclusions For optimal detection of drinking habits, using a combination of short- and long-term alcohol biomarkers provided best information. PEth was the single most positive alcohol biomarker, whereas GGT and MCV offered little additional value over PEth and CDT.
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Affiliation(s)
- Jasna Neumann
- MVZ Labor Dessau GmbH, Bauhüttenstrasse 6, D-06847 Dessau-Roßlau, Germany
| | - Olof Beck
- MVZ Labor Dessau GmbH, Bauhüttenstrasse 6, D-06847 Dessau-Roßlau, Germany.,Department of Clinical Neuroscience, CPF, Norra Stationsgatan 69, Karolinska Institutet, Stockholm, SE-171 77, Sweden
| | - Anders Helander
- Department of Laboratory Medicine, C1:74, Karolinska University Hospital, Karolinska Institutet, Stockholm, SE-141 86, Sweden
| | - Michael Böttcher
- MVZ Labor Dessau GmbH, Bauhüttenstrasse 6, D-06847 Dessau-Roßlau, Germany
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44
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Helander A, Hermansson U, Beck O. Dose-Response Characteristics of the Alcohol Biomarker Phosphatidylethanol (PEth)-A Study of Outpatients in Treatment for Reduced Drinking. Alcohol Alcohol 2020; 54:567-573. [PMID: 31529064 DOI: 10.1093/alcalc/agz064] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/13/2019] [Accepted: 07/02/2019] [Indexed: 12/25/2022] Open
Abstract
AIM Measurement of whole-blood phosphatidylethanol (PEth) offers high sensitivity and specificity as alcohol biomarker. A remaining issue of importance for the routine application is to better establish the relationship between PEth concentration and amount and duration of drinking. METHODS The study included 36 subjects (32-83 years) voluntarily attending outpatient treatment for reduced drinking. At ~ 3- to 4-week intervals, they provided a diary on their daily alcohol intake and gave blood samples for measurement of PEth and carbohydrate-deficient transferrin (CDT). Whole-blood PEth 16:0/18:1 was measured by liquid chromatography-tandem mass spectrometry and serum CDT (%disialotransferrin) by high-performance liquid chromatography. RESULTS At start, the self-reported past 2-week alcohol intake ranged 0-1260 (median 330) g ethanol, the PEth 16:0/18:1 concentration ranged 0.05-1.20 (median 0.23) μmol/L, and the CDT value ranged 0.7-13.0% (median 1.5%). At the final sampling after 5-20 (median 12) weeks, neither reported alcohol intake nor PEth and CDT levels differed significantly from the starting values. The PEth concentration showed best association with past 2-week drinking, followed by for intake in the next last week. The changes in PEth concentration vs past 2-week alcohol intake between two successive tests revealed that an increased ethanol intake by ~ 20 g/day elevated the PEth concentration by on average ~ 0.10 μmol/L, and vice versa for decreased drinking. CONCLUSIONS The PEth concentration correlated well with past weeks alcohol intake, albeit with a large inter-individual scatter. This indicates that it is possible to make only approximate estimates of drinking based on a single PEth value, implying risk for misclassification between moderate and heavy drinking.
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Affiliation(s)
- Anders Helander
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden.,Division of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Ulric Hermansson
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm Centre for Dependence Disorders, Stockholm Health Care Services Riddargatan 1, Stockholm, Sweden
| | - Olof Beck
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
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45
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Reisinger A, Rabensteiner J, Hackl G. Diagnosis of acute intoxications in critically ill patients: focus on biomarkers - part 2: markers for specific intoxications. Biomarkers 2020; 25:112-125. [PMID: 32011177 DOI: 10.1080/1354750x.2020.1725787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In medical intensive care units, acute intoxications contribute to a large proportion of all patients. Epidemiology and a basic overview on this topic were presented in part one. The purpose of this second part regarding toxicological biomarkers in the ICU setting focuses on specific poisons and toxins. Following the introduction of anion and osmol gap in part one, it's relevance in toxic alcohols and other biomarkers for these poisonings are presented within this publication. Furthermore, the role of markers in the blood, urine and cerebrospinal fluid for several intoxications is evaluated. Specific details are presented, amongst others, for cardiovascular drug poisoning, paracetamol (acetaminophen), ethanol, pesticides, ricin and yew tree intoxications. Detailed biomarkers and therapeutic decision tools are shown for carbon monoxide (CO) and cyanide (CN-) poisoning. Also, biomarkers in environmental toxicological situations such as mushroom poisoning and scorpion stings are presented.
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Affiliation(s)
- Alexander Reisinger
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Gerald Hackl
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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46
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Harmful alcohol use among acutely ill hospitalized medical patients in Oslo and Moscow: A cross-sectional study. Drug Alcohol Depend 2019; 204:107588. [PMID: 31590131 DOI: 10.1016/j.drugalcdep.2019.107588] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 07/03/2019] [Accepted: 08/09/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim was to estimate the prevalence of harmful alcohol use in relation to socio-demographic characteristics among acutely ill medical patients, and examine identification measures of alcohol use, including the alcohol biomarker phosphatidylethanol 16:0/18:1 (PEth). METHODS A cross-sectional study, lasting one year at one hospital in Oslo, Norway and one in Moscow, Russia recruiting acute medically ill patients (≥ 18 years), able to give informed consent. Self-reported data on socio-demographics, mental distress (Symptom Check List-5), alcohol use (Alcohol Use Disorder Identification Test-4 (AUDIT-4) and alcohol consumption past 24 h were collected. PEth and alcohol concentration were measured in whole blood. RESULTS Of 5883 participating patients, 19.2% in Moscow and 21.1% in Oslo were harmful alcohol users, measured by AUDIT-4, while the prevalence of PEth-positive patients was lower: 11.4% in Oslo, 14.3% in Moscow. Men in Moscow were more likely to be harmful users by AUDIT-4 and PEth compared to men in Oslo, except of those being ≥ 71 years. Women in Oslo were more likely to be harmful users compared to those in Moscow by AUDIT-4, but not by PEth for those aged < 61 years. CONCLUSIONS The prevalence of harmful alcohol use was high at both study sites. The prevalence of harmful alcohol use was lower when assessed by PEth compared to AUDIT-4. Thus, self-reporting was the most sensitive measure in revealing harmful alcohol use among all groups except for women in Moscow. Hence, screening and identification with objective biomarkers and self-reporting might be a method for early intervention.
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47
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Stenton J, Walther L, Hansson T, Andersson A, Isaksson A. Inter Individual Variation and Factors Regulating the Formation of Phosphatidylethanol. Alcohol Clin Exp Res 2019; 43:2322-2331. [PMID: 31509266 DOI: 10.1111/acer.14195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alcohol use disorders are a major but often unrecognized health problem. Alcohol markers can therefore be of great value for diagnosis, follow-up, and treatment evaluation. Phosphatidylethanol in blood (B-PEth) is an alcohol biomarker with higher clinical sensitivity and specificity than commonly used alcohol markers but has shown a considerable interindividual variation in relation to reported consumption. METHODS An in vitro system was used to investigate factors, which may affect the formation rate of PEth or which may give rise to interindividual variation in the rate of formation. In this system, isolated erythrocytes from 31 individuals were incubated in the presence of various concentrations of ethanol (EtOH). The concentration of PEth and phosphatidylcholine (PC), the parent molecule of PEth, was determined by chromatographic methods. RESULTS Time, EtOH, and PC concentration were major factors determining the amount of PEth formed. The interindividual variation in PEth formation rate, calculated at an EtOH concentration of 50 mmol/l, showed a coefficient of variation (CV) from 23 to 31% for the different PEth forms studied (PEth 16:0/18:2, total PEth and PEth 16:0/18:1). The concentration of PC was found to be an important determinant of this variation. The formation rate for PEth 16:0/18:2 was somewhat higher than for PEth 16:0/18:1. The formation of PEth 16:0/18:1 but not PEth 16:0/18:2 showed a positive correlation to the concentration of PEth at baseline (endogenous PEth). Calculation of enzyme kinetics for the reaction resulting in the formation of PEth 16:0/18:1 or PEth 16:0/18:2 showed an apparent Km (Michaelis constant) of approximately 160 to 170 mmol/l. CONCLUSIONS Interindividual variation in the formation rate of PEth appears to be a significant but relatively modest source of variation in the relation between B-PEth and reported consumption. Correction for interindividual variation in PC concentrations might substantially reduce the interindividual variability in PEth formation and consequently in B-PEth.
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Affiliation(s)
- Joanna Stenton
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, University Hospital, Lund, Sweden
| | - Lisa Walther
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, University Hospital, Lund, Sweden
| | - Therese Hansson
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, University Hospital, Lund, Sweden
| | - Anders Andersson
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, University Hospital, Lund, Sweden
| | - Anders Isaksson
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, University Hospital, Lund, Sweden
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48
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Design of a randomized controlled trial examining the efficacy of oxytocin to enhance alcohol behavioral couple therapy. Contemp Clin Trials 2019; 82:1-8. [PMID: 31063869 DOI: 10.1016/j.cct.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/20/2019] [Accepted: 05/02/2019] [Indexed: 12/15/2022]
Abstract
Combining pharmacological interventions with evidence-based behavioral interventions may help optimize treatment outcomes for alcohol use disorder (AUD). While several effective behavioral interventions for AUD have been developed, the vast majority target individual patients, despite evidence that behavioral interventions for couples have the ability to outperform individual treatments for AUD. Alcohol Behavioral Couples Therapy (ABCT) is an evidence-based behavioral intervention for couples that has been shown to significantly reduce AUD severity as well as improve relationship functioning. Accumulating evidence suggests that the neuropeptide oxytocin has the ability to reduce alcohol craving and consumption, symptoms of tolerance and withdrawal, and ameliorate neurobiological deficits associated with AUD. Furthermore, oxytocin has demonstrated the ability to increase prosocial behavior and cognition, and restore sensitivity to natural rewards such as interpersonal relationships. No study to date has examined the ability of oxytocin to enhance ABCT. Thus, the primary objective of this Phase II study is to examine the effects of oxytocin versus placebo in combination with ABCT in reducing AUD severity and improving relationship functioning. We also will utilize neuroimaging techniques before and after treatment to investigate the underlying pathophysiology of AUD among couples and identify prognostic indicators of treatment outcome. The findings from this study might provide critical new information to help inform clinical practice and accelerate research on the pharmacological treatment of AUD.
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49
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Howlett H, Mackenzie S, Gray WK, Rankin J, Nixon L, Brown NW. Assessing the prevalence of alcohol consumption in early pregnancy using blood biomarker analysis: a consistent pattern across north-east England? J Public Health (Oxf) 2019; 42:e74-e80. [DOI: 10.1093/pubmed/fdz039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/20/2019] [Accepted: 03/19/2019] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
We previously investigated the prevalence of alcohol consumption in early pregnancy in Northumbria Healthcare NHS Foundation Trust, a locality of north-east England. The prevalence was 1.4% based on blood sample biomarker analysis using carbohydrate deficient transferrin (CDT) and 3.5% for gamma-glutamyltransferase (GGT).
Aims
To supplement this research by investigating the prevalence of alcohol use using identical methods in a different locality of the same region.
Methods
Six-hundred random blood samples taken at the antenatal booking appointment were anonymously analysed for the presence of CDT, a validated marker of chronic alcohol exposure (normalizing 2–3 weeks from abstinence) and GGT, a liver enzyme elevated for up to 8 weeks after alcohol exposure.
Results
The North Tees and Hartlepool NHS Foundation Trust data revealed a CDT prevalence rate of 1.7% (95% CI: 0.7–2.9) and GGT prevalence rate of 4.2% (95% CI: 2.6–5.9). However, these measures are not sensitive to low levels of alcohol; and no overlapping cases were identified or a significant correlation demonstrated between CDT or GGT.
Discussion
These data support our earlier work. Prevalence rates according to CDT and GGT analysis were similar in both areas, suggesting similar patterns of sustained alcohol use in pregnancy across the region.
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Affiliation(s)
- Helen Howlett
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Shonag Mackenzie
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Leanne Nixon
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Nigel W Brown
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
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50
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Lakso HÅ, Wuolikainen A, Sundkvist A, Johansson I, Marklund SL. Long-term stability of the alcohol consumption biomarker phosphatidylethanol in erythrocytes at -80 °C. CLINICAL MASS SPECTROMETRY 2018; 11:37-41. [PMID: 34841071 DOI: 10.1016/j.clinms.2018.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 01/31/2023]
Abstract
Phosphatidylethanol (PEth) is a recently introduced biomarker with high specificity, high sensitivity, and response correlating with alcohol consumption. It has the potential to be a valuable biomarker in population studies on the health effects of alcohol, however its stability in long-term stored blood is not known. We used LC-MS/MS to assess the stability of PEth-16:0/18:1 in blood samples (packed erythrocytes) that were stored between 1 and 19 years at -80 °C in a biobank from a large population survey. The participants answered a life-style questionnaire that included questions on alcohol consumption. For analysis, we selected blood samples from seven homogenous ethanol consumption cohorts collected at intervals from 1997 to 2015. Despite the narrow stated alcohol consumption range, 10-15 g/day, there were large differences in PEth values between individuals in the cohorts, from below the limit of detection of 0.005 µmol/L to 1.40 µmol/L. The median was 0.08 µmol/L. Neither generalized linear modeling, nor principal component analysis revealed a statistically significant association between time of storage and PEth levels. The PEth results indicate that the participants had, on average, under-reported their alcohol consumption several-fold. The findings suggest that PEth in blood has a sufficient long-term stability for use as an alcohol biomarker in prospective case-control studies. Analysis of blood stored in biobanks could significantly improve the validity of assessments exploring the health effects of alcohol.
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Affiliation(s)
- Hans-Åke Lakso
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | | | - Anneli Sundkvist
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.,Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | | | - Stefan L Marklund
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
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