Short communicationHair ethyl glucuronide as a biomarker of alcohol consumption in alcohol-dependent patients: Role of gender differences
Introduction
Ethyl glucuronide (EtG) is a minor metabolite of alcohol that has gained attention as a biomarker for the detection of excessive/chronic alcohol consumption (reviewed in Crunelle et al., 2014). EtG accumulates in hair (Aderjan et al., 1994) and can be used to determine chronic alcohol consumption retrospectively over a large period of time (months to years depending on hair length). The Society of Hair Testing (SoHT; www.soht.org) proposes an EtG cut-off of 30 pg/mg hair to establish excessive chronic alcohol consumption (>60 g pure ethanol per day over several months). EtG quantification in hair has high sensitivity and specificity compared to blood alcohol biomarkers (Høiseth et al., 2009, Kharbouche et al., 2012), a non-invasive sample collection and easy storage conditions, making hair EtG a useful tool for the objective detection of alcohol use.
Considerable variation is observed in hair EtG levels of alcohol consumers (Alt et al., 2000, Høiseth et al., 2009, Kharbouche et al., 2012, Kronstrand et al., 2012, Politi et al., 2006, Stewart et al., 2013, Yegles et al., 2004). A few studies showed a correlation between hair EtG levels and amounts of alcohol consumed (Appenzeller et al., 2007, Kerekes et al., 2009, Politi et al., 2006), while other studies found no or modest correlations (Stewart et al., 2013, Yegles et al., 2004). The lack of correlation between hair EtG levels and amounts of alcohol consumed could be explained by several factors, such as by the presence of variables that may influence EtG incorporation in hair (i.e., hair treatments, pathophysiological conditions, or factors underlying alcohol metabolism such as age and gender). Of these, gender can influence EtG incorporation in hair, but, in contrast to other variables, the influence of gender on measured hair EtG levels has not been investigated. Upon similar alcohol consumption, females have higher blood alcohol concentrations (BAC) than males (Sutker et al., 1983), and presumably eliminate alcohol faster than males (Jones, 2010), resulting in shorter but higher BAC peaks. As EtG is incorporated into hair primarily through the blood supply, the question arises whether, as a result of differences in BACs, males and females differ in their EtG incorporation in hair.
Here, we investigated the correlation between alcohol consumption and hair EtG in alcohol-dependent patients, as these are participants that consume substantial amounts of alcohol over considerable time periods of months to years. Additionally, we investigated if there was an effect of gender on this correlation.
Section snippets
Samples
Hair samples were collected from alcohol-dependent patients recruited from a Belgian addiction treatment center (Psychiatric Center Broeders Alexianen, Boechout). Patients were included when aged 18–60 years, having a diagnosis of alcohol dependence, and entering in-patient treatment for alcohol dependence. Exclusion criteria were: hair shorter than 3 cm; gastrointestinal-, liver- or kidney-pathologies; and/or bleached, permed or cosmetically straightened hair, factors that influence EtG content
Patient characteristics
Thirty-nine Caucasian alcohol-dependent individuals were included. Of these, 36 had alcohol consumptions >60 g/day and are further described (25 males and 11 females). Participants were abstinent from alcohol for 2 ± 1 day when hair samples were collected. Patient characteristics (age, BMI) did not differ between males and females (Table 1). Table 1 provides an overview of the patients/hair characteristics. Mean AUDIT scores were 28 ± 6, confirming severe harmful alcohol consumption (cut-off score
Discussion
There is a linear and positive correlation between hair EtG values in the proximal 0–3 cm hair segment and the amounts of alcohol consumed in the past 3 months in alcohol-dependent patients, confirming previous results (Appenzeller et al., 2007, Politi et al., 2006). Here, for the first time, we show that gender does not influence the correlation between hair EtG levels and amounts of alcohol consumption. First, these findings show that hair EtG is a reliable marker for the estimation of
Role of funding source
Nothing declared.
Contributors
H. Neels and C.L. Crunelle designed the study. C.L. Crunelle, D. Cappelle, M. Yegles, H. Neels, P. Michielsen, A. Covaci, A. van Nuijs, K. Maudens, B. Sabbe and G. Dom were involved in the interpretation of the data, the writing of the report, and the decision to submit the paper for publication. Data collection was performed mainly by C.L. Crunelle and data analysis by C.L. Crunelle, D. Cappelle and M. Yegles.
Conflict of interest
No conflict declared.
Acknowledgement
None.
References (18)
- et al.
Segmental determination of ethyl glucuronide in hair: a pilot study
Forensic Sci. Int.
(2007) - et al.
Hair ethyl glucuronide levels as a marker for alcohol use and abuse: a review of the current state of the art
Drug Alcohol Depend.
(2014) Evidence-based survey of the elimination rates of ethanol from blood with applications in forensic casework
Forensic Sci. Int.
(2010)- et al.
Ethyl glucuronide in human hair after daily consumption of 16 or 32 g of ethanol for 3 months
Forensic Sci. Int.
(2012) - et al.
Acute alcohol intoxication, mood states and alcohol metabolism in women and men
Pharmacol. Biochem. Behav.
(1983) - et al.
Comparison of ethyl glucuronide and fatty acid ethyl ester concentrations in hair of alcoholics, social drinkers and teetotallers
Forensic Sci. Int.
(2004) - et al.
Ethyl glucuronide – a non volatile metabolite in human hair
- et al.
Determination of ethyl glucuronide in hair samples
Alcohol Alcohol.
(2000) - et al.
AUDIT The Alcohol Use Disorder Identification Test: Guidelines for Use in Primary Health Care. WHO/MNH/DAT 89.4
(1989)
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