Elsevier

Drug and Alcohol Dependence

Volume 141, 1 August 2014, Pages 163-166
Drug and Alcohol Dependence

Short communication
Hair ethyl glucuronide as a biomarker of alcohol consumption in alcohol-dependent patients: Role of gender differences

https://doi.org/10.1016/j.drugalcdep.2014.05.014Get rights and content

Abstract

Background

Ethyl glucuronide (EtG) is a minor alcohol metabolite that accumulates in hair and is proposed as a stable marker for the detection of chronic and excessive alcohol consumption above a cut-off level of 30 pg/mg hair. A correlation between drinking behavior and EtG hair concentrations is observed, but large variability exists.

Aims

To investigate the correlation between alcohol consumption and hair EtG concentrations in alcohol dependent patients, and the effect of gender differences as a factor for the variability on this correlation.

Methods

EtG was measured by gas chromatography coupled to mass spectrometry in the hairs (first 3 cm) of 36 alcohol dependent patients (25 males/11 females) starting and alcohol detoxification program. Factors that possibly influence EtG content in hair (except age and gender) were excluded. Detailed retrospective alcohol consumption was obtained over the last 3 months using the Timeline Follow Back interview.

Results

Median total alcohol consumption over 3 months was 13,050 g pure alcohol (range 60–650 g/day). Hair EtG concentrations varied between 32 and 662 pg/mg. There was a statistically significant linear and positive correlation between hair EtG and amounts of alcohol consumed (Pearson r = 0.83; p < 0.001), in both males (Pearson r = 0.83; p < 0.001) and females (Pearson r = 0.76; p = 0.007).

Conclusions

There is a linear correlation, with no significant effect of gender, between hair EtG concentrations and amounts of alcohol consumed in alcohol-dependent individuals. Analysis of EtG in hair can be applied to estimate retrospective alcohol consumption in both male and female alcohol dependent subjects using the same cut-off.

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)

There are more references available in the full text version of this article.

Cited by (34)

  • Does ethyl glucuronide in hair correlate with alcohol consumption? A comparative study with other traditional biomarkers among individuals with alcohol dependence syndrome

    2023, Alcohol
    Citation Excerpt :

    On the other hand, a linear and positive correlation (r = 0.60, p < 0.001) between hair EtG values (proximal 0–3 cm hair) and the amounts of alcohol consumed in the past three months among the ADS participants was observed. These findings conform with the previous results (Appenzeller, Agirman, Neuberg, Yegles, & Wennig, 2007; Crunelle et al., 2014). In both studies, a similar study population was adopted and it was observed that the concentration of EtG in hair was significantly correlated to their alcohol consumption.

  • Ethyl glucuronide hair testing: A review

    2019, Forensic Science International
View all citing articles on Scopus
View full text