G Model DAD-5165; No. of Pages 4
ARTICLE IN PRESS Drug and Alcohol Dependence xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Drug and Alcohol Dependence journal homepage: www.elsevier.com/locate/drugalcdep
Short communication
Hair ethyl glucuronide as a biomarker of alcohol consumption in alcohol-dependent patients: Role of gender differences Cleo L. Crunelle a,∗ , Delphine Cappelle a , Adrian Covaci a , Alexander L.N. van Nuijs a , Kristof E. Maudens a , Bernard Sabbe b , Geert Dom b , Peter Michielsen c , Michel Yegles d , Hugo Neels a,e a
Toxicological Center, University of Antwerp, Universiteitsplein 1, B2610 Antwerp, Belgium Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Universiteitsplein 1, B2610 Antwerp, Belgium c Department of Gastroenterology and Hepatology, University Hospital Antwerp, Wilrijkstraat 10, B2650 Antwerp, Belgium d Laboratoire National de Santé, Service de Toxicologie, L3555 Dudelange, Luxembourg e Toxicology Laboratory, ZNA Stuivenberg, Lange Beeldekenstraat 267, B2060 Antwerp, Belgium b
a r t i c l e
i n f o
Article history: Received 15 April 2014 Received in revised form 16 May 2014 Accepted 18 May 2014 Available online xxx Keywords: Ethyl glucuronide Hair Alcohol dependence Alcohol biomarker Gender
a b s t r a c t 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. © 2014 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Ethyl glucuronide (EtG) is a minor metabolite of alcohol that has gained attention as a biomarker for the detection of
∗ Corresponding author at: Toxicological Center, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1-R.3.27, 2610 Antwerp (Wilrijk), Belgium. Tel.: +32 03 265 27 67. E-mail addresses: [email protected] (C.L. Crunelle), [email protected] (D. Cappelle), [email protected] (A. Covaci), [email protected] (A.L.N. van Nuijs), [email protected] (K.E. Maudens), [email protected] (B. Sabbe), [email protected] (G. Dom), [email protected] (P. Michielsen), [email protected] (M. Yegles), [email protected] (H. Neels).
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 cutoff 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.,
http://dx.doi.org/10.1016/j.drugalcdep.2014.05.014 0376-8716/© 2014 Elsevier Ireland Ltd. All rights reserved.
Please cite this article in press as: Crunelle, C.L., et al., Hair ethyl glucuronide as a biomarker of alcohol consumption in alcohol-dependent patients: Role of gender differences. Drug Alcohol Depend. (2014), http://dx.doi.org/10.1016/j.drugalcdep.2014.05.014
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ARTICLE IN PRESS C.L. Crunelle et al. / Drug and Alcohol Dependence xxx (2014) xxx–xxx
2
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.
Table 1 Patients’ characteristics and characteristics of the proximal (0–3 cm) hair segment of 36 alcohol-dependent patients.
2. Methods
gender influences the effect of alcohol consumption on the measured hair EtG values. A separate linear regression analysis addressed whether there was an influence of gender on the nominal EtG hair levels.
2.1. 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 in hair (Crunelle et al., 2014; Ettlinger et al., 2014; Kerekes and Yegles, 2013). Hair coloring was allowed. This study was approved by the Ethical Committee of the Antwerp University Hospital. Participants gave written informed consent. 2.2. Measures 2.2.1. Hair EtG. Two hair locks were collected from the vertex posterior of the head, and combined into one hair strand used for hair EtG analyses. For analysis, a mean amount of 31.2 ± 1.0 mg hair was used. Hair samples were analyzed using gas chromatography mass spectrometry (GC–MS) described previously, using 2 ng of EtG-d5 as internal standard and heptafluorobutyric anhydride as derivatization agent (Kerekes et al., 2009; Kerekes and Yegles, 2013). EtG analyses were performed in negative chemical ionization with a limit of detection (LOD) of 0.02 pg/mg hair and a limit of quantification (LOQ) of 0.08 pg/mg hair. 2.2.2. Alcohol consumption. The Timeline Follow Back method (TLFB; Sobell and Sobell, 1992) was used to retrospectively estimate daily alcohol consumption (including amounts of alcohol) of the past 3 months. The Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993) was used to assess the degree of harmful consumption of alcohol. 2.2.3. Patient’ characteristics and hair treatment. Gender, age, body mass index (BMI) and hair treatment (shampoo and conditioner use, hair color) were assessed using an in-house developed questionnaire.
Age (years) BMI AUDIT score Total alcohol consumption/3 months (g) Hair color Black (%) Brown (%) Red (%) Blond (%) Hair coloring Patients with color treatments (%) Number of treatments in past 3 months Shampoo use (times/week) Conditioner use (times/week)
Male (n = 25)
Female (n = 11)
p-value
46 ± 8 25 ± 4 29 ± 6 14,400 ± 14,210*
41 ± 7 26 ± 9 28 ± 8 8820 ± 6750*
0.069 NS 0.513 NS 0.574 NS 0.036
16% 56% 0% 28%
18% 45% 9% 28%
0%
55%
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 20; Babor et al., 1989). Mean age was 45 ± 8 years. 3.2. Correlations between hair EtG and alcohol (amount) consumption Total median consumption over the last 3 months (90 days) was 13,050 ± 12,020 g pure alcohol (range 60–650 g/day). Hair EtG concentrations varied between 32 and 662 pg/mg hair, with a linear and positive correlation with amounts of alcohol consumed (Pearson r = 0.83; B = 0.116; t = 8.798; p < 0.001). Sensitivity and positive predictive value of hair EtG analyses were both 100%. 3.3. Effects of gender differences on the correlation between hair EtG and alcohol consumption
2.3. Statistical analyses Differences in age, BMI and alcohol consumption between males and females were analyzed using parametric student T-tests or with nonparametric Mann–Whitney U tests where appropriate. All data are presented as mean ± standard deviation (SD) or as median ± interquartile range (IQR) where appropriate. A p-value 60 g/day. In this study, participants were well characterized on amounts of alcohol consumed and were of similar age, BMI and alcohol dependence severity. Additionally, none were included with pathophysiological conditions and/or cosmetic treatments that influence hair EtG incorporation, thereby providing samples with limited variability, except for gender, which could account for EtG hair concentration variations. However, we included a relatively small female sample population compared to males. Also, this study focused on the correlation between hair EtG and alcohol consumption in dependent patients: whether these findings can be extended to non-harmful drinking, where cut-offs of 7 pg/mg hair are used to differentiate between teetotalers and non-harmful alcohol consumption, is a question that remains unanswered thus far and should be further investigated.
No conflict declared. Acknowledgement None. References Aderjan, R., Besserer, H., Sachs, H., Schmitt, G., Skopp, G., 1994. Ethyl glucuronide – a non volatile metabolite in human hair. In: Proceedings of the TIAFT-SOFT Joint Meeting, Abstract 12, Tampa, FL. Alt, A., Janda, I., Seidl, S., Wurst, F.M., 2000. Determination of ethyl glucuronide in hair samples. Alcohol Alcohol. 35, 313–314. Appenzeller, B.M., Agirman, R., Neuberg, P., Yegles, M., Wennig, R., 2007. Segmental determination of ethyl glucuronide in hair: a pilot study. Forensic Sci. Int. 173, 87–92. Babor, T.F., de la Fuente, J.R., Saunders, J., Grant, M., 1989. AUDIT The Alcohol Use Disorder Identification Test: Guidelines for Use in Primary Health Care. WHO/MNH/DAT 89.4. World Health Organization, Geneva. Crunelle, C.L., Yegles, M., van Nuijs, A.L., Covaci, A., De Doncker, M., Maudens, K.E., Sabbe, B., Dom, G., Lambert, W.E., Michielsen, P., Neels, H., 2014. Hair ethyl glucuronide levels as a marker for alcohol use and abuse: a review of the current state of the art. Drug Alcohol Depend. 134, 1–11. Ettlinger, J., Kirchen, L., Yegles, M., 2014. Influence of thermal hair straightening on ethyl glucuronide content in hair. Drug Test. Anal. 6 (Suppl. 1), 74–77. Høiseth, G., Morini, L., Polettini, A., Christophersen, A., Mørland, J., 2009. Ethyl glucuronide in hair compared with traditional alcohol biomarkers – a pilot study of heavy drinkers referred to an alcohol detoxification unit. Alcohol. Clin. Exp. Res. 33, 812–816. Jones, A.W., 2010. Evidence-based survey of the elimination rates of ethanol from blood with applications in forensic casework. Forensic Sci. Int. 200, 1–20. Kerekes, I., Yegles, M., Grimm, U., Wennig, R., 2009. Ethyl glucuronide determination: head hair versus non-head hair. Alcohol Alcohol. 44, 62–66. Kerekes, I., Yegles, M., 2013. Coloring, bleaching, and perming: influence on EtG content in hair. Ther. Drug Monit. 35, 527–529. Kharbouche, H., Faouzi, M., Sanchez, N., Daeppen, J.B., Augsburger, M., Mangin, P., Staub, C., Sporkert, F., 2012. Diagnostic performance of ethyl glucuronide in hair for the investigation of alcohol drinking behavior: a comparison with traditional biomarkers. Int. J. Legal Med. 126, 243–250. Kronstrand, R., Brinkhagen, L., Nyström, F.H., 2012. Ethyl glucuronide in human hair after daily consumption of 16 or 32 g of ethanol for 3 months. Forensic Sci. Int. 215, 51–55. Politi, L., Morini, L., Leone, F., Polettini, A., 2006. Ethyl glucuronide in hair: is it a reliable marker of chronic high levels of alcohol consumption? Addiction 101, 1408–1412. Saunders, J.B., Aasland, O.G., Babor, T.F., de la Fuente, J.R., Grant, M., 1993. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons With Harmful Alcohol Consumption: II. Addiction 88, 791–804. Sobell, L.C., Sobell, M.B., 1992. Timeline Follow-back: a technique for assessing self-reported alcohol consumption. In: Measuring Alcohol Consumption: Psychosocial and Biological Methods. Humana Press, New Jersey, pp. 41–72.
Please cite this article in press as: Crunelle, C.L., et al., Hair ethyl glucuronide as a biomarker of alcohol consumption in alcohol-dependent patients: Role of gender differences. Drug Alcohol Depend. (2014), http://dx.doi.org/10.1016/j.drugalcdep.2014.05.014
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ARTICLE IN PRESS C.L. Crunelle et al. / Drug and Alcohol Dependence xxx (2014) xxx–xxx
Sutker, P.B., Tabakoff, B., Goist Jr., K.C., Randall, C.L., 1983. Acute alcohol intoxication, mood states and alcohol metabolism in women and men. Pharmacol. Biochem. Behav. 18 (Suppl. 1), 349–354. Stewart, S.H., Koch, D.G., Willner, I.R., Randall, P.K., Reuben, A., 2013. Hair ethyl glucuronide is highly sensitive and specific for detecting moderate-to-heavy drinking in patients with liver disease. Alcohol Alcohol. 48, 83–87.
Yegles, M., Labarthe, A., Auwärter, V., Hartwig, S., Vater, H., Wennig, R., Pragst, F., 2004. Comparison of ethyl glucuronide and fatty acid ethyl ester concentrations in hair of alcoholics, social drinkers and teetotallers. Forensic Sci. Int. 145, 167–173.
Please cite this article in press as: Crunelle, C.L., et al., Hair ethyl glucuronide as a biomarker of alcohol consumption in alcohol-dependent patients: Role of gender differences. Drug Alcohol Depend. (2014), http://dx.doi.org/10.1016/j.drugalcdep.2014.05.014
ARTICLE IN PRESS Drug and Alcohol Dependence xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Drug and Alcohol Dependence journal homepage: www.elsevier.com/locate/drugalcdep
Short communication
Hair ethyl glucuronide as a biomarker of alcohol consumption in alcohol-dependent patients: Role of gender differences Cleo L. Crunelle a,∗ , Delphine Cappelle a , Adrian Covaci a , Alexander L.N. van Nuijs a , Kristof E. Maudens a , Bernard Sabbe b , Geert Dom b , Peter Michielsen c , Michel Yegles d , Hugo Neels a,e a
Toxicological Center, University of Antwerp, Universiteitsplein 1, B2610 Antwerp, Belgium Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Universiteitsplein 1, B2610 Antwerp, Belgium c Department of Gastroenterology and Hepatology, University Hospital Antwerp, Wilrijkstraat 10, B2650 Antwerp, Belgium d Laboratoire National de Santé, Service de Toxicologie, L3555 Dudelange, Luxembourg e Toxicology Laboratory, ZNA Stuivenberg, Lange Beeldekenstraat 267, B2060 Antwerp, Belgium b
a r t i c l e
i n f o
Article history: Received 15 April 2014 Received in revised form 16 May 2014 Accepted 18 May 2014 Available online xxx Keywords: Ethyl glucuronide Hair Alcohol dependence Alcohol biomarker Gender
a b s t r a c t 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. © 2014 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Ethyl glucuronide (EtG) is a minor metabolite of alcohol that has gained attention as a biomarker for the detection of
∗ Corresponding author at: Toxicological Center, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1-R.3.27, 2610 Antwerp (Wilrijk), Belgium. Tel.: +32 03 265 27 67. E-mail addresses: [email protected] (C.L. Crunelle), [email protected] (D. Cappelle), [email protected] (A. Covaci), [email protected] (A.L.N. van Nuijs), [email protected] (K.E. Maudens), [email protected] (B. Sabbe), [email protected] (G. Dom), [email protected] (P. Michielsen), [email protected] (M. Yegles), [email protected] (H. Neels).
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 cutoff 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.,
http://dx.doi.org/10.1016/j.drugalcdep.2014.05.014 0376-8716/© 2014 Elsevier Ireland Ltd. All rights reserved.
Please cite this article in press as: Crunelle, C.L., et al., Hair ethyl glucuronide as a biomarker of alcohol consumption in alcohol-dependent patients: Role of gender differences. Drug Alcohol Depend. (2014), http://dx.doi.org/10.1016/j.drugalcdep.2014.05.014
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ARTICLE IN PRESS C.L. Crunelle et al. / Drug and Alcohol Dependence xxx (2014) xxx–xxx
2
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.
Table 1 Patients’ characteristics and characteristics of the proximal (0–3 cm) hair segment of 36 alcohol-dependent patients.
2. Methods
gender influences the effect of alcohol consumption on the measured hair EtG values. A separate linear regression analysis addressed whether there was an influence of gender on the nominal EtG hair levels.
2.1. 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 in hair (Crunelle et al., 2014; Ettlinger et al., 2014; Kerekes and Yegles, 2013). Hair coloring was allowed. This study was approved by the Ethical Committee of the Antwerp University Hospital. Participants gave written informed consent. 2.2. Measures 2.2.1. Hair EtG. Two hair locks were collected from the vertex posterior of the head, and combined into one hair strand used for hair EtG analyses. For analysis, a mean amount of 31.2 ± 1.0 mg hair was used. Hair samples were analyzed using gas chromatography mass spectrometry (GC–MS) described previously, using 2 ng of EtG-d5 as internal standard and heptafluorobutyric anhydride as derivatization agent (Kerekes et al., 2009; Kerekes and Yegles, 2013). EtG analyses were performed in negative chemical ionization with a limit of detection (LOD) of 0.02 pg/mg hair and a limit of quantification (LOQ) of 0.08 pg/mg hair. 2.2.2. Alcohol consumption. The Timeline Follow Back method (TLFB; Sobell and Sobell, 1992) was used to retrospectively estimate daily alcohol consumption (including amounts of alcohol) of the past 3 months. The Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993) was used to assess the degree of harmful consumption of alcohol. 2.2.3. Patient’ characteristics and hair treatment. Gender, age, body mass index (BMI) and hair treatment (shampoo and conditioner use, hair color) were assessed using an in-house developed questionnaire.
Age (years) BMI AUDIT score Total alcohol consumption/3 months (g) Hair color Black (%) Brown (%) Red (%) Blond (%) Hair coloring Patients with color treatments (%) Number of treatments in past 3 months Shampoo use (times/week) Conditioner use (times/week)
Male (n = 25)
Female (n = 11)
p-value
46 ± 8 25 ± 4 29 ± 6 14,400 ± 14,210*
41 ± 7 26 ± 9 28 ± 8 8820 ± 6750*
0.069 NS 0.513 NS 0.574 NS 0.036
16% 56% 0% 28%
18% 45% 9% 28%
0%
55%
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 20; Babor et al., 1989). Mean age was 45 ± 8 years. 3.2. Correlations between hair EtG and alcohol (amount) consumption Total median consumption over the last 3 months (90 days) was 13,050 ± 12,020 g pure alcohol (range 60–650 g/day). Hair EtG concentrations varied between 32 and 662 pg/mg hair, with a linear and positive correlation with amounts of alcohol consumed (Pearson r = 0.83; B = 0.116; t = 8.798; p < 0.001). Sensitivity and positive predictive value of hair EtG analyses were both 100%. 3.3. Effects of gender differences on the correlation between hair EtG and alcohol consumption
2.3. Statistical analyses Differences in age, BMI and alcohol consumption between males and females were analyzed using parametric student T-tests or with nonparametric Mann–Whitney U tests where appropriate. All data are presented as mean ± standard deviation (SD) or as median ± interquartile range (IQR) where appropriate. A p-value 60 g/day. In this study, participants were well characterized on amounts of alcohol consumed and were of similar age, BMI and alcohol dependence severity. Additionally, none were included with pathophysiological conditions and/or cosmetic treatments that influence hair EtG incorporation, thereby providing samples with limited variability, except for gender, which could account for EtG hair concentration variations. However, we included a relatively small female sample population compared to males. Also, this study focused on the correlation between hair EtG and alcohol consumption in dependent patients: whether these findings can be extended to non-harmful drinking, where cut-offs of 7 pg/mg hair are used to differentiate between teetotalers and non-harmful alcohol consumption, is a question that remains unanswered thus far and should be further investigated.
No conflict declared. Acknowledgement None. References Aderjan, R., Besserer, H., Sachs, H., Schmitt, G., Skopp, G., 1994. Ethyl glucuronide – a non volatile metabolite in human hair. In: Proceedings of the TIAFT-SOFT Joint Meeting, Abstract 12, Tampa, FL. Alt, A., Janda, I., Seidl, S., Wurst, F.M., 2000. Determination of ethyl glucuronide in hair samples. Alcohol Alcohol. 35, 313–314. Appenzeller, B.M., Agirman, R., Neuberg, P., Yegles, M., Wennig, R., 2007. Segmental determination of ethyl glucuronide in hair: a pilot study. Forensic Sci. Int. 173, 87–92. Babor, T.F., de la Fuente, J.R., Saunders, J., Grant, M., 1989. AUDIT The Alcohol Use Disorder Identification Test: Guidelines for Use in Primary Health Care. WHO/MNH/DAT 89.4. World Health Organization, Geneva. Crunelle, C.L., Yegles, M., van Nuijs, A.L., Covaci, A., De Doncker, M., Maudens, K.E., Sabbe, B., Dom, G., Lambert, W.E., Michielsen, P., Neels, H., 2014. Hair ethyl glucuronide levels as a marker for alcohol use and abuse: a review of the current state of the art. Drug Alcohol Depend. 134, 1–11. Ettlinger, J., Kirchen, L., Yegles, M., 2014. Influence of thermal hair straightening on ethyl glucuronide content in hair. Drug Test. Anal. 6 (Suppl. 1), 74–77. Høiseth, G., Morini, L., Polettini, A., Christophersen, A., Mørland, J., 2009. Ethyl glucuronide in hair compared with traditional alcohol biomarkers – a pilot study of heavy drinkers referred to an alcohol detoxification unit. Alcohol. Clin. Exp. Res. 33, 812–816. Jones, A.W., 2010. Evidence-based survey of the elimination rates of ethanol from blood with applications in forensic casework. Forensic Sci. Int. 200, 1–20. Kerekes, I., Yegles, M., Grimm, U., Wennig, R., 2009. Ethyl glucuronide determination: head hair versus non-head hair. Alcohol Alcohol. 44, 62–66. Kerekes, I., Yegles, M., 2013. Coloring, bleaching, and perming: influence on EtG content in hair. Ther. Drug Monit. 35, 527–529. Kharbouche, H., Faouzi, M., Sanchez, N., Daeppen, J.B., Augsburger, M., Mangin, P., Staub, C., Sporkert, F., 2012. Diagnostic performance of ethyl glucuronide in hair for the investigation of alcohol drinking behavior: a comparison with traditional biomarkers. Int. J. Legal Med. 126, 243–250. Kronstrand, R., Brinkhagen, L., Nyström, F.H., 2012. Ethyl glucuronide in human hair after daily consumption of 16 or 32 g of ethanol for 3 months. Forensic Sci. Int. 215, 51–55. Politi, L., Morini, L., Leone, F., Polettini, A., 2006. Ethyl glucuronide in hair: is it a reliable marker of chronic high levels of alcohol consumption? Addiction 101, 1408–1412. Saunders, J.B., Aasland, O.G., Babor, T.F., de la Fuente, J.R., Grant, M., 1993. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons With Harmful Alcohol Consumption: II. Addiction 88, 791–804. Sobell, L.C., Sobell, M.B., 1992. Timeline Follow-back: a technique for assessing self-reported alcohol consumption. In: Measuring Alcohol Consumption: Psychosocial and Biological Methods. Humana Press, New Jersey, pp. 41–72.
Please cite this article in press as: Crunelle, C.L., et al., Hair ethyl glucuronide as a biomarker of alcohol consumption in alcohol-dependent patients: Role of gender differences. Drug Alcohol Depend. (2014), http://dx.doi.org/10.1016/j.drugalcdep.2014.05.014
G Model DAD-5165; No. of Pages 4 4
ARTICLE IN PRESS C.L. Crunelle et al. / Drug and Alcohol Dependence xxx (2014) xxx–xxx
Sutker, P.B., Tabakoff, B., Goist Jr., K.C., Randall, C.L., 1983. Acute alcohol intoxication, mood states and alcohol metabolism in women and men. Pharmacol. Biochem. Behav. 18 (Suppl. 1), 349–354. Stewart, S.H., Koch, D.G., Willner, I.R., Randall, P.K., Reuben, A., 2013. Hair ethyl glucuronide is highly sensitive and specific for detecting moderate-to-heavy drinking in patients with liver disease. Alcohol Alcohol. 48, 83–87.
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Please cite this article in press as: Crunelle, C.L., et al., Hair ethyl glucuronide as a biomarker of alcohol consumption in alcohol-dependent patients: Role of gender differences. Drug Alcohol Depend. (2014), http://dx.doi.org/10.1016/j.drugalcdep.2014.05.014
