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Indian Journal of Clinical Biochemistry logoLink to Indian Journal of Clinical Biochemistry
. 2003 Jul;18(2):111–118. doi: 10.1007/BF02867376

Biochemical markers for alcohol consumption

Subir Kumar Das 1,, Prasunpriya Nayak 2, D M Vasudevan 3
PMCID: PMC3453888  PMID: 23105401

Abstract

A variety of laboratory tests are available to assist in the diagnosis of alcohol consumption and related disorders. The levels of intake at which laboratory results become abnormal vary from person to person. Laboratory tests are particularly useful in settings where cooperativeness is suspected or when a history is not available. Several biochemical and hematological tests, such as γ-glutamyltransferase (GGT) activity, aspartate aminotransferase (AST) activity, high-density lipoprotein cholesterol (HDL-C) content of serum, and erythrocyte mean corpuscular volume (MCV) are established markers of alcohol intake. Their validity as markers is based largely on correlations with recent intake at a single time point and on decreases in elevated values when heavy drinkers abstain from alcohol. These readily available laboratory tests provide important prognostic information and should be integral part of the assessment of persons with hazardous alcohol consumption. There are several other markers with considerable potential for more accurate reflection of recent alcohol intake. These include carbohydrate deficient transferrin, β-hexosaminidase, acetaldehyde adducts and the urinary ratio of serotonin metabolites, 5-hydroxytryptophol and 5-hydroxyindoleacetic acid. These markers provide hope for more sensitive and specific aids to diagnosis and improved monitoring for intake.

Key Words: Alcohol, Biochemical marker, γ-Glutamyltransferase, Aminotransferase, Carbohydrate deficient transferrin

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References

  • 1.Ryback R.S., Eckardt M.J., Felsher B., Rawlings R.R. Biochemical and histologic correlates of alcoholism and liver disease. J. Am. Med. Assoc. 1982;248(18):2261–65. doi: 10.1001/jama.248.18.2261. [DOI] [PubMed] [Google Scholar]
  • 2.Skinner H.A., Holt S., Schuller R., Roy J., Israel Y. Identification of alcohol abuse using laboratory tests and a history of trauma. Annals Internal Med. 1984;101:847–851. doi: 10.7326/0003-4819-101-6-847. [DOI] [PubMed] [Google Scholar]
  • 3.Conigrave K.M., Saunders J.B., Whitfield J.B. Diagnostic tests for alcohol consumption. Alcohol and Alcoholism. 1995;30:13–26. [PubMed] [Google Scholar]
  • 4.Conigrave K.M., Degenhardt L.J., Whitfield J.B., Saunders J.B., Helander A., Tabakoff B. CDT, GGT and AST as markers of alcohol use: the WHO/ISBRA collaborative project. Alcohol Clin. Exp. Res. 2002;26:332–339. [PubMed] [Google Scholar]
  • 5.Rosalki S. Identifying the alcoholic. In: Rosalki S, editor. Clinical Biochemistry of Alcoholism. Edinburgh: Churchill, Livingstone; 1984. pp. 65–92. [Google Scholar]
  • 6.Wu A., Slavin G., Levi A.J. Elevated serum gamma-glutamyl-transferase (transpeptidase) and histological liver damage in alcoholism. Am. J. Gastroenterol. 1976;65:318–323. [PubMed] [Google Scholar]
  • 7.Lewis K.O., Paton A. Tools of detection. Br. Med. J. 1981;283:1531–32. doi: 10.1136/bmj.283.6305.1531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Salaspuro M. Conventional and coming laboratory markers of alcoholism and heavy drinking. Alcoholism. Clin. Exp. Res. 1986;10:5S–12S. doi: 10.1111/j.1530-0277.1986.tb05174.x. [DOI] [PubMed] [Google Scholar]
  • 9.Whitfield J.B., Hensley W.J., Bryden D., Gallagher H. Some laboratory correlates of drinking habits. Annal. Clin. Biochem. 1978;15:297–303. doi: 10.1177/000456327801500171. [DOI] [PubMed] [Google Scholar]
  • 10.Bellini M., Tumino E., Giordani R., Fabrini G., Costa F., Galli R., Rucco M., Belcari C., Michelassi C., Murri L., Maltini G., Marchi S. Serum gamma glutamyl transpeptidase isoforms in alcoholic liver disease. Alcohol and Alcoholism. 1997;32:259–266. doi: 10.1093/oxfordjournals.alcalc.a008265. [DOI] [PubMed] [Google Scholar]
  • 11.Stefanini G.F., Addolorato G., Caputo F., Olanda S., Gasbarrini G. Can the gamma glutamyl transpeptidase isoforms really be utilized in the diagnosis of alcoholic liver disease? Alcohol and alcoholism: Int. J. Med. Council Alcoholism. 1998;33:92–93. doi: 10.1093/oxfordjournals.alcalc.a008356. [DOI] [PubMed] [Google Scholar]
  • 12.Chick J., Kreitman N., Plant M. Mean-cell volume and gamma-glutamyl transpeptidase as markers of drinking in working men. Lancet. 1981;i:1249–1251. doi: 10.1016/S0140-6736(81)92413-2. [DOI] [PubMed] [Google Scholar]
  • 13.Bell H., Steensland H. Serum activity of gamma-glutamyltranspeptidase (GGT) in relation to estimated alcohol consumption and questionnaires in alcohol dependence syndrome. British J. Addiction. 1987;82:1021–1026. doi: 10.1111/j.1360-0443.1987.tb01563.x. [DOI] [PubMed] [Google Scholar]
  • 14.Sillanaukee P., Seppa K., Koivula T., Israel Y., Niemela O. Acetaldehyde-modified hemoglobin as a marker of alcohol consumption: comparison of two new methods. J. Lab. Clin. Med. 1992;120:42–47. [PubMed] [Google Scholar]
  • 15.Kew M.C. Serum aminotransferase concentration as evidence of hepatocellular damage. Lancet. 2000;355(9204):591–592. doi: 10.1016/S0140-6736(99)00219-6. [DOI] [PubMed] [Google Scholar]
  • 16.Rej R. Aspartate aminotransferase activity and isoenzyme proportions in human liver tissues. Clin. Chem. 1978;24:1971–1979. [PubMed] [Google Scholar]
  • 17.Panteghini M., Falsetti F., Chiari E., Malshiodi A. Determination of aspartate aminotransferase isoenzymes in hepatic disease—preliminary findings. Clinica Chimica Acta. 1983;128:133–140. doi: 10.1016/0009-8981(83)90063-3. [DOI] [PubMed] [Google Scholar]
  • 18.Wadstein J., Skude G. Changes in amylase, hepatic enzymes and bilirubin in serum upon initiation of alcohol abstinence. Acta. Med. Scand. 1979;205:313–6. doi: 10.1111/j.0954-6820.1979.tb06054.x. [DOI] [PubMed] [Google Scholar]
  • 19.Ahlgren A., Hedenborg G., Norman A., Wisen O. Serum bilirubin subfractions in patients with alcohol abuse during detoxication. Scand. J. Clin. Lab. Invest. 1988;48:319–26. doi: 10.3109/00365518809167502. [DOI] [PubMed] [Google Scholar]
  • 20.Skinner H.A., Holt S., Sheu W.J., Israel Y. Clinical versus laboratory detection of alcohol abuse: the alcohol clinical index. Br. Med. J. 1986;292:1703–08. doi: 10.1136/bmj.292.6537.1703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Chalmers D.M., Grinsler M.G., MacDermott S., Spicer C.C., Levi A.J. Biochemical and haematological indicators of excessive alcohol consumption. Gut. 1981;22:992–996. doi: 10.1136/gut.22.12.992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Paton A. In: ABC of Alcohol. Paton A, editor. USA: BMJ Publishing; 1994. [Google Scholar]
  • 23.Annoni G., Weiner F.R., Colombo M., Czaja M.J., Zern M.A. Albumin and collagen gene regulation in alcohol- and virus-induced human liver disease. Gastroenterology. 1990;98:197–202. doi: 10.1016/0016-5085(90)91310-3. [DOI] [PubMed] [Google Scholar]
  • 24.Rothschild M.A., Oratz M., Schreiber S.S. Effects of nutrition and alcohol on albumin synthesis. Alcohol Clin. Exp. Res. 1983;7:28–30. doi: 10.1111/j.1530-0277.1983.tb05406.x. [DOI] [PubMed] [Google Scholar]
  • 25.Oratz M., Rothschild M.A., Schreiber S.S. Alcohol, amino acids, and albumin synthesis. III. Effects of ethanol, acetaldehyde, and 4-methylpyrazole. Gastroenterology. 1978;74:672–6. [PubMed] [Google Scholar]
  • 26.Oratz M., Rothschild M.A., Schreiber S.S. Alcohol, amino acids, and albumin synthesis. II. Alcohol inhibition of albumin synthesis reversed by arginine and spermine. Gastroenterology. 1976;71:123–7. [PubMed] [Google Scholar]
  • 27.Waern A.U., Hellsing K. Indices of alcohol intake. Comparison between serum concentrations of alkaline phosphatase and gamma glutamyltransferase in middle-aged men. Ups. J. Med. Sci. 1980;85:159–63. doi: 10.3109/03009738009179183. [DOI] [PubMed] [Google Scholar]
  • 28.Donohue T.M., Zetterman R.K., Zhang-Gouillon Z.Q., French S.W. Peptidase activities of the multicatalytic protease in rat liver after voluntary and intragastric ethanol administration. Hepatol. 1998;28:486–91. doi: 10.1002/hep.510280228. [DOI] [PubMed] [Google Scholar]
  • 29.Trotti R., Carratelli M., Barbieri M., Micieli G., Bosone D., Rondanelli M., Bo P. Oxidative stress and a thrombophilic condition in alcoholics without severe liver disease. Haematologica. 2001;86:85–91. [PubMed] [Google Scholar]
  • 30.Wisniewska-Knypl J.M., Wronska-Nofer T. Biological markers of oxidative stress induced by ethanol and iron overload in rat. Int. J. Occup. Med. Environ. Health. 1994;7:355–63. [PubMed] [Google Scholar]
  • 31.Hoffmann T., Meyer R.J., Sorrell M.F., Tuma D.J. Reaction of acetaldehyde with proteins: formation of stable fluorescent adducts. Alcoholism Clin. Exp. Res. 1993;17:69–74. doi: 10.1111/j.1530-0277.1993.tb00728.x. [DOI] [PubMed] [Google Scholar]
  • 32.Eriksson C.J.P., Fukunaga T. Human blood acetaldehyde (update 1992) Alcohol and Alcoholism. 1993;2:9–25. [PubMed] [Google Scholar]
  • 33.Halvorson M.R., Campbell J.L., Sprague G., Slater K., Noffsinger J.K., Peterson C.M. Comparative evaluation of the clinical utility of three markers of ethanol intake: the effect of gender. Alcoholism Clin. Exp. Res. 1993;17:225–228. doi: 10.1111/j.1530-0277.1993.tb00753.x. [DOI] [PubMed] [Google Scholar]
  • 34.Niemela O., Juvonen T., Pakkila S. Immunohistochemical demonstration of acetaldehyde-modified epitopes in human liver after alcohol consumption. J. Clin. Inv. 1991;87:1367–1374. doi: 10.1172/JCI115141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Niemela O., Israel Y. Hemoglobin-acetaldehyde adducts in human alcohol abusers. Lab. Invest. 1992;67:246–252. [PubMed] [Google Scholar]
  • 36.Niemela O., Israel Y., Mizoi Y., Fukunaga T., Eriksson C.J.P. Hemoglobin-acetaldehyde adducts in human volunteers following acute ethanol ingestion. Alcoholism Clin. Exp. Res. 1990;14:838–841. doi: 10.1111/j.1530-0277.1990.tb01824.x. [DOI] [PubMed] [Google Scholar]
  • 37.Israel Y, Orego H, Niemela O. Immune responses to alcohol metabolites: pathogenic and diagnostic implications. Seminars in Liver Disease. 1988;8:81–90. doi: 10.1055/s-2008-1040530. [DOI] [PubMed] [Google Scholar]
  • 38.Worral S., deJersy J., Shanley B.C., Wilce P.A. Antibodies against acetaldehyde-modified epitopes: an elevated IgA response in alcoholics. Eur. J. Clin. Invest. 1991;21:90–95. doi: 10.1111/j.1365-2362.1991.tb01364.x. [DOI] [PubMed] [Google Scholar]
  • 39.Lin C.C., Potter J.J., Mezey E. Erythrocyte aldehyde dehydrogenase activity in alcoholism. Alcoholism Clin. Exp. Res. 1984;8:539–541. doi: 10.1111/j.1530-0277.1984.tb05725.x. [DOI] [PubMed] [Google Scholar]
  • 40.Johnson R.D., Bahgnisch J., Steward B., Shearman D.J.C., Edwards J.B. Optimized spectrophotometric determination of aldehyde dehydrogenase activity in erythrocytes. Clin. Chem. 1992;38:584–588. [PubMed] [Google Scholar]
  • 41.Huang Y.S., Chan C.Y., Wu J.C., Pai C.H., Chao Y., Lee S.D. Serum levels of interleukin-8 in alcoholic liver disease: relationship with disease stage, biochemical parameters and survival. J. Hepatol. 1994;24:377–384. doi: 10.1016/S0168-8278(96)80156-5. [DOI] [PubMed] [Google Scholar]
  • 42.DeGoede E., Yap S.H. Exceptional high concentration of serum CA 19.9 in a patient with alcoholic liver disease. Gut. 1997;41:579–580. [PubMed] [Google Scholar]
  • 43.Ohhira M., Ohtake T., Saito H., Ikuta K., Tanaka K., Tanabe H., Kawashima T., Fujimoto Y., Naraki T., Ono M., Kohgo Y. Increase of serum des-gamma-carboxy prothrombin in alcoholic liver disease without hepatocellular carcinoma. Alcoholism Clin. Exp. Res. 1999;23:67S–70S. doi: 10.1111/j.1530-0277.1999.tb04537.x. [DOI] [PubMed] [Google Scholar]
  • 44.Hultberg B., Isaksson A., Tiderstrom G. β-Hexosaminidase, leucine aminopeptidase, cystidyl aminopeptidase, hepatic enzymes and bilirubin in serum of chronic alcoholics with acute ethanol intoxication. Clinica Chemic Acta. 1980;105:317–323. doi: 10.1016/0009-8981(80)90111-4. [DOI] [PubMed] [Google Scholar]
  • 45.Karkkainen P., Poikolainen K., Salaspuro M. Serum β-Hexosaminidase as a marker of heavy drinking. Alcoholism Clin. Exp. Res. 1990;14:187–190. doi: 10.1111/j.1530-0277.1990.tb00469.x. [DOI] [PubMed] [Google Scholar]
  • 46.Nystrom M., Perasalo J., Salaspuro M. Serum β-hexosaminidase in young university students. Alcoholism Clin. Exp. Res. 1991;15:877–880. doi: 10.1111/j.1530-0277.1991.tb00617.x. [DOI] [PubMed] [Google Scholar]
  • 47.Cameron R.G., Neuman M.G. Novel morphologic finding in alcoholic liver disease. Clin. Biochem. 1999;32:579–584. doi: 10.1016/S0009-9120(99)00058-2. [DOI] [PubMed] [Google Scholar]
  • 48.Urashima S., Tsutsumi M., Shimanaka K., Ueshima Y., Tsuchishima M., Itoh T., Kawahara H., Takase S. Histochemical study of hyaluronate in alcoholic liver disease. Alcoholism Clin. Exp. Res. 1999;23:56S–60S. doi: 10.1111/j.1530-0277.1999.tb04535.x. [DOI] [PubMed] [Google Scholar]
  • 49.Philips E.L.R., Little R.E., Hillman R.S., Labbe R.F., Campbell C. A field test of the sweat patch. Alcoholism Clin. Exp. Res. 1984;8:233–237. doi: 10.1111/j.1530-0277.1984.tb05846.x. [DOI] [PubMed] [Google Scholar]
  • 50.Swift RM, Martin CS, Swette L, LaConti A, Kackley N. Studies of a wearable, electronic, transdermal alcohol sensor. alcoholism Clin. Exp. Res. 1992;16:721–725. doi: 10.1111/j.1530-0277.1992.tb00668.x. [DOI] [PubMed] [Google Scholar]
  • 51.Voltaire A, Beck O, Borg S. Urinary 5-hydroxytryptophol: a possible marker of recent alcohol consumption. Alcoholism Clin. Exp. Res. 1992;16:281–285. doi: 10.1111/j.1530-0277.1992.tb01377.x. [DOI] [PubMed] [Google Scholar]
  • 52.Matsuda Y., Takada A., Kanayama R., Takase S. Changes of hepatic microtubules and secretory proteins in human alcoholic liver disease. Pharmacol, Biochem Behaviour. 1983;18(suppl 1):479–482. doi: 10.1016/0091-3057(83)90221-6. [DOI] [PubMed] [Google Scholar]
  • 53.Stibler H. Carbohydrate-deficient transferrin in serum: a new marker of potentially harmful alcohol consumption reviewed. Clin. Chem. 1991;37:2029–2037. [PubMed] [Google Scholar]
  • 54.Ghosh P., Okoh C., Liu Q.H., Lakshman M.R. Effects on chronic ethanol on enzymes regulating sialylation and desialylation of transferrin in rats. Alcoholism Clin. Exp. Res. 1993;17:576–579. doi: 10.1111/j.1530-0277.1993.tb00802.x. [DOI] [PubMed] [Google Scholar]
  • 55.Behrens U.J., Worner T.M., Braly L.F., Schaffner F., Leber C.S. Carbohydrate-deficient transferrin, a marker for chronic alcohol consumption in different ethnic populations. Alcoholism Clin. Exp. Res. 1988;12:427–432. doi: 10.1111/j.1530-0277.1988.tb00221.x. [DOI] [PubMed] [Google Scholar]
  • 56.Chan A.W.K., Leong F.W., Schanley D.L., Welte J.W., Wieczoreck W., Rej R., Whitney R.B. Transferrin and mitochondrial aspartate aminotransferase in young adult alcoholics. Drug and Alcohol Dependence. 1989;23:13–18. doi: 10.1016/0376-8716(89)90028-8. [DOI] [PubMed] [Google Scholar]
  • 57.Stibler H., Borg S., Beckman G. Transferrin phenotype and level of carbohydrate-deficient transferrin in healthy individuals. Alcoholism Clin. Exp. Res. 1988;12:450–453. doi: 10.1111/j.1530-0277.1988.tb00224.x. [DOI] [PubMed] [Google Scholar]
  • 58.Xin Y., Rosman A.S., Lasker J.M., Lieber C.S. Measurement of carbohydrate—deficient transferrin by isoelectric focussing/western blotting and by micro anion-exchange chromatography/radioimmunoassay: comparison of diagnostic accuracy. Alcohol and Alcoholism. 1992;27:425–433. [PubMed] [Google Scholar]
  • 59.Stibler H., Borg S., Allgulander C. Clinical significance of abnormal heterogeneity of transferrin in relation to alcohol consumption. Acta Med. Scand. 1979;206:275–81. doi: 10.1111/j.0954-6820.1979.tb13510.x. [DOI] [PubMed] [Google Scholar]
  • 60.Scouller K., Conigrave K.M., Macaskill P., Irwig L., Whitfield J.B. Should we use carbohydrate-deficient transferrin instead of γ-glutamyl transferase for detecting problem drinkers? Asystemic review ad metaanalysis. Clin. Chem. 2000;46:1894–1902. [PubMed] [Google Scholar]
  • 61.Beresford T.P., Blow F.C., Hill E., Singer K., Lucey M.R. Comparison of CAGE questionnaire and computer-assisted laboratory profiles in screening for covert alcoholism. Lancet. 1990;336:482–485. doi: 10.1016/0140-6736(90)92022-A. [DOI] [PubMed] [Google Scholar]
  • 62.Lichtenstein M.J., Burger M.C., Yarnell J.W.G., Elwood P.C., Sweetnam P.M. Derivation and validation of a prediction rule for identifying heavy consumers of alcohol. Alcoholism Clin. Exp. Res. 1989;13:626–630. doi: 10.1111/j.1530-0277.1989.tb00394.x. [DOI] [PubMed] [Google Scholar]
  • 63.Conigrave K.M., Saunders J.B., Reznik R.B., Whitfield J.B. Prediction of alcohol-related harm by laboratory test results. Clin. Chem. 1993;39:2266–2270. [PubMed] [Google Scholar]
  • 64.Lumeng L. New diagnostic marker of alcohol abuse. Hepatol. 1986;6:742–45. doi: 10.1002/hep.1840060434. [DOI] [PubMed] [Google Scholar]

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