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Journal of Clinical Medicine logoLink to Journal of Clinical Medicine
. 2019 Nov 27;8(12):2076. doi: 10.3390/jcm8122076

Basic Human Body Dimensions Relate to Alcohol Dependence and Predict Hospital Readmission

Bernd Lenz 1,*, Martin G Köllner 2, Christiane Mühle 1, Christian Weinland 1, Johannes Kornhuber 1
PMCID: PMC6947550  PMID: 31783685

Abstract

Alcohol dependence is a severe mental illness and there is a need for more effective preventive and therapeutic strategies. Translational research suggests that intrauterine sex hormone exposure modulates the risk and course of alcohol dependence during adulthood. During development, sex hormones permanently shape sexually dimorphic body dimensions. Thus, these dimensions may provide insight into sex hormone organization. Here, we compared body measurements (absolute, relative to, and residualized on height) between 200 alcohol-dependent in-patients and 240 age-matched healthy control subjects and investigated how these measurements associate with the patients’ prospective 12- and 24-month outcome. The results show that alcohol dependence is related to lower absolute, relative, and residualized body measurements for height and weight, head circumference, bitragion head arc, lip-chin distance, hip, thigh, and calf circumference, and foot length and breadth. In male alcohol-dependent in-patients, higher risk, shorter latency, and more alcohol-related readmissions were predicted by higher absolute, relative, and residualized thigh and calf circumferences. The second-to-fourth finger length ratio, a putative proxy for prenatal sex hormone organization, was not convincingly correlated with the body dimensions, suggesting that the results represent pubertal (or later) effects. The study’s findings have implications for further research. The body measurements’ high accessibility may facilitate the future transition into clinical settings.

Keywords: Alcohol Dependence, Relapse Prediction, Body Measurements, Body Dimensions, Organizational Sex Hormone Effects, Anthropometry, Pubertal Hormones

1. Introduction

The World Health Organization (WHO) estimated that the harmful use of alcohol accounted for 5.1% of all deaths and 5.3% of all disability-adjusted life years during 2016. Worldwide, the highest levels of alcohol consumption per capita were found within the European region [1]. To develop preventive and individualized treatment strategies, we need to improve the knowledge of the mechanisms that underlie alcohol dependence. Easily accessible and clinically relevant biomarkers for both alcohol dependence per se and its prospective course are required.

In 2016, males in all WHO regions were more likely to be current alcohol drinkers and had heavy drinking sessions more often than females. In the European Region, 14.8% of males and 3.5% of females suffered from alcohol use disorder. Globally, 2.3 million male deaths compared to 0.7 million female deaths have been attributed to alcohol [1]. Alcohol dependence often runs a chronic course, with higher 12-month alcohol-related readmission rates following withdrawal in males (57.5%) compared to females (41.4%) [2]. Men are also known to have higher striatal dopamine release after oral alcohol intake than women [3]. These sex differences suggest that sex hormone activities are involved in alcohol dependence. This assumption is supported by studies that associate alcohol dependence and its related phenotypes with genes that are involved in sex hormone signaling, biosynthesis, and degradation (estrogen receptor 1 [4,5], androgen receptor [6,7], aromatase [8], 5α-reductases [9,10]). However, to our knowledge, the cited genetic links still lack replication and only one association originates from a genome-wide association study [4].

Animal and human studies indicate that during key periods such as the prenatal window and puberty, sex hormones organize the development of the brain with lasting behavioral effects and, in parallel, shape the body with lifelong consequences [11,12,13]. Hence, permanent sex dimorphisms in many human body dimensions are established during certain developmental episodes and thereafter remain stable or at least do not severely change throughout life. Thus, differences in body dimensions between males and females may be used to investigate the associations of organizing prenatal, pubertal, and later sex hormone exposures with psychiatric disorders, which include alcohol dependence.

The second-to-fourth finger length ratio (2D:4D) has been proposed as a proxy for the intrauterine sex hormone exposure, with lower values indicating prenatal hyperandrogenization [14,15] (for a critical review see [16,17]). Lower 2D:4D has been associated with a whole range of impairments such as behavioral problems in childhood [18], video game addiction [19], problematic and pathological internet use during adolescence [20], suicide in adulthood [21,22], and reduced life expectancy [23,24,25].

Lower 2D:4D has been reported in males and females that have high alcohol consumption defined as “daily” or “daily+” in a large BBC internet study [26] and as “at least two problems in the CAGE test and alcohol consumption of at least a few times each week” in a young university student sample [27]. Our first investigation on the 2D:4D-alcohol dependence relationship revealed lower 2D:4D in both males and females that were diagnosed with alcohol dependence [28]. Three additional studies on this topic have since been published [25,29,30]. In support of the initial investigation, our recent meta-analysis confirmed lower 2D:4D in alcohol-dependent males with a medium effect size (Hedge’s g = −0.552) [31]. Lower 2D:4D has also been shown to predict more alcohol-related 12-month hospital readmissions in alcohol-dependent in-patients [29]. These results suggest that higher androgen load during early intrauterine development increases the risk of alcohol dependence in adulthood and also predicts a worse outcome in affected in-patients. This early sex hormone activity model for alcohol dependence [32] is in agreement with a rodent study that demonstrated that prenatal androgen receptor inhibition reduces alcohol consumption in adult male mice, and that prenatal androgen receptor stimulation increases alcohol consumption in adult female mice [12]. Further support is provided by the fact that the opioid receptor mu 1 may interact with prenatal androgen exposure [12] and 2D:4D [33] to influence alcohol consumption during adulthood.

Another method to investigate prenatal influences of androgens on adult behaviors is the twin testosterone transfer model (TTT). The TTT is based on the assumption that compared to a female twin, a male twin increases the prenatal androgen load of his co-twin in the shared intrauterine environment [34,35]. A study using a discovery sample and an independent replication sample has shown that in males, a male co-twin reduces the risk for alcohol dependence during adulthood; in this study, there was no significant effect of the co-twin’s sex on risk of alcohol dependence in females [36]. Another study exclusively on females showed more lifetime alcohol use disorder symptoms in women with a male co-twin than in women with a female co-twin [37]. The inconsistent results in females may indicate false positive findings. By contrast, the consistent observations in males suggest that higher androgen load during early intrauterine development might decrease the risk of alcohol dependence in adulthood, which is in line with the early sex hormone activity model of alcohol dependence. However, it also implies a protective effect of higher prenatal androgen exposure in males, which may seem contradictory to the 2D:4D results described above. 2D:4D and the TTT may provide insight regarding the different prenatal developmental windows. 2D:4D sex dimorphisms are thought to originate during early pregnancy (i.e., before gestational week 9 [38] and 14 [39]). Thus, 2D:4D is believed to represent a marker of the first trimester. Because androgen levels in male fetuses peak between gestational weeks 12 and 18, the TTT may be used to investigate phenotypes that are established during the second trimester [35]. However, other explanations might also account for the inconsistent findings of studies using 2D:4D and those based on the TTT. Opposite- and same-sex human twins may differ in postnatal social factors (e.g., peer group characteristics) which also influence the risk to develop alcohol dependence later in life. Such bias may entail misinterpretation of results based on the TTT. Additionally, it cannot be ruled out that some of the above cited investigations have produced false positive findings.

In summary, a direct preclinical study and human investigations using the indirect biomarker 2D:4D and the TTT suggest that sex hormone exposure during development modulates the risk of alcohol dependence during adulthood. The organizational effects of sex hormones may depend on the developmental window during which they occur. Although an initial clinical study is being conducted to transfer this knowledge into prevention techniques [40], the field is subject to several limitations that include weaknesses related to 2D:4D and the TTT. Today, we are far from using such knowledge to improve the treatment of alcohol-dependent patients.

Moreover, little is known about the organizational effects of sex hormone exposures during puberty (and later) on alcohol dependence during adulthood. Only recently, the novel research area on sex hormone organization during the pubertal window has evolved [13]. Pubertal sex hormones shape sexual dimorphisms in physical traits and these might, therefore, be used to enlighten the associations between behavioral traits and pubertal sex hormone exposures; e.g., meta-analyses have demonstrated that the facial width-to-height ratio, which is subject to a sexual dimorphism appearing during puberty [41], is related to aggression and threat behavior among males and to dominance behavior in both sexes [42,43].

As far as we know, the association of easily measurable and thus highly accessible sexually dimorphic body dimensions with alcohol dependence and the prospective course of affected in-patients has not been systematically investigated.

Aims of the Study

Sex dimorphisms in body dimensions can provide initial insights into the organizational effects of sex hormones on the brain with clinically relevant behavioral outcomes. Thus, we analyzed here the differences in 15 absolute body measurements, 13 body measurements divided by height (= relative), and 13 body measurements residualized on height between alcohol-dependent in-patients and healthy control subjects of both sexes. We also investigated their relationships to the patients’ prospective 12- and 24-month outcome, following alcohol withdrawal treatment, in an effort to identify parameters that will be helpful to determine the individual prognosis. Finally, we explored the associations between absolute, relative, and residualized body measurements with 2D:4D, the age of onset of regular alcohol drinking, the age of the first in-patient treatment due to alcohol problems, total lifetime drinking, and daily ethanol intake.

2. Materials and Methods

2.1. Study Sample

This project was part of the bicentric, cross-sectional, and prospective Neurobiology of Alcoholism (NOAH) study, which included 200 alcohol-dependent in-patients and 240 age-matched healthy controls subjects [29]. All in-patients were diagnosed with alcohol dependence according to the tenth revision of the International Classification of Diseases (ICD-10) criteria [44] and alcohol use disorder according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria [45]. During the screening procedure, alcohol-dependent in-patients were excluded due to denial of written informed consent (n = 379), a mental comorbidity, such as primary depression (i.e., depression was present before the alcohol dependence), anxiety disorder, schizophrenia, substance use disorder other than alcohol or nicotine, posttraumatic stress disorder, or eating disorder (n = 194), a severe somatic disorder (n = 90), abstinence longer than 72 hours prior to inclusion (n = 88), or other reasons (n = 37). Healthy control subjects were hired with online advertisement and distribution of flyers. After a multistep screening procedure of 1215 interested individuals, 240 healthy control subjects were enrolled. The exclusion criteria of the control group included severe somatic disorders, prior medical treatment due to alcohol dependence, ≥2 affirmed CAGE questions [46], prior psychiatric in-patient treatment, psychiatric or psychotherapeutic outpatient treatment during the past 10 years, and an Alcohol Use Disorders Identification Test (German version [47]) score > 12.

The NOAH study design included two study-visits for alcohol-dependent in-patients and one study-visit for healthy control subjects. For in-patients, the first study-visit took place during early abstinence (i.e., 24–72 h of abstinence according to the in-patients’ self-reports of their last alcohol intake prior to study inclusion); 81.5% of the in-patients attended the second direct study-visit, which took place during the median 5th day post-inclusion (interquartile range (IQR) 3–6). The subjects were recruited at the Psychiatrische und Psychotherapeutische Klinik of the Universitätsklinikum Erlangen and at the Klinik für Psychiatrie, Sucht, Psychotherapie und Psychosomatik of the Klinikum am Europakanal, Germany. Post-inclusion, we followed the patients’ records for 12 and 24 months to analyze the outcome parameters: alcohol-related readmissions per se, latency (in days) to the first alcohol-related readmission, and total number of alcohol-related readmissions during the 12- and 24-month follow-up periods. For statistical analyses, days to first readmission were set to 365 (12-month follow-up) and 730 days (24-month follow-up) in patients without any recorded alcohol-related readmission during the observation period. Clinically experienced psychiatrists and well-trained and regularly supervised doctoral students (from our study team) conducted the semi-structured interviews. The interviews at study enrolment included the age of onset of regular alcohol drinking (i.e., daily over at least 7 days), the age of first in-patient treatment due to alcohol problems, the alcohol lifetime drinking history [48], and the number of previous in-patient withdrawal treatments in the group of alcohol-dependent in-patients, the Alcohol Use Disorders Identification Test (German version [47]) for the group of healthy control subjects, and smoking status for both groups. We also quantified the breath alcohol concentration in alcohol-dependent in-patients. Moreover, carbohydrate-deficient transferrin (CDT) was measured in serum samples of both groups (Central Laboratory of the University Hospital Erlangen, Germany, DIN EN ISO 15189 accredited). For previously published articles of the NOAH study, see [2,5,29,33,49,50,51,52].

2.2. Ethical Approval

This study was approved by the Ethics Committee of the Medical Faculty from the Friedrich-Alexander University Erlangen-Nürnberg (ID 81_12 B; April 19, 2012). All participants provided written informed consent. The study is in accordance with the ethical principles of the World Medical Association (sixth revision of the Declaration of Helsinki, Seoul 2008).

2.3. Basic Human Body Dimensions

We selected body height, body weight, and mandibular arc as established, sexually dimorphic features [53,54,55]. The lip-chin distance was included as an indicator for jaw height, which is a constituent part of facial masculinity [56]. We used lip-chin distance instead of full jaw height to exclude lower lip height, which is larger in females than males [57]. The waist and hip circumferences were investigated as sexually dimorphic traits that are largely determined during puberty [58]. Additional parameters with likely relationships to skeletal and/or soft-tissue growth in general were included, such as head, thigh, calf, and ankle circumference, bitragion and sagittal head arcs, foot length and breadth.

For the measurements, the participants wore only underwear and took off their shoes. Body height, body weight, head circumference, bitragion and sagittal head arcs, wrist, waist, hip, thigh, and calf circumferences, as well as foot length and breadth were quantified according to the Basic human measurements for technological design—Part 1: Body measurement definitions and landmarks (ISO 7250-1:2008); German version EN ISO 7250-1:2010. For body dimensions not included in the above list, we used the following definitions: Mandibular arc, distance between the two anguli mandibulae spanning over the point of the chin; lip-chin distance, lower lip mucocutaneous boundary to platysma mandible insertion; hip circumference, length over the widest part of the gluteal region; ankle circumference, maximum length parallel to the floor over the malleoli mediales and laterales. Body weight was measured in kg using a weighing scale and length dimensions in cm with a tape measure. All measurements were conducted once, by a non-blinded rater, in the standing position with the exception of foot length and breadth. Soles of the right and left feet were scanned in the sitting position using an HP Scanjet G4050 (HP Deutschland GmbH, Böblingen, Germany). Foot length and breadth were quantified by three independent and blinded raters with Microsoft PowerPoint (two-way random intra-class correlation coefficients (absolute agreement): mean of right and left foot length 0.996, mean of right and left foot breadth 0.990). We did not exclude hallux valgus deformations. Most of the missing values in the alcohol-dependent in-patients were due to a lower participation rate in the second study-visit, during which body measurements were conducted (if not already done during the first study visit).

2.4. 2D:4D

Right and left hands were scanned using an HP Scanjet G4050. The absolute index and ring finger lengths were quantified by three independent blinded raters and we analyzed the means of the right-hand and left-hand 2D:4D values, which are published (GNU Image Manipulation Program, www.gimp.org, two-way random intra-class correlation coefficient (absolute agreement) of mean of the right-hand and left-hand 2D:4D 0.986) [29].

2.5. Statistical Analyses

Data were analyzed using SPSS for Windows 24.0 (SPSS Inc., Chicago, IL, USA). The descriptive statistics report medians, IQR, and frequencies, which were calculated with the custom tables function of SPSS. We used the Mann–Whitney U test and Spearman’s correlation because some of the body measurements deviated significantly from a normal distribution, according to the Kolmogorov–Smirnov test. The χ2 test was employed to analyze differences in the frequency of nominal variables. Values of P < 0.05 for two-tailed tests were considered significant. To respect the well-known sex differences in alcohol dependence [32], we analyzed males and females separately.

Mean values of right and left-side body measurements were analyzed for wrist, thigh, calf, and ankle circumferences as well as foot length and breadth. We tested for associations of absolute body measurements, body measurements divided by height, and body measurements residualized on height with alcohol dependence and outcome. Body measurements were divided by height to obtain a relative measure in analogy to those frequently used in other fields of marker research (e.g., 2D:4D, facial width-to-height ratio). Moreover, the absolute values of body measurements were residualized for height to determine possible sex differences in and the predictive value of each parameter above and beyond general differences in body height. Linear regression, using the whole study population, was applied to residualize each single body measurement (dependent variable) on body height (predictor). The obtained residuals were interpreted as body measurement values that are independent of general body height. Residuals were z-standardized.

The field of organizational sex hormone effects in alcohol dependence is early in development. Hence, we tested a high number of predictors. In total, we predefined the following 656 statistical tests:

  • 82 group comparisons “alcohol-dependent in-patients versus healthy control subjects”: (15 absolute body measurements + 13 body measurements divided by height + 13 body measurements residualized on height) × 2 sexes

  • 164 group comparisons “readmission yes versus no”: (15 absolute body measurements + 13 body measurements divided by height + 13 body measurements residualized on height) × 2 sexes × 2 follow-up periods (12-month, 24-month)

  • 328 correlations with “outcome parameters”: (15 absolute body measurements + 13 body measurements divided by height + 13 body measurements residualized on height) × 2 sexes × 2 follow-up periods (12-month, 24-month) × 2 outcome parameters (latency, number)

  • 82 group comparisons “male versus female”: (15 absolute body measurements + 13 body measurements divided by height + 13 body measurements residualized on height) × 2 groups (alcohol-dependent in-patients versus healthy control subjects)

All reported P values are uncorrected. To consider type 1 error risk in multiple hypothesis testing, we employed the false discovery rate (FDR) procedure using a macro for Microsoft Excel (see Appendix S1 of Pike [59], classical one-stage method including all 656 tests; critical P value (FDR-derived significance threshold): 0.007470; [60]). In parallel, we also employed the more conservative Bonferroni adjustment (critical P value: 0.05/656 = 0.000076). We chose both correction methods to differentiate between robust (FDR) and very robust (Bonferroni) results. However, we acknowledge the problem of statistical power in view of the high number of tests. The sample size has been initially chosen to demonstrate group differences in 2D:4D already published in [29]. The body measurements analyzed in this article represent secondary endpoints and were not included into the a priori sample size estimation.

Finally, we performed the following explorative analyses that were not corrected for multiple hypothesis testing:

  • Correlations of absolute, relative, and residualized body measurements with 2D:4D in alcohol-dependent in-patients and healthy control subjects of both sexes.

  • Correlations of absolute, relative, and residualized body measurements with the age of onset of regular alcohol drinking and the age of first in-patient treatment due to alcohol problems in alcohol-dependent in-patients of both sexes.

  • Correlations of absolute, relative, and residualized body measurements with total lifetime drinking and daily ethanol intake in alcohol-dependent in-patients of both sexes.

  • Inter-correlations among the body measurements within the three groups of absolute, relative, and residualized body dimensions in alcohol-dependent in-patients and healthy control subjects of both sexes.

3. Results

3.1. Sociodemographic Characteristics

Both male and female alcohol-dependent in-patients did not significantly differ from healthy control subjects with regard to age, but were more often active and ever-smokers and had higher CDT blood levels. In the group of alcohol-dependent in-patients, male sex was significantly related to a younger age of onset of regular alcohol drinking (i.e., daily over at least 7 days), higher total lifetime drinking and daily ethanol intake since onset, a higher alcohol concentration at admission, higher CDT blood levels, and worse 12- and 24-month outcomes. Moreover, we found significantly higher Alcohol Use Disorders Identification Test scores and higher CDT blood levels in male (than in female) healthy control subjects (Table 1).

Table 1.

Demographic characteristics of male and female alcohol-dependent in-patients (ADP) and healthy control subjects (HCS).

Males Females ADP versus HCS Males versus Females
ADP (N = 113) HCS (N = 133) ADP (N = 87) HCS (N = 107) Males Females ADP HCS
N M/F IQR N M/F IQR N M/F IQR N M/F IQR U2 P U2 P U2 P U2 P
Age (years) 113 48 40 53 133 48 38 56 87 48 42 55 107 49 39 55 7369 0.794 4542 0.772 4502 0.308 6954 0.762
The age of onset of regular alcohol drinking
(i.e., daily over at least 7 days) (years)
92 26 19 34 - 67 33 23 41 - 2152 0.001
The age of first in-patient treatment due to alcohol problems (years) 96 36 30 47 - 77 40 32 46 - 3256 0.179
Total lifetime drinking (kg) 88 705 364 1838 - 62 332 174 747 - 1485 <0.001
Daily ethanol intake (g/d since onset) 86 140 80 310 - 60 65 30 120 - 1400 <0.001
Previous withdrawal treatments (n) 89 6 2 12 - 58 5 2 11 - 2547 0.892
Alcohol concentration at admission (‰) 108 1.7 0.5 2.4 - 85 1.2 0.1 1.8 - 3696 0.020
AUDIT score - 125 4 3 6 - 96 3 2 4 4295 <0.001
Active smokers (%) 104 78 133 22 78 77 107 19 74 <0.001 62 <0.001 <1 0.878 <1 0.552
Active and ex-smokers (%) 101 92 133 59 75 85 105 48 31 <0.001 27 <0.001 2 0.154 3 0.070
CDT (nephelometry, %) 113 2.8 1.9 4.0 132 1.5 1.3 1.7 87 1.9 1.6 2.5 107 1.5 1.3 1.6 1636 <0.001 1415 <0.001 3003 <0.001 6692 0.486
12-month alcohol-related readmissions
Readmission rate (%) 113 58 - 87 41 - 5 0.024
Latency (days) 113 285 57 ≥365 - 87 ≥365 97 ≥365 - 4142 0.042
Total number 113 1 0 3 - 87 0 0 2 - 4175 0.051
24-month alcohol-related readmissions
Readmission rate (%) 113 67 - 87 53 - 4 0.039
Latency (days) 113 285 57 ≥730 - 87 625 90 ≥730 - 4136 0.047
Total number 113 2 0 4 - 87 1 0 3 - 4014 0.021

The table shows medians (M) or relative frequencies (F), interquartile ranges (IQR), and results of Mann-Whitney U tests or χ2 tests. AUDIT: Alcohol Use Disorders Identification Test; CDT: carbohydrate-deficient transferrin. P < 0.05 in bold.

3.2. Basic Human Body Dimensions: Alcohol-Dependent In-Patients versus Healthy Control Subjects

After FDR correction, several absolute, relative, and residualized body measurements were significantly and consistently lower in alcohol-dependent in-patients than in healthy control subjects, except for sagittal head arc divided by height, which was significantly longer in alcohol-dependent in-patients (Table 2).

Table 2.

Differences in body measurements between alcohol-dependent in-patients (ADP) and healthy control subjects (HCS) and between males and females (Mann-Whitney U tests).

Males Females ADP versus HCS Males versus Females
ADP HCS ADP HCS Males Females ADP HCS
N M IQR N M IQR N M IQR N M IQR U P U P U P U P
Absolute measure
Body height 107 176.8 172.0 181.0 133 179.1 173.8 184.1 77 164.5 162.0 169.0 107 165.6 161.5 169.1 5668 0.007 4064 0.876 943 <0.001 * 864 <0.001 *
Body weight 106 79.3 68.7 86.6 133 87.4 81.0 97.2 77 66.7 59.8 79.8 106 68.0 59.3 79.3 4115 <0.001 * 4078 0.993 2484 <0.001 * 2260 <0.001 *
Head circumference 107 57.5 56.2 58.9 133 58.4 57.2 59.4 79 55.0 54.0 56.5 107 56.0 54.5 57.3 5436 0.002 3198 0.005 1348 <0.001 * 2626 <0.001 *
Bitragion head arc 107 36.7 35.6 37.5 133 37.4 36.5 38.7 79 35.5 34.5 36.3 107 36.0 35.0 37.4 5149 <0.001 3318 0.012 2444 <0.001 * 4149 <0.001 *
Sagittal head arc 107 36.0 35.0 37.7 133 35.6 34.5 37.0 79 35.0 34.0 36.1 107 34.5 33.0 36.0 6319 0.136 3900 0.367 2814 <0.001 5030 <0.001
Mandibular arc 106 24.0 23.0 25.2 133 24.0 22.5 26.0 77 22.2 21.3 23.0 106 22.4 21.0 23.6 6905 0.785 3907 0.621 1501 <0.001 * 3694 <0.001 *
Lip-chin distance 106 5.5 4.9 6.0 132 5.6 5.4 6.0 79 5.0 4.4 5.5 107 5.0 4.7 5.5 5303 0.001 3446 0.031 2731 <0.001 * 3758 <0.001 *
Wrist circumference 102 17.7 16.8 18.4 128 17.9 17.2 18.6 75 16.0 15.5 16.8 103 15.8 14.9 16.7 5761 0.126 3382 0.156 1037 <0.001 * 1825 <0.001 *
Waist circumference 106 93.0 87.8 103.5 133 96.0 89.5 104.8 77 87.0 78.0 93.5 107 84.0 72.7 92.7 6198 0.109 3565 0.119 2545 <0.001 * 3498 <0.001 *
Hip circumference 106 94.2 88.8 100.0 133 102.0 98.0 107.0 77 96.0 90.8 106.0 107 101.2 95.0 106.8 3076 <0.001 * 3130 0.005 3424 0.063 6342 0.148
Thigh circumference 106 55.2 50.8 58.5 133 60.5 57.8 64.6 79 56.5 53.7 62.0 106 60.5 57.0 64.0 3043 <0.001 * 3000 0.001 3294 0.013 6627 0.426
Calf circumference 106 36.8 35.4 38.9 132 39.5 37.7 41.5 79 36.0 33.8 39.2 107 37.3 35.0 39.5 3785 <0.001 * 3647 0.110 3657 0.141 3999 <0.001 *
Ankle circumference 106 26.2 25.3 27.2 131 26.6 25.9 27.9 79 24.2 23.1 25.8 107 24.6 23.6 25.4 5720 0.020 4107 0.741 1922 <0.001 * 2313 <0.001 *
Foot length 99 26.1 25.1 27.0 105 26.9 26.0 27.6 77 24.0 23.1 24.7 100 24.1 23.5 25.0 3625 <0.001 3413 0.195 805 <0.001 * 733 <0.001 *
Foot breadth 100 9.7 9.4 10.1 107 10.1 9.8 10.4 78 9.1 8.8 9.5 101 9.2 8.9 9.4 3375 <0.001 * 3930 0.978 1559 <0.001 * 725 <0.001 *
Measure divided by body height
Head circumference 107 0.33 0.32 0.33 133 0.32 0.32 0.33 77 0.33 0.32 0.34 107 0.34 0.33 0.35 6846 0.614 3142 0.006 3036 0.002 3505 <0.001 *
Bitragion head arc 107 0.21 0.20 0.21 133 0.21 0.20 0.22 77 0.22 0.21 0.22 107 0.22 0.21 0.23 6394 0.177 3251 0.015 2492 <0.001 * 3940 <0.001 *
Sagittal head arc 107 0.21 0.20 0.21 133 0.20 0.19 0.21 77 0.21 0.20 0.22 107 0.21 0.20 0.22 5313 0.001 3933 0.601 2912 0.001 3829 <0.001 *
Mandibular arc 106 0.14 0.13 0.14 133 0.14 0.13 0.14 75 0.13 0.13 0.14 106 0.14 0.13 0.14 6665 0.470 3731 0.482 3551 0.222 6906 0.788
Lip-chin distance 106 0.03 0.03 0.03 132 0.03 0.03 0.03 77 0.03 0.03 0.03 107 0.03 0.03 0.03 5843 0.029 3299 0.021 3634 0.206 6382 0.200
Wrist circumference 102 0.10 0.10 0.10 128 0.10 0.10 0.10 73 0.10 0.09 0.10 103 0.10 0.09 0.10 6366 0.746 3343 0.211 2761 0.004 4722 <0.001
Waist circumference 106 0.53 0.50 0.58 133 0.53 0.50 0.59 75 0.52 0.47 0.57 107 0.51 0.44 0.57 6702 0.513 3544 0.180 3654 0.355 5569 0.004
Hip circumference 106 0.53 0.50 0.56 133 0.57 0.54 0.60 75 0.59 0.54 0.64 107 0.61 0.57 0.66 3669 <0.001 * 3095 0.009 1974 <0.001 * 4140 <0.001 *
Thigh circumference 106 0.31 0.29 0.33 133 0.34 0.32 0.36 77 0.34 0.33 0.37 106 0.36 0.34 0.39 3603 <0.001 * 2976 0.002 1868 <0.001 * 4234 <0.001 *
Calf circumference 106 0.21 0.20 0.22 132 0.22 0.21 0.23 77 0.22 0.21 0.24 107 0.23 0.21 0.24 4762 <0.001 * 3492 0.078 3078 0.005 6078 0.064
Ankle circumference 106 0.15 0.14 0.15 131 0.15 0.14 0.15 77 0.15 0.14 0.15 107 0.15 0.14 0.16 6535 0.437 3943 0.619 4036 0.898 6769 0.650
Foot length 99 0.15 0.14 0.15 105 0.15 0.15 0.15 74 0.14 0.14 0.15 100 0.15 0.14 0.15 4526 0.111 2843 0.009 2525 <0.001 4158 0.010
Foot breadth 100 0.06 0.05 0.06 107 0.06 0.05 0.06 75 0.06 0.05 0.06 101 0.06 0.05 0.06 4296 0.014 3759 0.932 3629 0.715 4594 0.062
Measure residualized on body height
Head circumference 107 0.08 −0.46 0.66 133 0.26 −0.19 0.73 77 −0.46 −1.00 0.24 107 −0.15 −0.53 0.60 6241 0.102 2976 0.001 2674 <0.001 * 5615 0.005
Bitragion head arc 107 −0.09 −0.75 0.30 133 0.25 −0.44 0.91 77 −0.28 −0.99 0.27 107 −0.01 −0.68 0.78 5509 0.003 3195 0.009 3650 0.187 6453 0.215
Sagittal head arc 107 0.15 −0.49 0.78 133 −0.09 −0.80 0.45 77 0.06 −0.62 0.65 107 −0.05 −0.76 0.57 5769 0.012 3783 0.345 3792 0.358 6873 0.649
Mandibular arc 106 0.10 −0.24 0.53 133 0.13 −0.57 0.75 75 −0.22 −0.54 0.15 106 −0.17 −0.73 0.43 6838 0.691 3756 0.527 2843 0.001 5923 0.034
Lip-chin distance 106 0.12 −0.83 0.77 132 0.29 −0.24 0.91 77 −0.37 −1.06 0.28 107 −0.12 −0.80 0.57 5668 0.012 3303 0.022 3288 0.025 5390 0.002
Wrist circumference 102 0.28 −0.11 0.61 128 0.18 −0.10 0.58 73 −0.02 −0.18 0.22 103 −0.13 −0.51 0.32 6409 0.812 3334 0.201 2623 0.001 4477 <0.001 *
Waist circumference 106 −0.01 −0.43 0.63 133 0.10 −0.36 0.84 75 −0.18 −0.88 0.35 107 −0.42 −1.21 0.37 6531 0.329 3517 0.157 3317 0.058 4872 <0.001 *
Hip circumference 106 −0.57 −0.99 −0.02 133 0.19 −0.20 0.63 75 −0.30 −0.90 0.55 107 0.17 −0.42 0.73 3080 <0.001 * 2999 0.004 3238 0.034 6762 0.508
Thigh circumference 106 −0.61 −1.29 −0.11 133 0.20 −0.25 0.79 77 −0.37 −0.82 0.35 106 0.25 −0.26 0.79 3061 <0.001 * 2897 0.001 3065 0.004 6982 0.900
Calf circumference 106 −0.34 −0.83 0.22 132 0.22 −0.23 0.74 77 −0.29 −0.88 0.43 107 0.06 −0.54 0.58 4173 <0.001 * 3527 0.096 3910 0.628 5678 0.009
Ankle circumference 106 0.00 −0.35 0.48 131 0.15 −0.25 0.41 77 −0.22 −0.58 0.15 107 −0.19 −0.45 0.25 6167 0.139 3957 0.647 3229 0.016 5040 <0.001
Foot length 99 −0.02 −0.55 0.72 105 0.23 −0.35 1.08 74 −0.38 −0.97 0.18 100 0.04 −0.65 0.50 4547 0.123 2866 0.011 2628 0.001 4270 0.021
Foot breadth 100 −0.07 −0.69 0.68 107 0.32 −0.15 1.02 75 −0.19 −0.81 0.51 101 −0.14 −0.77 0.36 4056 0.003 3755 0.923 3345 0.222 3389 <0.001 *

Medians (M), interquartile ranges (IQR), absolute body weight in kg, absolute length dimensions in cm, P < 0.05 after adjustment using the false discovery rate is colored and indicates the following direction: ADP < HCS, ADP > HCS, males > females, males < females. * P < 0.05 after Bonferroni correction.

Absolute Body Measurements: Alcohol dependence was related to shorter head, hip, and thigh circumference in both sexes and to lower body height and weight, bitragion head arc length, lip-chin distance, calf circumference, and foot length and breadth in males. Body Measurements Divided by Height: Alcohol dependence was associated with shorter thigh circumference in both sexes, with longer sagittal head arc length and shorter hip and calf circumference in males, and with shorter head circumference in females. Body Measurements Residualized on Height: Alcohol dependence was related to shorter hip and thigh circumferences in both sexes, to a shorter bitragion head arc, calf circumference, and foot breadth in males, and to shorter head circumference in females.

The smaller absolute, relative, and residualized hip, thigh, and calf circumferences and the smaller absolute body weight and foot breadth in male alcohol-dependent in-patients, in comparison to male healthy control subjects, remained significant after the Bonferroni correction.

3.3. Basic Human Body Dimensions: Prospective Alcohol-Related Readmission

After FDR correction, worse patients’ outcomes were consistently related to significantly higher absolute, relative, and residualized thigh and calf circumferences in male alcohol-dependent in-patients. We did not find any significant association of absolute, relative, or residualized body measurement with outcomes in female alcohol-dependent in-patients (Table 3, Table 4 and Table 5).

Table 3.

Differences in body measurements between alcohol-dependent in-patients (ADP) without and those with prospective 12-month alcohol-related readmission.

12-Month Readmission in Male ADP 12-Month Readmission in Female ADP
No Yes No Yes
N M IQR N M IQR U P N M IQR N M IQR U P
Absolute measure
Body height 46 177.7 173.0 181.0 61 176.2 171.0 181.4 1200 0.201 45 164.3 160.5 169.0 32 164.8 163.0 169.2 628 0.339
Body weight 45 74.2 68.1 83.3 61 80.2 71.8 90.4 1098 0.079 47 68.2 57.9 76.7 30 65.7 60.5 81.3 650 0.562
Head circumference 46 57.3 56.2 58.0 61 57.5 56.4 59.0 1209 0.221 47 54.5 54.0 56.0 32 55.5 53.7 57.0 593 0.111
Bitragion head arc 46 37.0 36.0 37.7 61 36.3 35.4 37.5 1140 0.097 47 35.5 34.5 36.2 32 35.5 35.0 36.5 640 0.260
Sagittal head arc 46 36.0 35.0 37.4 61 36.0 34.7 37.7 1381 0.890 47 34.8 33.0 36.0 32 35.2 34.1 36.3 608 0.149
Mandibular arc 46 24.2 23.4 25.5 60 23.6 22.8 25.0 1120 0.096 47 22.0 21.0 23.0 30 22.3 22.0 23.1 582 0.194
Lip-chin distance 46 5.5 4.9 6.0 60 5.5 5.0 5.8 1306 0.635 47 5.0 4.2 5.5 32 5.0 4.6 5.5 710 0.668
Wrist circumference 44 17.7 16.5 18.2 58 17.7 16.9 18.5 1131 0.327 46 15.9 15.5 16.8 29 16.1 15.5 16.5 590 0.401
Waist circumference 46 92.0 86.4 97.7 60 95.6 88.3 105.5 1115 0.091 45 87.0 81.0 93.5 32 86.8 77.0 101.0 713 0.938
Hip circumference 46 92.6 88.0 99.4 60 95.3 90.0 100.8 1201 0.252 45 96.5 91.7 103.0 32 95.2 89.8 108.1 717 0.971
Thigh circumference 46 52.9 49.8 56.5 60 56.6 53.5 60.2 911 0.003 47 56.0 53.0 62.5 32 56.9 54.0 61.0 709 0.668
Calf circumference 46 36.2 34.5 37.9 60 37.4 35.8 39.7 998 0.015 47 35.8 33.3 39.2 32 36.8 34.2 39.4 686 0.506
Ankle circumference 46 26.0 25.0 27.0 60 26.5 25.5 27.5 1109 0.084 47 24.1 23.0 26.0 32 24.5 23.8 25.3 672 0.423
Foot length 41 26.0 25.0 27.2 58 26.1 25.3 26.8 1183 0.966 45 23.7 22.7 24.7 32 24.1 23.5 24.8 604 0.229
Foot breadth 42 9.7 9.5 10.0 58 9.7 9.4 10.2 1180 0.788 46 9.1 8.8 9.5 32 9.1 8.9 9.5 731 0.959
Measure divided by body height
Head circumference 46 0.32 0.31 0.33 61 0.33 0.32 0.34 1071 0.036 45 0.33 0.32 0.34 32 0.33 0.32 0.35 705 0.877
Bitragion head arc 46 0.21 0.20 0.21 61 0.21 0.20 0.22 1304 0.531 45 0.22 0.21 0.22 32 0.22 0.21 0.22 705 0.873
Sagittal head arc 46 0.20 0.20 0.21 61 0.21 0.20 0.21 1285 0.456 45 0.21 0.20 0.22 32 0.21 0.20 0.22 694 0.784
Mandibular arc 46 0.14 0.13 0.15 60 0.14 0.13 0.14 1255 0.426 45 0.13 0.13 0.14 30 0.13 0.13 0.14 628 0.611
Lip-chin distance 46 0.03 0.03 0.03 60 0.03 0.03 0.03 1357 0.883 45 0.03 0.03 0.03 32 0.03 0.03 0.03 689 0.749
Wrist circumference 44 0.10 0.09 0.10 58 0.10 0.10 0.10 1034 0.102 44 0.10 0.09 0.10 29 0.10 0.09 0.10 620 0.839
Waist circumference 46 0.51 0.49 0.56 60 0.54 0.51 0.59 1026 0.024 43 0.54 0.49 0.57 32 0.51 0.46 0.59 663 0.785
Hip circumference 46 0.52 0.49 0.56 60 0.54 0.52 0.57 1076 0.052 43 0.60 0.54 0.64 32 0.57 0.54 0.64 660 0.764
Thigh circumference 46 0.30 0.28 0.32 60 0.32 0.30 0.34 811 <0.001 45 0.34 0.33 0.37 32 0.34 0.33 0.37 690 0.753
Calf circumference 46 0.21 0.19 0.22 60 0.21 0.20 0.23 939 0.005 45 0.22 0.20 0.24 32 0.22 0.21 0.24 677 0.653
Ankle circumference 46 0.15 0.14 0.15 60 0.15 0.14 0.16 1017 0.021 45 0.15 0.14 0.15 32 0.15 0.14 0.15 714 0.946
Foot length 41 0.15 0.14 0.15 58 0.15 0.14 0.15 1050 0.323 42 0.14 0.14 0.15 32 0.15 0.14 0.15 612 0.513
Foot breadth 42 0.05 0.05 0.06 58 0.06 0.05 0.06 1092 0.379 43 0.06 0.05 0.06 32 0.06 0.05 0.06 603 0.363
Measure residualized on body height
Head circumference 46 −0.14 −0.50 0.40 61 0.23 −0.38 0.76 1104 0.059 45 −0.58 −1.02 0.07 32 −0.34 −0.90 0.39 609 0.251
Bitragion head arc 46 0.01 −0.45 0.31 61 −0.26 −0.99 0.29 1173 0.147 45 −0.49 −0.99 0.32 32 −0.23 −0.95 0.27 677 0.653
Sagittal head arc 46 0.15 −0.44 0.78 61 0.16 −0.54 0.77 1351 0.741 45 −0.02 −0.62 0.62 32 0.08 −0.58 0.69 637 0.391
Mandibular arc 46 0.12 −0.21 0.74 60 0.05 −0.35 0.38 1209 0.276 45 −0.33 −0.69 0.17 30 −0.18 −0.46 0.15 610 0.482
Lip-chin distance 46 0.07 −0.86 1.02 60 0.13 −0.67 0.52 1345 0.823 45 −0.36 −1.23 0.28 32 −0.39 −0.87 0.35 681 0.687
Wrist circumference 44 0.05 −0.18 0.52 58 0.33 −0.03 0.66 1040 0.111 44 −0.04 −0.16 0.24 29 0.01 −0.40 0.22 628 0.910
Waist circumference 46 −0.19 −0.49 0.34 60 0.10 −0.31 0.89 1045 0.032 43 −0.05 −0.60 0.34 32 −0.30 −0.97 0.69 664 0.793
Hip circumference 46 −0.68 −1.11 −0.07 60 −0.42 −0.92 0.09 1189 0.222 43 −0.28 −0.90 0.37 32 −0.38 −0.87 0.77 682 0.949
Thigh circumference 46 −0.98 −1.43 −0.42 60 −0.42 −0.82 0.14 891 0.002 45 −0.42 −0.84 0.51 32 −0.30 −0.73 0.34 677 0.653
Calf circumference 46 −0.61 −1.21 0.01 60 −0.22 −0.60 0.40 964 0.008 45 −0.42 −0.92 0.43 32 −0.09 −0.87 0.44 663 0.552
Ankle circumference 46 −0.10 −0.39 0.28 60 0.15 −0.26 0.68 1041 0.031 45 −0.22 −0.64 0.20 32 −0.21 −0.53 0.13 704 0.865
Foot length 41 −0.03 −0.79 0.51 58 0.09 −0.48 0.86 1054 0.338 42 −0.44 −0.93 0.09 32 −0.07 −1.19 0.21 622 0.585
Foot breadth 42 −0.40 −0.69 0.72 58 0.10 −0.73 0.66 1108 0.442 43 −0.19 −0.70 0.54 32 −0.31 −0.94 0.27 623 0.486

Medians (M), interquartile ranges (IQR), absolute body weight in kg, absolute length dimensions in cm, P < 0.05 after adjustment using the false discovery rate is colored and indicates the following direction: ADP without 12-month readmission < ADP with 12-month readmission (no P < 0.05 after Bonferroni correction).

Table 4.

Differences in body measurements between alcohol-dependent in-patients (ADP) without and those with prospective 24-month alcohol-related readmission.

24-Month Readmission in Male ADP 24-Month Readmission in Female ADP
No Yes No Yes
N M IQR N M IQR U P N M IQR N M IQR U P
Absolute measure
Body height 36 178.1 174.4 181.2 71 176.2 171.0 181.0 973 0.044 35 164.1 160.0 169.2 42 165.0 163.0 169.0 600 0.167
Body weight 35 74.2 67.9 81.9 71 80.0 69.1 89.9 1034 0.161 37 67.2 57.9 76.7 40 66.6 61.2 80.5 675 0.507
Head circumference 36 57.3 56.1 58.0 71 57.5 56.3 59.0 1135 0.343 37 54.8 54.0 56.0 42 55.2 53.4 56.8 707 0.490
Bitragion head arc 36 37.0 36.0 37.8 71 36.5 35.5 37.5 1077 0.184 37 35.5 34.3 36.0 42 35.5 35.0 36.5 666 0.274
Sagittal head arc 36 35.9 34.9 37.6 71 36.0 35.0 37.7 1213 0.665 37 35.0 33.1 36.0 42 35.1 34.0 36.3 691 0.397
Mandibular arc 36 24.4 23.5 25.5 70 24.0 22.6 25.0 977 0.058 37 22.0 21.0 23.0 40 22.3 21.4 23.1 648 0.345
Lip-chin distance 36 5.5 4.9 6.1 70 5.5 4.9 5.8 1099 0.280 37 5.0 4.2 5.5 42 5.0 4.4 5.5 765 0.901
Wrist circumference 34 17.6 16.5 18.2 68 17.7 16.9 18.5 1046 0.433 36 15.8 15.2 16.8 39 16.0 15.5 16.5 613 0.342
Waist circumference 36 92.0 87.3 97.4 70 95.2 88.0 105.0 1058 0.178 35 87.0 76.8 93.5 42 86.8 78.0 94.0 698 0.701
Hip circumference 36 92.6 88.3 99.4 70 95.3 89.2 100.5 1112 0.322 35 96.5 89.0 106.0 42 96.0 90.8 106.0 727 0.931
Thigh circumference 36 52.9 50.0 56.8 70 56.1 52.0 60.0 934 0.029 37 56.0 53.1 62.0 42 56.6 54.0 61.0 738 0.702
Calf circumference 36 36.2 34.3 38.0 70 37.0 35.8 39.3 999 0.081 37 36.0 33.8 39.2 42 36.2 34.0 39.0 762 0.883
Ankle circumference 36 26.0 25.3 27.0 70 26.3 25.4 27.4 1131 0.387 37 24.0 23.0 26.0 42 24.5 23.8 25.5 699 0.440
Foot length 33 26.2 25.2 27.2 66 26.0 25.1 26.8 1013 0.570 35 23.6 22.5 24.7 42 24.1 23.1 25.0 581 0.114
Foot breadth 34 9.7 9.4 10.0 66 9.8 9.4 10.2 999 0.371 36 9.1 8.7 9.5 42 9.1 8.9 9.5 732 0.806
Measure divided by body height
Head circumference 36 0.32 0.31 0.33 71 0.33 0.32 0.34 906 0.014 35 0.34 0.32 0.34 42 0.33 0.32 0.34 667 0.483
Bitragion head arc 36 0.21 0.20 0.21 71 0.21 0.20 0.22 1231 0.757 35 0.22 0.21 0.22 42 0.22 0.21 0.22 706 0.763
Sagittal head arc 36 0.20 0.20 0.21 71 0.21 0.20 0.21 1055 0.141 35 0.21 0.20 0.23 42 0.21 0.20 0.22 686 0.613
Mandibular arc 36 0.14 0.13 0.15 70 0.14 0.13 0.14 1133 0.397 35 0.13 0.13 0.14 40 0.13 0.13 0.14 675 0.787
Lip-chin distance 36 0.03 0.03 0.03 70 0.03 0.03 0.03 1194 0.660 35 0.03 0.03 0.03 42 0.03 0.03 0.03 720 0.874
Wrist circumference 34 0.10 0.09 0.10 68 0.10 0.10 0.10 894 0.063 34 0.10 0.09 0.10 39 0.10 0.09 0.10 638 0.782
Waist circumference 36 0.51 0.48 0.55 70 0.54 0.50 0.59 948 0.037 33 0.54 0.47 0.57 42 0.51 0.47 0.58 669 0.794
Hip circumference 36 0.52 0.49 0.56 70 0.54 0.52 0.57 978 0.059 33 0.60 0.54 0.64 42 0.58 0.54 0.63 653 0.669
Thigh circumference 36 0.30 0.28 0.32 70 0.32 0.30 0.34 787 0.002 35 0.34 0.33 0.37 42 0.34 0.33 0.37 686 0.613
Calf circumference 36 0.20 0.19 0.22 70 0.21 0.20 0.23 893 0.014 35 0.22 0.20 0.24 42 0.22 0.21 0.23 718 0.858
Ankle circumference 36 0.15 0.14 0.15 70 0.15 0.14 0.16 978 0.059 35 0.15 0.14 0.15 42 0.15 0.14 0.15 727 0.931
Foot length 33 0.15 0.14 0.15 66 0.15 0.14 0.15 929 0.235 32 0.14 0.14 0.15 42 0.15 0.14 0.15 550 0.183
Foot breadth 34 0.05 0.05 0.06 66 0.06 0.05 0.06 866 0.062 33 0.06 0.05 0.06 42 0.06 0.05 0.06 616 0.411
Measure residualized on body height
Head circumference 36 −0.14 −0.48 0.37 71 0.20 −0.41 0.79 1005 0.071 35 −0.58 −1.02 0.24 42 −0.41 −1.00 0.25 712 0.810
Bitragion head arc 36 0.01 −0.60 0.31 71 −0.26 −0.93 0.30 1140 0.363 35 −0.50 −1.03 0.34 42 −0.23 −0.90 0.18 698 0.701
Sagittal head arc 36 −0.16 −0.54 0.80 71 0.17 −0.34 0.77 1150 0.399 35 0.02 −0.70 0.65 42 0.06 −0.58 0.68 711 0.806
Mandibular arc 36 0.17 −0.21 0.73 70 0.05 −0.46 0.40 1079 0.227 35 −0.33 −0.64 0.17 40 −0.18 −0.49 0.15 653 0.614
Lip-chin distance 36 0.11 −0.85 1.03 70 0.12 −0.76 0.54 1160 0.505 35 −0.35 −1.18 0.28 42 −0.45 −1.05 0.39 723 0.898
Wrist circumference 34 −0.02 −0.20 0.51 68 0.31 −0.02 0.65 907 0.077 34 −0.01 −0.18 0.28 39 −0.04 −0.26 0.22 645 0.842
Waist circumference 36 −0.18 −0.54 0.32 70 0.06 −0.37 0.86 970 0.053 33 −0.04 −0.88 0.34 42 −0.28 −0.88 0.58 676 0.852
Hip circumference 36 −0.73 −1.09 −0.08 70 −0.43 −0.94 0.08 1104 0.296 33 −0.35 −0.96 0.41 42 −0.30 −0.76 0.64 689 0.966
Thigh circumference 36 −0.98 −1.43 −0.41 70 −0.48 −1.06 0.08 914 0.021 35 −0.42 −0.84 0.51 42 −0.32 −0.74 0.35 697 0.694
Calf circumference 36 −0.62 −1.21 0.04 70 −0.28 −0.62 0.35 946 0.036 35 −0.35 −1.05 0.61 42 −0.19 −0.88 0.38 735 0.996
Ankle circumference 36 −0.05 −0.37 0.31 70 0.07 −0.27 0.58 1034 0.131 35 −0.21 −0.70 0.29 42 −0.23 −0.49 0.13 720 0.874
Foot length 33 −0.09 −0.81 0.40 66 0.12 −0.48 0.92 928 0.232 32 −0.45 −0.95 −0.01 42 0.04 −1.13 0.23 561 0.226
Foot breadth 34 −0.48 −0.69 0.49 66 0.12 −0.63 0.73 888 0.089 33 −0.21 −0.70 0.62 42 −0.16 −0.87 0.28 651 0.654

Medians (M), interquartile ranges (IQR), absolute body weight in kg, absolute length dimensions in cm, P < 0.05 after adjustment using the false discovery rate is colored and indicates the following direction: ADP without 24-month readmission < ADP with 24-month readmission (no P < 0.05 after Bonferroni correction).

Table 5.

Spearman correlations of absolute body measurements with days to first and number of alcohol-related readmissions in alcohol-dependent in-patients (ADP).

Male ADP 12-Month Readmission Male ADP 24-Month Readmission Female ADP 12-Month Readmission Female ADP 24-Month Readmission
Latency (Days) Number Latency (Days) Number Latency (Days) Number Latency (Days) Number
N ρ P ρ P ρ P ρ P N ρ P ρ P ρ P ρ P
Absolute measure
Body height 107 0.091 0.349 −0.082 0.400 0.122 0.210 −0.131 0.179 77 −0.041 0.722 0.123 0.286 −0.098 0.399 0.152 0.187
Body weight 106 −0.150 0.126 0.175 0.072 −0.140 0.152 0.188 0.054 77 −0.028 0.807 0.102 0.379 −0.062 0.592 0.104 0.368
Head circumference 107 −0.131 0.178 0.140 0.151 −0.126 0.196 0.160 0.099 79 −0.132 0.245 0.167 0.141 −0.090 0.433 0.149 0.189
Bitragion head arc 107 0.195 0.044 −0.179 0.065 0.190 0.050 −0.147 0.131 79 −0.058 0.614 0.073 0.525 −0.037 0.743 0.099 0.385
Sagittal head arc 107 −0.006 0.952 0.120 0.217 −0.019 0.848 0.162 0.095 79 −0.178 0.116 0.206 0.069 −0.169 0.137 0.192 0.090
Mandibular arc 106 0.122 0.212 −0.141 0.149 0.141 0.151 −0.142 0.147 77 −0.078 0.503 0.115 0.319 −0.058 0.618 0.102 0.376
Lip-chin distance 106 0.040 0.686 −0.094 0.339 0.060 0.542 −0.133 0.174 79 −0.040 0.724 0.002 0.986 0.008 0.945 −0.020 0.865
Wrist circumference 102 −0.121 0.225 0.110 0.270 −0.116 0.244 0.120 0.230 75 −0.049 0.679 0.103 0.378 −0.096 0.411 0.111 0.342
Waist circumference 106 −0.106 0.279 0.142 0.147 −0.096 0.326 0.146 0.135 77 0.043 0.708 0.011 0.928 0.010 0.930 0.044 0.706
Hip circumference 106 −0.095 0.334 0.127 0.196 −0.091 0.351 0.151 0.123 77 0.050 0.666 −0.012 0.920 0.035 0.761 −0.029 0.801
Thigh circumference 106 −0.260 0.007 0.274 0.004 −0.240 0.013 0.257 0.008 79 −0.055 0.628 0.118 0.301 −0.080 0.484 0.095 0.405
Calf circumference 106 −0.270 0.005 0.199 0.041 −0.249 0.010 0.181 0.063 79 −0.050 0.660 0.124 0.276 −0.050 0.664 0.060 0.598
Ankle circumference 106 −0.123 0.210 0.140 0.153 −0.097 0.322 0.087 0.376 79 −0.062 0.588 0.118 0.302 −0.090 0.431 0.094 0.408
Foot length 99 −0.030 0.765 0.006 0.953 −0.009 0.929 −0.026 0.797 77 −0.088 0.449 0.185 0.108 −0.150 0.193 0.215 0.061
Foot breadth 100 −0.110 0.276 0.039 0.700 −0.131 0.195 0.092 0.363 78 0.062 0.588 0.002 0.987 0.015 0.899 −0.004 0.974
Measure divided by body height
Head circumference 107 −0.184 0.058 0.200 0.038 −0.203 0.036 0.260 0.007 77 −0.044 0.702 −0.016 0.891 0.024 0.837 −0.048 0.676
Bitragion head arc 107 0.108 0.267 −0.101 0.300 0.079 0.416 −0.040 0.686 77 0.013 0.911 −0.060 0.605 0.058 0.614 −0.051 0.660
Sagittal head arc 107 −0.040 0.684 0.145 0.136 −0.069 0.478 0.224 0.020 77 −0.100 0.386 0.060 0.605 −0.054 0.642 0.026 0.824
Mandibular arc 106 0.041 0.674 −0.079 0.423 0.050 0.612 −0.064 0.517 75 −0.031 0.792 0.025 0.833 0.000 0.997 0.010 0.931
Lip-chin distance 106 0.022 0.826 −0.063 0.520 0.030 0.764 −0.083 0.397 77 −0.047 0.687 0.000 0.999 0.002 0.985 −0.019 0.869
Wrist circumference 102 −0.175 0.079 0.159 0.109 −0.187 0.060 0.187 0.060 73 0.034 0.776 0.010 0.933 0.010 0.934 −0.004 0.973
Waist circumference 106 −0.151 0.123 0.183 0.060 −0.149 0.128 0.192 0.049 75 0.065 0.577 −0.033 0.777 0.064 0.584 −0.022 0.852
Hip circumference 106 −0.161 0.100 0.180 0.064 −0.164 0.093 0.211 0.030 75 0.054 0.644 −0.037 0.750 0.052 0.659 −0.062 0.598
Thigh circumference 106 −0.308 0.001 0.315 0.001 −0.303 0.002 0.320 0.001 77 0.009 0.935 0.040 0.729 −0.001 0.994 0.003 0.979
Calf circumference 106 −0.284 0.003 0.212 0.029 −0.277 0.004 0.223 0.022 77 −0.047 0.685 0.098 0.395 −0.034 0.769 0.023 0.845
Ankle circumference 106 −0.181 0.063 0.178 0.068 −0.172 0.079 0.153 0.117 77 −0.017 0.884 0.038 0.740 −0.028 0.809 0.002 0.984
Foot length 99 −0.122 0.230 0.090 0.374 −0.129 0.201 0.103 0.312 74 −0.086 0.464 0.129 0.272 −0.159 0.175 0.177 0.131
Foot breadth 100 −0.142 0.159 0.084 0.407 −0.178 0.076 0.163 0.105 75 0.115 0.325 −0.098 0.402 0.100 0.391 −0.121 0.300
Measure residualized on body height
Head circumference 107 −0.184 0.058 0.196 0.043 −0.187 0.054 0.232 0.016 77 −0.115 0.320 0.112 0.331 −0.058 0.614 0.089 0.439
Bitragion head arc 107 0.183 0.059 −0.171 0.078 0.170 0.080 −0.120 0.217 77 −0.016 0.891 0.002 0.986 0.019 0.871 0.020 0.864
Sagittal head arc 107 −0.021 0.832 0.129 0.184 −0.042 0.669 0.187 0.054 77 −0.134 0.246 0.136 0.237 −0.114 0.324 0.123 0.287
Mandibular arc 106 0.068 0.487 −0.099 0.311 0.080 0.412 −0.089 0.366 75 −0.038 0.746 0.043 0.716 −0.015 0.900 0.031 0.793
Lip-chin distance 106 0.023 0.812 −0.069 0.485 0.037 0.705 −0.095 0.331 77 −0.051 0.659 0.005 0.967 −0.001 0.995 −0.017 0.885
Wrist circumference 102 −0.171 0.085 0.158 0.113 −0.181 0.068 0.183 0.066 73 0.023 0.846 0.021 0.857 −0.001 0.994 0.006 0.956
Waist circumference 106 −0.144 0.140 0.178 0.068 −0.141 0.149 0.187 0.056 75 0.069 0.556 −0.026 0.824 0.058 0.620 −0.012 0.919
Hip circumference 106 −0.101 0.302 0.132 0.177 −0.097 0.322 0.155 0.114 75 0.036 0.756 −0.001 0.990 0.020 0.866 −0.017 0.883
Thigh circumference 106 −0.269 0.005 0.282 0.003 −0.249 0.010 0.267 0.006 77 −0.058 0.614 0.125 0.280 −0.083 0.471 0.101 0.380
Calf circumference 106 −0.280 0.004 0.209 0.032 −0.265 0.006 0.204 0.036 77 −0.049 0.671 0.117 0.311 −0.043 0.708 0.047 0.686
Ankle circumference 106 −0.165 0.092 0.166 0.089 −0.147 0.132 0.125 0.202 77 −0.018 0.875 0.052 0.652 −0.042 0.717 0.026 0.822
Foot length 99 −0.118 0.244 0.088 0.387 −0.127 0.210 0.102 0.314 74 −0.076 0.521 0.117 0.320 −0.147 0.212 0.166 0.158
Foot breadth 100 −0.139 0.167 0.080 0.431 −0.173 0.085 0.156 0.122 75 0.099 0.397 −0.067 0.571 0.068 0.562 −0.078 0.508

P < 0.05 after adjustment using the false discovery rate is colored and indicates the following direction: higher values of body measurements correspond to a shorter latency to the first readmission and to a higher number of readmissions for the 12- and 24-month follow-up periods (no P < 0.05 after Bonferroni correction).

Absolute Body Measurements: Thigh circumference was linked to risk, latency, and the number of alcohol-related readmissions throughout the 12-month follow-up. Calf circumference correlated with the 12-month latency to alcohol-related readmission. Body Measurements Divided by Height: Thigh circumference was associated with risk, latency, and the number of alcohol-related readmissions for the 12-month and 24-month follow-ups. Calf circumference was linked to 12-month risk and 12-month and 24-month latency to alcohol-related readmission. Moreover, there was an association between head circumference values and number of alcohol-related readmissions during the 24-month follow-up. Body Measurements Residualized on Height: Thigh circumference was linked to risk, latency, and the number of alcohol-related readmission for the 12-month follow-up and the number of alcohol-related readmissions for the 24-month follow-up. Calf circumference related to 12-month und 24-month latency to alcohol-related readmission.

None of these effects remained significant after the Bonferroni adjustment.

3.4. Basic Human Body Dimensions: Sex Differences

After FDR correction, we found significantly longer absolute and residualized body measurements in males than in females, except for the shorter residualized thigh circumference in male than in female alcohol-dependent in-patients. Many relative body measurements were significantly lower in males than in females (Table 2).

Absolute Body Measurements: Male sex was related to higher body weight and height, head circumference, lengths of bitragion and sagittal head arc and mandibular arc, lip-chin distance, wrist, waist, and ankle circumference, and foot length and breadth in both groups and to a longer calf circumference in the healthy control subjects. Body Measurements Divided by Height: Male sex was linked to lower head circumference values, lengths of bitragion and sagittal head arc, a higher wrist circumference, and lower hip and thigh circumferences in both groups, to a smaller calf circumference and a longer foot length in alcohol-dependent in-patients, and to a higher waist circumference in healthy control subjects. Body Measurements Residualized on Height: Male sex was associated with longer head and wrist circumference in both groups, with a longer mandibular arc, shorter thigh circumference, and higher foot length in alcohol-dependent in-patients, and with longer lip-chin distance, waist and ankle circumference, and foot breadth in healthy control subjects.

Many of these sex differences remained significant after the Bonferroni correction.

3.5. Basic Human Body Dimensions: Exploratory Analysis of Correlations with 2D:4D, the Age of Onset of Regular Alcohol Drinking and First In-Patient Treatment Due to Alcohol Problems, Total Lifetime Drinking and Daily Ethanol Intake, and Inter-Correlations

The analyses revealed no convincing pattern of significant relationships between 2D:4D and absolute body measurements, body measurements divided by height, or body measurements residualized on height (no significant correlation except for seven tests with P > 0.039, Table A1 in Appendix A).

The age of onset of regular drinking (i.e., daily over at least 7 days) and the age of the subjects’ first in-patient treatment due to alcohol problems correlated positively and significantly with many absolute, relative, and residualized body measurements in both male and female alcohol-dependent in-patients; however, there were also significant negative correlations with the lengths of sagittal head arc and thigh circumference in male patients (Table A2 in Appendix A).

Absolute Body Measurements: In male alcohol-dependent in-patients, the age of onset of regular drinking and/or the age of first in-patient treatment due to alcohol problems correlated positively with lengths of mandibular arc, waist, hip, and ankle circumferences and negatively with sagittal head arc and thigh circumference. Body Measurements Divided by Height: The age of onset of regular drinking and/or the age of first in-patient treatment due to alcohol problems correlated positively with lengths of mandibular arc and waist and ankle circumference and negatively with sagittal head arc and thigh circumference in male alcohol-dependent in-patients and positively with wrist and ankle circumference and foot length and breadth in female alcohol-dependent in-patients. Body Measurements Residualized on Height: The age of onset of regular drinking and/or the age of first in-patient treatment due to alcohol problems correlated positively with lengths of mandibular arc and waist, hip, and ankle circumferences and negatively with sagittal head arc and thigh circumference in male alcohol-dependent in-patients and positively with bitragion head arc, wrist and ankle circumference, and foot length and breadth in female alcohol-dependent in-patients.

Total lifetime drinking and daily ethanol intake did not significantly correlate with absolute, relative, or residualized body measurements in male and female alcohol-dependent in-patients, except for a significant negative correlation between total lifetime drinking and absolute lip-chin distance in male patients and between daily ethanol intake and absolute, relative, and residualized mandibular arc length in male and female patients (P > 0.025) (Table A3 in Appendix A).

We found multiple significant inter-correlations among the absolute body measurements (Table A4 and Table A5 in Appendix A), the body measurements divided by height (Table A6 and Table A7 in Appendix A), and the body measurements residualized on height (Table A8 and Table A9 in Appendix A).

4. Discussion

As far as we know, this is the first systematic and comprehensive anthropomorphic study that determined the associations between basic human body dimensions and alcohol dependence. Separately for both sexes, we have found many shorter body measurements in alcohol-dependent in-patients than in healthy control subjects. These results are supported by two earlier studies that indicated that participants recruited from alcoholism in-patient treatment programs have lower body height, body weight, and thigh volume than controls [61,62], although it should be noted that these projects focused primarily on body composition and sex differences in alcohol consumption. Moreover, we showed here for the first time that in male alcohol-dependent in-patients, a higher thigh circumference may predict a worse 12-month outcome with a higher risk, shorter latency to the first alcohol-related readmission, and a higher number of alcohol-related readmissions.

We were able to verify many of the a priori expected sexual dimorphisms with shorter absolute and residualized on height physical dimensions in females than males. These results confirm the assumption that the body dimensions may provide insight into the organizational effects of sex hormones. Hence, the associations between sexually dimorphic body measurements and alcohol dependence observed here may support that the organizational effects of sex hormones are involved in alcohol dependence. Interestingly, the absolute, relative, and residualized body measurements did not convincingly correlate with 2D:4D in any subgroup. The independence of these factors may suggest that, rather than prenatal sex hormones, the pubertal (or later) sex hormones organize the physical dimensions analyzed in this study. Support of this idea comes from a rodent study that failed to show consistent effects of prenatal androgen receptor modulation on head size and body length [11]. It is therefore more likely that pubertal (or even later), rather than prenatal sex hormone effects, account for the differences between alcohol-dependent in-patients and healthy control subjects observed here. Moreover, the smaller body height of alcohol-dependent males in comparison to healthy control males detected here is contradictory to the expectations based on findings from the TTT. In males, a male co-twin in comparison to a female co-twin reduces both the risk for later alcohol dependence [36] and body height [63], although the effect sizes were small in both investigations. However, this entails the prediction of larger body height in alcohol-dependent males. The opposite finding in this study further corroborates that, rather than prenatal sex hormones, the pubertal (or later) sex hormones organize the physical dimensions analyzed here. It may also indicate that other factors as discussed in the following section are involved.

4.1. Possible Reasons for Smaller Body Dimensions in Alcohol Dependence

We detected many shorter absolute, relative, and residualized body measurements in alcohol-dependent in-patients than in healthy control subjects. Shorter measurements for most of the absolute and residualized parameters were also present in females than in males. At first glance, the shorter body measurements in the alcohol dependence group (compared to the control group), in light of the shorter values in females than in males, might appear contradictory to the higher prevalence of alcohol dependence in males than in females [1]. However, different reasons might account for these results.

Prepubertal boys show lower estradiol levels than prepubertal girls [64], which entails the later onset of puberty in males. Sex differences in bone mass, size, and strength strongly increase during puberty, with higher values in males compared to females [65,66]. Males are taller and develop longer bones than females because their growth spurts last longer before the epiphyses fuse, which results from the later rise and lower peak levels of estradiol (see [67], regarding sex differences in estrogen and epiphyseal fusing). Thus, lifelong smaller body measurements, which were observed here in alcohol dependence, may result from both a later pubertal onset and factors that reinforce estrogen signaling during puberty that may prematurely terminate the growth of the body. With regard to pubertal onset, we have already shown that male alcohol-dependent in-patients and male binge drinkers report a later age at puberty onset than control males [24,29], which may result in shorter body measurements. In addition, we hypothesize a premature termination of pubertal growth in the group of alcohol-dependent in-patients. Here, we found an overlap between the age of onset of regular alcohol drinking and puberty (the age of onset of regular alcohol drinking in years: minimum to 25% percentile, males 14–19, females 14–23) and 17.4% of males (16 out of 92) and 4.5% of females (3 out of 67) stated that they had started drinking alcohol regularly before turning 18 years old. Phytoestrogens are found in many alcoholic beverages. They are produced from plants that contain estrogen-like substances [68]. In addition, low dose alcohol consumption has been shown to increase testosterone levels in both sexes [69,70] and testosterone is converted to estradiol by aromatase. We speculate that the early onset of regular alcohol drinking in the groups studied here, in male, and to a lesser extent, female alcohol-dependent in-patients, may have led to a premature epiphyseal fusing via phytoestrogens and testosterone to estradiol conversion (see [67], regarding sex differences in estrogen and epiphyseal fusing, [71]). We provide some support for this model in that the age of onset of regular drinking (i.e., daily over at least 7 days) and the age of first in-patient treatment due to alcohol problems were found to correlate positively with many absolute, relative, and residualized body measurements in both male and female alcohol-dependent in-patients. However, we acknowledge that the age of onset of regular drinking was assessed retrospectively and that the correlations do not allow for causal conclusions. In a nutshell, the smaller body dimensions in alcohol dependence observed here might be explained by a shorter pubertal growth period with later ages of pubertal onset and a premature end of bone growth. Additionally, the data reported here indicate that earlier ages at the onset of regular alcohol drinking (i.e., daily over at least 7 days) in males (more than in females) may account for the stronger group differences in body measurements between males and females that were observed in this study.

Moreover, additive genetic effects explain 40% of pubertal timing in boys and 46% in girls [72], and genes involved in sex hormone signaling have previously been associated with alcohol dependence and craving for alcohol [4,5,6,8,9,10]. Hence, shared genetic variance of pubertal timing and addictive behaviors might explain why absolute, relative, and residualized body dimensions are smaller in alcohol-dependent in-patients in the analyzed cohort.

Fetal alcohol spectrum disorder (FASD) provides another explanation for the many lower values of absolute, relative, and residualized body measurements in alcohol-dependent in-patients compared to the healthy control subjects in this study. A meta-analysis reported a high prevalence of pooled alcohol or drug dependence in 54.5% of the subjects diagnosed with FASD [73]. Growth restriction including height and head circumference is a typical phenomenon in subjects with FASD, which is also present in adulthood [74]. Thus, a higher percentage of prenatal alcohol exposure in the in-patients’ cohort might also account for the smaller absolute, relative, and residualized body dimensions. We have not investigated FASD in this project and future research is necessary to further test this hypothesis. However, a recent register-based study estimated a rate of FASD of 177 children per 10,000 live births [75]. Although this study might underestimate the prevalence of FASD, it is unlikely that FASD explains the observed group differences completely.

Unhealthy nutrition and poor physical activity are frequent consequences of alcohol dependence and influence body composition, particularly the muscle and fat tissues. The smaller body dimensions, including body weight and hip, thigh, and calf circumferences in the in-patients’ groups, may represent direct sequelae of alcohol dependence. Surprisingly, total lifetime drinking and daily ethanol intake in the cohort of male and female in-patients did not convincingly correlate with absolute, relative, or residualized body measurements (except for some correlations with lip-chin distance and mandibular arc). This suggests that the individual alcohol intake over time does not largely account for the group differences in body measurements and their associations with prospective outcomes. However, the lack of a clear correlation between lifetime drinking history and body measurements might be specific to the investigated cohort, because the patients were exclusively recruited in psychiatric hospitals and we did not include in-patients with severe somatic disorders. Furthermore, alcohol-dependent in-patients in this study are more likely than healthy control subjects to identify as active (males: 78% versus 22%, females: 77% versus 19%) or ever-smoker (males: 92% versus 59%, females: 85% versus 48%). Both lifetime and current smoking might influence body dimensions and contribute to the effects observed here.

In summary, the smaller body dimensions in alcohol dependence may be due to a later age of pubertal onset, a premature end of bone growth due to the effects of alcohol, such as phytoestrogens and impaired sex hormone signaling, an increased rate of FASD, and unhealthy life-style factors that include nutrition, physical activity, and smoking behavior, which are related to alcohol dependence.

4.2. Thigh Circumference: Alcohol Dependence and Prospective Outcome

In this study, we found shorter thigh circumference in alcohol-dependent in-patients than in healthy control subjects. Moreover, longer thigh circumference predicted a worse prospective outcome in male alcohol-dependent patients. The latter associations with outcome did not remain significant after Bonferroni correction; although they did remain significant after FDR correction, and are thus considered robust, these results should be interpreted with caution.

In the same cohort that was analyzed here, we previously showed a lower body mass index in alcohol-dependent in-patients than in healthy control subjects [29] and an association between higher body mass index and a worse outcome in the patients’ group [52]. This parallels the pattern demonstrated here for thigh circumference. Thigh circumference mirrors a combination of both bone and soft tissue, which is a similarity to the body mass index. The smaller thigh circumference (in line with the lower body mass index) in alcohol-dependent in-patients compared to the healthy control subjects might be a consequence of malnutrition and/or inactivation. Because of a strong positive correlation between body mass index and thigh circumference (males: alcohol-dependent in-patients, n = 105, ρ = 0.833, P < 0.001, healthy control subjects, n = 133, ρ = 0.666, P < 0.001; females: alcohol-dependent in-patients, n = 75, ρ = 0.730, P < 0.001, healthy control subjects, n = 105, ρ = 0.807, P < 0.001), the relationship between higher thigh circumference and alcohol-related readmissions in male alcohol-dependent in-patients observed here might be explained by potential mediators of the association between higher body mass index and alcohol relapse, which we elaborated on in [52], such as N-acetylaspartate, appetite-regulating peptides, neuroticism, impulsivity, and temporal discounting. Both increased relapse risk and higher body mass index have been associated with low thalamic N-acetylaspartate [76,77] and neuroticism [78,79,80]. Moreover, ghrelin, which regulates energy homeostasis, influences cerebral reward pathways. Pharmacological strategies targeting ghrelin pathways are being tested in the treatment of alcohol-dependent patients [81]. Higher body mass index and obesity are associated with higher impulsivity and higher temporal discounting [82,83]. Thus, higher thigh circumference (indicating higher body mass index) may be related to higher impulsivity and temporal discounting with more difficulties to resist the urge to drink alcohol in risky situations. Future longitudinal studies are needed to investigate these hypotheses.

4.3. Limitations and Strengths

The present research project is subject to several limitations. We did not differentiate between bone and soft tissue [for a discussion of this topic in a pubertally organized marker, see [84]. This is especially critical for thigh circumference, which is clinically the most promising body dimension identified here. Future research, which might involve medical imaging techniques in addition to direct surface measurement, is needed to disentangle the different roles of bone and soft tissue. We wish to note that this limitation is true for a large part of marker research in general. Even the correlation between surface and x-ray-measurements of 2D:4D as an often used biomarker is comparatively low (r = 0.45 [85]). The related imprecision might result in an underestimation of the relationship between markers and external criteria. Moreover, we cannot conclusively determine to what extent prenatal, pubertal, and even later factors account for the observations. Here, we provided evidence in the form of associations that does not allow for drawing causal conclusions. Further studies using longitudinal designs and investigating neurobiological aspects are needed to relate the potential mechanisms underlying the development of the here quantified absolute, relative, and residualized body measurements to alcohol dependence. The field’s early stage of development resulted in many statistical tests involving absolute values, ratios, and residuals. Aiming to identify promising markers, we decided to use the less conservative FDR method to consider the type 1 error risk. Unsurprisingly, some of the significant effects disappeared after the more conservative Bonferroni adjustment. However, the results from this research project build a solid basis and reveal which body measurements merit future research to confirm that the results can be replicated and generalized. We acknowledge that the patients’ outcome data were gathered using electronic patient records; no direct resurveys have been conducted. The parameter quantified here, i.e., alcohol-related readmission, differs from alcohol relapse.

The strengths of our study include the sex- and age-balanced cohorts and the long-term follow-up of alcohol-dependent patients. We specifically addressed alcohol-related readmissions, which are substantial problems in the long-term course of alcohol dependence. We also found consistent differences between alcohol-dependent in-patients and healthy control subjects across several body dimensions and considered the absolute values, ratios, and residuals. Finally, the physical measurements are easily accessible, which facilitates the transition of the results into daily clinical routine.

5. Conclusions

Here, we reported consistently lower values of a line of absolute, relative, and residualized body dimensions in alcohol-dependent in-patients than in healthy control subjects across both sexes. Differences in pubertal age, the effects of alcohol drinking during puberty, such as phytoestrogens and impaired sex hormone signaling, FASD, and life-style alterations related to alcohol dependence might account for these effects. Moreover, our results may have important clinical implications, as thigh circumference has turned out to be a potential and easily measureable predictor for alcohol-related readmissions. If the results observed here can be replicated, thigh circumference might serve as a measure to assess an in-patient’s risk of prospective hospital readmissions. These findings can be utilized to establish individualized treatment strategies.

Acknowledgments

We thank Andreas Ahnert, Ute Hamers, and Kristina Bayerlein for the opportunity and the support to recruit in-patients at the Klinik für Psychiatrie, Sucht, Psychotherapie und Psychosomatik of the Klinikum am Europakanal. We are grateful and appreciate the support of Birgit Braun, Juliane Behrens, Sarah Kubis, Katrin Mikolaiczik, Sarah Saigali, Marina Sibach, and Petya Tanovska for recruiting patients and control subjects. We thank Sina Therese Kirsten and Terezie Sedlinská for measuring foot length and breadth and Katrin Mikolaiczik, Marcel-René Muschler, and Petya Tanovska for measuring index and ring finger lengths. Moreover, we thank the reviewers for constructive suggestions.

Abbreviations

2D:4D Second-to-fourth finger length ratio
CDT Carbohydrate-deficient transferrin
DSM-5 Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders
FASD Fetal alcohol spectrum disorder
FDR False discovery rate
ICD-10 Tenth revision of the International Classification of Diseases
IQR Interquartile range
TTT Twin testosterone transfer model
WHO World Health Organization

Appendix A

Table A1.

Spearman correlations of body measurements with 2D:4D in male and female alcohol-dependent in-patients (ADP) and healthy control subjects (HCS).

Males Females
ADP HCS ADP HCS
N ρ P N ρ P N ρ P N ρ P
Absolute measure
Body height 103 0.049 0.625 133 −0.068 0.439 76 −0.016 0.894 105 0.090 0.360
Body weight 102 −0.112 0.261 133 −0.059 0.501 76 −0.104 0.369 104 0.006 0.955
Head circumference 103 0.011 0.914 133 −0.109 0.210 78 0.060 0.603 105 −0.038 0.703
Bitragion head arc 103 0.003 0.979 133 0.062 0.480 78 0.008 0.944 105 −0.015 0.878
Sagittal head arc 103 0.007 0.943 133 −0.048 0.587 78 0.029 0.802 105 −0.057 0.564
Mandibular arc 102 −0.066 0.512 133 −0.056 0.526 76 −0.130 0.264 104 0.112 0.259
Lip-chin distance 102 −0.021 0.832 132 −0.034 0.702 78 −0.069 0.549 105 −0.092 0.351
Wrist circumference 98 −0.156 0.126 128 −0.091 0.308 74 0.061 0.609 101 −0.124 0.218
Waist circumference 102 −0.143 0.153 133 −0.131 0.134 76 −0.017 0.886 105 0.026 0.789
Hip circumference 102 −0.187 0.060 133 −0.086 0.325 76 −0.074 0.523 105 −0.024 0.810
Thigh circumference 102 −0.052 0.601 133 −0.086 0.323 78 −0.119 0.297 104 −0.059 0.549
Calf circumference 102 −0.082 0.412 132 −0.046 0.599 78 −0.055 0.635 105 0.065 0.508
Ankle circumference 102 −0.041 0.682 131 −0.176 0.044 78 0.055 0.630 105 0.051 0.603
Foot length 96 0.061 0.556 105 0.074 0.451 76 0.047 0.689 98 0.039 0.702
Foot breadth 97 −0.021 0.842 107 −0.088 0.368 77 0.030 0.798 99 −0.025 0.806
Measure divided by body height
Head circumference 103 −0.037 0.711 133 −0.002 0.985 76 0.022 0.853 105 −0.169 0.085
Bitragion head arc 103 −0.032 0.748 133 0.105 0.227 76 0.010 0.929 105 −0.090 0.361
Sagittal head arc 103 0.000 0.999 133 −0.002 0.981 76 0.049 0.671 105 −0.151 0.124
Mandibular arc 102 −0.092 0.358 133 −0.040 0.649 74 −0.105 0.372 104 0.016 0.875
Lip-chin distance 102 −0.057 0.570 132 −0.027 0.762 76 −0.056 0.634 105 −0.130 0.188
Wrist circumference 98 −0.204 0.044 128 −0.018 0.836 72 0.059 0.622 101 −0.198 0.048
Waist circumference 102 −0.153 0.125 133 −0.084 0.335 74 −0.011 0.926 105 −0.019 0.850
Hip circumference 102 −0.197 0.047 133 −0.039 0.655 74 −0.023 0.845 105 −0.073 0.459
Thigh circumference 102 −0.060 0.549 133 −0.043 0.626 76 −0.093 0.425 104 −0.122 0.217
Calf circumference 102 −0.079 0.431 132 −0.031 0.726 76 −0.004 0.975 105 −0.003 0.979
Ankle circumference 102 −0.090 0.367 131 −0.153 0.082 76 0.079 0.496 105 −0.060 0.546
Foot length 96 −0.043 0.676 105 0.060 0.546 73 0.067 0.573 98 −0.092 0.368
Foot breadth 97 −0.103 0.313 107 −0.087 0.374 74 0.020 0.864 99 −0.097 0.341
Measure residualized on body height
Head circumference 103 −0.003 0.979 133 −0.077 0.378 76 0.043 0.715 105 −0.107 0.276
Bitragion head arc 103 −0.006 0.952 133 0.082 0.349 76 −0.019 0.872 105 −0.042 0.674
Sagittal head arc 103 0.017 0.868 133 −0.018 0.840 76 0.002 0.988 105 −0.095 0.335
Mandibular arc 102 −0.090 0.367 133 −0.046 0.596 74 −0.138 0.241 104 0.050 0.617
Lip-chin distance 102 −0.059 0.556 132 −0.032 0.717 76 −0.054 0.641 105 −0.120 0.221
Wrist circumference 98 −0.204 0.044 128 −0.021 0.810 72 0.059 0.624 101 −0.201 0.044
Waist circumference 102 −0.156 0.118 133 −0.101 0.245 74 −0.018 0.882 105 −0.014 0.887
Hip circumference 102 −0.190 0.055 133 −0.086 0.326 74 −0.062 0.602 105 −0.026 0.789
Thigh circumference 102 −0.055 0.585 133 −0.081 0.355 76 −0.121 0.296 104 −0.066 0.503
Calf circumference 102 −0.083 0.407 132 −0.056 0.524 76 −0.044 0.703 105 0.040 0.688
Ankle circumference 102 −0.092 0.357 131 −0.180 0.040 76 0.069 0.556 105 −0.027 0.787
Foot length 96 −0.048 0.641 105 0.051 0.606 73 0.077 0.519 98 −0.095 0.354
Foot breadth 97 −0.091 0.377 107 −0.091 0.351 74 0.000 0.999 99 −0.098 0.333

P < 0.05 in bold. Significant negative correlation.

Table A2.

Spearman correlations of body measurements with the age of onset of regular alcohol drinking (i.e., daily over at least 7 days) and the age of first in-patient treatment due to alcohol problems in male and female alcohol-dependent in-patients.

Males: The Age of Females: The Age of
Onset of Regular Alcohol Drinking (i.e., Daily over at Least 7 Days) First In-Patient Treatment Due to Alcohol Problems Onset of Regular Alcohol Drinking (i.e., Daily over at Least 7 Days) First In-Patient Treatment Due to Alcohol Problems
N ρ P N ρ P N ρ P N ρ P
Absolute measure
Body height 91 −0.087 0.412 95 −0.043 0.677 61 −0.145 0.265 71 −0.089 0.462
Body weight 91 −0.070 0.510 95 0.133 0.201 61 0.031 0.812 71 0.055 0.650
Head circumference 91 0.039 0.715 95 0.129 0.212 63 −0.015 0.906 73 0.030 0.800
Bitragion head arc 91 0.127 0.231 95 0.110 0.288 63 0.061 0.637 73 0.159 0.180
Sagittal head arc 91 −0.225 0.032 95 −0.311 0.002 63 0.056 0.662 73 0.116 0.330
Mandibular arc 90 0.213 0.044 94 0.202 0.051 61 0.084 0.519 71 0.051 0.674
Lip-chin distance 90 0.011 0.921 94 0.115 0.271 63 0.023 0.861 73 0.044 0.714
Wrist circumference 87 −0.077 0.478 91 0.150 0.157 61 0.132 0.311 70 0.202 0.094
Waist circumference 91 0.016 0.880 95 0.215 0.036 63 0.124 0.331 71 0.110 0.359
Hip circumference 91 0.061 0.569 95 0.221 0.031 63 0.024 0.851 71 0.111 0.356
Thigh circumference 91 −0.222 0.035 95 0.048 0.646 63 −0.028 0.825 73 0.018 0.882
Calf circumference 91 −0.161 0.126 95 0.072 0.485 63 0.046 0.722 73 0.054 0.653
Ankle circumference 91 −0.103 0.333 95 0.234 0.022 63 −0.093 0.470 73 0.108 0.361
Foot length 84 −0.097 0.382 87 0.090 0.405 62 −0.123 0.339 71 0.025 0.838
Foot breadth 85 −0.049 0.659 88 0.155 0.149 63 0.189 0.137 72 0.180 0.130
Measure divided by body height
Head circumference 91 0.097 0.361 95 0.078 0.451 61 0.170 0.190 71 0.120 0.319
Bitragion head arc 91 0.164 0.121 95 0.136 0.190 61 0.219 0.090 71 0.219 0.067
Sagittal head arc 91 −0.147 0.164 95 −0.266 0.009 61 0.187 0.149 71 0.193 0.107
Mandibular arc 90 0.227 0.031 94 0.206 0.047 59 0.165 0.211 69 0.192 0.114
Lip-chin distance 90 0.043 0.685 94 0.129 0.216 61 0.067 0.610 71 0.099 0.413
Wrist circumference 87 −0.087 0.424 91 0.156 0.140 59 0.271 0.038 68 0.339 0.005
Waist circumference 91 0.004 0.973 95 0.216 0.035 61 0.200 0.122 69 0.208 0.087
Hip circumference 91 0.074 0.486 95 0.195 0.058 61 0.108 0.409 69 0.201 0.098
Thigh circumference 91 −0.218 0.038 95 0.042 0.684 61 0.108 0.406 71 0.110 0.359
Calf circumference 91 −0.143 0.176 95 0.073 0.482 61 0.133 0.308 71 0.119 0.324
Ankle circumference 91 −0.057 0.590 95 0.226 0.028 61 0.055 0.671 71 0.287 0.015
Foot length 84 −0.009 0.939 87 0.174 0.107 59 0.003 0.985 68 0.300 0.013
Foot breadth 85 −0.024 0.826 88 0.149 0.166 60 0.321 0.012 69 0.287 0.017
Measure residualized on body height
Head circumference 91 0.042 0.694 95 0.104 0.317 61 0.085 0.516 71 0.130 0.279
Bitragion head arc 91 0.159 0.133 95 0.127 0.219 61 0.140 0.280 71 0.234 0.050
Sagittal head arc 91 −0.200 0.058 95 −0.312 0.002 61 0.097 0.457 71 0.155 0.197
Mandibular arc 90 0.244 0.020 94 0.209 0.043 59 0.155 0.242 69 0.158 0.194
Lip-chin distance 90 0.039 0.718 94 0.128 0.219 61 0.058 0.654 71 0.084 0.487
Wrist circumference 87 −0.097 0.369 91 0.154 0.145 59 0.256 0.050 68 0.332 0.006
Waist circumference 91 −0.012 0.907 95 0.207 0.045 61 0.198 0.126 69 0.192 0.114
Hip circumference 91 0.069 0.518 95 0.222 0.030 61 0.055 0.674 69 0.141 0.246
Thigh circumference 91 −0.216 0.040 95 0.054 0.602 61 0.021 0.872 71 0.070 0.561
Calf circumference 91 −0.144 0.173 95 0.083 0.425 61 0.098 0.453 71 0.100 0.406
Ankle circumference 91 −0.070 0.507 95 0.229 0.026 61 0.019 0.886 71 0.260 0.028
Foot length 84 −0.012 0.915 87 0.177 0.101 59 0.014 0.918 68 0.319 0.008
Foot breadth 85 −0.040 0.713 88 0.149 0.166 60 0.302 0.019 69 0.287 0.017

P < 0.05 in bold. Significant positive correlation, significant negative correlation.

Table A3.

Spearman correlations of body measurements with total lifetime drinking and daily ethanol intake in male and female alcohol-dependent in-patients.

Males Females
Total Lifetime Drinking Daily Ethanol Intake Total Lifetime Drinking Daily Ethanol Intake
N ρ P N ρ P N ρ P N ρ P
Absolute measure
Body height 87 0.001 0.993 85 0.142 0.196 57 −0.051 0.705 55 0.060 0.664
Body weight 87 0.073 0.504 85 0.099 0.368 57 0.188 0.162 55 0.075 0.587
Head circumference 87 −0.074 0.493 85 −0.051 0.643 59 −0.046 0.728 57 0.059 0.660
Bitragion head arc 87 0.061 0.575 85 0.059 0.593 59 0.056 0.674 57 0.026 0.847
Sagittal head arc 87 −0.071 0.513 85 0.064 0.561 59 0.198 0.134 57 0.128 0.341
Mandibular arc 86 −0.144 0.186 84 −0.189 0.085 57 −0.115 0.393 55 −0.272 0.045
Lip-chin distance 86 −0.228 0.035 84 −0.188 0.086 59 −0.188 0.155 57 −0.080 0.553
Wrist circumference 83 0.018 0.870 81 0.068 0.546 58 0.042 0.756 56 −0.039 0.773
Waist circumference 87 0.097 0.370 85 0.005 0.963 58 0.219 0.099 56 0.134 0.323
Hip circumference 87 0.095 0.383 85 0.072 0.512 58 0.108 0.422 56 0.006 0.963
Thigh circumference 87 −0.035 0.745 85 0.040 0.718 59 0.066 0.618 57 0.103 0.444
Calf circumference 87 −0.019 0.860 85 0.073 0.506 59 0.047 0.721 57 −0.059 0.661
Ankle circumference 87 −0.150 0.166 85 −0.044 0.692 59 0.084 0.526 57 −0.064 0.638
Foot length 79 −0.087 0.444 77 0.108 0.348 57 0.144 0.284 55 0.141 0.306
Foot breadth 80 −0.028 0.808 78 −0.006 0.960 58 0.052 0.701 56 −0.015 0.914
Measure divided by body height
Head circumference 87 −0.058 0.595 85 −0.185 0.091 57 −0.046 0.733 55 −0.038 0.783
Bitragion head arc 87 0.099 0.360 85 −0.054 0.621 57 0.075 0.577 55 −0.009 0.951
Sagittal head arc 87 −0.073 0.501 85 −0.036 0.741 57 0.156 0.248 55 0.070 0.614
Mandibular arc 86 −0.154 0.156 84 −0.242 0.027 55 −0.129 0.349 53 −0.301 0.029
Lip-chin distance 86 −0.204 0.059 84 −0.211 0.054 57 −0.201 0.134 55 −0.111 0.419
Wrist circumference 83 0.046 0.681 81 −0.020 0.862 56 0.036 0.794 54 −0.098 0.482
Waist circumference 87 0.114 0.295 85 −0.012 0.913 56 0.182 0.180 54 0.093 0.505
Hip circumference 87 0.129 0.233 85 0.041 0.707 56 0.110 0.419 54 −0.032 0.819
Thigh circumference 87 0.010 0.924 85 0.017 0.874 57 0.000 0.997 55 0.033 0.812
Calf circumference 87 0.000 0.997 85 0.046 0.677 57 0.055 0.686 55 −0.117 0.394
Ankle circumference 87 −0.140 0.196 85 −0.130 0.235 57 0.092 0.495 55 −0.127 0.354
Foot length 79 −0.068 0.549 77 0.021 0.857 54 0.132 0.341 52 0.126 0.375
Foot breadth 80 0.039 0.734 78 −0.093 0.417 55 0.044 0.751 53 −0.117 0.406
Measure residualized on body height
Head circumference 87 −0.077 0.477 85 −0.120 0.275 57 −0.080 0.556 55 0.018 0.898
Bitragion head arc 87 0.069 0.525 85 0.009 0.934 57 0.058 0.666 55 0.003 0.980
Sagittal head arc 87 −0.072 0.509 85 0.007 0.946 57 0.197 0.142 55 0.135 0.327
Mandibular arc 86 −0.151 0.166 84 −0.226 0.039 55 −0.154 0.261 53 −0.306 0.026
Lip-chin distance 86 −0.207 0.056 84 −0.189 0.085 57 −0.209 0.119 55 −0.116 0.400
Wrist circumference 83 0.035 0.752 81 −0.013 0.908 56 0.037 0.784 54 −0.094 0.501
Waist circumference 87 0.115 0.290 85 −0.009 0.936 56 0.193 0.154 54 0.119 0.393
Hip circumference 87 0.099 0.361 85 0.067 0.545 56 0.090 0.511 54 0.008 0.954
Thigh circumference 87 −0.025 0.822 85 0.038 0.731 57 0.037 0.784 55 0.091 0.508
Calf circumference 87 −0.003 0.979 85 0.062 0.573 57 0.052 0.700 55 −0.079 0.566
Ankle circumference 87 −0.158 0.144 85 −0.109 0.320 57 0.097 0.473 55 −0.086 0.534
Foot length 79 −0.068 0.554 77 0.020 0.862 54 0.133 0.339 52 0.111 0.434
Foot breadth 80 0.046 0.684 78 −0.067 0.562 55 0.032 0.814 53 −0.107 0.446

P < 0.05 in bold. Significant negative correlation.

Table A4.

Inter-correlations between absolute male body measurements (alcohol-dependent in-patients bottom left, healthy control subjects top right).

N Body height 133 133 133 133 133 132 128 133 133 133 132 131 105 107
ρ 0.264 0.227 0.232 0.295 0.141 0.146 0.189 −0.097 0.090 0.029 0.065 0.335 0.610 0.474
P 0.002 0.009 0.007 0.001 0.105 0.095 0.033 0.269 0.303 0.741 0.461 <0.001 <0.001 <0.001
N 106 Body weight 133 133 133 133 132 128 133 133 133 132 131 105 107
ρ 0.368 0.259 0.074 0.026 0.204 0.166 0.626 0.818 0.874 0.698 0.675 0.467 0.213 0.360
P <0.001 0.003 0.395 0.765 0.019 0.057 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 0.029 <0.001
N 107 106 Head circum-ference 133 133 133 132 128 133 133 133 132 131 105 107
ρ 0.175 0.453 0.500 0.475 0.152 0.271 0.319 0.183 0.229 0.206 0.304 0.408 0.338 0.264
P 0.071 <0.001 <0.001 <0.001 0.081 0.002 <0.001 0.035 0.008 0.017 <0.001 <0.001 <0.001 0.006
N 107 106 107 Bitragion head arc 133 133 132 128 133 133 133 132 131 105 107
ρ 0.326 0.168 0.390 0.393 −0.013 0.138 0.143 −0.004 0.044 0.038 0.046 0.198 0.351 0.215
P 0.001 0.085 <0.001 <0.001 0.880 0.115 0.107 0.961 0.612 0.661 0.600 0.023 <0.001 0.026
N 107 106 107 107 Sagittal head arc 133 132 128 133 133 133 132 131 105 107
ρ 0.285 0.031 0.288 0.341 0.040 0.162 0.020 −0.094 0.011 0.081 0.120 0.248 0.219 0.111
P 0.003 0.749 0.003 <0.001 0.647 0.063 0.819 0.281 0.901 0.353 0.171 0.004 0.025 0.255
N 106 105 106 106 106 Mandi-bular arc 132 128 133 133 133 132 131 105 107
ρ 0.115 0.411 0.283 0.161 −0.085 0.330 0.303 0.195 0.162 0.089 0.245 0.348 0.213 0.128
P 0.239 <0.001 0.003 0.099 0.389 <0.001 0.001 0.024 0.062 0.306 0.005 <0.001 0.029 0.188
N 106 105 106 106 106 105 Lip-chin distance 127 132 132 132 131 130 104 106
ρ 0.001 0.187 0.284 0.094 −0.259 0.397 0.239 0.127 0.140 0.190 0.229 0.201 0.282 0.229
P 0.990 0.055 0.003 0.339 0.007 <0.001 0.007 0.147 0.110 0.029 0.008 0.022 0.004 0.018
N 102 101 102 102 102 101 101 Wrist circum-ference 128 128 128 127 126 101 103
ρ 0.337 0.692 0.414 0.222 0.001 0.467 0.337 0.503 0.552 0.459 0.483 0.535 0.187 0.361
P 0.001 <0.001 <0.001 0.025 0.995 <0.001 0.001 <0.001 <0.001 <0.001 <0.001 <0.001 0.061 <0.001
N 106 105 106 106 106 105 105 102 Waist circum-ference 133 133 132 131 105 107
ρ 0.169 0.886 0.395 0.183 −0.081 0.455 0.259 0.569 0.778 0.581 0.531 0.314 0.013 0.135
P 0.084 <0.001 <0.001 0.061 0.407 <0.001 0.008 <0.001 <0.001 <0.001 <0.001 <0.001 0.893 0.165
N 106 105 106 106 106 105 105 102 106 Hip circum-ference 133 132 131 105 107
ρ 0.263 0.878 0.457 0.228 −0.012 0.435 0.242 0.623 0.839 0.768 0.625 0.377 0.088 0.229
P 0.007 <0.001 <0.001 0.019 0.905 <0.001 0.013 <0.001 <0.001 <0.001 <0.001 <0.001 0.371 0.018
N 106 105 106 106 106 105 105 102 106 106 Thigh circum-ference 132 131 105 107
ρ 0.160 0.831 0.426 0.012 −0.033 0.428 0.291 0.595 0.725 0.708 0.673 0.319 −0.067 0.157
P 0.101 <0.001 <0.001 0.902 0.739 <0.001 0.003 <0.001 <0.001 <0.001 <0.001 <0.001 0.495 0.107
N 106 105 106 106 106 105 105 102 106 106 106 Calf circum-ference 131 104 106
ρ 0.126 0.724 0.285 0.077 0.024 0.336 0.155 0.560 0.580 0.569 0.706 0.417 0.054 0.348
P 0.199 <0.001 0.003 0.430 0.807 <0.001 0.115 <0.001 <0.001 <0.001 <0.001 <0.001 0.587 <0.001
N 106 105 106 106 106 105 105 102 106 106 106 106 Ankle circum-ference 103 105
ρ 0.323 0.626 0.424 0.264 −0.060 0.347 0.381 0.580 0.574 0.578 0.539 0.582 0.497 0.565
P 0.001 <0.001 <0.001 0.006 0.543 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
N 99 98 99 99 99 98 98 95 98 98 98 98 98 Foot length 105
ρ 0.690 0.497 0.253 0.293 0.239 0.245 0.262 0.480 0.354 0.425 0.354 0.330 0.544 0.527
P <0.001 <0.001 0.012 0.003 0.017 0.015 0.009 <0.001 <0.001 <0.001 <0.001 0.001 <0.001 <0.001
N 100 99 100 100 100 99 99 95 99 99 99 99 99 99 Foot breadth
ρ 0.293 0.563 0.368 0.234 −0.034 0.264 0.253 0.602 0.443 0.482 0.431 0.472 0.636 0.494
P 0.003 <0.001 <0.001 0.019 0.739 0.008 0.012 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001

Spearman correlations. P < 0.05 in bold.

Table A5.

Inter-correlations between absolute female body measurements (alcohol-dependent in-patients bottom left, healthy control subjects top right).

N Body height 106 107 107 107 106 107 103 107 107 106 107 107 100 101
ρ 0.168 0.304 0.079 0.288 0.078 0.070 0.196 −0.057 0.051 0.018 0.032 0.336 0.610 0.267
P 0.085 0.001 0.421 0.003 0.429 0.472 0.047 0.563 0.603 0.852 0.743 <0.001 <0.001 0.007
N 75 Body weight 106 106 106 105 106 102 106 106 105 106 106 99 100
ρ 0.246 0.344 0.020 −0.010 0.500 0.252 0.533 0.842 0.898 0.848 0.821 0.596 0.291 0.510
P 0.034 <0.001 0.841 0.922 <0.001 0.009 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 0.003 <0.001
N 77 77 Head circum-ference 107 107 106 107 103 107 107 106 107 107 100 101
ρ 0.234 0.432 0.612 0.433 0.219 0.258 0.220 0.214 0.319 0.312 0.263 0.335 0.330 0.381
P 0.041 <0.001 <0.001 <0.001 0.024 0.007 0.026 0.027 0.001 0.001 0.006 <0.001 0.001 <0.001
N 77 77 79 Bitragion head arc 107 106 107 103 107 107 106 107 107 100 101
ρ 0.221 0.190 0.405 0.382 0.142 0.242 −0.003 −0.016 0.015 0.091 0.028 0.139 0.100 0.258
P 0.054 0.097 <0.001 <0.001 0.146 0.012 0.978 0.867 0.875 0.351 0.776 0.154 0.323 0.009
N 77 77 79 79 Sagittal head arc 106 107 103 107 107 106 107 107 100 101
ρ 0.080 0.227 0.352 0.311 −0.052 0.214 −0.094 −0.164 0.010 0.070 −0.044 0.035 0.221 0.173
P 0.489 0.047 0.001 0.005 0.595 0.027 0.343 0.092 0.920 0.477 0.652 0.721 0.027 0.083
N 75 75 77 77 77 Mandibu-lar arc 106 103 106 106 105 106 106 99 100
ρ 0.146 0.459 0.278 0.295 0.039 0.304 0.299 0.434 0.508 0.458 0.413 0.433 0.194 0.360
P 0.213 <0.001 0.014 0.009 0.738 0.002 0.002 <0.001 <0.001 <0.001 <0.001 <0.001 0.055 <0.001
N 77 77 79 79 79 77 Lip-chin distance 103 107 107 106 107 107 100 101
ρ −0.103 0.089 0.188 −0.039 −0.443 0.206 0.216 0.276 0.225 0.226 0.167 0.104 0.166 0.099
P 0.375 0.442 0.096 0.733 <0.001 0.073 0.028 0.004 0.020 0.020 0.085 0.287 0.098 0.323
N 73 73 75 75 75 73 75 Wrist circum-ference 103 103 102 103 103 96 97
ρ 0.304 0.742 0.311 0.207 0.088 0.493 0.211 0.422 0.494 0.433 0.449 0.514 0.244 0.268
P 0.009 <0.001 0.007 0.075 0.451 <0.001 0.069 <0.001 <0.001 <0.001 <0.001 <0.001 0.017 0.008
N 75 75 77 77 77 75 77 73 Waist circum-ference 107 106 107 107 100 101
ρ 0.004 0.839 0.325 0.178 0.044 0.427 0.200 0.641 0.732 0.654 0.685 0.406 0.068 0.258
P 0.969 <0.001 0.004 0.121 0.702 <0.001 0.082 <0.001 <0.001 <0.001 <0.001 <0.001 0.501 0.009
N 75 75 77 77 77 75 77 73 77 Hip circum-ference 106 107 107 100 101
ρ 0.031 0.878 0.397 0.199 −0.002 0.447 0.240 0.684 0.861 0.842 0.746 0.594 0.187 0.394
P 0.794 <0.001 <0.001 0.083 0.986 <0.001 0.035 <0.001 <0.001 <0.001 <0.001 <0.001 0.063 <0.001
N 77 77 79 79 79 77 79 75 77 77 Thigh circum-ference 106 106 99 100
ρ 0.184 0.821 0.309 0.055 0.061 0.397 0.144 0.632 0.614 0.728 0.754 0.546 0.224 0.454
P 0.109 <0.001 0.006 0.628 0.596 <0.001 0.207 <0.001 <0.001 <0.001 <0.001 <0.001 0.026 <0.001
N 77 77 79 79 79 77 79 75 77 77 79 Calf circum-ference 107 100 101
ρ 0.164 0.788 0.263 0.148 0.187 0.477 0.033 0.702 0.603 0.742 0.775 0.592 0.171 0.470
P 0.154 <0.001 0.019 0.194 0.098 <0.001 0.776 <0.001 <0.001 <0.001 <0.001 <0.001 0.088 <0.001
N 77 77 79 79 79 77 79 75 77 77 79 79 Ankle circum-ference 100 101
ρ 0.426 0.681 0.235 0.172 0.108 0.452 −0.003 0.736 0.526 0.586 0.587 0.750 0.537 0.538
P <0.001 <0.001 0.037 0.130 0.345 <0.001 0.980 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
N 74 74 76 76 76 74 76 72 75 75 76 76 76 Foot length 100
ρ 0.722 0.387 0.328 0.225 0.146 0.174 −0.001 0.469 0.217 0.223 0.249 0.388 0.582 0.405
P <0.001 0.001 0.004 0.051 0.208 0.138 0.993 <0.001 0.061 0.055 0.030 0.001 <0.001 <0.001
N 75 75 77 77 77 75 77 73 76 76 77 77 77 77 Foot breadth
ρ 0.266 0.541 0.198 0.216 0.117 0.314 0.027 0.626 0.375 0.408 0.379 0.642 0.645 0.567
P 0.021 <0.001 0.085 0.059 0.312 0.006 0.817 <0.001 0.001 <0.001 0.001 <0.001 <0.001 <0.001

Spearman correlations. P < 0.05 in bold.

Table A6.

Inter-correlations between male body measurements divided by height (alcohol-dependent in-patients bottom left, healthy control subjects top right).

N Head circum-ference 133 133 133 132 128 133 133 133 132 131 105 107
ρ 0.642 0.488 0.253 0.299 0.497 0.431 0.449 0.421 0.511 0.502 0.321 0.383
P <0.001 <0.001 0.003 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 0.001 <0.001
N 107 Bitragion head arc 133 133 132 128 133 133 133 132 131 105 107
ρ 0.547 0.486 0.085 0.172 0.297 0.227 0.237 0.230 0.229 0.336 0.280 0.255
P <0.001 <0.001 0.333 0.049 0.001 0.009 0.006 0.008 0.008 <0.001 0.004 0.008
N 107 107 Sagittal head arc 133 132 128 133 133 133 132 131 105 107
ρ 0.459 0.374 0.064 0.196 0.156 0.101 0.162 0.222 0.232 0.246 0.080 0.084
P <0.001 <0.001 0.467 0.024 0.079 0.246 0.063 0.010 0.007 0.005 0.416 0.390
N 106 106 106 Mandibular arc 132 128 133 133 133 132 131 105 107
ρ 0.390 0.183 −0.004 0.338 0.397 0.297 0.284 0.194 0.362 0.374 0.208 0.151
P <0.001 0.061 0.964 <0.001 <0.001 0.001 0.001 0.025 <0.001 <0.001 0.033 0.121
N 106 106 106 105 Lip-chin distance 127 132 132 132 131 130 104 106
ρ 0.360 0.198 −0.147 0.434 0.253 0.217 0.224 0.281 0.298 0.241 0.242 0.141
P <0.001 0.042 0.132 <0.001 0.004 0.012 0.010 0.001 0.001 0.006 0.013 0.149
N 102 102 102 101 101 Wrist circum-ference 128 128 128 127 126 101 103
ρ 0.388 0.195 −0.039 0.449 0.378 0.602 0.644 0.510 0.590 0.601 0.271 0.404
P <0.001 0.050 0.694 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 0.006 <0.001
N 106 106 106 105 105 102 Waist circum-ference 133 133 132 131 105 107
ρ 0.350 0.198 −0.085 0.402 0.275 0.559 0.810 0.633 0.623 0.489 0.181 0.352
P <0.001 0.041 0.388 <0.001 0.004 <0.001 <0.001 <0.001 <0.001 <0.001 0.065 <0.001
N 106 106 106 105 105 102 106 Hip circum-ference 133 132 131 105 107
ρ 0.366 0.199 −0.047 0.408 0.283 0.573 0.842 0.783 0.694 0.519 0.142 0.348
P <0.001 0.041 0.631 <0.001 0.003 <0.001 <0.001 <0.001 <0.001 <0.001 0.149 <0.001
N 106 106 106 105 105 102 106 106 Thigh circum-ference 132 131 105 107
ρ 0.398 0.019 0.004 0.416 0.290 0.575 0.712 0.709 0.714 0.452 −0.059 0.263
P <0.001 0.849 0.971 <0.001 0.003 <0.001 <0.001 <0.001 <0.001 <0.001 0.547 0.006
N 106 106 106 105 105 102 106 106 106 Calf circum-ference 131 104 106
ρ 0.330 0.158 0.076 0.322 0.182 0.598 0.625 0.586 0.695 0.533 0.088 0.439
P 0.001 0.107 0.439 0.001 0.062 <0.001 <0.001 <0.001 <0.001 <0.001 0.376 <0.001
N 106 106 106 105 105 102 106 106 106 106 Ankle circum-ference 103 105
ρ 0.434 0.260 −0.045 0.444 0.452 0.584 0.532 0.544 0.534 0.631 0.399 0.526
P <0.001 0.007 0.644 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
N 99 99 99 98 98 95 98 98 98 98 98 Foot length 105
ρ 0.196 0.140 0.068 0.332 0.373 0.370 0.312 0.354 0.290 0.296 0.523 0.356
P 0.052 0.166 0.505 0.001 <0.001 <0.001 0.002 <0.001 0.004 0.003 <0.001 <0.001
N 100 100 100 99 99 95 99 99 99 99 99 99 Foot breadth
ρ 0.411 0.282 0.040 0.271 0.292 0.538 0.351 0.403 0.373 0.472 0.629 0.436
P <0.001 0.004 0.695 0.007 0.003 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001

Spearman correlations. P < 0.05 in bold.

Table A7.

Inter-correlations between female body measurements divided by height (alcohol-dependent in-patients bottom left, healthy control subjects top right).

N Head circum-ference 107 107 106 107 103 107 107 106 107 107 100 101
ρ 0.768 0.518 0.375 0.322 0.363 0.396 0.445 0.457 0.447 0.479 0.329 0.594
P <0.001 <0.001 <0.001 0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 0.001 <0.001
N 77 Bitragion head arc 107 106 107 103 107 107 106 107 107 100 101
ρ 0.618 0.537 0.344 0.357 0.203 0.249 0.279 0.335 0.301 0.379 0.260 0.512
P <0.001 <0.001 <0.001 <0.001 0.039 0.010 0.004 <0.001 0.002 <0.001 0.009 <0.001
N 77 77 Sagittal head arc 106 107 103 107 107 106 107 107 100 101
ρ 0.582 0.480 0.092 0.270 −0.032 −0.027 0.155 0.195 0.101 0.094 0.148 0.303
P <0.001 <0.001 0.346 0.005 0.746 0.782 0.111 0.045 0.303 0.334 0.142 0.002
N 75 75 75 Mandibular arc 106 103 106 106 105 106 106 99 100
ρ 0.444 0.413 0.207 0.402 0.361 0.509 0.591 0.543 0.513 0.559 0.267 0.491
P <0.001 <0.001 0.074 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 0.008 <0.001
N 77 77 77 75 Lip-chin distance 103 107 107 106 107 107 100 101
ρ 0.388 0.222 −0.110 0.364 0.278 0.333 0.327 0.291 0.255 0.223 0.295 0.272
P <0.001 0.052 0.340 0.001 0.005 <0.001 0.001 0.002 0.008 0.021 0.003 0.006
N 73 73 73 71 73 Wrist circum-ference 103 103 102 103 103 96 97
ρ 0.421 0.271 0.292 0.482 0.287 0.514 0.552 0.515 0.517 0.579 0.220 0.361
P <0.001 0.020 0.012 <0.001 0.014 <0.001 <0.001 <0.001 <0.001 <0.001 0.032 <0.001
N 75 75 75 73 75 71 Waist circum-ference 107 106 107 107 100 101
ρ 0.386 0.282 0.196 0.484 0.256 0.632 0.761 0.671 0.724 0.579 0.201 0.467
P 0.001 0.014 0.092 <0.001 0.027 <0.001 <0.001 <0.001 <0.001 <0.001 0.045 <0.001
N 75 75 75 73 75 71 75 Hip circum-ference 106 107 107 100 101
ρ 0.506 0.323 0.219 0.537 0.290 0.768 0.889 0.827 0.762 0.697 0.242 0.527
P <0.001 0.005 0.059 <0.001 0.012 <0.001 <0.001 <0.001 <0.001 <0.001 0.015 <0.001
N 77 77 77 75 77 73 75 75 Thigh circum-ference 106 106 99 100
ρ 0.271 0.077 0.118 0.384 0.204 0.653 0.653 0.739 0.785 0.673 0.289 0.558
P 0.017 0.508 0.308 0.001 0.075 <0.001 <0.001 <0.001 <0.001 <0.001 0.004 <0.001
N 77 77 77 75 77 73 75 75 77 Calf circum-ference 107 100 101
ρ 0.309 0.195 0.253 0.455 0.095 0.701 0.611 0.752 0.735 0.717 0.237 0.620
P 0.006 0.090 0.026 <0.001 0.411 <0.001 <0.001 <0.001 <0.001 <0.001 0.018 <0.001
N 77 77 77 75 77 73 75 75 77 77 Ankle circum-ference 100 101
ρ 0.229 0.168 0.073 0.435 0.116 0.699 0.548 0.664 0.557 0.725 0.445 0.615
P 0.045 0.145 0.530 <0.001 0.315 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
N 74 74 74 72 74 70 73 73 74 74 74 Foot length 100
ρ 0.173 0.149 0.137 0.122 0.098 0.362 0.218 0.292 0.114 0.363 0.464 0.453
P 0.140 0.206 0.246 0.306 0.408 0.002 0.064 0.012 0.332 0.001 <0.001 <0.001
N 75 75 75 73 75 71 74 74 75 75 75 74 Foot breadth
ρ 0.348 0.404 0.267 0.392 0.138 0.624 0.404 0.477 0.344 0.605 0.601 0.463
P 0.002 <0.001 0.021 0.001 0.239 <0.001 <0.001 <0.001 0.002 <0.001 <0.001 <0.001

Spearman correlations. P < 0.05 in bold.

Table A8.

Inter-correlations between male body measurements residualized on height (alcohol-dependent in-patients bottom left, healthy control subjects top right).

N Head circum-ference 133 133 133 132 128 133 133 133 132 131 105 107
ρ 0.459 0.384 0.125 0.246 0.390 0.275 0.232 0.228 0.333 0.379 0.336 0.226
P <0.001 <0.001 0.153 0.005 <0.001 0.001 0.007 0.008 <0.001 <0.001 <0.001 0.019
N 107 Bitragion head arc 133 133 132 128 133 133 133 132 131 105 107
ρ 0.309 0.323 −0.040 0.097 0.142 0.063 0.047 0.048 0.041 0.176 0.227 0.101
P 0.001 <0.001 0.651 0.269 0.109 0.470 0.591 0.584 0.642 0.044 0.020 0.300
N 107 107 Sagittal head arc 133 132 128 133 133 133 132 131 105 107
ρ 0.239 0.251 −0.015 0.136 0.013 −0.073 −0.023 0.069 0.074 0.130 0.035 −0.041
P 0.013 0.009 0.864 0.120 0.881 0.403 0.794 0.432 0.401 0.138 0.725 0.673
N 106 106 106 Mandibular arc 132 128 133 133 133 132 131 105 107
ρ 0.307 0.086 −0.139 0.320 0.355 0.245 0.156 0.096 0.291 0.305 0.202 0.096
P 0.001 0.383 0.156 <0.001 <0.001 0.004 0.073 0.273 0.001 <0.001 0.039 0.326
N 106 106 106 105 Lip-chin distance 127 132 132 132 131 130 104 106
ρ 0.355 0.089 −0.278 0.420 0.209 0.158 0.136 0.204 0.248 0.181 0.205 0.104
P <0.001 0.365 0.004 <0.001 0.018 0.070 0.121 0.019 0.004 0.039 0.037 0.291
N 102 102 102 101 101 Wrist circum-ference 128 128 128 127 126 101 103
ρ 0.404 0.112 −0.105 0.434 0.384 0.578 0.509 0.418 0.522 0.533 0.270 0.372
P <0.001 0.262 0.295 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 0.006 <0.001
N 106 106 106 105 105 102 Waist circum-ference 133 133 132 131 105 107
ρ 0.401 0.152 −0.141 0.398 0.273 0.549 0.732 0.551 0.572 0.399 0.179 0.298
P <0.001 0.120 0.149 <0.001 0.005 <0.001 <0.001 <0.001 <0.001 <0.001 0.068 0.002
N 106 106 106 105 105 102 106 Hip circum-ference 133 132 131 105 107
ρ 0.350 0.151 −0.096 0.350 0.212 0.494 0.796 0.763 0.612 0.397 0.071 0.233
P <0.001 0.122 0.326 <0.001 0.030 <0.001 <0.001 <0.001 <0.001 <0.001 0.474 0.016
N 106 106 106 105 105 102 106 106 Thigh circum-ference 132 131 105 107
ρ 0.381 −0.042 −0.089 0.370 0.264 0.522 0.715 0.709 0.666 0.362 −0.122 0.152
P <0.001 0.671 0.365 <0.001 0.007 <0.001 <0.001 <0.001 <0.001 <0.001 0.216 0.117
N 106 106 106 105 105 102 106 106 106 Calf circum-ference 131 104 106
ρ 0.282 0.066 −0.010 0.298 0.160 0.573 0.609 0.545 0.689 0.447 0.042 0.356
P 0.003 0.502 0.920 0.002 0.104 <0.001 <0.001 <0.001 <0.001 <0.001 0.669 <0.001
N 106 106 106 105 105 102 106 106 106 106 Ankle circum-ference 103 105
ρ 0.396 0.168 −0.171 0.398 0.435 0.562 0.540 0.501 0.519 0.616 0.382 0.495
P <0.001 0.085 0.080 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
N 99 99 99 98 98 95 98 98 98 98 98 Foot length 105
ρ 0.190 0.082 0.018 0.306 0.370 0.370 0.303 0.284 0.260 0.293 0.505 0.356
P 0.060 0.419 0.856 0.002 <0.001 <0.001 0.002 0.005 0.010 0.003 <0.001 <0.001
N 100 100 100 99 99 95 99 99 99 99 99 99 Foot breadth
ρ 0.304 0.166 −0.085 0.221 0.257 0.519 0.367 0.341 0.317 0.448 0.584 0.428
P 0.002 0.099 0.400 0.028 0.010 <0.001 <0.001 0.001 0.001 <0.001 <0.001 <0.001

Spearman correlations. P < 0.05 in bold.

Table A9.

Inter-correlations between female body measurements residualized on height (alcohol-dependent in-patients bottom left, healthy control subjects top right).

N Head circum-ference 107 107 106 107 103 107 107 106 107 107 100 101
ρ 0.652 0.372 0.219 0.265 0.231 0.267 0.290 0.301 0.245 0.296 0.210 0.354
P <0.001 <0.001 0.024 0.006 0.019 0.005 0.002 0.002 0.011 0.002 0.036 <0.001
N 77 Bitragion head arc 107 106 107 103 107 107 106 107 107 100 101
ρ 0.380 0.388 0.205 0.283 0.060 0.095 0.023 0.102 0.064 0.198 0.165 0.324
P 0.001 <0.001 0.035 0.003 0.549 0.332 0.811 0.296 0.515 0.041 0.101 0.001
N 77 77 Sagittal head arc 106 107 103 107 107 106 107 107 100 101
ρ 0.351 0.303 −0.056 0.187 −0.170 −0.148 0.000 0.067 −0.057 −0.075 0.061 0.111
P 0.002 0.007 0.567 0.054 0.086 0.128 0.996 0.493 0.563 0.441 0.548 0.269
N 75 75 75 Mandibular arc 106 103 106 106 105 106 106 99 100
ρ 0.294 0.268 0.049 0.350 0.334 0.478 0.469 0.443 0.438 0.497 0.236 0.404
P 0.011 0.020 0.676 <0.001 0.001 <0.001 <0.001 <0.001 <0.001 <0.001 0.019 <0.001
N 77 77 77 75 Lip-chin distance 103 107 107 106 107 107 100 101
ρ 0.279 0.054 −0.339 0.291 0.255 0.299 0.203 0.213 0.170 0.145 0.279 0.190
P 0.014 0.643 0.003 0.011 0.009 0.002 0.036 0.028 0.080 0.137 0.005 0.057
N 73 73 73 71 73 Wrist circum-ference 103 103 102 103 103 96 97
ρ 0.291 0.120 0.180 0.429 0.258 0.499 0.458 0.401 0.452 0.521 0.217 0.324
P 0.012 0.310 0.128 <0.001 0.028 <0.001 <0.001 <0.001 <0.001 <0.001 0.033 0.001
N 75 75 75 73 75 71 Waist circum-ference 107 106 107 107 100 101
ρ 0.304 0.163 0.095 0.417 0.213 0.620 0.695 0.622 0.684 0.507 0.201 0.413
P 0.008 0.162 0.418 <0.001 0.066 <0.001 <0.001 <0.001 <0.001 <0.001 0.045 <0.001
N 75 75 75 73 75 71 75 Hip circum-ference 106 107 107 100 101
ρ 0.382 0.207 0.035 0.446 0.210 0.671 0.863 0.838 0.722 0.589 0.135 0.354
P 0.001 0.074 0.767 <0.001 0.071 <0.001 <0.001 <0.001 <0.001 <0.001 0.181 <0.001
N 77 77 77 75 77 73 75 75 Thigh circum-ference 106 106 99 100
ρ 0.207 −0.023 0.030 0.296 0.099 0.541 0.590 0.727 0.746 0.562 0.193 0.410
P 0.071 0.844 0.796 0.010 0.392 <0.001 <0.001 <0.001 <0.001 <0.001 0.055 <0.001
N 77 77 77 75 77 73 75 75 77 Calf circum-ference 107 100 101
ρ 0.214 0.110 0.188 0.413 0.032 0.655 0.585 0.747 0.740 0.643 0.174 0.509
P 0.062 0.342 0.101 <0.001 0.784 <0.001 <0.001 <0.001 <0.001 <0.001 0.083 <0.001
N 77 77 77 75 77 73 75 75 77 77 Ankle circum-ference 100 101
ρ 0.157 0.115 0.058 0.388 0.032 0.639 0.511 0.634 0.542 0.725 0.432 0.533
P 0.172 0.318 0.615 0.001 0.783 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
N 74 74 74 72 74 70 73 73 74 74 74 Foot length 100
ρ 0.212 0.180 0.176 0.130 0.112 0.403 0.247 0.294 0.098 0.369 0.474 0.453
P 0.070 0.125 0.134 0.275 0.342 0.001 0.035 0.012 0.409 0.001 <0.001 <0.001
N 75 75 75 73 75 71 74 74 75 75 75 74 Foot breadth
ρ 0.153 0.240 0.132 0.331 0.088 0.585 0.371 0.378 0.263 0.559 0.569 0.506
P 0.190 0.038 0.258 0.004 0.452 <0.001 0.001 0.001 0.022 <0.001 <0.001 <0.001

Spearman correlations. P < 0.05 in bold.

Author Contributions

Conceptualization, B.L. and J.K.; methodology, B.L. and M.G.K.; validation, C.M., C.W. and J.K.; formal analysis, B.L.; resources, J.K.; data curation, B.L.; writing—original draft preparation, B.L.; writing—review and editing, M.G.K., C.M., C.W. and J.K.; project administration, B.L.

Funding

This work was supported by intramural grants from the University Hospital of the Friedrich-Alexander University Erlangen-Nürnberg (FAU). C.M. is an associated fellow of the research training group 2162 funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)-270949263/GRK2162. The funders had no role in the study design, data collection, analyses, decision to publish, or preparation of the manuscript.

Conflicts of Interest

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

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