High blood alcohol levels in women

Alcoholic liver disease in the elderly

Although per capita alcohol consumption, and thus the prevalence of alcoholic liver disease, decreases generally with age in Europe and in the United States, recently an increase in alcohol consumption has been reported in individuals over 65 years. Reasons explaining this observation may include an increase in life expectancy or a loss of life partners and, thus, loneliness and depression. Although ethanol metabolism and ethanol distribution change with age, and an elderly person's liver is more susceptible to the toxic effect of ethanol, the spectrum of alcoholic liver diseases and their symptoms and signs is similar to that seen in patients of all ages. However, prognosis of alcoholic liver disease in the elderly is poor. In addition, chronic alcohol consumption may enhance drug associated liver disease and may also act as a cofactor in other liver diseases, such as viral hepatitis and nonalcoholic fatty liver disease.

Age, alcohol metabolism and liver disease

PURPOSE OF REVIEW

Alcohol consumption among the elderly has increased. Alcohol metabolism changes with age and the elderly are more sensitive to the toxic effects; this increased consumption is therefore of great clinical relevance.

RECENT FINDINGS

Metabolism of ethanol changes with advancing age because activity of the enzymes involved, such as alcohol and acetaldehyde dehydrogenase and cytochrome P-4502E1, diminish with age. The water distribution volume also decreases with age. Both lead to increased blood concentrations of ethanol. Also, elderly people take more drugs, and ethanol and these drugs may interact; therefore, alcohol consumption can modify serum drug concentrations and their toxicity. Finally, elderly people may suffer more frequently from other types of liver disease, and alcohol may exacerbate these.

SUMMARY

Over recent decades alcohol consumption has increased among those who are older than 65 years. Alcohol is more toxic in the ageing organism because of changes in its metabolism, distribution and elimination, which lead to central nervous system effects at lower levels of intake; also, ageing organs such as brain and liver are more sensitive to the toxicity of alcohol. For these reasons, alcohol should be used in moderation, especially among those of older age.

Honey-Induced Stimulation of Blood Ethanol Elimination and Its Influence on Serum Triacylglycerol and Blood Pressure in Man

The effect of honey on blood alcohol metabolism and the accompanying changes in serum triacylglycerol and blood pressure were investigated using volunteers. Fifty consenting undergraduates in apparent good health, between the ages of 15 and 30 years (23.6 +/- 7.4), were recruited for the study. The subjects were moderate alcohol drinkers (<30 g ethanol/day), matched in body weight and frame size. The participants were given ethanol (0.5 g/kg) and ethanol + honey (0.5 g/kg + 1.25 ml/kg) on two different occasions separated by 1 week. The results show that honey significantly (p < 0.01) increased blood alcohol disappearance and elimination rates by 32.4 and 28.6%, respectively, but reduced the intoxication time (that is, the time taken to attain zero blood alcohol level) and its degree (the peak blood alcohol level) by 30.0 and 4.4%. Ethanol + honey further increased serum triacylglycerol and blood pressure by 20.8 and 1.3/1.4% when compared with the proportion induced by ethanol after about 10 h of ingestion. The occasional use of honey as an anti-intoxicating agent may be approved. Meanwhile, further studies on how to ameliorate or prevent the associated increase in serum triacylglycerol and blood pressure is required.

Gender differences in risk factors and consequences for alcohol use and problems

Women drink less alcohol and have fewer alcohol-related problems than men. Women appear to be less likely than men to manifest certain risk factors for alcohol use and problems and are more likely to have certain protective factors against these problems: women perceive greater social sanctions for drinking; women are less likely to have characteristics associated with excessive drinking including aggressiveness, drinking to reduce distress, behavioral undercontrol, sensation-seeking and antisociality; and women are more likely to have desirable feminine traits (e.g., nurturance) protective against excessive drinking. In addition, consequences of heavy alcohol use, or alcohol use disorders, appear to be more negative for women than men, at least in some domains: women suffer alcohol-related physical illnesses at lower levels of exposure to alcohol than men, and some studies suggest women suffer more cognitive and motor impairment due to alcohol than men; women may be more likely than men to suffer physical harm and sexual assault when they are using alcohol; heavy alcohol use in women is associated with a range of reproductive problems. Implications of these findings for future research and public health education campaigns are discussed.

Medical risks for women who drink alcohol

OBJECTIVE

To summarize for clinicians recent epidemiologic evidence regarding medical risks of alcohol use for women.

METHODS

MEDLINE and PsychINFO, 1990 through 1996, were searched using key words "women" or "woman," and "alcohol." MEDLINE was also searched for other specific topics and authors from 1980 through 1996. Data were extracted and reviewed regarding levels of alcohol consumption associated with mortality, cardiovascular disease, alcohol-related liver disease, injury, osteoporosis, neurologic symptoms, psychiatric comorbidity, fetal alcohol syndrome, spontaneous abortion, infertility, menstrual symptoms, breast cancer, and gynecologic malignancies. Gender-specific data from cohort studies of general population or large clinical samples are primarily reviewed.

MAIN RESULTS

Women develop many alcohol-related medical problems at lower levels of consumption than men, probably reflecting women's lower total body water, gender differences in alcohol metabolism, and effects of alcohol on postmenopausal estrogen levels. Mortality and breast cancer are increased in women who report drinking more than two drinks daily. Higher levels of alcohol consumption by women are associated with increased menstrual symptoms, hypertension, and stroke. Women who drink heavily also appear to have increased infertility and spontaneous abortion. Adverse fetal effects occur after variable amounts of alcohol consumption, making any alcohol use during pregnancy potentially harmful.

CONCLUSIONS

In general, advising nonpregnant women who drink alcohol to have fewer than two drinks daily is strongly supported by the epidemiologic literature, although specific recommendations for a particular woman should depend on her medical history and risk factors.

Molecular biological aspects of alcohol-induced liver disease

Molecular biological investigations have become a predominant methodology applied to the study of alcohol-induced liver disease. The enzymatic pathways responsible for ethanol metabolism, and their genetic as well as environmental control, have become the focus of detailed investigation. More recently, the significance of cytokines in the pathogenesis of alcohol-induced liver disease has also become a major area of speculation. This review focuses on the advances made in studies of two important enzymes responsible for alcohol metabolism, alcohol dehydrogenase and aldehyde dehydrogenase, as well as the investigation of the proinflammatory and profibrogenic cytokines involved in the process of hepatic fibrogenesis. The quality and quantity of new discoveries made in the field of alcohol-induced liver disease is impressive, especially when one realizes that molecular biological approaches have been employed in this area for only 15 years. However, in most cases the studies have been predominantly descriptive, with little direct relevance to the therapeutics of alcoholism and alcohol-induced organ injury. Because the groundwork has been laid, one hopes that the next 15 years will rectify this failure.

Epidemiology of alcoholic liver disease

Although mortality from alcoholic liver disease has declined in some Western countries in recent years, elsewhere it is increasing and overall it remains a major health problem. Deaths are predominantly seen in patients with alcoholic hepatitis or cirrhosis, and when they occur in patients with fatty liver are usually unrelated to liver disease. Progression to cirrhosis is correlated with the severity of fatty liver and particularly with the presence of alcoholic hepatitis. Mortality from cirrhosis is strongly correlated with per capita alcohol consumption. The decline in cirrhosis mortality rates seen recently is related in part to decreases in per capita consumption, but probably also to the growth of self-help organizations which facilitate abstinence from alcohol. Recent studies suggest there is not an invariable dose-response relationship between alcohol intake and the severity of liver disease and that alcohol has a permissive effect which allows other aetiological factors to operate. Factors that influence susceptibility to alcoholic liver disease include gender (women develop alcoholic cirrhosis more readily than men), concomitant hepatitis C infection and possibly hepatitis B infection. It is uncertain whether HLA status or immune mechanisms are implicated. The systematic use of screening tests for hazardous consumption combined with early intervention therapies offers a good prospect of reducing morbidity and mortality from alcoholic liver disease.

Simulation studies on ethanol metabolism in different human populations with a physiological pharmacokinetic model

A physiological pharmacokinetic model of ethanol metabolism was used to simulate ethanol metabolism in standard, fasted, human males of the white American, white European, black American, and Japanese populations. Gastric ethanol metabolism accounted for only 0.24% of the dose in the several populations. In contrast, hepatic first-pass ethanol metabolism accounted for 3.7-4.2% of the dose. Ethanol elimination by the lung and kidney accounted for 1.3-1.7% of the dose in the several populations. The black American population had a significantly higher maximum blood ethanol concentration and area under the blood ethanol concentration versus time curve than the other populations studied when either a single dose or multiple doses of ethanol were ingested. These increases were due to the presence of a considerable amount of the beta 3 beta 3-alcohol dehydrogenase (ADH) isoenzyme, with a Michaelis constant of 34 mM in the black American population. The Japanese population, which has a relatively high proportion of the beta 2 beta 2-ADH isozyme, metabolized ethanol somewhat more rapidly than the other populations, as previously noted.

Brain gray and white matter volume loss accelerates with aging in chronic alcoholics: a quantitative MRI study

Magnetic resonance imaging (MRI) was used to study in vivo the brains of 49 patients with chronic alcoholism, 3 to 4 weeks post-withdrawal, and 43 normal healthy controls, all right-handed male veterans between the ages of 23 and 70 years. MRI scans were analyzed using a semi-automated procedure, which allowed the subcortical regions to be segmented into cerebrospinal fluid (CSF) and brain tissue and the cortical regions to be segmented into CSF, gray matter, and white matter. An age regression model was used to examine the effects of alcohol on brain structure, over and above that expected from the normal aging process. The alcoholics exhibited decreased tissue and increased CSF after correcting for aging. In the cortex, there was significant loss of both gray matter and white matter volume. In this sample of alcoholics, no particular cortical region was preferentially affected or spared. Furthermore, brain tissue volume loss increased with advanced age in the alcoholics. In this group of alcoholics there was no relationship between length of illness and age, i.e., the younger alcoholics had as heavy alcohol use histories as did the older alcoholics. Thus, the increased brain tissue loss with advanced age is interpreted as evidence for age-related increase in brain vulnerability to chronic alcohol abuse.