Evaluation of indices of alcohol intake in a population of 60-year-old men in Uppsala, Sweden

Distribution and population determinants of gamma-glutamyltransferase in a random sample of Sardinian inhabitants. 'ATS-SARDEGNA' Research Group

The relation of a number of determinants to serum gamma-glutamyltransferase (GGT) was studied in a random sample of Sardinian inhabitants of 2283 males and 2520 females aged 20-59 years. The aim of the study was to assess the influence of environmental, behavioural and biochemical factors on GGT levels. Mean values were higher in males than in females and increased with age in both sexes. In sex-specific multiple regression analysis, GGT showed a positive association with body mass index (BMI), alcohol use, total serum cholesterol (T-C), HDL cholesterol (HDL-C), triglycerides (TG), apolipoprotein B (ApoB) and age, and a negative one with coffee consumption and physical activity in males, while in females the enzyme was positively associated with BMI, alcohol use, age, T-C, ApoB, TG and cigarette smoking. The negative association between coffee drinking and serum GGT observed in males suggests that coffee may inhibit the inducing effects of other factors, particularly alcohol use, on GGT in the liver. No biological mechanism has been suggested to explain the association of GGT with BMI, age or physical activity. This study confirms the importance of GGT as a strong marker for alcohol use; but a number of variables, ranging from life-style to biological characteristics, are also important determinants of its plasma values in the 'normal' population.

The "WAM" score: sensitivity and specificity of a user friendly biological screening test for alcohol problems in trauma patients

Based on a weighted aggregation of three biological alcohol markers (gamma-glutamyltransferase, blood alcohol and mean corpuscular volume), this study presents a screening instrument for alcohol problems in trauma patients. The sex-specific performance of this instrument was explored on 1088 male and 352 female patients, 18 years or older, admitted with blunt or penetrating trauma during a 30-month period to a regional level one trauma center in Seattle, Washington (USA). The sum of the differentially weighted alcohol markers ("WAM"), determined from one blood sample, formed a "score continuum" ranging from 0 to 24. The WAM scores distributed themselves across the trauma population with higher WAM scores being correlated to higher screening instrument scores for alcohol problems. By using two of the best established screening tests for alcohol problems (CAGE and SMAST) to define cut-off points for likely "alcohol abuse/dependence", the WAM score of > or = 7 in males showed 75% sensitivity and 83% specificity, whereas the WAM score of > or = 6 for females displayed 85% sensitivity and 85% specificity. We conclude that a weighted combination of biological alcohol markers (WAM score) is a useful tool for identifying alcohol problems among trauma patients. Representing an alternative or addition to a more extensive interview, it could be used as a routine part of the care of trauma patients.

Correlations between presbyacusis and extrinsic noxious factors

As part of the longitudinal gerontological and geriatric population study of 70-year-olds in Göteborg, Sweden, the possible correlation between presbyacusis and extrinsic factors affecting health in elderly persons was investigated. Participants from one cohort (F 01) were studied longitudinally at ages 70, 75, 79 and 85 years, and from another cohort (F 06) at age 70 years. A weak correlation between hearing loss and smoking, alcohol abuse and head trauma was found for men and between hearing loss and intake of pharmaceutical agents (especially salicylates) for women.

Marital coital activity in men at the age of 75: relation to somatic, psychiatric, and social factors at the age of 70

OBJECTIVE

To find somatic, psychiatric, and social variables that predicted cessation of coital activity in elderly married men.

DESIGN

Prospective, longitudinal, observational study

SETTING

General survey of a representative sample of 70-year-old urban men (born in 1901-02) in Göteborg, Sweden.

PARTICIPANTS

Forty-one men who were married and had coital activity at age 70 and who, at the age of 75, were still married when the sample was reinterviewed.

MAIN OUTCOME MEASURES

Presence (c) or absence (nc) of coital activity at age 75.

RESULTS

Cessation of coital activity was associated with vasculogenic factors. At least one of the following disorders--systemic hypertension, ischemic heart disease, congestive heart failure, diabetes mellitus, or hypertriglyceridemia--was found in three of the C men and 14 of the NC men, P less than 0.005. Systemic hypertension was the most common disorder and was found in one C man and 10 NC men, P less than 0.01. Cessation of coital activity was associated with specified types of stress between 65 and 70 years of age in the subgroup of men who had stopped due to inability; six out of eight reported stress against five out of 20 in the C group, P less than 0.05. There was no association with any of the psychiatric or social factors studied.

CONCLUSIONS

Cessation of coital activity is predicted by somatic disorders which are associated with vascular damage and especially by hypertension. This observation does not allow the conclusion that antihypertensive treatment would be effective in postponing the cessation of coital activity.

The Tromsø Heart Study: distribution of, and determinants for, gamma-glutamyltransferase in a free-living population

Gamma-glutamyltransferase (GGT) was measured in 1579 men, aged 20-54 years, and 1654 women, aged 20-49 years, screened for coronary risk factors. The distribution was right-skewed with medians 15 and 10 U/l for men and women, respectively. Less than 3.8% of the men and 0.8% of the women had GGT greater than or equal to 50 U/l. The low level of GGT matched well with the low mortality of cirrhosis and the modest use of alcohol in Norway. Multiple regression analysis for each sex showed a strong positive association with body mass index, use of alcohol and, unexpectedly, a negative association with coffee consumption, whereas serum triglycerides and the time since the last meal showed a weaker positive association. In women, use of oral contraceptives was positively associated with GGT.

Alcohol consumption and cardiovascular risk factors

This chapter reviews epidemiologic evidence relating alcohol consumption to the cardiovascular risk factors of high-density lipoprotein (HDL)-cholesterol and blood pressure. Alcohol consumption shows a linear dose-response relationship with HDL-cholesterol that is independent of other known determinants of HDL-cholesterol. The effect of alcohol on HDL-cholesterol appears to be reversible. The relationship of alcohol consumption to HDL-cholesterol subfractions and to the HDL apoproteins is not clear. Alcohol consumption also shows a linear dose-response relationship with blood pressure. Although the association is consistent, the estimated effect of alcohol consumption on blood pressure is small. This effect of alcohol may also be reversible. No biological mechanisms have been established for these associations. Some of the effect of alcohol on the risk of coronary heart disease may be explained by the effects of alcohol on these risk factors. It remains to be determined if alcohol also exerts an effect that is independent of these risk factors.

High density lipoprotein cholesterol and alcohol consumption in a French male population

The mean high density lipoprotein cholesterol (HDL-C) level in a sample of 640 apparently healthy male employees of a branch of the Paris civil service, aged 22-56, appears high (between 56.5 and 61.8 mg/dl depending on age groups). A positive relationship between HDL-C and alcohol intake is observed only after age 30, but is revealed in all age groups when the triglyceride level is taken into account. Differences in drinking habits by age may explain this. The moderate effect of alcohol intake on HDL-C is not sufficient to account for the high mean levels observed.

Serum gamma-glutamyl transferase and a somatic health score in middle-aged men

In an ongoing population investigation of middle-aged men in Malmö, Sweden, several health screening variables showed strong but crude individual covariations with the level of the hepatic enzyme, serum gamma-glutamyl transferase (GGT). These variables were combined, according to an analysis of their normal distributions, into a score index which exhibited a much smoother correlation with low, normal, and elevated levels of GGT when tested in a random population subsample. It is concluded that this scoring system may find further utilisation as a general descriptive method of recording statistical covariations between health screening tests and sum them up.

Indices of alcohol intake. Comparison between serum concentrations of alkaline phosphatase and gamma glutamyltransferase in middle-aged men

A comparison was performed on the validity of serum-gamma-glutamyltransferase (S-GT) and serum-alkaline phosphatase (S-ALP) concentrations for establishing the increased alcohol intake in a group of middle-aged men in Uppsala. These men were all born in 1915 and were participants of a special health investigation performed at their age of 60 years. Subjects who were registered at the Temperance Board, or had ethyl alcohol in urine or gave a positive reply to a question of alcohol intake were designated alcohol index cases. The mean S-GT values of these different alcohol index groups were significantly higher than that of a randomly selected subgroup devoid of alcohol findings in the same population. No such differences were found when comparing the corresponding mean S-ALP values. The authors thus point to the superiority of S-GT determinations to S-ALP determinations, especially in patients where the alcohol consumption certainly not is to be regarded as excessive.

Structural, functional, and clinical aspects of gamma-glutamyltransferase

GGT catalyses the transfer of gamma-glutamyl residues to amino acids or small peptides. A number of publications report the purification of GGT, the rat kidney enzyme being the best characterized. Bromelain treatment liberates an active form with a molecular weight of 68,000 separable into two nonidentical glycopeptides with molecular weights of 46,000 and 22,000; the latter contains the gamma-glutamyl binding site. GGT is intimately concerned in the synthesis and metabolism of glutathione through the gamma-glutamyl cycle. There is good evidence that this plays a role in the absorption of amino acids from the glomerular filtrate and from the intestinal lumen through a translocation mechanism. Many studies indicate that the GGT content of liver is increased by enzyme-inducing drugs and that this increase is reflected in elevated activity of the enzyme in blood serum. The serum assay has potential in monitoring drug compliance. Increased serum GGT activity encountered in chronic alcoholics seems to be partly due to microsomal enzyme induction. Utility of the assay in detecting alcoholism is controversial, but it is a useful index to compliance with therapy. Dramatic increases in activity are found in many chemically-induced animal tumors, and can be recognized in premalignant cells long before any morphological changes become evident. It has been used as a test for hepatic metastases, but its predictive value has shown a wide range in the hands of many authors. A similar controversy applies to its role in monitoring cancer therapy. Many synthetic substrates have been used to measure serum GGT activity. Currently, L-gamma-glutamyl-p-nitroanilide is the most popular. Males have higher values than females; activity is very high in the neonate and rather low in pregnancy. The most universal application of serum GGT assay is in diagnosis of liver and biliary tract disease. It is widely believed that higher values occur in biliary obstruction than in parenchymal disease. However, the percentage incidence of abnormalities and the overlap of values in individual cases in different disease categories are so great that the enzyme cannot be recommended for this purpose. Isoenzyme analyses have been performed in an attempt to improve the diagnostic specificity of the serum GGT assay. Tissue-specific patterns have not been described, and disease-specific patterns cannot be reproduced with confidence. Whereas exciting advances are being made in understanding the molecular structure, mechanism, and functions of the enzyme it has yet to find a genuinely useful diagnostic role substantiated by a convincing body of scientific data.