Alcohol & Alcoholism Vol. 39, No. 1, pp. 33-38, 2004
© Medical Council on Alcohol 2004; all rights reserved
CONCENTRATION OF FATTY ACID ETHYL ESTERS IN HAIR OF ALCOHOLICS: COMPARISON TO OTHER BIOLOGICAL STATE MARKERS AND SELF REPORTED-ETHANOL INTAKE
1 Psychiatric University Hospital and 2 Department Central Laboratory, University of Basel, Switzerland, 3 Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Switzerland, 4 Department of Medical Neurochemistry, Lund, Sweden, 5 State Mental Hospital Bayreuth, 6 Department of Legal Medicine, University of Magdeburg, Magdeburg and 7 Institute of Legal Medicine, Humboldt University, Berlin, Germany and 8 Pacific Institute for Research and Evaluation, Calverton, MD, USA
* Author to whom correspondence should be addressed at: Psychiatric University Hospital, University of Basel, Wilhelm Klein Strasse 27, CH-4025 Basel, Switzerland. Tel.: +41 61 325 5512; Fax: +41 61 325 5583; E-mail: friedrich.wurst{at}pukbasel.ch
(Received 17 February 2003; first review notified 11 April 2003; in revised form 23 September 2003; accepted 30 September 2003)
Aims: In a variety of clinical and forensic situations long term use of alcohol must be monitored. In this project we explore the utility of fatty acid ethyl esters (FAEE) in this regard. Additionally, we propose a cut-off value of FAEE to distinguish teetotallers/moderate/social drinkers from alcoholics or individuals drinking at harmful levels. Patients and methods: FAEE levels from 18 alcohol-dependent patients in detoxification were contrasted with those of 10 social drinkers and 10 teetotallers. FAEE in hair were determined, using headspace solid phase microextraction and gas chromatography mass spectrometry. CFAEE, as sum of the concentrations of four esters, was compared to a major FAEE, ethyl palmitate. PEth was measured in heparinized whole blood with a high pressure liquid chromatography (HPLC) method. Drinking validation criteria include self reports, phosphatidyl ethanol (PEth) in whole blood as well as the traditional markers of heavy drinking, gamma glutamyl transpeptidase (GGT), mean corpuscular volume (MCV) and carbohydrate deficient transferrin (CDT). Results: Receiver-operating characteristic (ROC) curve analysis for CFAEE, indicated a sensitivity of 100% and a specificity of 90% for a cut-off of 0.29 ng/mg. By using a cut-off of 0.4 ng/mg, CFAEE identified 94.4% correctly. CFAEE and ethyl palmitate were significantly associated (r = 0.945; P < 0.001) as were CFAEE and PEth (r = 0.527; P = 0.025). No significant correlation was found between CFAEE and total grams of ethanol consumed last month, blood-alcohol concentration at admission to the hospital, CDT, MCV, or GGT. Among the serum and blood markers, %CDT identified 47.1%, MCV 38.8% and GGT 72.2% of patients with chronic intake of higher amounts of ethanol correctly, whereas PEth achieved 100% accuracy. Conclusions: The data suggest that CFAEE is a potentially valuable marker of chronic intake of high quantities of ethanol. Furthermore, the results indicate that a reasonable and provisional FAEE cut-off to distinguish between social/moderate and heavy drinking/alcoholism in hair is 0.4 ng/mg.
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