title: Concentration of fatty acid ethyl esters in hair of alcoholics: comparison to other biological state markers and self reported-ethanol intake.
abstract: OBJECTIVE
  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.
  
  
  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. C(FAEE), 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 C(FAEE), 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, C(FAEE) identified 94.4% correctly. C(FAEE) and ethyl palmitate were significantly associated (r = 0.945; P < 0.001) as were C(FAEE) and PEth (r = 0.527; P = 0.025). No significant correlation was found between C(FAEE) 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 C(FAEE) 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.
authors.affiliation: Psychiatric University Hospital and Department Central Laboratory, University of Basel, Switzerland. friedrich.wurst@pukbasel.ch
authors.forename: Friedrich Martin
authors.initials: FM
authors.lastname: Wurst
authors.forename: Stefan
authors.initials: S
authors.lastname: Alexson
authors.forename: Manfred
authors.initials: M
authors.lastname: Wolfersdorf
authors.forename: Gaby
authors.initials: G
authors.lastname: Bechtel
authors.forename: Stephan
authors.initials: S
authors.lastname: Forster
authors.forename: Christer
authors.initials: C
authors.lastname: Alling
authors.forename: Steina
authors.initials: S
authors.lastname: Aradóttir
authors.forename: Katja
authors.initials: K
authors.lastname: Jachau
authors.forename: Peter
authors.initials: P
authors.lastname: Huber
authors.forename: John P
authors.initials: JP
authors.lastname: Allen
authors.forename: Volker
authors.initials: V
authors.lastname: Auwärter
authors.forename: Fritz
authors.initials: F
authors.lastname: Pragst
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D000437:Alcoholism / Q000175:diagnosis* / Q000378:metabolism; D015415:Biomarkers / Q000032:analysis; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006197:Hair / Q000737:chemistry*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009226:Myristates / Q000032:analysis; D009829:Oleic Acids / Q000032:analysis; D010169:Palmitic Acids / Q000032:analysis*; D012372:ROC Curve; D013228:Stearates / Q000032:analysis; D015813:Substance Abuse Detection / Q000379:methods
chemical_list: D015415:Biomarkers; D009226:Myristates; D009829:Oleic Acids; D010169:Palmitic Acids; D013228:Stearates; C032396:ethyl myristate; C026345:ethyl stearate; C007680:ethyl palmitate; C033180:ethyl oleate