Concentration of fatty acid ethyl esters in hair of alcoholics: comparison to other biological state markers and self reported-ethanol intake.
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.
Wurst
Friedrich Martin
FM
Psychiatric University Hospital and Department Central Laboratory, University of Basel, Switzerland. friedrich.wurst@pukbasel.ch
Alexson
Stefan
S
Wolfersdorf
Manfred
M
Bechtel
Gaby
G
Forster
Stephan
S
Alling
Christer
C
Aradóttir
Steina
S
Jachau
Katja
K
Huber
Peter
P
Allen
John P
JP
Auwärter
Volker
V
Pragst
Fritz
F
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
D015415:Biomarkers; D009226:Myristates; D009829:Oleic Acids; D010169:Palmitic Acids; D013228:Stearates; C032396:ethyl myristate; C026345:ethyl stearate; C007680:ethyl palmitate; C033180:ethyl oleate