title: BMI but not stage or etiology of nonalcoholic liver disease affects the diagnostic utility of carbohydrate-deficient transferrin.
abstract: BACKGROUND
  A reliable biomarker is required in hepatology clinics for detection and follow-up of heavy alcohol consumption. Carbohydrate-deficient transferrin (CDT) increases with sustained heavy alcohol consumption and is the most specific biomarker of ethanol (EtOH) consumption. Recent introduction of a standardized method for measuring CDT has improved its clinical application. This study was designed to determine whether alcohol-independent factors influence CDT levels in patients with chronic liver disease (CLD).
  
  
  METHODS
  The relationship between serum %CDT and self-reported history of alcohol consumption was examined in 254 patients referred for evaluation of liver disease. CDT analysis was performed on serum collected at time of liver biopsy.
  
  
  RESULTS
  CDT levels were not affected by severity or etiology of nonalcoholic liver disease. Thirteen of 254 subjects had a %CDT >1.7, predictive of heavy alcohol intake, 6 of whom did not acknowledge heavy drinking. Twelve of these 13 subjects were suspected heavy drinkers on review of their medical records and clinical results. Conversely, not all acknowledged heavy drinkers had %CDT >1.7. Heavy drinkers with a body mass index (BMI) in the overweight or obese range had significantly lower %CDT than lean heavy drinkers. This persisted even when lean body weight was used as an approximation of the EtOH volume of distribution.
  
  
  CONCLUSIONS
  An elevated BMI reduces the diagnostic utility of CDT at higher alcohol intake in subjects with CLD using the standardized method. In a hepatology outpatient setting, this assay is likely to be useful to confirm suspicion of heavy drinking in subjects who are not overweight, but cannot reliably identify moderate drinkers or heavy drinkers who are overweight.
authors.affiliation: Department of Gastroenterology and Hepatology , Princess Alexandra Hospital, Brisbane, Queensland, Australia; Centre for Liver Disease Research , School of Medicine, Brisbane, Queensland, Australia.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Fagan
authors.forename: Katharine M
authors.initials: KM
authors.lastname: Irvine
authors.forename: Brett C
authors.initials: BC
authors.lastname: McWhinney
authors.forename: Linda M
authors.initials: LM
authors.lastname: Fletcher
authors.forename: Leigh U
authors.initials: LU
authors.lastname: Horsfall
authors.forename: Lambro A
authors.initials: LA
authors.lastname: Johnson
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Clouston
authors.forename: Julie R
authors.initials: JR
authors.lastname: Jonsson
authors.forename: Peter
authors.initials: P
authors.lastname: O'Rourke
authors.forename: Jennifer
authors.initials: J
authors.lastname: Martin
authors.forename: Carel J
authors.initials: CJ
authors.lastname: Pretorius
authors.forename: Jacobus P J
authors.initials: JP
authors.lastname: Ungerer
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Powell
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000097:blood* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D014168:Transferrin / Q000031:analogs & derivatives* / Q000378:metabolism
chemical_list: D015415:Biomarkers; D014168:Transferrin; C056759:carbohydrate-deficient transferrin
keywords: Alcohol; Biomarker; Cirrhosis; High-Performance Liquid Chromatography