BMI But Not Stage or Etiology of Nonalcoholic Liver Disease Affects the Diagnostic Utility of Carbohydrate-Deficient Transferrin
Article first published online: 22 JUL 2013
Copyright © 2013 by the Research Society on Alcoholism
Alcoholism: Clinical and Experimental Research
Volume 37, Issue 10, pages 1771–1778, October 2013
How to Cite
Fagan, K. J., Irvine, K. M., McWhinney, B. C., Fletcher, L. M., Horsfall, L. U., Johnson, L. A., Clouston, A. D., Jonsson, J. R., O'Rourke, P., Martin, J., Pretorius, C. J., Ungerer, J. P. J. and Powell, E. E. (2013), BMI But Not Stage or Etiology of Nonalcoholic Liver Disease Affects the Diagnostic Utility of Carbohydrate-Deficient Transferrin. Alcoholism: Clinical and Experimental Research, 37: 1771–1778. doi: 10.1111/acer.12143
- Issue published online: 3 OCT 2013
- Article first published online: 22 JUL 2013
- Manuscript Accepted: 2 MAR 2013
- Manuscript Received: 9 NOV 2012
- National Health and Medical Research Council of Australia, The Queensland Government's Smart State Health and Medical Research Fund, The Princess Alexandra Hospital Research and Development Foundation and the Australian Liver Foundation
- High-Performance Liquid Chromatography;
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).
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.
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.
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.