Bertil Hood

Serum γ-glutamyltransferase: Statistical distribution in a middle-aged male population and evaluation of alcohol habits in individuals with elevated levels

Abstract Serum γ-glutamyltransferase activity (GGT) was measured in two middle-aged, male Malmo birth-year cohorts. Increased GGT-values were found in 16% of this population sample. There were broad correlations, throughout both the normal and elevated range of GGT values with screening serum triglycerides, 120-min blood glucose in oral glucose tolerance tests, pulse and blood pressure indices, body weight, serum urate and, more weakly, serum cholesterol values. Results of other tests related to liver dysfunction were elevated in only about half of a study group of individuals with elevated screening GGT. Careful evaluation of alcohol habits in this group revealed heavy drinking as the most probable underlying factor in about three-fourths of the cases. We conclude that serum GGT, when included in a general medical screening examination, may help in detecting hidden alcoholism and may also be utilized in an individually oriented program aimed at the prevention of alcoholism.

Risk factors for premature death in middle aged men

The causes of premature death and the associated risk factors were analysed in a cohort of 7935 middle aged men participating in a preventive population programme in Malmö. They were screened when aged 46-48 and then followed up for 3½-8 years. Two hundred and eighteen died, of whom 181 (83%) underwent necropsy. Three major causes of death were established: cancer in 61 (28%), deaths related to consumption of alcohol in 55 (25%), and coronary heart disease in 50 (23%). Distinctly different patterns of risk factors were found to be associated with each of the three main causes of premature death. In death due to coronary heart disease smoking (p=0·0062), serum cholesterol concentration (p=0·00014), serum triglyceride concentration (p=0·00013), systolic blood pressure (p=0·000012), and diastolic blood pressure (p=0·0021) were the strongest single determinants but diastolic blood pressure ceased to be a predictive factor in a multivariate analysis whereas all the other variables could be combined in a highly predictive logistic model. In death related to consumption of alcohol equal or even stronger associations were found for serum γ glutamyltransferase activity (p<0·0001), points scored in a questionnaire screening for alcoholism (p<0·0001), and, inversely, serum cholesterol (p=0·0046) and serum creatinine (p<0·0001) concentrations both when applied independently and when combined in a logistic model. In death due to cancer significant associations were found for serum urate concentration (p=0·023) and, inversely, serum cholesterol concentration (p=0·056-0·031). Malignant diseases and diseases related to consumption of alcohol were at least as prominent as cardiovascular disorders in causing premature death in the cohort of men studied. All three types of conditions are potentially avoidable and seem to be associated with significant and distinctive patterns of risk factors. These patterns should be used, as blood pressure and serum lipid concentrations already are, to predict the risk of premature death and indicate preventive measures.

Comparison of gamma-glutamyltransferase and other health screening tests in average middle-aged males, heavy drinkers and alcohol non-users

Physical and biochemical health screening variables were compared in matched, middle-aged male samples of (a) ideological teetotallers, (b) average men, (c) self-reported alcohol abstainers, (d) low gamma-glutamyltransferase (GGT) activity, and (e-f) high GGT activity with or without admitted alcohol consumption background. The alcohol non-user groups and the individuals with low GGT had significantly lower mean values of relative body weight, pulse, systolic and diastolic blood pressure, haematocrit, serum urate, triglyceride, cholesterol, and zero and 120 min blood glucose than individuals with elevated GGT and alcohol overconsumption. The average men had intermediate levels. The frequency of increased values of the same tests was notably higher in the subjects with elevated GGT and heavy alcohol consumption than in the teetotallers and the other groups; and was lowest in the teetotallers.

The efflux rate of norepinephrine from platelets and its relation to blood pressure

Abstract The uptake and efflux rate of norepinephrine in platelets have been studied in 63 individuals, 48 men and 15 women. 40 of these had a diastolic blood pressure ⩾95 mm Hg. If the initial efflux rate, k, was correlated to the diastolic blood pressure a highly significant relationship (r = 0.748 p

Premature death and associated risk factors in urban middle-aged men

The full range of premature mortality and associated risk factors was analyzed for a follow-up period of three and a half to eight years in a uniform group of 7,935 middle-aged males (46 to 48 years old at screening) participating between the years 1975 and 1979 in the preventive population program in Malmö (participation rate 76.7 percent). Of the 218 deaths that occurred, necropsy was performed in 181 (83.0 percent). Three major causes of death were established: cancer (61/218), alcohol-related deaths (55/218), and coronary heart disease (50/218). In these three main categories of male premature mortality, significant and distinctly differential risk factor patterns were found. In coronary heart disease, smoking (p = 0.0062), serum cholesterol level (p = 0.00014), serum triglyceride level (p = 0.00013), systolic blood pressure (p = 0.000012), and diastolic blood pressure (p = 0.0021) were the strongest single determinants, but the independent role of the diastolic blood pressure disappeared in a multivariate analysis whereas all the others could be combined in a highly predictive logistic model. In the alcohol-related group, equal or stronger risk factor associations were present for serum gamma-glutamyltransferase level (p less than 0.0001), questionnaire alcoholism screening response (p less than 0.0001) and, inversely, serum cholesterol level (p = 0.0046) and serum creatinine level (p less than 0.0001), all of which were independent and could be combined in an even more predictive logistic model than in the coronary heart disease group. In the cancer deaths, significant associations were found for serum urate level (p = 0.023) and, inversely, serum cholesterol level (p = 0.056 - 0.031). Malignant and alcohol-related diseases constituted at least equally prominent groups as the cardiovascular disorders of the total premature deaths that occurred during middle age in these cohorts of Malmö males. All of these conditions are potentially avoidable and seem to be associated with significant and distinctive risk factor patterns. It seems possible that these factors may be applied, in current alcohol-related disorders and in future malignant diseases, both as indicators of the respective risks and as signals and instruments for directed preventive measures like the previously well established and tested methods for the regulation of blood pressure, serum lipids levels, and so on.

Convictions for drunkenness or drunken driving, sick absenteeism, and morbidity in middle-aged males with different levels of serum γ-glutamyltransferase

Abstract In a continuous population study of middle-aged males in Malmo, serum γ-glutamyltransferase (GGT) has been utilized both as a biochemical indicator of alcohol consumption and as an aid in further investigation and treatment. The individuals in the top decentile of the GGT distribution were compared with individuals in other GGT brackets. The number of individuals with legal convictions for drunkenness or drunken driving was 2.8 times larger in the top decentile of GGT compared with those below the median. The corresponding ratio for drunken driving alone was 3.4. The number of sick days was analyzed for 1,290 individuals in a 21-year long-term study before screening and random subsamples with different GGT values were compared. Increasing GGT values were correlated with the disability rate over all years. There was a dramatic rise in the occurrence of sick days in the top decentile of GGT during the 6 years before screening. Conversely, 50% of the individuals (below the median on GGT) had less sick absenteeism than the mean for all Swedish males throughout the 21 years before screening. Morbidity was analyzed in a subsample of 285 individuals with >90 sick days during the final 3 years of the study. The ratios of disability between the individuals in the highest and lowest decentile of the GGT distribution were highest in the diagnostic groups injuries (5.5) and mental disorders (4.3). We concluded that an accumulation of alcohol-related disabilities is present in groups of individuals with high GGT values.

Hospitalization and alcohol-related morbidity within three years after screening in middle-aged men.

All men living in Malmö who were born in 1926-1929 were invited for a health screening examination which included, among many other things, measurement of gamma-glutamyltransferase (GGT). They were followed up and within three years after the screening 963 of 4571 men had been hospitalized. They had 17158 hospital days or almost 6 days per individual each year. The impact of alcohol on the admissions was analysed both according to the International Classifications of Diseases and a new design where all the diagnoses were grouped and coded in conditions which were judged to be alcohol-related, potentially alcohol-influenced and non-alcohol-related. Of the total days in hospital, alcohol psychosis and alcoholism accounted for 13.6 per cent. Altogether 29.2% of the days were caused by alcohol-related and potentially alcohol-influenced conditions. GGT values at the screening investigation were significantly increased in 25% of the hospitalized men. Alcohol-related admissions were seven times as many in men with GGT values in the highest quintile compared with those who had values in the lowest quintile.

Two-hour glucose and insulin responses after a standardized oral glucose load in relation to serum gamma-glutamyl transferase and alcohol consumption

SummaryIn a population study of 4,763 middle-aged men, the 120-min responses of blood glucose as well as plasma IRI in OGTTs were studied in subgroups of the screening population with different levels of gamma-glutamyl transferase (GGT) and/or defined alcohol consumption levels. In the group with low GGT (below the median, n=2, 196), both 120-min blood glucose and plasma IRI tended to be lower than in the whole screening cohort and there was a significantly smaller number of cases with 120-min blood glucose values ≥ 7.0 mmol/l. In a group of ideological alcohol abstainers the values of fasting as well as 120-min blood glucose were largely the same as in the average middle-aged men. In members of the study population with increased screening GGT, however, both fasting and, especially, 120-min values of blood glucose and plasma IRI were higher than in the average males, particularly in the cases in which the interview revealed chronic heavy alcohol consumption as the predominant underlying factor associated with elevated GGT. In these individuals, the prevalence of 120-min screening OGTT blood glucose values ≥ 7.0 mmol/l was 26%, in comparison with 13% in the average men and 9% in the individuals with screening GGT left of the median. This indicates that GGT and alcohol consumption are of clinical importance both for the results and interpretation of OGTTs.

Aryl hydrocarbon hydroxylase induction levels in patients with malignant tumors associated with smoking.

SummaryThe levels of aryl hydrocarbon hydroxylase (AHH) inducibility were assessed in 173 patients with cancers statistically associated with smoking, i.e., squamous cell and transitional cell carcinomas, at various sites. In 34 patients with carcinomas of the oral cavity, 41 patients with laryngeal carcinomas, and 22 patients with pulmonary carcinomas there was a highly significant overrepresentation of high inducers, whereas 30 patients with carcinomas of the renal pelvis and ureter and 46 patients with urinary bladder carcinomas did not differ significantly in this respect from a control population comprising 92 subject with no history of neoplastic disease.The results add further support to the concept of AHH as a major activator of carcinogens belonging to the group of polycyclic aromatic hydrocarbons (PAH) when these affect·the oral cavity and/or the respiratory tract.The role of AHH in urothelial carcinogenesis seems to be less explicit.

Spontaneous efflux of platelet α-granule components in relation to 14C-norepinephrine in buffers

Abstract In an investigation of the spontaneous efflux of beta-thromboglobulin (β-TG), 14C-norepinephrine (14C-NE) and growth stimulating activity (GSA), measured as incorporation of 3H-thymidine in rabbit aortic smooth cells, from platelets resuspended in Ca++- and Mg++- free buffer a continuous increase in 3H-thymidine incorporation was seen during 120 min. There was good stoichiometric parallelism between β-TG and 14C-NE during the 80 minutes the experiment lasted, indicating that norepinephrine is incorporated in α-granules and released by exocytosis.