Hans Kristenson

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.

Comparison of γ-glutamyltransferase and questionnaire test as alcohol indicators in different risk groups

gamma-Glutamyltransferase (gamma-GT) and a Malmö modification of the Michigan Alcoholism Screening Test (Mm-MAST) were compared in subsamples of a health screening population of urban middle aged males with characterized levels of alcohol consumption and in the total group of deaths 0-6 years after the screening investigation. The questionnaire was markedly superior to gamma-GT in identifying the alcohol consumption in the known alcoholics but not in the other study groups. gamma-GT may be indicative of alcohol related health disturbances and may be used in their early recognition and as biochemical feedback in their further treatment and control in individuals. It may therefore be of value particularly as an instrument in a programme aimed at prevention of alcohol-related health complications.

Serum ferritin, gammaglutamyl-transferase and alcohol consumption in healthy middle-aged men

Serum ferritin was analysed in 169 middle-aged men. Ninety-one were heavy drinkers with increased serum gammaglutamyltransferase (GGT) values in otherwise normal routine screening tests; 39 were from the same birth year cohorts with normal GGT values; and 39 were teetotalers. Increased ferritin values were found in 67% of the heavy drinkers, but only in 2.5% in the two other groups. The mechanisms of the serum ferritin elevation in otherwise healthy alcohol over-consumers are unknown, but heavy drinking should be taken into consideration in the interpretation of increased serum ferritin values in individual cases.

Lower limb fractures and registration for alcoholism

During two consecutive years 607 individuals with lower limb fractures were diagnosed. Half of the individuals, 315, were women and only 14 of them had an earlier registration for alcoholism. In the 292 men, however, 73 men or 25%, had been registered at the Department of Alcohol Diseases at least once during the 13 years of observation, the highest registration frequency (30%) was noted in the malleolar fractures in men. In males, 30–50 years of age, there were 37 per cent who had a registration for alcoholism, the highest registration (44%) was noted for fracture of the tibial diaphysis. Males with fracture of the proximal end of the femur between 16–80 years of age were registered for alcoholism in 23%.

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.

Correlations of Serum Lipids and Lipoproteins with Gamma-Glutamyltransferase and Attitude to Alcohol Consumption

The correlation of three markers of alcohol consumption: serum concentration of gamma-glutamyltransferase (GT), high density lipoprotein cholesterol (HDL-cholesterol), apolipoprotein AI (Apo AI), and the results of a questionnaire (Mm-MAST) designed to measure the attitude towards alcohol consumption were determined in a population of healthy men aged 48 years. Apo AI (r = 0·27) and GT (r = 0·31) were correlated (p < 0·001) to the questionnaire score to a similar degree while the correlation between HDL-cholesterol and the questionnaire score was (r = 0·18), somewhat less good but statistically significant (p < 0·01). There was no correlation between GT and HDL-cholesterol or Apo AI.

Sex differences in problem drinking among 42-year-old residents of Malmö, Sweden

The main objective was to describe sex‐related differences in rates of nonidentified vs identified problem drinking in 42‐year‐old Malmö residents. All 1264 women and 1368 men born in 1941 were invited to a health screening at the Preventive Medicine Section, Malmö General Hospital. Individuals registered at the Department of Alcohol Diseases because of problem drinking prior to screening (identified problem drinkers) were excluded and analyzed separately. Intervention in the remaining subjects was made if any of 3 sets of inclusion criteria was met. The sex ratios (female:male) of identified and nonidentified problem drinking were 1:4.1 and 1:2.8 respectively. Thus, nonidentified problem drinking is by and large proportional to identified problem drinking in both sexes, arguing against hidden drinking being an exclusively female phenomenon.

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.

Orthopedic disorders, morbidity, and sick absenteeism in men with different levels of serum γ-glutamyltransferase☆

All orthopedic treatment administered between 1970 and 1982 was analyzed in random subsamples of men 28, 38, and 48 years old being screened for serum gamma-glutamyltransferase (GGT) levels. Of 1,151 screened participants, 631 men had been treated for fracture, distortion, contusion, low-back pain with or without sciatica, or radial epicondylitis. The extent of care and incidence of the different diagnoses over the 13 years, as well as the number of sick days incurred by these men during 1981, were investigated for different GGT brackets. Those men with the highest GGT values (greater than or equal to 1.34 mu kat/liter approximately 80 IU) had 4-6 times more fractures and consulted surgeons 6-13 times more often than those men with the lowest GGT values (less than 0.35 mu kat/liter approximately 20 IU). Epicondylitis and distortion showed the opposite frequency distribution, with the highest incidence occurring in the lowest GGT brackets. Increasing GGT values were also correlated with sick leave days. Men in the highest decile for sick leave had 25 times more fractures than those men with no sick absenteeism. We conclude that an accumulation of alcohol-related orthopedic disorders occurs among men with high GGT values.