Academic journal article Journal of Health Population and Nutrition

Association of Alcohol Consumption with Specific Biomarkers: A Cross-Sectional Study in South Africa

Academic journal article Journal of Health Population and Nutrition

Association of Alcohol Consumption with Specific Biomarkers: A Cross-Sectional Study in South Africa

Article excerpt


Due to rapid urbanization, South Africa is experiencing a health transition associated with a triple burden of disease characterized by a high prevalence of undernutrition-related infectious diseases, the emergence of non-communicable diseases, and the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) pandemic (1). The World Health Organization (WHO) recently stated that alcohol consumption is the fifth leading cause of death worldwide and that intakes are on the increase, especially in developing countries (2). According to the WHO's database, South Africa's adult per-capita consumption of pure alcohol is 9.46 litre. What is, however, of concern is that those who reported to drink have a 34.90 litre percapita consumption of pure alcohol by adults for both genders, which is one of the highest in the world (2). Alcohol-abuse in South Africa is reported to be responsible for at least half of the 14,000 annual road deaths, high crime rates, violence, sexual risk behaviour, family disruption, and a host of individual and societal problems (3). Additionally, binge drinking results in an increased cardiovascular disease (CVD) risk as well as micronutrient deficiencies (4) both having high prevalence in the South African population (1).

Epidemiological evidence suggests a J- or U-shaped relationship between alcohol consumption and CVD (5-7). There is a need to assess, with accuracy, the high-risk drinking in this population and to relate alcohol intakes (exposure) to different health outcomes.

Identification and assessment of high-risk drinking in a population can be problematic when selfreports of alcohol consumption is used as an indicator as there is usually under- or overreporting by the respondents. Although a detailed, validated quantitative food frequency questionnaire (QFFQ) is an important source of consumption information (8) and typically has low rates of false-positive responses, the primary weakness is that people struggle to report their alcohol consumption levels accurately (9). Underreporting has been shown to be common in population surveys (10), and this is largely attributed to the low participation by alcoholics and heavy drinkers in these surveys. Additionally, there is the tendency of respondents, especially those that are alcohol-dependent to underreport their consumption in questionnaire and interviews (11,12).

There are biological markers, such as circulating carbohydrate-deficient transferrin (CDT) and gamma glutamyl transferase (GGT) that are sensitive to high alcohol consumption and are suitable biomarkers for identifying alcohol-use or abuse in most populations (13,14). These biomarkers may be used in estimating or verifying reported alcohol consumption or real consumption rates in different populations; %CDT, which measures the relative amount of CDT isoforms in proportion to total transferrin, has been shown to be a slightly better marker compared to absolute CDT values (15-22).

It is important to use these biomarkers to verify reported intakes and to identify and assess highrisk drinking patterns with better accuracy in African populations. The aim of this study was to assess cross-sectionally the self-reported alcohol consumption and its association with the levels of %CDT and GGT in a randomized sample in the North-West Province of South Africa.


Study design and subjects

This cross-sectional epidemiological survey is part of the North-West Province, South African leg of the 12-year PURE study which investigates the health transition in urban and rural subjects. The main selection criteria for recruitment in this study were that (i) there should be migration stability within the chosen rural and urban communities and (ii) participants should be older than 35 years of age, with no reported chronic diseases for lifestyle, tuberculosis, and known HIV infection. The baseline data were collected from October to December 2005. …

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