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Alcoholic Tolerance, Drinking Behavior, and Alcohol- Related Health Disorders Among the Japanese

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Alcoholic Tolerance, Drinking Behavior, and Alcohol- Related Health Disorders Among the Japanese 〔日農 医 誌 40巻4号 917～929頁 1991.11〕 Original: Alcoholic Tolerance, Drinking Behavior, and Alcohol- related Health Disorders among the Japanese Tsuyoshi IMURA*, Akiyoshi BANDOH*, Norimi NISHIMURA*, Mikio ASAI*, Akiyoshi KAKUTANI*, Toshihiro ISHII*, Shigeki ISHIHARA*, Kazuhiro KAWANO* and Shigehito HAYASHI* In Japan there are many people who are intolerant to alcohol. Known as flushers, they do not genetically have low Km acetaldehyde dehydrogenase (AlDH2). Flushers are judged easily and accu- rately by the alcohol patch test. An ethanol patch test carried out on agricultural and fishing popula- tions in Japan showed that approx. 40% were deficient in AlDH2. A questionnaire survey of the drinking behavior of many people showed significant differences between the normal AlDH2 and AlDH2-deficient groups. The normal group drinks positively and actively, while the deficient group drinks negatively and passively. As a result, there were significant differences in subjective and objective symptoms that result from drinking between the two groups: More frequent hangovers, abnormal physical conditions and higher KAST scores were seen in the normal group, and health examination showed higher values in liver function tests, including ƒÁ-GTP, and higher levels of blood pressure, HDL-cholesterol (HDL-C), etc., in the normal AlDH2group. It may be very useful for prevention of alcohol-related health disorders to help Mongoloid peoples, such as the Japanese, recognize whether their AlDH2 is normal or deficient, which is as determined by the ethanol patch test. (1) AlDH2deficiency (2) Ethanol patch test (3) Epidemiology of drinking (4) KAST (Kurihama Alcoholism Screening Test) (5) Health disorders by alcohol intake presence or absence of alcoholic tolerance, deter- Introduction mined by this test, is greatly related to Japanese In the Mongoloid group of mankind, which drinking behavior, and in turn closely related to the includes the Japanese, there are many people who results of health examinations. exhibit facial flushing upon ingestion of even small Subjects and Methods amounts of alcohol and who do not have alcoholic tolerance. The so called Oriental flushing is consid- The subjects consisted mainly of agricultural ered due to defficiency in low Km acetaldehyde and fishing people undergoing our physical exami- dehydrogenase (AlDH2) as reported by Mizoi1) and nation, and part of the staff of the head offices of Harada et al2). It is not easy to determine the agricultural cooperatives and our hospital. Drinking presence or absence of AlDH2 in mass groups. behavior was investigated by a questionnaire includ- However, the ethanol patch test developed by Higu- ing such inquires as frequency of drinking (grades 4 chi et al3,4,5) made the determination possible for -7) , alcohol intake (grades 4-7), drinking behavior, epidemiological research. We report here that the disorders due to drinking and manner of drinking. * Tokushima-Ken-Koseiren Oe-Kyodoh-Hospital, 252 Kamojima Kamojima-cho Oe-gun Tokushima-prefecture, 776, Japan 918 The Kurihama alcoholism screening test (KAST) 2. Drinking behavior in patch test-positive and- was also performed. The details of the question- negative groups naire differed somewhat with the individual subject, (1) Number of drinkers in blood relatives purpose, etc., at the time, and were reported previ- AlDH2 deficiency is believed to be an inherited ously. condition. The results of the questionnaire on blood Table 1 shows the procedure for the ethanol relatives of both groups are shown in Table 3. There patch test. In principle, it followed the method of Higuchi et al3)., except for the use of a finn chamber Table 1. Procedure for the ethanol patch test for the plaster. A finn chamber appears to be more 1) Materials suitable for mass screening because it is empirically Finn chamber, filter paper for plaster (8 mm in nonspecifically less irritative and samples were liq- diameter), 70% ethanol, control liquid: distilled uid ethanol. water. Hematochemistry in health examination was 2) Soak a piece of test filter paper in ethanol or done with autoanalyzers. distilled water. Wipe the plaster paper with clean gauze, etc., Results so that the paper has the proper amount of moisture. 1. Ethanol patch test-positive rate 3) Apply the plaster paper with the finn chamber Table 2 shows the positive rate in the test, to the inner surface of the upper arm (for 7 performed on inhabitants in 7 areas of Japan, fol- min). lowing the procedure given in Table 1, which have 4) Make a judgement 15 min after the plaster is been reported previously7) by our research group. removed. As seen in earlier reports, approx. 40% of the sub- 5) Judgement: Judge erythema on the patched jects were found positive for the ethanol patch test area to be (+). and regarded as deficient in AlDH2 and intolerant to alcohol. Note: Slightly modified method of Higuchi et al.2) Table 2. Positive rate in the ethanol patch test (1987-1988) (There was no difference in positive rate between the sexes.) Table 3. Degree of drinking among blood relatives -Difference between the ethanol patch test (+) and (-) groups- (*P<0.005) 919 were more drinkers in blood relatives of the (-) Table 6 shows the ages when the subjects who group than the (+) group. underwent health examination began drinking. (2) Frequency of drinking Although minors are prohibited from drinking alco- Table 4 shows the frequency of drinking. In the hol, 12.1% in the (-) group, who have alcoholic (-) group, 84% of the subjects drink once or more tolerance, began drinking in their teens, compared a week and 16% do not drink at all while in the (+) with 3.8% in the (+) group. group, approx. 45% have no habit of drinking. Table 7 shows the degree of drinking of the (3) Alcohol intake staff members of agricultural cooperatives when Naturally, there was a significant difference in they were in college. Apparently, the (-) group alcohol intake between the groups; 46% of the drank more often and the (+) group showed a subjects in the (-) group drink 60 ml/day or more negative drinking behavior. alcohol, while 51% in the (+) group drink less than (6) Places of drinking, etc. 30 ml/day (Table 5). The places, frequency of drinking, expenditure (4) Age at the start of drinking and degree of on drinks, etc., are presented in Table 8. The (-) drinking in adulthood group drinks frequently both at home and outdide. Table 4. Frequency of drinking of the patch test (+) and (-) groups Table 5. Alcohol intake of the patch test (+) and (-) groups Table 6. Age at the start of drinking 920 The (+) group drinks more often outside than at compared with the results of the abcohol patch test. home, which suggests that they drink unavoidably The differences were significant; the (-) group as a social duty. Naturally, in the (-) group the (tolerant to alcohol) tended more strongly toward expenditure on drinks was significantly higher . alcohol dependency than the (+) group. (7) Psychological behavior, etc. 4. Differences in health conditions between the Table 9 summarizes the relationship between patch test-positive and-negative groups drinking and psychological behavior, such as the (1) Subjective symptoms necessity of drinking, mental attitude toward drink- Hangover is the most common subjective symp- ing, and feeling during drinking . The (-) group tom of disorders due to drinking. The (-) group positively supported the necessity of drinking while suffered from the aftereffect significantly more the (+) group negatively supported it . The reasons often (Table 11). Among the subjects aware of for drinking showed a similar trend . The contrast physically poor conditions at that time, there were between positiveness and negativeness was clear more subjects who had alcohol-associated physical also in the mental attitude toward drinking . Com- symptoms in the (-) group. mission of errors to due drinking was also more (2) Health examination frequent in the (-) group. As described above, the differences in drinking 3. Alcohol tolerance and KAST score (Table 10) behavior due to the presence or absence of alcoholic The scores in KAST, which was developed with tolerance, wchch is ascribed to an inherited disposi- the aim of screening for alcohol dependence , were tion, were expressed as a difference in subjective Table 7. Drinking in adulthood-Difference between the patch test (+) and (-) groups- (*P<0.005) Table 8. Differences in the range of drinking behavior , etc., between the patch test (+) and (-) groups [Place of drinking] [Frequency of drinking outside the home] P<0.05 921 symptoms under ill physical conditions, and may be of drinking, 40IU/l or more were defined as abnor- expressed as a difference in indexes of various mal, and the percentage of abnormal subjects is health examinations. shown in Table 13. It was high in the (-) group; Table 12 shows the results of health examina- one-fourth of the group was abnormal. Alcohol tions. ƒÁ-GTP, HDL-C, and blood pressure levels intake was graded into 4 grades according to the were significantly higher in the (-) group than the amount of ethanol per week, and the correlation (+) group, indicating the influence of drinking. between alcohol intake and ƒÁ-GTP was examined (3) Liver functions, such as ƒÁ-GTP (Fig. 1). ƒÁ-GTP levels rose in proportion to alcohol For ƒÁ-GTP, known as the most sensitive index intake in both the (+) and (-) groups. The same Table 9. Differences in psychological behavior during drinking between the patch test (+) and (-) groups (1) Reasons for drinking (Three options were chosen out of 10 possibilities. Onlyitems with a significant difference are shown.) (No. of subjects) (2) Mental attitude toward drinking (Three options were chosen out of 10 possibilities. Only items with a significant difference are shown.) (No. of subjects) (3) Necessity of drinking (4) Commission of errors Table 10. Differences in KAST scores between the patch test (+) and (-) groups (No. of subjects) P<0.001 922 Table 11.
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