Validation of Alcohol Flushing Questionnaires in Determining Inactive <i>Aldehyde Dehydrogenase‐2</i> and Its Clinical Implication in Alcohol‐Related Diseases

Shin, Cheol Min; Kim, Na Young; Cho, Sung-Il; Sung, Joohon; Lee, Hee Jung

doi:10.1111/acer.13569

Cited by 19 publications

(18 citation statements)

References 40 publications

(49 reference statements)

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“…A note of caution is that, despite the presence of ALDH2*1/*2 or ALDH2*2/*2, individuals with a semi-active or knockout form of ADH2 (e.g., ADH2*1/*1 or ADH2*2/*1) may not experience obvious flushing after light drinking or facial flushing may be diminished in individuals with a long or heavy drinking history [32]. Another study found that the sensitivity and specificity of the modified alcohol flushing questionnaires were 95.1% and 76.5%, respectively, in healthy male subjects, and 78.9% and 82.1%, respectively, in subjects who participated in a gastric cancer screening program or received esophagogastroduodenoscopy [33].…”

Section: Screening Strategy For Aldh2mentioning

confidence: 99%

Aldehyde Dehydrogenase, Liver Disease and Cancer

Wang

et al. 2020

Int. J. Biol. Sci.

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Acetaldehyde dehydrogenase 2 (ALDH2) is the key enzyme responsible for metabolism of the alcohol metabolite acetaldehyde in the liver. In addition to conversion of the acetaldehyde molecule, ALDH is also involved in other cellular functions. Recently, many studies have investigated the involvement of ALDH expression in viral hepatitis, alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), liver fibrosis, and liver cancer. Notably, ALDH2 expression has been linked with liver cancer risk, as well as pathogenesis and prognosis, and has emerged as a promising therapeutic target. Of note, approximately 8% of the world's population, and approximately 30-40% of the population in East Asia carry an inactive ALDH2 gene. This review summarizes new progress in understanding tissue-specific acetaldehyde metabolism by ALDH2 as well as the association of ALDH2 gene polymorphisms with liver disease and cancer. New research directions emerging in the field are also briefly discussed.

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Section: Screening Strategy For Aldh2mentioning

confidence: 99%

Aldehyde Dehydrogenase, Liver Disease and Cancer

Wang

et al. 2020

Int. J. Biol. Sci.

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“…In a case–control study of esophageal cancer, Yokoyama and colleagues () reported that the sensitivity of the alcohol flushing questionnaire to identify ALDH2 deficiency decreased with higher level of alcohol consumption, significantly ( p < 0.0001) for the controls (sensitivity = 95.4% for never/rare to light drinkers, 74.3% for moderate drinkers, and 70.4% for heavy drinkers) and nonsignificantly ( p = 0.75) for the patients with esophageal cancer (sensitivity = 92.3% for never/rare to light drinkers, 82.5% for moderate drinkers, and 83.6% for heavy drinkers). Similarly, a study from Korea by Shin and colleagues () showed that heavy drinking was associated with a lower sensitivity of the alcohol flushing questionnaire to identify ALDH2 deficiency. Because of the lower sensitivity associated with the higher alcohol consumption, using self‐reported alcohol flushing symptom as a marker for ALDH2 deficiency will tend to underestimate the risk of alcohol‐related cancers among the ALDH2*2 carriers.…”

Section: Discussionmentioning

confidence: 90%

“…In a case–control study of esophageal cancer conducted in Japan, Yokoyama and colleagues () reported that the alcohol flushing questionnaire achieved a sensitivity of 85% among the cases and 90% among the controls in identifying ALDH2‐deficient individuals. Another study from Korea by Shin and colleagues () reported that the sensitivity of the alcohol flushing questionnaire to identify ALDH2*2 carriers was 95% for healthy men and 79% for individuals who underwent esophagogastroduodenoscopy. These results indicated that the alcohol flushing questionnaire can be used to identify ALDH2‐deficient individuals with a fairly high sensitivity across different East Asian populations.…”

Section: Discussionmentioning

confidence: 99%

“…Because 2 previous studies reported that the sensitivity of the alcohol flushing questionnaire may be affected by alcohol use (Shin et al., ; Yokoyama et al., ), we also examined whether the status of alcohol use (almost never/occasional drinker, former regular drinker, and current regular drinker) might affect the sensitivity and the specificity of the alcohol flushing questionnaire in identifying ALDH2‐deficient individuals. In addition, we also examined the influence of several factors, including age, education, and 2 other major risk factors of HNC (cigarette smoking and betel quid chewing), on the sensitivity and the specificity of the alcohol flushing questionnaire.…”

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confidence: 99%

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Validation of Alcohol Flushing Questionnaire to Identify ALDH2 Status in a Case–Control Study of Head and Neck Cancer

Hsiao

Lee

et al. 2019

Alcoholism Clin & Exp Res

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Background: Carriers of the ALDH2*2 allele have impaired alcohol metabolism and are more susceptible to the development of alcohol-related cancers, including head and neck cancer (HNC). Screening for ALDH2*2 allele may identify high-risk individuals for alcohol health education. Although genotyping of ALDH2 is the most accurate way to identify ALDH2 deficiency, it may not be practical due to the cost and requirement for genotyping service.Methods: This study evaluated the accuracy of the alcohol flushing questionnaire to identify ALDH2 deficiency in a case-control study of HNC conducted in Taiwan using data collected from 904 patients with HNC and 1,078 controls.Results: Overall, alcohol flushing questionnaire had a high sensitivity (89%) of identifying ALDH2*2 carriers among the control subjects and a good sensitivity (79%) among the patients with HNC. The sensitivity of the alcohol flushing questionnaire in identifying ALDH2*2 carriers was affected by alcohol use, with a lower sensitivity among individuals who consumed alcohol, particularly among current regular (drinking alcohol once per week or more) alcohol drinkers.Conclusions: The current validation study showed that the alcohol flushing questionnaire may be a reasonable method to identify ALDH2-deficient individuals. However, current regular users of alcohol who reported no alcohol flushing may need to undergo genotyping of ALDH2 for a more accurate assessment of the ALDH2 status.

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“…This questionnaire was rated to have a high sensitivity rate of 90.1% and specificity rate of 88.0% [28] in classifying respondents into never, former, and current sufferers of ALDH2 deficiency. Although created for a Japanese sample, the questionnaire was validated for Korean samples and found to have a relatively lower sensitivity rate of 78.9% and specificity rate of 82.1% [29].…”

Section: Methodsmentioning

confidence: 99%

Primary Reason for Drinking Among Current, Former, and Never Flushing College Students

Lee

et al. 2019

IJERPH

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Alcohol consumption among individuals who experience a flushing response (reddening of the face, nausea, dizziness, headache, anxiety, and increased heartbeat) can result in serious health problems. However, studies on reasons for drinking among flushers, especially in the college context, are limited. Thus, this study investigated the association between primary reason for drinking and alcohol use among a nationally representative sample of current, former, and never flushing college students. The aim was to measure whether college students with current or former experience of facial flushing have different primary reasons for drinking compared to students with no experience of facial flushing. We surveyed and analyzed the data of 4590 students in a nationally representative sample of 82 colleges in South Korea. Multiple regression analysis was used to identify the association between primary reason for drinking and alcohol intake. Alcohol intake was measured using the Alcohol Use Disorders Identification Test (AUDIT). Among 1537 current (33.5%), 152 former (3.3%), and 2901 (63.2%) never flushers, mean AUDIT scores were 7.715 ± 5.434, 11.039 ± 6.405, and 10.465 ± 5.779, respectively. Current flushers had significantly higher AUDIT scores when drinking for pleasure (β = 2.696, p < 0.0001) or stress/depression (β = 2.578, p < 0.0001). Primary reasons for drinking were not associated with alcohol intake for former flushers. Never flushers had significantly higher AUDIT scores when drinking for pleasure (β = 2.696, p < 0.0001), stress/depression (β = 2.578, p < 0.0001), or boredom (β = 0.740, p = 0.029) than peer pressure. Our results suggest that former and never flushers consume higher amounts of alcohol on average than never flushers. For current flushers, drinking for pleasure or stress/depression may increase alcohol intake, while for never flushers, drinking for pleasure, stress/depression, as well as boredom may have the same effect.

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Validation of Alcohol Flushing Questionnaires in Determining Inactive Aldehyde Dehydrogenase‐2 and Its Clinical Implication in Alcohol‐Related Diseases

Abstract: Simple flushing questionnaires may be administered to the Korean population as a screening tool in detecting individuals who carry inactive ALDH2. Alcohol flushing response negatively correlates with drinking problems and can modify the risk for BGU by alcohol intake.

Cited by 19 publications

References 40 publications

Aldehyde Dehydrogenase, Liver Disease and Cancer

Aldehyde Dehydrogenase, Liver Disease and Cancer

Validation of Alcohol Flushing Questionnaire to Identify ALDH2 Status in a Case–Control Study of Head and Neck Cancer

Primary Reason for Drinking Among Current, Former, and Never Flushing College Students

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