Predictability of Complete Blood Count Parameters for Heavy Drinking according to the Facial Flushing

Hyun Chul Joung; Hyun Ju Yang; Jong Sung Kim; Sung Soo Kim; Seok Joon Yoon; Jung Wei Chang

doi:10.15384/kjhp.2016.16.2.84

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Joung, Yang, Kim, Kim, Yoon, and Chang: Predictability of Complete Blood Count Parameters for Heavy Drinking according to the Facial Flushing

Original Article

Korean J Health Promot 2016;16(2):84-91.

Published online: 20 January 2016

DOI: https://doi.org/10.15384/kjhp.2016.16.2.84

Predictability of Complete Blood Count Parameters for Heavy Drinking according to the Facial Flushing

Hyun Chul Joung, Hyun Ju Yang, Jong Sung Kim, Sung Soo Kim, Seok Joon Yoon, Jung Wei Chang

Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea

Corresponding author: Jong Sung Kim, MD, PhD Department of Family Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Junggu, Daejeon 35015, Korea Tel: +82-42-280-8172, Fax: +82-42-280-7879 E-mail: jskim@cnuh.co.kr

Received 20 December 2015 Accepted 2 June 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Alcohol is personal and social problem around the world. Though binge drinking is associated with the elevation of arbohydrate deficient trasnferrin and r-glutamyl transpeptidase, studies of the relationship between heavy drinking and other biological markers are rare. The purpose of this study is to investigate the association between heavy drinking and CBC figures through flushing and non flushing using both NIAAA and Korean guidelines.

Methods

The subjects were 581 Korean adult males: who had undergone a comprehensive medical evaluation at Chungnam National University Hospital between June and December of 2013. 98 of total were non-drinkers, 225 of them flushers, and the rest 258 of them were non-flushers. One standard drink is defined as any drink that contains 14 grams of alcohol. Criteria for immoderate drinking was applied to greater than 14 glasses/week and more than 8 glasses on any day for a non-flush group with reference to the United States' guideline (National Institute in Alcohol Abuse and Alcoholism, NIAAA) and South Korean guideline, and it was also applied to greater than seven glasses/week, and more than four glasses on any day for a flushing group. It was to investigate whether immoderate drinking would be predictable according to increased mean corpuscular volume (MCV), decreased hemoglobin (Hb), and decreased platelet (PLT). Our investigation was to find the correlation with the increased MCV, decreased Hb, and decreased PLT as a means of predictions for immoderate drinking. The study was to examine the CBC's predictability of immoderate drinking through a combination of increased MCV, decreased Hb, or decreased PLT. If one of these three items were abnormal: group A, if two of the three items were abnormal: group B.

Results

Predictability of group A was 23.1% in flushing drinkers and 21.7% in non-flushing drinkers for US NIAAA immoderate drinking, whereas 30.8% in flushing drinkers and 30.4% in non-flushing drinkers considering Korean guideline immoderate drinking. Predictability of B group was 100% in flushing and non-flushing drinkers for both NIAAA guidelines and Korean guidelines.

Conclusions

It is desirable for physicians to use any combination of the three CBC indicators (increased MCV, decreased Hb, or decreased PLT) for predicting immoderate drinking.

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Table 1.

General characteristics of the subjects

Parameter	Non drinker (n=98)	Flushing group (n=225)	Non flushing group (n=258)
Age, y	55.71±11.06	50.50±9.72^a	47.60±10.04^a
BMI, kg/m²	23.82±3.12	24.45±3.05	24.58±3.02
Exercise time, min/week	231.94±310.78	206.27±289.64	221.63±342.9
Smoking
Non-smoker	37 (37.8)	45 (20.0)^a	56 (21.7)^a
Ex-smoker	41 (41.8)	89 (39.6)	87 (33.7)
Current-smoker	20 (20.4)	91 (40.4)	115 (44.6)
Alcohol
Alcohol consumption, drinks/times	0.00±0.00	4.18±5.91^a	5.14±7.99^a
Alcohol frequency, times/week	0.00±0.00	2.05±1.70^a	2.44±1.64^a
Alcohol consumption, drinks/week	0.00±0.00	8.56±10.05^a	12.55±13.10^a
WBC, ×10³/uL	6.12±1.92	6.16±1.83	6.24±1.80
Hb, g/dL	14.99±1.18	15.20±1.07	15.24±1.03
PLT, ×10³/uL	247.74±55.07	235.13±53.79	231.06±52.33^a
ESR, mm/h	12.63±9.81	10.60±9.74	10.62±10.57
MCHC, g/dL	34.14±1.07	34.15±0.86	34.36±0.86
MCV, fL	90.19±4.46	91.47±4.11^a	91.37±4.29^a
Hct, %	43.91±3.31	44.50±3.06	44.35±2.83
RBC, ×10³/uL	4.87±0.39	4.87±0.37	4.86±0.36

Abbreviations: BMI, body mass index; WBC, white blood cell; Hb, hemoglobin; PLT, platelet; ESR, erythrocyte sedimentation rate; MCHC, mean corpuscular hemoglobin concentration; MCV, mean corpuscular volume; Hct, hematocrit; RBC, red blood cell. Values are presented as mean±SD or n (%).

^a P<0.05 by Chi-square test for categorical variable or by t-test for continuous variables compared with non drinkers.

Table 2.

Distributions of increased MCV, decreased Hb, and decreased PLT according to alcohol consumption state considering NIAAA guideline and Korean guideline

Parameter	Non D (n=98)	NIAAA Guideline				Korean Guideline
		Flusher		Non flusher		Flusher		Non flusher
		(n=225)		(n=258)		(n=225)		(n=258)
		Moderate^a	Heavy^b	Moderate^a	Heavy^b	Moderate^a	Heavy^b	Moderate^a	Heavy^b
		(n=137)	(n=88)	(n=172)	(n=86)	(n=114)	(n=111)	(n=127)	(n=131)
MCV, fL >100	0 (0.0)	3 (2.2)	3 (3.4)	2 (1.2)	6 (7.0)^d	2 (1.8)	4 (3.6)	0 (0)	8 (6.1)^c
Hb, g/dL <13.5	9 (9.2)	5 (3.6)	5 (5.7)	4 (2.3)^c	3 (3.5)	4 (3.5)	6 (5.4)	4 (3.1)	3 (2.3)^c
PLT, 1×10³/uL <1.3×10⁵	1 (1.0)	2 (1.5)	2 (2.3)	2 (1.2)	4 (4.7)	2 (1.8)	2 (1.8)	2 (1.6)	4 (3.1)

Abbreviations: MCV, mean corpuscular volume; Hb, hemoglobin; PLT, platelet; NIAAA, National Institute on Alcohol Abuse and Alcoholism; Non D, non drinker. Values are presented as n (%).

^a Moderate drinkers: ≤7 units/week in flushers and ≤14 units/wk in non flusher considering NIAAA Guideline. ≤4 units/week in flushers and ≤8 units/wk in non flusher considering Korean Guideline.

^b Heavy drinkers: >7 units/week in flushers and >14 units/wk in non flusher considering NIAAA Guideline. >4 units/week in flushers and >8 units/wk in non flusher considering Korean Guideline. 1 units=14 g of alcohol.

^c P<0.05 by Fisher's exact test compared with non drinkers.

^d P<0.01 by Fisher's exact test compared with non drinkers.

Table 3.

Odds ratio of increased MCV, decreased Hb, and decreased PLT according to alcohol consumption considering NIAAA guideline and Korean guideline

	Drinking status by NIAAA guideline	Risk of abnormalities OR (95% CI)	Drinking status by Korean guideline	Risk of abnormalities OR (95% CI)
Flusher
MCV, fL >100	Non drinker	1 (reference)	Non drinker	1 (reference)
	(n=98)		(n=98)
	Moderate drinker^a	NA	Moderate drinker^a	NA
	(n=137) ^b		(n=114) ^b
	Heavy drinker^b	NA	Heavy drinker^b	NA
	(n=88)		(n=111)
Hb, g/dL <13.5	Non drinker	1 (reference)	Non drinker	1 (reference)
	(n=98)		(n=98)
	Moderate drinker^a	0.42 (0.12–1.45)	Moderate drinker^a	0.35 (0.09–1.40)
	(n=137)		(n=114)
	Heavy drinker^b	1.10 (0.31–3.86)	Heavy drinker^b	1.00 (0.31–3.05)
	(n=88)		(n=111)
PLT, /uL <1.30×10⁵	Non drinker	1 (reference)	Non drinker	1 (reference)
	(n=98)		(n=98)
	Moderate drinker^a	3.47 (0.25–47.86)	Moderate drinker^a	3.73 (0.27–51.54)
	(n=137)		(n=114)
	Heavy drinker^b	2.24 (0.12–41.68)	Heavy drinker^b	1.90 (0.10–35.61)
	(n=88)		(n=111)
Non flusher
MCV, fL >100	Non drinker	1 (reference)	Non drinker	1 (reference)
	(n=98)		(n=98)
	Moderate drinker^a	NA	Moderate drinker^a	NA
	(n=172) ^b		(n=127) ^b
	Heavy drinker^b	NA	Heavy drinker^b	NA
	(n=86)		(n=131)
Hb, g/dL <13.5	Non drinker	1 (reference)	Non drinker	1 (reference)
	(n=98)		(n=98)
	Moderate drinker^a	0.44 (0.12–1.66)	Moderate drinker^a	0.63 (0.16–2.48)
	(n=172)		(n=127)
	Heavy drinker^b	0.39 (0.06–2.37)	Heavy drinker^b	0.23 (0.04–1.31)
	(n=86)		(n=131)
PLT, /uL <1.30×10⁵	Non drinker	1 (reference)	Non drinker	1 (reference)
	(n=98) ^a		(n=98) ^a
	Moderate drinker^a	1.94 (0.13–28.95)	Moderate drinker^a	3.17 (0.18–55.35)
	(n=172) ^b	^c	(n=127) ^b
	Heavy drinker^b	11.63 (1.03–130.89)^c	Heavy drinker^b	6.07 (0.57–65.13)
	(n=86)		(n=131)

Abbreviations: MCV, mean corpuscular volume; Hb, hemoglobin; PLT, platelet; NIAAA, National Institute on Alcohol Abuse and Alcoholism; OR, odd ratio; CI, confidence interval; NA, not available.

^b Heavy drinkers: >7 units/week in flushers and >14 units/wk in non flusher considering NIAAA guideline. >4 units/week in flushers and >8 units/wk in non flusher considering Korean guideline. 1 units=14 g of alcohol.

^c P<0.05 by multivariate logistic regression compared with non drinkers adjusted for age, body mass index, exercise, and smoking.

Table 1.

Characteristics of selected studies

Table 5.

Predictability of CBC abnormality scores for heavy drinking considering NIAAA guideline and Korean guideline

	Heavy drinker^c
	NIAAA guideline		Korean guideline
	Flusher	Non flusher	Flusher	Non flusher
A^a (n=39)
Non drinker (n=10)	6/26 (23.1%)	5/23 (21.7%)	8/26 (30.8%)	7/23 (30.4%)
Flushing (n=16)
Non flushing (n=13)
B^b (n=6)
Non drinker (n=0)	2/2 (100%)	4/4 (100%)	2/2 (100%)	4/4 (100%)
Flushing (n=2)
Non flushing (n=4)

Abbreviations: CBC, complete blood cell count; NIAAA, National Institute on Alcohol Abuse and Alcoholism; MCV, mean corpuscular volume; Hb, hemoglobin; PLT, platelet.

^a A group applicable for one of the three biochemical indicators (increased MCV, decreased Hb, and decreased PLT).

^b B group with any combination of two of the three biochemical indicators (increased MCV, decreased Hb, and decreased PLT).

^c Heavy drinkers: >7 units/wk in flushers and >14 units/wk in non flusher considering NIAAA guideline. >4 units/wk in flushers and >8 units/wk in non flusher considering Korean guideline.

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