High blood alcohol levels in women. The role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism.
Level 3 - non-randomized controlled study
Non-randomized comparative study evaluating physiological and enzymatic parameters across sex and clinical groups.
PubMed 2248624 · doi:10.1056/NEJM199001113220205
What was done
The researchers evaluated the contribution of gastric first-pass metabolism to sex-related differences in blood alcohol concentrations in 20 men and 23 women (including 6 alcoholics in each group; total n = 43). First-pass metabolism was calculated by comparing the area under the blood alcohol concentration curves after intravenous and oral administration of ethanol (0.3 g/kg of body weight). Gastric alcohol dehydrogenase (ADH) activity was measured from endoscopic gastric mucosal biopsies.
What was found
In nonalcoholic subjects, first-pass metabolism and gastric ADH activity in women were 23% and 59%, respectively, of the levels observed in men. There was a significant positive correlation between first-pass metabolism and gastric mucosal ADH activity (rs = 0.659). In alcoholic men, first-pass metabolism and gastric ADH activity were approximately half the levels of nonalcoholic men. In alcoholic women, gastric ADH activity was lower than in alcoholic men, and first-pass metabolism was virtually abolished.
Why it matters
This study provides an enzymatic and pharmacokinetic mechanism for why women attain higher blood alcohol levels than men after consuming equivalent doses adjusted for body weight, contributing to understanding sex differences in alcohol vulnerability.
Limits
The total sample size was small (n = 43), with very small subgroups of alcoholic men and women (n = 6 each). The study only tested a single low-to-moderate ethanol dose (0.3 g/kg), and the abstract does not assess clinical endpoints or long-term organ toxicity directly.
Cited by
- supports Women generally have lower gastric levels of alcohol dehydrogenase compared to men.