High Blood Alcohol Levels in Women: The Role of Decreased Gastric Alcohol Dehydrogenase Activity and First-Pass Metabolism
Open accessAbstract
After consuming comparable amounts of ethanol, women have higher blood ethanol concentrations than men, even with allowance for differences in size, and are more susceptible to alcoholic liver disease. Recently, we documented significant "first-pass metabolism" of ethanol due to its oxidation by gastric tissue. We report a study of the possible contribution of this metabolism to the sex-related difference in blood alcohol concentrations in 20 men and 23 women. Six in each group were alcoholics. The first-pass metabolism was determined on the basis of the difference in areas under the curves of blood alcohol concentrations after intravenous and oral administration of ethanol (0.3 g per kilogram of body weight). Alcohol dehydrogenase activity was also measured in endoscopic gastric biopsies. In nonalcoholic subjects, the first-pass metabolism and gastric alcohol dehydrogenase activity of the women were 23 and 59 percent, respectively, of those in the men, and there was a significant correlation (rs = 0.659) between first-pass metabolism and gastric mucosal alcohol dehydrogenase activity. In the alcoholic men, the first-pass metabolism and gastric alcohol dehydrogenase activity were about half those in the nonalcoholic men; in the alcoholic women, the gastric mucosal alcohol dehydrogenase activity was even lower than in the alcoholic men, and first-pass metabolism was virtually abolished. We conclude that the increased bioavailability of ethanol resulting from decreased gastric oxidation of ethanol may contribute to the enhanced vulnerability of women to acute and chronic complications of alcoholism.
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Men and women metabolise alcohol differently due to differences in body fat distribution, body size, and alcohol solubility.
“Women and men metabolise alcohol differently because of differences in body fat distribution, body size, and alcohol solubility.7”
From The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis (2017) · cites this paper as [7]
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- Authors
- Frezza, M., di Padova, C., Pozzato, G., Terpin, M., Baraona, E., & Lieber, C. S.
- Affiliations
- University of Trieste (IT)
- Mount Sinai Hospital (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1990-01-11
- Volume
- 322
- Issue
- 2
- Pages
- 95-99
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2955761657
- Cited by
- 1,328
- References
- 27
- Citations by year
- 2026: 34 · 2025: 42 · 2024: 27 · 2023: 26 · 2022: 42 · 2021: 40 · 2020: 36 · 2019: 50 · 2018: 27 · 2017: 30 · 2016: 34 · 2015: 34 · 2014: 35 · 2013: 30 · 2012: 36
- FWCI
- 66.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5p50aa003508-18)
- National Institute on Alcohol Abuse and Alcoholism (AA-03508)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
- Keywords
- sex differences, blood alcohol concentration, alcohol metabolism, first-pass metabolism, gastric alcohol dehydrogenase, alcoholism, alcoholic liver disease
- MeSH terms
- Adult, Alcohol Oxidoreductases, Ethanol, Alcoholism, Biological Availability, Female, Gastric Mucosa, Humans, Male, Metabolic Clearance Rate, Middle Aged, Oxidation-Reduction, Sex Factors
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