European Journal of Epidemiology

, Volume 18, Issue 6, pp 493–501

Assessment of alcohol consumption by mailed questionnaire in epidemiological studies: Evaluation of misclassification using a dietary history interview and biochemical markers

  • Sofia Carlsson
  • Niklas Hammar
  • Paula Hakala
  • Jaakko Kaprio
  • Jukka Marniemi
  • Tapani Rönnemaa
Article

Abstract

Background: Self-reported information on alcohol from questionnaires is generally assumed to introduce misclassification of consumption, mainly in the direction of underestimation. The aim of this study was to evaluate self-reported information on alcohol consumption from a mailed questionnaire by comparing to a dietary history interview and biochemical markers of alcohol intake. Subjects and Methods: For 76 male twin pairs of the Finnish Twin Cohort Study aged 40–70 years information on self-reported alcohol consumption was collected through mailed questionnaire and dietary history interview. Carbohydrate-deficient transferrin (CDT), Gamma-glutamyltransferase (Gamma-GT) and mean corpuscular volume (MCV) were determined from blood samples. Results: Mean levels of CDT, gamma-GT and MCV showed a rise with increased self-reported alcohol consumption already at low levels of reported consumption (<20 g alcohol/day). There was a positive correlation between reported amount alcohol intake per day and levels of CDT (r = 0.46), gamma-GT (r = 0.32) and MCV (r = 0.36) but within the high consumption group (≥ 30 g/day) there was no such correlation. The questionnaire had sensitivity of 28–43% and specificity of 89% for identification of high consumers of alcohol using the biochemical markers as reference and sensitivity 41% and specificity 94% using the dietary history interview as reference. Sensitivity was improved when information on binge drinking (82%) or possible drinking problems (73%) was considered. Conclusion: Comparison to dietary history interview as well as to biochemical markers indicate that self-reported information on alcohol consumption from a mailed questionnaire may be used to distinguish between groups with different levels of alcohol consumption. The suggested misclassification of high consumers implies that only strong associations between high alcohol intake and disease are likely to be detected in studies based on questionnaire data.

Alcohol Carbohydrate-deficient transferrin Gamma-glutamyl transferrase Interview Mean corpuscular volume Misclassification Questionnaire 

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References

  1. 1.
    Feunekes GIJ, Van't Veer P, van Staveren WA, Kok FJ. Alcohol intake assessment: The sober facts. Am J Epidemiol 1999; 150: 105–112.Google Scholar
  2. 2.
    Grant KA, Tonigan JS, Miller WR. Comparison of three alcohol consumption measures: A concurrent validity study. J Stud Alcohol 1995; 56: 168–172.Google Scholar
  3. 3.
    Gronbaek M, Heitmann BL. Validity of self-reported intakes of wine, beer and spirits in population studies. European J Clin Nutr 1996; 50: 487–490.Google Scholar
  4. 4.
    Koppes LL, Twisk JW, Snel J, Kemper HC. Concurrent validity of alcohol consumption measurement in a healthy population; quantity-frequency questionnaire v. dietary history interview. Br J Nutr 2002; 4: 427–434.Google Scholar
  5. 5.
    Williams GD, Aitken SS, Malin H. Reliability of selfreported alcohol consumption in a general population survey. J Stud Alcohol 1985; 46: 223–227.Google Scholar
  6. 6.
    Rosman AS. Utility and evaluation of biochemical markers of alcohol consumption. J Subst Abuse 1992; 4: 277–297.Google Scholar
  7. 7.
    Sharpe PC, McBride R, Archbold GPR. Biochemical markers of alcohol abuse. Q J Med 1996; 89: 137–144.Google Scholar
  8. 8.
    Gordon HM, Morgan MY. Carbohydrate-deficient transferrin as a marker for recent alcohol abuse. Alcohol Res 1997; 2: 54–57.Google Scholar
  9. 9.
    Lesch OM, Walter H. New ‘state’ markers for the detection of alcoholism. Alcohol Alcohol 1996; Suppl 1: 59–62.Google Scholar
  10. 10.
    Watson RR, Mohs ME, Eskelson C, Sampliner RE, Hartmann B. Identification of alcohol abuse and alcoholism with biological parameters. Alcohol Clin Exp Res 1986; 4: 364–385.Google Scholar
  11. 11.
    Meerkerk GJ, Njoo KH, Bongers IM, Trienekens P, van Oers JA. Comparing the diagnostic accuracy of carbohydrate-deficient transferrin, gamma-glutamyltransferase, and mean cell volume in a general practice population. Alcohol Clin Exp Res 1999; 23: 1052–1059.Google Scholar
  12. 12.
    Whitehead TP, Clarke CA, Whitfield AGW. Biochemical and haematological markers of alcohol intake. Lancet 1978; I: 978–981.Google Scholar
  13. 13.
    Kaprio J, Sarna S, Koskenvuo M, Rantasalo I. The Finnish Twin Registry: Formation and compilation, questionnaire study, zygosity determination procedures and research program. Prog Clin Biol Res 1978; 24B: 179–184.Google Scholar
  14. 14.
    Hammar N, Kaprio J, Hagström U, Alfredsson L, Koskenvuo M, Hammar T. Migration and mortality - a 20-year follow-up of Finnish twin pairs with migrant co-twins in Sweden. J Epidemiol Community Health 2002; 56: 362–366.Google Scholar
  15. 15.
    Jartti L, Rönnemaa T, Kaprio J, et al. Population-based twin study of the effects of migration from Finland to Sweden on endothelial function and intima-media thickness. Arterioscler Thromb Vasc Biol. 2002; 33: 832–837.Google Scholar
  16. 16.
    Leino A, Impivaara O, Irjala K, Maki J, Peltola O, Jarvisalo J. Health-based reference intervals for ALAT, ASAT and GT in serum, measured according to the recommendations of the European Committee for Clinical Laboratory Standards (ECCLS). Scand J Clin Lab Invest 1995; 55: 243–250.Google Scholar
  17. 17.
    Kaprio J, Koskenvuo M, Langinvainio H, Romanov K, Sarna S, Rose RJ. Genetic influences on use and abuse of alcohol: A study of 5638 adult Finnish twin brothers. Alcohol Clin Exp Res 1987; 11: 349–356.Google Scholar
  18. 18.
    Kaprio J, Viken R, Koskenvuo M, Romanov K, Rose RJ. Consistency and change in patterns of social drinking: A 6-year follow-up of the Finnish Twin Cohort. Alcohol Clin Exp Res 1992; 16: 234–240.Google Scholar
  19. 19.
    Romanov K, Rose RJ, Kaprio J, Koskenvuo M, Langinvainio H, Sarna S. Self-reported alcohol use: A longitudinal study of 12,994 adults. Alcohol Alcohol 1987; Suppl 1: 619–623.Google Scholar
  20. 20.
    Kaprio J, Sarna S, Koskenyou M, Rantasalo I. Baseline characteristics of the Finnish Twin Registry II. History of symptoms and illnesses, use of drugs, physical characteristics, smoking, alcohol and physical activity. Helsinki, Finland: Publication of the Department of Public Health Science M37, 1978.Google Scholar
  21. 21.
    Liang KY, Zeger S. Longitudinal data analysis using generalized linear models. Biometrika 1986; 73: 13–22.Google Scholar
  22. 22.
    Sillanaukee P, Olsson U. Improved diagnostic classification of alcohol abusers by combining carbohydratedeficient transferrin and gamma-glutamyltransferase. Clin Chem 2001; 4: 681–685.Google Scholar
  23. 23.
    Chick J, Kreitman N, Plant M. Mean cell volume and gamma-glutamyl-tranpeptidase as markers of drinking in working men. Lancet 1981; 1: 1249–1251.Google Scholar
  24. 24.
    Eschwege E, Papoz L, Lellouch J, et al. Blood cells and alcohol consumption with special reference to smoking habits. J Clin Pathol 1978; 31: 654–658.Google Scholar
  25. 25.
    Whitfield JB, Fletcher LM, Murphy TL, et al. Smoking, obesity, and hypertension alter the dose-response curve and test sensitivity of carbohydrate-deficient transferrin as a marker of alcohol intake. Clin Chem 1998; 44: 2480–2489.Google Scholar
  26. 26.
    Gronbaek M, Henriksen JH, Becker U. Carbohydrate-deficient transferrin - A valid marker of alcoholism in population studies? Results from the Copenhagen City Heart Study. Alcohol Clin Exp Res 1995; 19: 475–461.Google Scholar
  27. 27.
    Aithal GP, Thornes H, Dwarakanath AD, Tanner AR. Measurement for carbohydrate-deficient transferrin (CDT) in a general medical clinic: Is this test useful in assessing alcohol consumption. Alcohol Alcohol 1998; 33: 304–309.Google Scholar
  28. 28.
    Burke V, Puddey IB, Rakic V, et al. Carbohydrate-deficient transferrin as a marker of change in alcohol intake in men drinking 20 to 60 g of alcohol per day. Alcohol Clin Exp Res 1998; 22: 1973–1980.Google Scholar
  29. 29.
    Robinson D, Monk C, Bailey A. The relationship between serum gamma-glutamyl transpeptidase level and reported alcohol consumption in healthy men. J Studies Alcohol 1979; 40: 896–901.Google Scholar
  30. 30.
    Fletcher LM, Murphy TM, Whitfield JB, Powell LW, Martin NG, Halliday JW. Carbohydrate-deficient transferrin (CDT) in a twin-based population study of alcohol dependence. J Gastroenterol Hepatol 1997; 12(Suppl).Google Scholar
  31. 31.
    Conigrave KM, Saunders JB, Whitfield JB. Diagnostic tests for alcohol consumption. Alcohol Alcohol 1995; 1: 13–26.Google Scholar
  32. 32.
    Meregalli M, Giacomini V, Lina S, et al. Carbohydrate-deficient transferrin in alcohol and non-alcohol abusers with liver disease. Alcohol Clin Exp Res 1995; 19: 1525–1527.Google Scholar
  33. 33.
    Stauber RE, Stepan V, Trauner M, Wilders-Truschnig M, Leb G, Krejs GJ. Evaluation for carbohydrate-deficient transferrin for detection of alcohol abuse in patients with liver dysfunction. Alcohol Alcohol 1995; 2: 171–176.Google Scholar
  34. 34.
    Poikolainen K, Vartiainen E. Determinants of gamma-glutamyltransferase: Positive interaction with alcohol and body mass index, negative association with coffee. Am J Epidemiol 1997; 146: 1019–1024.Google Scholar
  35. 35.
    Whitehead TP, Robinson D, Allaway SL. The effects of cigarette smoking and alcohol consumption on serum liver enzyme activities: A dose-related study in men. Ann Clin Biochem 1996; 33: 530–535.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Sofia Carlsson
    • 1
  • Niklas Hammar
    • 1
  • Paula Hakala
    • 2
  • Jaakko Kaprio
    • 3
    • 4
  • Jukka Marniemi
    • 2
  • Tapani Rönnemaa
    • 5
  1. 1.Division of Epidemiology, Stockholm Centre of Public Health, and Department of Epidemiology, Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
  2. 2.Research and Development CentreSocial Insurance InstitutionTurkuFinland
  3. 3.Department of Public HealthUniversity of HelsinkiHelsinki
  4. 4.Department of Mental HealthNational Public Health InstituteHelsinkiFinland
  5. 5.Department of MedicineUniversity of TurkuTurkuFinland

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