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ORIGINAL ARTICLE
Year : 2022  |  Volume : 13  |  Issue : 1  |  Page : 18-21

A cross-sectional study of serum B12 and folate level in alcoholics and nonalcoholics


1 Department of General Medicine, Government Erode Medical College and Hospital, Erode, Tamil Nadu, India
2 Department of Physiology, Government Erode Medical College and Hospital, Erode, Tamil Nadu, India

Date of Submission09-Feb-2022
Date of Acceptance26-Apr-2022
Date of Web Publication02-Sep-2022

Correspondence Address:
Dr. Panneerselvam Periaswamy
Department of Physiology, Government Erode Medical College, Perundurai, Erode, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjmsr.mjmsr_10_22

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  Abstract 


Introduction: One of the world's most important public health and global health issues is alcoholism. In terms of illness burden, alcohol is the world's third leading cause of death. Repeated alcohol-related issues in at least two of the eleven life areas that clump together over the same 12-month period are considered as alcoholism (alcohol use disorder). Moderate and heavy drinkers were separated into two groups. Materials and Methods: This is a cross-sectional observational study comprising 25 moderate alcoholics, 25 severe alcoholics, and 50 adult individuals who were nonalcoholics. Data pertaining to demographics, clinical history including alcohol consumption and laboratory data were collected and recorded from the study participants. Laboratory data included parameters like hematological profile, serum Vitamin B12 and folic acid, liver function tests, renal function tests, blood sugar levels, and prothrombin time. Results: In our study, anemia affects 76% of severe alcoholics and 72% of moderate drinkers. Mean Corpuscular Volume (MCV) of more than 99 fl was found in 28% of heavy drinkers and 8% of moderate drinkers. The average Hb in heavy drinkers was 9.372.30. Alcoholics have abnormal red blood cell morphology, such as target cells, acanthocytes, stomatocytes, elliptocytes, and ovalocytes. Discussion: Alcoholism affects both men and women, but it is more common in men, especially in lower socioeconomic groups, in their third to fifth decade. Chronic drinkers are more likely to develop anemia, which is linked to the amount and duration of alcohol consumption. Severe alcoholics are prone to infections. Conclusion: Early detection and treatment of hematological abnormalities associated with alcohol misuse will help prevent future alcohol-related problems and reduce morbidity and mortality.

Keywords: Alcoholism, anemia, bone marrow, erythrocytes, thrombocytopenia


How to cite this article:
Myilsamy S, Kandasamy S, Vijayakumar P, Periaswamy P. A cross-sectional study of serum B12 and folate level in alcoholics and nonalcoholics. Muller J Med Sci Res 2022;13:18-21

How to cite this URL:
Myilsamy S, Kandasamy S, Vijayakumar P, Periaswamy P. A cross-sectional study of serum B12 and folate level in alcoholics and nonalcoholics. Muller J Med Sci Res [serial online] 2022 [cited 2022 Dec 2];13:18-21. Available from: https://www.mjmsr.net/text.asp?2022/13/1/18/355289




  Introduction Top


One of the world's most important public health and global health issues is alcoholism. In terms of illness burden, alcohol is the world's third leading cause of death. Repeated alcohol-related issues in at least two of the eleven life areas that clump together over the same 12-month period are considered as alcoholism (alcohol use disorder [AUD]).[1] In most Western countries, the lifetime risk of an AUD is around 10%–15% for men and 5%–8% for women. Genes are responsible for around 60% of the risk of AUD. Each year, 3.3 million people die as a result of alcoholism worldwide. AUD reduces life expectancy by 10 years. According to the WHO estimates, two billion people consume alcohol worldwide.[2]

AUD has been prevalent in the two billion people those who consume alcohol globally. The overall alcoholism incidence is high, especially among the lower socioeconomic status groups, and also most of them opt for beverages of low cost with less quality that may lead to more deleterious effects on various organ systems of human body. AUD is held by 76.3 million people. Alcoholism is very common, especially among lower socioeconomic classes, and they prefer low-cost beverages that are of inferior quality and have greater negative effects on the organ system.[3] Our goal is to describe alcoholics' hematological changes and compare them with nonalcoholics. The study's foundation and need are that early detection and treatment of hematological abnormalities can minimize complications and lower mortality. In addition, early detection of alcohol abuse with the help of a hematological profile can help prevent future alcohol-related diseases such as cirrhosis of the liver, cardiac failure, renal disease, cerebellar atrophy, peripheral neuropathy, pancreatitis, and tuberculosis.[4] By providing psychiatric counseling and treatment for alcoholism, morbidity and mortality from alcoholism will be reduced.[5],[6]

As a result, the purpose of this research is to investigate the hematological manifestations in alcoholics, as well to compare the hematological symptoms of drinkers, and nonalcoholics were also compared in this study.


  Materials and Methods Top


This is a government-sponsored prospective cross-sectional study undertaken by the Departments of Pathology and Biochemistry at Mohan Kumaramangalam Medical College and Hospital, Salem, Tamil Nadu. A convenient sample of 100 people were researched for a year, including 50 alcoholics (25 severe and 25 moderate alcoholics) and 50 nonalcoholics. Alcoholics were classified based on their pattern of alcohol consumption, where the term drink refers to a pattern of alcohol consumption that causes a rise in blood alcohol concentration to >0.08%. All the adult individuals who are moderately alcoholic, defined as “less than or equal to two drinks per day for men and less than or equal to one drink per day for women,” and all adult patients who are severe alcoholics, defined as “more than 7 drinks per week in women and more than 14 drinks per week in men,” were included in the study and evaluated” after receiving institutional ethical committee approval. Individuals under the age of 18 years were excluded from the study, as were those having a “history of hematological malignancies, other liver diseases, chronic illnesses, such as tuberculosis (or) diabetes mellitus, and those taking any hepatotoxic medicines.

From the cases and controls, data such as demographics, clinical history including alcohol consumption and laboratory data were collected and recorded. The laboratory data included parameters like hematological profile, serum Vitamin B12 and folic acid, liver function tests, renal function tests, blood sugar levels, and prothrombin time. This information was entered into Microsoft Excel and then evaluated and shown in [Table 1].
Table 1: Comparison of various study parameters with the study by Oduola et al.

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Statistical analysis

A total of one-hundred patients' information was gathered and recorded into a Microsoft Excel spreadsheet. SPSS 11.5 (Statistical Package for Social Sciences Inc. Released 2009. PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc.) was used to conduct the statistical analysis. For comparing discrete variables, Chi-square tests were used, whereas for comparing continuous variables, Student's t-tests were used. P < 0.05 was considered statistically significant.


  Results Top


The hematological profiles of severe alcoholics, moderate alcoholics, and nonalcoholics were compared and evaluated in this study. The alcoholic group had a median age of 26 and a maximum age of 71 years. The most alcoholics were between the ages of 31 and 50 years, with alcohol misuse being less common between the ages of 25 and 71 years. In a group of 50 alcoholics, 90% are men and barely 10% are women. This indicates that males were more likely than females to be alcoholics. However, there was a shift in the way women consume alcohol. In a group of 50 alcoholics, 78% had a poor socioeconomic status, whereas 22% had a middling socioeconomic status. This demonstrates that poor people were serious alcoholics who consume lower-quality beverages, and they were suffering from more hematological manifestations.

Pedal edema and ascites were reported by 42% of alcoholics in our study. Melena was found in 40% of patients. Thirty percent of patients had jaundice, and 20% had hematemesis. Peripheral neuropathy affected 4% of alcoholics, and cerebellar ataxia affected 2% of them. In our study, 42% of patients consumed alcohol for 11–20 years, 36% consumed alcohol for more than 20 years, and 22% consumed alcohol for <10 years.


  Discussion Top


In moderate and severe alcoholics, the Hb level is >10 in 72% and 76%, respectively. Only 24% of nonalcoholic patients had an Hb level of >10 g. When compared to the control group, moderate alcoholics have a lower white blood cell (WBC) count. Due to infections, severe alcoholics have a higher WBC count than the general population, which is in accordance with a study by Barboriak et al.[7] This demonstrates that drinkers are more susceptible to infections. MCV is high in severe drinkers (93.44+12.21) (in femtoliters). As a result, macrocytosis is widespread in alcoholics and shows the intensity of their addiction.[8] Thrombocytopenia can be found in 26% of severe drinkers and 29% of moderate alcoholics. Anemia affects 74% of drinkers. The majority of the participants in our study had “microcytic hypochromic anemia” (56% in severe and 24% in moderate alcoholic), which is in accordance with a study by Oduola et al.[9] Macrocytosis is a condition that affects 16% of alcoholics. Pancytopenia affects 3% of alcoholics, while dimorphic blood images affect 3% of alcoholics, and 26% of alcoholics have thrombocytopenia, which is similar to a study by Paassilta et al.[10] In 36%, 24%, and 12% of alcoholics, abnormal morphology of red blood cells (RBCs), such as target cells, stomatocytes, and acanthocytes, is present.[11]

Alcohol consumption is directly toxigenic to the blood-forming organs, such as the bone marrow, resulting in less than normal or nonfunctional adult blood cells and the blood cell precursors, thus altering the hematological profile. Alcohol consumption can indirectly induce metabolic or physiological changes, which can cause liver disease and the nutritional deficiencies such as folate deficiency. This folate deficiency can impede the generation and function of numerous blood cells, resulting in altered hematological parameters.[12]

A study from India by Patel et al. examined the hematological alterations in male individuals aged between 20 and 40 years who consumed 2–3 units of alcohol on a daily basis to non-alcoholics in the same age range. The data of this study imply that even brief or moderate amounts of alcohol might influence hematological parameters such as platelet count and mean corpuscular volume (MCV).[13] In addition, another study from North India by Quraishi et al. assessed the hematological profile of alcoholics and found that they had a higher mean cell volume (MCV) and mean corpuscular hemoglobin and lower mean values of total leucocyte, RBC, and platelet counts, especially among those who consumed more alcohol.[14] The hematological characteristics of male alcoholics were evaluated by another South Indian investigation by Honnamurthy et al., whose findings corroborated a previous study, which revealed that the MCV was higher in individuals with alcoholism as compared to healthy people.[15]

In our investigation, alcoholics have hypoalbuminemia and serum glutamic oxaloacetic transaminase outnumbers serum glutamic pyruvic transaminase. Phosphatase alkaline has little relevance (P value is 0.076). The levels of serum creatinine and blood urea and PT (Prothrombin Time) are all increased. When compared to controls, serum folic acid is low. Vitamin B12 levels are high in alcoholics, especially in the most severe cases [Table 1].


  Conclusion Top


Detecting hematological changes among the chronic alcoholics and facilitating the treatment and adequate psychiatric counseling for alcoholism will reduce further complications, such as cirrhosis of the liver, renal and heart disease, cerebellar degeneration, pancreatitis, neural disorders, and others, as well as alcoholics' morbidity and mortality.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Medici V, Halsted CH. Folate, alcohol, and liver disease. Mol Nutr Food Res 2013;57:596-606.  Back to cited text no. 1
    
2.
Burra P, Senzolo M, Adam R, Delvart V, Karam V, Germani G, et al. Liver transplantation for alcoholic liver disease in Europe: A study from the ELTR (European Liver Transplant Registry). Am J Transplant 2010;10:138-48.  Back to cited text no. 2
    
3.
Laufer EM, Hartman TJ, Baer DJ, Gunter EW, Dorgan JF, Campbell WS, et al. Effects of moderate alcohol consumption on folate and Vitamin B (12) status in postmenopausal women. Eur J Clin Nutr 2004;58:1518-24.  Back to cited text no. 3
    
4.
Liu Y, Geng T, Wan Z, Lu Q, Zhang X, Qiu Z, et al. Associations of serum folate and Vitamin B12 levels with cardiovascular disease mortality among patients with Type 2 diabetes. JAMA Netw Open 2022;5:e2146124.  Back to cited text no. 4
    
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Whitfield JB, Allen JK, Adena M, Gallagher HG, Hensley WJ. A multivariate assessment of alcohol consumption. Int J Epidemiol 1981;10:281-8.  Back to cited text no. 5
    
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Hoffmeister H, Schelp FP, Mensink GB, Dietz E, Böhning D. The relationship between alcohol consumption, health indicators and mortality in the German population. Int J Epidemiol 1999;28:1066-72.  Back to cited text no. 6
    
7.
Barboriak JJ, Jacobson GR, Cushman P, Herrington RE, Lipo RF, Daley ME, et al. Chronic alcohol abuse and high density lipoprotein cholesterol. Alcohol Clin Exp Res 1980;4:346-9.  Back to cited text no. 7
    
8.
Ruidavets JB, Ducimetière P, Arveiler D, Amouyel P, Bingham A, Wagner A, et al. Types of alcoholic beverages and blood lipids in a French population. J Epidemiol Community Health 2002;56:24-8.  Back to cited text no. 8
    
9.
Oduola T, Adeosun OG, Aduola TA, Agbaje NR, Raheem ZA. Drinking patterns: Biochemical and haematological findings in alcohol consumers in Ile-Ife, Nigeria. Afr J Biotechnol 2005;4:1304-8.  Back to cited text no. 9
    
10.
Paassilta M, Kervinen K, Rantala AO, Savolainen MJ, Lilja M, Reunanen A, et al. Social alcohol consumption and low Lp(a) lipoprotein concentrations in middle aged Finnish men: Population based study. BMJ 1998;316:594-5.  Back to cited text no. 10
    
11.
Choudhury SR, Ueshima H, Kita Y, Kobayashi KM, Okayama A, Yamakawa M, et al. Alcohol intake and serum lipids in a Japanese population. Int J Epidemiol 1994;23:940-7.  Back to cited text no. 11
    
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Sanvisens A, Zuluaga P, Pineda M, Fuster D, Bolao F, Juncà J, et al. Folate deficiency in patients seeking treatment of alcohol use disorder. Drug Alcohol Depend 2017;180:417-22.  Back to cited text no. 12
    
13.
Patel N, Gunjaliya A, Patel HL. Effect of moderate consumption of alcohol on hematologic profile of Indian men. Indian J Pathol Oncol 2016;3:191-3.  Back to cited text no. 13
    
14.
Quraishi R, Jain R, Ambekar A. Hematological profile of alcohol dependent subjects: Report from a tertiary care treatment centre in India. Int J Pharma Res Health Sci 2016;4:1420-3.  Back to cited text no. 14
    
15.
Honnamurthy JB, Shivashankara AR, Mathai PJ, Malathi M. Biochemical and haematological profile in patients with alcohol dependence syndrome (ADS) co-morbid with nicotine dependence syndrome (NDS). Int J Biochem Res Rev 2016;13:1-10.  Back to cited text no. 15
    



 
 
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