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yffK612.015.32:616.379-008.64-055.2:612.393.1
CAPILLARY BLOOD CONTENT OF YOUNG WOMEN WITH DIFFERENT ATTITUDES TO ALCOHOL IN THE DYNAMICS OF MENTAL WORK ON FASTING
© Blazhko A.S.1, Nikitina O.S.1, Welcome M.O.2, Razvodovsky Yu.E.3,Mastorakis N.E.4, Pereverzeva E.V.1, Sikorsky A.V.1,Pereverzev V.A.1
1Belarusian State Medical University, Republic of Belarus, 220116, Minsk, 83, Dzerzhinskogo Ave.
2 Nile University of Nigeria, Plot 681, Cadastral Zone C-OO Research and Institution Area, Jabi airport road Bypass, 240102, FCT, Abuja,Nigeria
3 Grodno State Medical University, 80, Gorky St.,230009, Grodno, Republic of Belarus
4Saint Klement Ohridksi Technical University of Sofia, 15,bulv. Tsar 0svoboditel,1504, Sofia, Bulgaria
Abstract
Objective. To analyze changes in capillary blood glucosein dynamics of mental work in young women who are alcohol users and abusers but in the sober state.
Methods. The dynamics of glycemia in 74 young (19-29 years old) women who consume (once a month and less often / group I) and abuse alcohol (2-4 times a month and more often / 2 group) was studied in course of mental work on fasting.
Results. There was a 100% prevalence of alcohol consumption among young women participating in the study with a relatively low prevalence of alcohol abuse among them. There were differences in the dynamics of changes in capillary blood glucose in relation to its baseline in women of groups 1 and 2. Also, there were differences in their use of alcohol (frequency and dose in terms of absolute ethanol), the duration of the sober period and the points scored on test "AUDIT".
Conclusion. A wide prevalence (100%) of alcohol consumption among young women with relatively low alcohol abuse was confirmed. The recognized consumption of alcoholic beverages by women was 2-4 times per month or more and monthly dose of 80-260 ml in sober group 2 respondents was associated with a reliable decrease in the level of capillary blood glucose during mental work in 100% of the subjects throughout the study. An analysis of the dynamics of glycemia in sober women during mental work on fasting compared with young men confirms the idea of a greater toxicity of alcohol for women. According to the dynamics of glycemia in the sober subjects of the 2nd group, the criteria for alcohol abuse among women according to the AUDIT test is likely to be recommended for revision in the direction of its decrease from 8 to 4 points.
Keywords: young women, alcohol, glucose, capillary blood, mental work
СОДЕРЖАНИЕ ГЛЮКОЗЫ В КАПИЛЛЯРНОЙ КРОВИ МОЛОДЫХ ЖЕНЩИН С РАЗЛИЧНЫМ ОТНОШЕНИЕМ К АЛКОГОЛЮ В ДИНАМИКЕ УМСТВЕННОЙ РАБОТЫ НАТОЩАК Блажко А.С.1, Никитина О.С.1, Вэлком М.О.2, Разводовский Ю.Е.3, Масторакис Н.Е.4, Переверзева Е.В.1, Сикорский А.В.1, Переверзев В.А.1
'Белорусский государственный медицинский университет, Республика Беларусь, 220116, Минск, пр. Дзержинского, 83
2Нил Университет Нигерии, Нигерия, ФТС, Абужа, 240102, объездная дорога аэропорта Джаби,
область исследований и учреждений, Кадастровая зона С-ОО, участок 681 3Гродненский государственный медицинский университет, Республика Беларусь, 230009, Гродно, ул. Горького, 80
4Технический Университет СофииСвятого Климента Орхидского,Болгария, 1504, София, бульв. Царя Освободителя, 15
Резюме
Цель. Анализ изменения содержания глюкозы в капиллярной крови в динамике умственной работы у молодых женщин, употребляющих и злоупотребляющих приёмом алкогольных напитков, в трезвом состоянии.
Методика. Изучена динамика гликемии у 74 молодых (19-29 лет) женщин употребляющих (1 раз в месяц и реже /1-я группа/) и злоупотребляющих (2-4 раза в месяц и чаще /2-я группа/) алкогольными напитками, во время умственной работы натощак.
Результаты. Показана 100% распространённость употребления алкогольных напитков среди молодых женщин, участвующих в исследовании при относительно низком злоупотреблении алкоголем среди них. Установлены различия в динамике изменения содержания глюкозы в капиллярной крови по отношению к её исходному уровню у молодых женщин 1 и 2 групп и показаны различия в употреблении ими алкоголя (частоты и дозы в пересчёте на абсолютный этанол), длительности периода трезвого состояния и баллов, набранных по шкале теста «AUDIT».
Заключение. Подтверждена широкая распространённость (100%) употребления алкогольных напитков среди молодых женщин при относительно низком злоупотреблении алкоголем. Признаваемое употребление алкогольных напитков женщинами 2-4 раза в месяц или чаще и в месячной дозе 80-260 мл приводит у трезвых респонденток 2-й группы к достоверному снижению уровня глюкозы в капиллярной крови во время умственной работы у 100% испытуемых на всём протяжении исследования. Анализ динамики гликемии у трезвых девушек во время работы натощак по сравнению с юношами подтверждает представления о большей токсичности алкоголя для женщин. По данным динамики гликемии у трезвых испытуемых 2-й группы злоупотребление алкоголем у женщин по тесту «AUDIT» вероятно можно рекомендовать к пересмотру в сторону его снижения с 8 до 4 баллов.
Ключевые слова /молодые женщины, алкоголь, глюкоза, капиллярная кровь, умственная работа
Introduction
Information on the dynamics of glycemia during mental work (SD) is very controversial: R.W. Flint (2004) reported an increase in blood glucose levels during mental stress; I.J. Deary (2007) reported a decrease in the level of glycemia in the working person, and Gschwend and coworkers (1995) did not find any changes in the blood glucose levels of participants. This is explained by the peculiarities of the methodology of different experiments, chosen type of mental work, its intensity and duration [9], and also,the individual characteristics of the subjects [1]. A very important feature of the test subjects, leading to the appearance of these contradictions, in our opinion is their attitude to alcohol consumption and the length of the period of sober state among the drinking respondents [13].
In the opinion of Deary I.J. &Frier B.M. (2007), the selective response of glycemia to mental work needs to be clarified and further studied. It seems important to make substantial additions to this opinion, namely, - the selective response of glycemia to mental work needs to be refined and deeply studied in people of different sexes (not only in men but also in women), taking into account their attitude towards alcohol use (periodicity / frequency / or episodicity / rare / consumption).
Theaimofthisresearchwas to analyze the changes in capillary blood glucose in the dynamics of mental work in young women who drink and abuse alcohol in a sober state.
Methods
The work was done with the participation of 74 young women aged 19-29 years. All subjects gave informed written voluntary consent to participate in study twice (1-7 days before the study and on the day of the experiments).
All women performed the same type, standard mentalworkon fasting (10 to 12 hours after the last meal) at the same time of the day for 8 hours. The overall design of the time course of the study is as follows. The first hour of the study was occupied by the 1st blood sampling with determination of fasting glycemia, attention and mental performance indicators, as well as completion of questionnaires. After this, a hourly blood sampling was done (2nd, 3rd, 4th, 5th, 6th, 7th, 8th and 9th) with determination of glycemia after 1st, 2nd, 3rd, 4th, 5th, 6th, 7th and 8thhrs fasting. In each study, 2 to5 subjects participated. In each of them whole capillary blood glucose content wasdetermined 9 times: 1st time (baseline), before mental work, on fasting and 8 times during mental work. The measurement was carried out in 1-3 ^l of capillary blood with the help of the "Rightest GM100" glucose monitoring system ("Bionime", Switzerland) with an accuracy of 0.1 mM/l.
Mental load in all subjects was completely identical and included two types of work - the implementation of the standard test "Correction probe" [13, 14] for determination of attention and mental performance, as
well as mental work with questionnaires and popular science texts. Mental work included filling of questionnaires and analyzing popular science texts. Subjects completed the questionnaire "General" (with the "Sincerity" test embedded in it), as well as the "AUDIT" test questionnaire. The "AUDIT" test consists of 10 questions and was proposed by WHO [5] for the early diagnosis of alcohol-related problems. The test is recommended as the most simple and reliable method for the initial assessment of alcohol problems in general medical practice in the Republic of Belarus [1]. It is consistent with DSM-IV and ICD-10 - definitions of alcohol dependence and alcohol abuse. A total score of 8 or more indicates the presence of alcohol problems and the need for specialized medical care [2, 3, 5].
Statistical processing of the results was carried out with the computer program "Statistical Package for the Social Science", version 16, using the parametric and nonparametric criteria of Student and Wilcoxon-Mann-Whitney, Pearson and Spearman.
Results and Discussion
According to the results of the questionnaire, all young women who participated in the study consumed alcoholic beverages. The findings confirm the negative trends in recent decades - the increase of the use of alcohol among women [2, 14]. At the same time, among young women (who scored 8 or more points on the scale "AUDIT"), the prevalence of alcohol abuse was relatively small - 8 out of 74 participants or 10.8%, which is significantly less (3-5 times) compared to men [2, 14]. The findings confirm the high prevalence of alcohol consumption among young people (reaching 95-100%), including at least 10% of young women with harmful consequences.
In earlier studies on young men under the age of 30, we found the dependence of the dynamics of capillary blood glucose of the subjects on the duration of their sober state [14]. In 1 to 2 weeks of abstinence, during prolonged mental work, functional hypoglycemia with a significant decrease in capillary blood glucose compared with the baseline after 6hrs from the beginning of mental work was reported. In contrast, young people who are in a sober state for more than 1 month, no hypoglycemia was observed. In this connection, a similar approach was used in the groups among young women, which made it possible to establish two groups among them (Table 1): women who were in a sober state for more than 1 month - 56 people (group 1); and those who were in sober state for 2 to 14 days subjects - 18 subjects (group 2).
Table 1. Groups of young women with different attitudes toward alcohol use: group 1, rare consumer; group 2, frequentconsumers___
Parameter Group 1 Group 2
Duration of sober state 30 day or more 2-14days
Number of women in the group 56 18
AUDIT (score); M±m (1-3) 1.5+0.3 (4-12) 6.5+0.8
Dose of ethanol, ml/session 10-30 20-90
Frequency of alcoholic beverage consumption once a month or less 2-4 times / month or more often
Data of both groups of subjects differed significantly. So, the recognized frequency (2-4 times a month and more often / Table 1 /) and the dose (20-90 ml / times in terms of absolute ethanol) of alcohol were much higher in young women of the 2nd group who scored on the scale "AUDIT "4-12 points (Table 1). These figures (frequency and reported session dose, average score on the scale "AUDIT") exceed similar data in episodic (once per month or less) consumers of alcoholic drinks (10-30 ml ethanol / times) by 2-8 times.
The analysis of absolute glucose levels in capillary blood showed no significant differences in the time of mental work in the subjects of the 1st group (Table 1). At the same time, the dynamics of glycemia relative to the initial level of glucose in the state of functional dormancy showed that in women of the first group its blood glucose level increased significantly during the first two hours of mental work (Table 2), and a significant decrease in glycemiawas noted only after 6-8 hours of mental work.
An increase in the level of glycemia is a necessary biochemical factor of adequate provision of energy demand for working neurons [11-14]. Neuronal stimulation, from the calculations of Mauro Di Nuzzo et al (2009), leads to a 12-50% increase in glucose metabolism [6] in the brain from its basal level (at the peak of mental activity, the increase in metabolism can reach 100%). Sources of glucose in the brain cells when it is activated are a neuroglia containing a sufficient amount of glycogen, and blood. According to Madsen PL et al (1995), activation of the brain leads to an increase in its consumption of glucose from the blood by 12% of the basal value and can last up to 40 minutes after its activation [10]. An increase in the
glucose level in the blood of the respondents after 2 h of mental work (table 2) under the conditions of its active glucose utilization by the brain and the absence of exogenous intake (on fasting) is possible due to two processes - glycogenolysis in the liver (predominates in the first 6-8 h of fasting) and / or gluconeogenesis (becomes the leading pathway after 10 hours of fasting) in the liver and in the kidneys with the release of glucose into blood [12-14]. Given the above facts and the reliable increase in the level of glycemia after 1 and 2 h, we can propose the possibility of stimulation of gluconeogenesis by at least 14% in relation to the initial value in women who rarely drink alcohol.
Table 2. The level of glucose in capillary blood on fasting and its dynamics during mental work in sober young women with different attitudes toward alcohol use (group 1 - rare consumers, group 2 frequent users)
Group 1 (n=56) Group 2 (n=18)
Absolute glycemic values, mM/L (M±m) In relation to the initial level of glycemia, mM/L (M±m) Absolute glycemic values, mM/L (M±m) In relation to the initial value, mM/L (M±m)
Initial, 4,47±0,08 Initial, 4,79±0,18
1 hr 4.53±0.07 tmitial=0.560; р>0.1 A toinitial +0.06±0.02 *" * tinitial=3.000; p<0.01 t18 sub,ects=3.153; p<0.01 1 hr 4.68±0.18tinitial=0.431; р>0.1 A toinitial -0.11±0.05 *" * tinitial=2.200; p<0.05 t56 Sub,ects=3.153; p<0.01
2 hrs 4.53±0.07 tmitial=0.560; р>0.1 Atoinitial+0.06±0.029*" * tinitial=2.069; p<0.05 t18 sub,ects=4.354;p<0.001 2 hrs 4.56±0.17 tinitial=0.927; р>0.1 A toinitial -0.23±0.06 *" * t1nitial=3.833; p<0.01 t56subiects=4.354; p<0.001
3 hrs 4.51±0.07 tinitial=0.374; р>0.1 A toinitial +0.04±0.035 tjpitial1.143; p>0.1 t18 sub,ects=6.154;p<0.001 3 hrs 4.43±0.17 tinitial=1.452; р>0.1 A toinitial -0.36±0.06 **" ** tinitial=6.000; p<0.001 t56 subiects=6.154;p<0.001
4 hrs 4.46±0.06 tinitial=0.100; р>0.1 A toinitial -0.01±0.050 ^=0.200; p>0.1 t18 sub,ects=8.974;p<0.001 4 hrs 4.31±0.16 tmitial=1.000; р>0.1 A toinitial -0.48±0.06 ** ** tmitial=8.000; p<0.001 t56 subiects=8.974; p<0.001
5 hrs 4.37±0.06 tinitial=1.000; р>0.1 A toinitial -0.10±0.050 tjpitial=2.000; p>0.05 t18 sub,ects=5.135;p<0.001 5 hrs 4.12±0.14 * * tinitial=2.913; р<0.01 A toinitial -0.67±0.10 **" **tmitial=10.500;p<0.001 t56 subiects=5.135; p<0.001
6 hrs 4.32±0.14 tinitial=0.920; р>0.1 t18 sub,ects=2.000; р>0.05 A toinitial -0.15±0.061* * tmitial=2.459; p<0.05 t18 sub,ects=6.832;p<0.001 6 hrs 3.95±0.12 ** **tinitial=3.889; р<0.002 t56 sub,ects=2.000; р>0.05 A toinitial -0.84±0.08 **" ** tmitial=6.700; p<0.001 t56 subiects=6.832; p<0.001
7 hrs 4.18±0.14 tjmtial=1.790; р>0.05 t18 sub,ects=2.515;p<0.025 A toinitial -0.29±0.08 ** **tinitial=3.625; p<0.001 t18 sub,ects=5.128;p<0.00 1 7 hrs 3.76±0.09** "**tinitial=5.050;p<0.001 t56 sub,ects=2.515;p<0.025 A toinitial -1.03±0.12 **" ** tmitial=8.583; p<0.001 t56 subiects=5.128; p<0.001
8 hrs 4.11±0.17 " tjmtial=1.919; р>0.05 t18 sub,ects=2.599;p<0.020 A toinitial -0.36±0.10** " ** tinitial=3.600;p<0.001 t18 sub,ects=3.814;p<0.005 8 hrs 3.61±0.09 ** " ** tjnitial=5.842;р<0.001 t56 sub,ects=2.599;p<0.020 A toinitial -1.18±0.19 **" ** tmitial=6.211; p<0.001 t56 sub,ects= 3.814; p<0.005
Further dynamics of the level of glycemiain relation to its initial value in subjects of the 1st group was different from the value at 2 hr of mental work (Table 2). The increase in glucose level in was replaced by gradual normalization after 4 hours of mental load and a significant decrease in glycemia after 6 h of mental work by -0.15 ± 0.061 mM/L (p<0.05), in comparison with its initial level, and a decrease by 0.21 mM/L (p<0.02) in relation to the value at 2 h of mental work (Table 2). After 7 and 8 hrs of mental work, the average level of glycemia in these 56 respondents continued to decline by -0.29 (p<0.001) and -0.36 (p<0.001) mM/L in relation to theinitial values (Table 2). This indicates the predominance of the processes of glucose utilization over its formation and entry into the blood (already after 3 hrs of mental work), that is, the limited reserves of stimulation of gluconeogenesis to maintain the proper level of glycemia in fasting young women who occasionally consume alcoholic beverages. In young sober men who rarely consume alcoholic beverages, the reserve capacity of gluconeogenesis under similar conditions was significantly higher [13, 14], which indicates a greater toxicity of ethanol to the female body.
In the second significantly smaller group of 18 people, decrease in the level of glycemia started within 1 h of mental work (Table 2). This indicates that the process of gluconeogenesis in these young women of group 2 on fasting stomach is already in a state of functional dormancy or working at the maximum of its activity. One-hour mental load on fasting, accompanied by increased glucose consumption by the brain, revealed a decrease in the level of glycemia, which reflects the rapid depletion of gluconeogenesis
reserves in sober women who drink frequently. This condition was constantly worsening with the extent of mental work and a there was a constant reliable decrease in the level of glycemia in these young women (Table 2): -2.3% (after 1 hr), -4.8% (after 2 hrs), -7.5 (after 3 hrs), -10.1% (after 4 hrs), -14.0% (after 5 hrs), -17.5% (after 6 hrs), -21.5% (after 7 hs) , -24.6% (after 8 hrs). The revealed dynamics of glycemia (Table 2) also indicates a greater toxicity of ethanol to women, since under similar conditions, sober men who frequently consume alcohol had a tendency of increase in the level of glycemia in the first 2 h of fasting urine [13, 14].
Analysis of the results of the "AUDIT" test showed that these young women of the second group used alcoholic beverages at least 2-4 times a month in volumes from 80 to 260 ml / month in terms of absolute ethanol and scored a total of 4 to 12 (Table 1). The data obtained on the dynamics of glucose during mental work in women of the 2nd group indicate a high probability of the existence of alcohol-related problems, in respect to glucose metabolism in the body and the need to revise the criterion of 8 points on the scale of the "AUDIT" test in the direction of reduction to 4 points.
According to Avogaro A., Tiego A. (1993), alcohol causes inhibition of gluconeogenesis by 45% and a dose-dependent release of catecholamines (epinephrine and norepinephrine) from the adrenals. According to the data presented in Table 2, it can be seen that a six-hour mental load in sober young women of the 2nd group causes the development of functional relative hypoglycemia, when the glucose content in the blood becomes a direct stimulant for the secretion of hormones such as glucagon and catecholamines (epinephrine and norepinephrine), and after 7-8 hours - for the secretion of cortisol and growth hormone [12].Increased secretion of these counter-insulin hormones can promote some accumulation of glucose in the blood and a tendency to increase the level of glycemia (within the physiological normal value) on fasting in a state of functional dormancy (baseline in women of the 2nd group in Table 2) during the first two to three weeks after drinking. Similar results were obtained by us in young men who abused alcohol [13, 14]. This (the tendency to increase fasting glycemia at rest) will also contribute to the inhibition of ethanol secretion of insulin and increase resistance to it [15]. The evidence suggests that ethanol may be considered a risk factor for type 2 diabetes, consistent with other studies [2, 9, 15].
Conclusion
1. There is a wide prevalence (100%) of alcohol consumption among young women with a relatively low alcohol abuse (10.8%) confirmed by the results of the "AUDIT" test.
2. The reported use of alcoholic beverages by women with a frequency of 2-4 times per month or more and at a monthly dose of 80-260 ml in sober respondents of the 2nd group leads to a significant decrease in the level of glucose in the capillary blood during mental work in 100% of the subjects throughout the study.
3. According to the dynamics of glycemia in sober subjects of the 2nd group, alcohol abuse among women based on the "AUDIT" test can probably be recommended for revision in the direction of its reduction from 8 to 4 points.
4. Analysis of the dynamics of glycemia in sober women compared with young men during mental work on fasting confirms the idea of a greater toxicity of alcohol for women.
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Information about the authors
Blazhko Andrey S. - Assistant at the Department of Normal Physiology of the Belarusian State Medical University. E-mail: 220270@mail.ru
Nikitina Olga S. - Senior Lecturer at the Department of Normal Physiology of the Belarusian State Medical University. E-mail: nikitulya@mail.ru
Welcome Menizibeya Osain - Senior Lecturer at the Department of Human Physiology, Nile University of Nigeria, Abuja / Nigeria, E-mail: menimed1@yahoo.com
Razvodovsky Yury E. - Assistant at the Department of Pathological Physiology, Grodno State Medical University. E-mail: anastasiayk@mail.ru
Mastorakis Nikos E. - Professor at the Department of Industrial Engineering at the Technical University of Sofia, President of the World Scientific and Engineering Academy in Athens / Greece. E-mail: mastor@tu-sofia.bg
Pereverzeva Elena V. - Associate Professor at the Department of Propaedeutics of Internal Diseases of the Belarusian State Medical University. E-mail: ElenaVP2015@mail.ru
Sikorsky Anatoly V. - Associate Professor, Rector of the Belarusian State Medical University, Ministry of Health of the Republic of Belarus, E-mail: rector@bsmu.by
Pereverzev Vladimir A. - Professor, Head of the Department of Normal Physiology of the Belarusian State Medical University. E-mail: Pereverzev2010@mail.ru; PereverzevVA@bsmu.by
Информация об авторах
Блажко Андрей Сергеевич - ассистент кафедры нормальной физиологии Белорусского государственного медицинского университета. E-mail: 220270@mail.ru
Никитина Ольга Сергеевна - старший преподаватель кафедры нормальной физиологии Белорусского государственного медицинского университета. E-mail: nikitulya@mail.ru
Вэлком Мэнизибэя Осайн - кандидат медицинских наук, старший преподаватель кафедры физиологии человека НИЛ университета, Абужа/Нигерия, E-mail: menimed1@yahoo.com
Разводовский Юрий Евгеньевич - ассистент кафедры патологической физиологии Гродненского государственного медицинского университета. E-mail: anastasiayk@mail.ru
Масторакис Никос Е. - кандидат технических наук, профессор кафедры индустриальной инженерии Технического университета в Софии, президент Мировой научной и инженерной академии в Афинах/Греция. E-mail: mastor@tu-sofia.bg
Переверзевa Елена Вячеславовна - кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезнейБелорусского государственного медицинского университета. E-mail: ElenaVP2015@mail.ru
Сикорский Анатолий Викторович-кандидат медицинских наук, доцент,ректорУО «Белорусский государственный медицинский университет»Министерства здравоохранения Республики Беларусь, E-mail: rector@bsmu.by
Переверзев Владимир Алексеевич - доктор медицинских наук, профессор, заведующий кафедрой нормальной физиологии Белорусского государственного медицинского университета. E-mail: Pereverzev2010@mail.ru; PereverzevVA@bsmu.by
