Alcoholic Ketosis: Prevalence, Determinants, and Ketohepatitis in Japanese Alcoholic Men

  1. Akira Yokoyama1,*,
  2. Tetsuji Yokoyama2,
  3. Takeshi Mizukami1,
  4. Toshifumi Matsui1,3,
  5. Koichi Shiraishi4,
  6. Mitsuru Kimura1,
  7. Sachio Matsushita1,
  8. Susumu Higuchi1 and
  9. Katsuya Maruyama1
  1. 1National Hospital Organization Kurihama Medical and Addiction Center, Kanagawa 239-0841, Japan
  2. 2Department of Health Promotion, National Institute of Public Health, Saitama 351-0104, Japan
  3. 3Department of Geriatric Medicine, Kyorin University Hospital, Tokyo 181-8611, Japan
  4. 4Department of Gastroenterology, Tokai University School of Medicine, Kanagawa 259-1193, Japan
  1. *Corresponding author: National Hospital Organization Kurihama Medical and Addiction Center, 5-3-1 Nobi, Yokosuka, Kanagawa 239-0841, Japan. Tel.: +81-46-848-1550; Fax: +81-46-849-7743; E-mail: a_yokoyama{at}
  • Received April 9, 2014.
  • Revision requested May 27, 2014.
  • Revision received June 9, 2014.
  • Accepted July 3, 2014.

Aims: Alcoholic ketosis and ketoacidosis are metabolic abnormalities often diagnosed in alcoholics in emergency departments. We attempted to identify determinants or factors associated with alcoholic ketosis. Methods: The subjects of this cross-sectional survey were 1588 Japanese alcoholic men (≥40 years) who came to an addiction center within 14 days of their last drink. Results: The results of the dipstick urinalyses revealed a prevalence of ketosis of 34.0% (±, 21.5%; +, 8.9%; and 2+/3+; 3.6%) in the alcoholics. Higher urine ketone levels were associated with higher serum total bilirubin, aspartate transaminase (AST), alanine transaminase and gamma-glutamyl transpeptidase levels. A multivariate analysis by the proportional odds model showed that the odds ratio (95% confidence interval) for an increase in ketosis by one category was 0.94 (0.84–1.06) per 10-year increase in age, 0.93 (0.89–0.97) per 1-day increase in interval since the last drink, 1.78 (1.41–2.26) in the presence of slow-metabolizing alcohol dehydrogenase-1B (ADH1B*1/*1), 1.61 (1.10–2.36) and 1.30 (1.03–1.65) when the beverage of choice was whiskey and shochu, respectively (distilled no-carbohydrate beverages vs. the other beverages), 2.05 (1.27–3.32) in the presence of hypoglycemia <80 mg/dl, 0.91 (0.88–0.94) per 1-kg/m2 increase in body mass index (BMI), 1.09 (1.00–1.18) per +10 cigarettes smoked, and 2.78 (2.05–3.75) when the serum total bilirubin level was ≥2.0 mg/dl, and 1.97 (1.47–2.66) when the serum AST level was ≥200 IU/l. Conclusion: Ketosis was a very common complication and frequently accompanied by alcoholic liver injury in our Japanese male alcoholic population, in which ADH1B*1/*1 genotype, consumption of whiskey or shochu, hypoglycemia, lower BMI and smoking were significant determinants of the development of ketosis.