The Effects of Age, Smoking, and Alcohol on
Routine Laboratory Tests
MOIRA CHAN-YEUNG, M.B., F.R.C.P.(C), F.R.C.P., F.A.C.P., PATRICK FERREIRA, M.B., M.Sc, F.R.C.P.(C),
JIRI FROHLICH, M.D., F.R.C.P.(C), MICHAEL SCHULZER, M.D., AND FELISA TAN, M.S.
Chan-Yeung, Moira, Ferreira, Patrick, Frohlich, Jiri,
Schulzer, Michael, and Tan, Felisa: The effects of age,
smoking, and alcohol on routine laboratory tests. Am J Clin
Pathol 75: 320-326, 1981. The effects of age, smoking,
and alcohol intake on the results of some routine hematology
and clinical chemistry tests have been determined for a
group of 1,826 healthy male workers. Increasing age was
significantly associated with higher hemoglobin, hematocrit,
SGOT, BUN, and creatinine levels and with lower total
protein concentration, but there was no significant association
with leukocyte count, total bilirubin, or alkaline phosphatase.
Smoking was significantly associated with higher hemoglobin,
hematocrit, leukocyte count, and alkaline phosphatase, and
with lower total bilirubin, SGOT, total protein, and BUN, but
there was no significant association with creatinine levels.
Alcohol consumption was significantly associated with higher
hematocrit, bilirubin, and SGOT and with lower BUN and
creatinine, but there was no significant association with
hemoglobin, leukocyte count, alkaline phosphatase, or total
protein. The possible reasons for these effects, and their impli-
cations, are discussed. (Key words: Age; Smoking; Alcohol;
Normal values; Hematology; Chemistry.)
A HEALTH SURVEY of 1,826 white male workers
in a pulp and paper mill in Powell River, British
Columbia was conducted to determine whether ex-
posure to various air contaminants had significant
adverse effects on the respiratory system, hemo-
poietic tissue, liver, and kidneys. The levels of various
air contaminants, such as total particulates, sulfur
dioxide, hydrogen sulfide, and chlorine, were low in
the pulp and paper mill in Powell River. 7 We were
unable to demonstrate any significant increase in the
prevalence of respiratory symptoms or lung function
abnormalities among these workers when compared
with control groups. 7 Moreover, we found only
minor differences between the results of hematologic
and liver and renal function tests of exposed workers
and those of nonexposed workers. 6 The working
population in this pulp and paper mill can be
Received May 12, 1980; received revised manuscript and ac-
cepted for publication August 18, 1980.
This study was supported by the Workers' Compensation Board
of British Columbia.
Address reprint requests to Dr. Chan-Yeung: Department of
Medicine, The University of British Columbia, 8th floor, 686 W.
Broadway, Vancouver, British Columbia, Canada V5Z 1G1.
0002-9173/81/0300/0320 $00.85 © American Society of Clinical Pathologists
320
Departments of Medicine and Pathology,
Vancouver General Hospital, University
of British Columbia
considered relatively healthy. In this report we present
the findings of the effects of age, smoking, and
alcohol consumption on routine hematologic and liver
and renal function tests.
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Methods
The details of the procedure of the health survey can
be found in the previous reports. 6,7 In addition to a
medical-occupational questionnaire, a detailed history
of smoking and alcohol consumption was taken during
the interview. The frequency of alcohol intake during
the past 12 months and the daily alcohol intake during
the seven days preceding the interview were enquired
into, and the average number of drinks per day was
calculated. One bottle of beer (12 oz), one glass of
wine (4 oz), or one measure of hard liquor was
regarded as one drink. We found a highly significant
correlation (r = 0.9) between the frequency of alcohol
intake and average daily intake of alcohol. There was
no difference in results whichever method of estimating
alcohol consumption was used. For simplicity, the
results using daily alcohol intake are presented below.
Fifteen millilters of nonfasting blood was taken from
each of the workers for measurement of hemoglobin,
hematocrit, leukocyte count, serum total bilirubin,
glutamic oxaloacetic transaminase (SGOT), alkaline
phosphatase, total protein, blood urea nitrogen (BUN),
and creatinine.
Hemoglobin, hematocrit, and leukocyte count were
performed on a Coulter-S® analyzer. Total bilirubin
was measured by a manual Jendrassik-Groff method. 25
SGOT, 21 alkaline phosphatase, 4 creatinine, 27 and
BUN, 34 were measured with an Abbott® ABA-100
with Spin-Chem® reagents from SKI Laboratories.
Total protein was measured by the Biuret method. 20
The normal values of various laboratory tests for the
Powell River General Hospital for the white male
population are as follows: hemoglobin, 13.6 to 16.8
Vol. 75. No. 3 AGE, SMOKING, ALCOHOL—LABORATORY TESTS 321
Table I. Smoking Habit and Alcohol Intake of Different Age Groups of Workers in Powell River, British Columbia
Age Group s (Years)
<20 21-30 31-40 41-50 51-60 >60 Total
Number of subjects 46 354 419 466 429 112 1,826
Smoking habits*
Nonsmoker 26 (56.5) 107 (30.2) 99 (23.6) 86(18.5) 65(15.2) 15(13.4) 398(21.8)
Exsmoker 6(13.0) 76(21.5) 146 (34.8) 186 (39.9) 184(42.9) 54 (48.2) 652 (35.7)
Current smoker 14 (30.4) 171 (48.3) 174(41.5) 194(41.6) 180 (42.0) 43 (38.4) 776 (42.5)
Daily alcohol intake
(no. of drinks/day)*t
0 8 (17.4) 66(18.9) 95 (22.8) 91 (19.8) 118(27.6) 32 (28.8) 410(22.6)
1 15 (33.6) 103 (29.4) 141 (33.8) 176 (38.3) 131 (30.6) 40 (36.0) 606 (33.5)
1-3 19(41.3) 126 (36.0) 138(33.1) 141 (30.7) 131 (30.6) 35(31.5) 590 (32.6)
>3 4 (8.7) 55 (15.7) 43 (10.3) 51 (11.1) 48(11.2) 4 (3.6) 205(11.3)
* Percentage of total in parentheses. the seven days preceding the interview (drink = 1 bottle of beer (12
1 glass
oz), of wine
t Daily alcohol intake was calculated from the total number of drinks recorded during (4•oz),
VA01oz of hard liquor).

g/dl; hematocrit, 40% to 51%; leukocyte count 4,000 variance on the effects of age, smoking, and alcohol
to 8,000/mm3; total bilirubin, 0.5 to 1 mg/dl; alkaline

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on the results of various laboratory tests. The following
phosphatase, 10 to 85 U/I; SGOT, 8 to 31 U/l; total is a more detailed presentation of the findings.
protein, 6.2 to 7.6 g/dl; creatinine, 0.9 to 1.5 mg/dl;
BUN, 6 to 22 mg/dl. These ranges of normal values Hematologic Findings (Tables 2 and 3)
were not significantly different from those used in
Hemoglobin. Smoking and age were the most
other major hospitals in Vancouver, British Columbia.
irnportant factors affecting hemoglobin, while alcohol
Statistical analysis was carried out using analysis
intake had no significant effect (Table 2). Figure 1
of variance, chi-square, and regression analysis, as
shows the mean hemoglobin level of workers in dif-
appropriate. 33 Multiple regression analysis of co-
ferent age groups according to smoking habits. The
variance and multidimensional contingency table
mean hemoglobin concentration increased slightly
analysis3-33 were used to examine the effects of age,
from the young age group (<20 years) to those between
smoking, and alcohol intake on the results of various
31 and 40 years, and plateaued thereafter. Current
laboratory tests.
smokers had a slightly higher mean hemoglobin than
nonsmokers and exsmokers in all age groups.
Results Hematocrit. Age, smoking, and alcohol intake all
The smoking and alcohol habits of workers in affected the hematocrit (Table 2). Figure 1 shows the
different age groups are presented in Table 1. There mean hematocrit of workers in different age groups
are statistical differences in the smoking and alcohol according to smoking habits. It can be seen that
habits in different age groups. The percentage of
nonsmokers was highest (56.5%) in those below the Table 2.. Statistical Significance of Correlation
age of 20, and it decreased with older age groups. The Between the Studied Variables and
proportion of exsmokers was lowest (13.0%) in the Laboratory Tests
young age groups and increased in older age groups. Significance (P)*
The proportion of current smokers was highest (48.3%)
among those between 21 arid 30 years of age. Of the Age Smoking Alcohol
total work force, 22.6% denied that they had had any
Hematology
alcoholic drinks during the week prior to the interview, Hemoglobin 0.0370 0.0001 0.2200
33.5% had less than one drink a day, 32.6% Had one to Hematocrit 0.0001 0.0001 0.0090
three drinks a day, and 11.3% had more than three Leukocyte count 0.0670 0.0001 0.5830
Liver function tests
drinks a day. There was a significant correlation Total bilirubin 0.8870 0.0001 0.0150
between smoking habit and alcohol intake (P < 0.004). Alkaline phosphatase 0.0920 0.0001 0.2610
A higher proportion of nonsmokers clairhed that they SGOT 0.0001 0.0001 0.0001
Total protein 0.0001 0.0001 0.2740
had had no alcohol during the past week, while a Renal function tests
higher proportion of current smokers had more than Creatinine 0.0001 0.0750 0.0070
three drinks a day during the preceding week. BUN 0.0020 0.0001 0.0310
Table 2 summarizes the results of analysis of co- ' P value results from analysis of covariance.
322 CHAN-YEUNGCTAZ.. A.J.C.P. • March 1981

._ — • Current smokers
46- 8.5
••-• • • Ex-smokers %
•••• •••• Non-smokers
1 6_
- 45- 8.0

E
^£. —
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• • 44 U 7.5

15- 43-

• 42 6.5 \ / \

1 1 1 1 1 _l_ _l_ J_ J_ J_ J 6.0 J_ _i_ _L _1_ _1_ J

<20 21-30 31-40 41-50 51-60 >60 < 20 21-30 31-40 41-50 51-60 >60 < 20 21-30 31-40 41-50 51-60 >60
Age (years) Age (years) Age (years)

FIG. 1. The effect of age on hemoglobin, hematocrit, and leukocyte count of workers according to smoking status.

current smokers had higher hematocrits than non- 1). There was also significant positive correlation

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smokers and exsmokers in all age groups. Hematocrit between the total leukocyte count and the amount
increased with age in all workers irrespective of of cigarette consumption (pack years). Moreover,
smoking habit. Alcohol consumption also affected the workers who gave a history of chronic bronchitis
hematocrit; those who admitted to having had more (cough and phlegm on most days and nights for two
than one drink a day had a higher hematocrit than years) had higher leukocyte counts than those without
those who drank less (Table 3). such a history (8,472 ± 2,242/cu mm versus 7,413
Leukocyte Count. Smoking was the only significant ± 1,839/cu mm). Table 3 shows that the leukocyte
factor affecting the total leukocyte count (Table 2). count was not influenced by alcohol intake.
Figure I shows the mean leukocyte count of workers in
different age groups according to smoking habits. It Liver Function Tests (Tables 2 and 4)
can be seen that current smokers had higher total Total Bilirubin. The mean total bilirubin level showed
leukocyte counts than nonsmokers and exsmokers in no correlation with age, but significantly correlated
all age groups. The total leukocyte count was highest with smoking and alcohol consumption (Table 2).
among workers below 20 years of age and decreased Figure 2 shows the mean total bilirubin levels in
in older age groups for both nonsmokers and ex- different age groups according to smoking habits.
smokers. The mean leukocyte count was approxi- While there was no difference in the mean total
mately 2,300/cu mm higher for current smokers than bilirubin levels of age groups, current smokers had
nonsmokers among workers 41-50 years of age (Fig. significantly lower bilirubin in alj age groups. Table 4

Table 3. Effect of Smoking and Alcohol Consumption on Hematologic Tests*

Alcohol Consumption (No. of Drinks/Day)
Test and Smoking
Status 0 <1 1-3 >3 Total
Hemoglobin (g/dl)
Nonsmokers 15.4 ± 0.8 15.2 ± 0.77 15.3 ± 1.02 15.2 ± 0.88 15.3 ± 0.9
Exsmokers 15.2 ± 1.09 15.1 ± 0.83 15.2 ± 0.86 15.2 ± 0.89 15.2 ± 0.9
Current smokers 15.3 ± 0.96 15.5 ± 0.92 15.6 ± 0.92 15.5 ± 0.91 15.5 ± 0.9
Total 15.3 ± 0.97 15.3 ± 0.87 15.4 ± 0.93 15.4 ± 0.90 15.3 + 0.9
Hematocrit (%)
Nonsmokers 43.9 ± 2.3 43.5 ± 2.2 43.7 ± 2.7 43.7 ± 2.2 43.7 ± 2.4
Exsmokers 43.5 ± 2.9 43.3 ± 2.3 43.7 ± 2.4 43.9 ± 2.4 43.5 ± 2.5
Current smokers 44.1 ± 2.7 44.8 ± 2.7 45.1 ± 2.7 44.7 ± 2.6 44.7 ± 2.7
Total 43.8 ± 2.7 43.8 ± 2.5 44.3 ± 2.7 44.3 ± 2.5 44.0 ± 2.6
Leukocyte count (#/cu mm)
Nonsmokers 6,661 ± 1,251 6,621 ± 1,463 6,870 ± 1,360 7,742 ± 1,858 6,773 ± 1,440
Exsmokers 7,189 ± 1,487 6,861 ± 1,303 6,945 ± 1,571 6,593 ± 1,252 6,933 ± 1,441
Current smokers 8,470 ± 2,027 8,432 ± 2,101 8,467 ± 2,029 8,330 ± 2,473 8,436 ± 2,112
Total 7,580 ± 1,843 7,370 ± 1,858 7,604 ± 1,915 7,700 ± 7,507 7,531 ± 1,920
* For results of statistical analyses, see Table 2.
 Vol. 75 • No. 3 AGE, SMOKING, ALCOHOL—LABORATORY TESTS
0.9r
FIG. 2. The effect of age on total bilirubin, alkaline
phosphatase, SGOT, and total protein of workers
according to smoking status.
<20 21-30 31-40 41-50 51-60 >60
shows the effect of alcohol consumption and smoking
on total bilirubin level. The total bilirubin level
increased with increased alcohol intake, but no inter-
action was found between smoking and alcohol
consumption.
Alkaline Phosphatase. The mean alkaline phos-
phatase activity was affected by smoking but not by
age or alcohol consumption (Table 2). Alkaline
phosphatase was significantly higher among current
smokers than nonsmokers and exsmokers in most age
groups (Fig. 2). No interaction was found between
alcohol consumption and smoking (Table 4).
SGOT. The mean SGOT was significantly correlated
with all three variables (Table 2). In general, SGOT
increased with age until 50 years, irrespective of
smoking habits, and current smokers had slightly
lower SGOT activity in all age groups (Fig. 2). For
workers who admitted to having had more than three
drinks a day during the past week, the SGOT activity
was significantly higher than for those who drank less,
irrespective of smoking habit (Table 4). Among
workers with heavy alcohol intake, older persons had
higher mean SGOT than younger ones.
323
28
• « Current smokers
• • Ex-smokers
• • Non-smokers
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<20 21-30 31-40 41-50 51-60 >60
Age (years) Age (years)
Total Protein. The mean total protein level was
related to age and smoking but not to alcohol
consumption (Table 2). The mean total protein de-
creased with age (Fig. 2). Current smokers had lower
total protein levels than nonsmokers and exsmokers
in all age and alcohol groups. Alcohol consumption
had no significant effect on the concentration of serum
protein (Table 4).
Renal Function Tests (Tables 2 and 5)
Creatinine. The mean concentration of serum
creatinine was related to age and alcohol consumption
but not to smoking (Table 2). It increased with age
(Fig. 3) and was lowest among persons with heavy
alcohol intake (Table 5). Among the latter group of
persons (those drinking more than three drinks a day),
the effect of alcohol was more marked than that of age.
BUN. The serum concentration of BUN was related
to all the studied variables (Table 2). Nonsmokers and
exsmokers had higher BUN levels than current
smokers. BUN levels increased with age among non-
smokers and exsmokers but not among current
324 CHAN-YEUNGE7AZ.. A.J.C.P. • March 1981
18r •—- . Cu rrenl smokers •
• - - «• - . Ex smokers
• "•• Non-smokers

17-
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,,../ /
5«
o>
^£ 1.15-
.•' / ^?
Z O)
..•* z• ^E .--TSKl.
16- ,*- ..--« / 0) 1.10- FIG. 3. The effect of age
v • *" c
/ .-#
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ean Creat
•• of workers according to
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1.05 smoking status.

15-
7 5 1.00
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i 1 I 1 1 _L I i
14 _l 0.90
20 21-30 31-40 41-50 51-60 60 20 21-30 31-40 41-50 51-60 60
Age (years) Age (years)

smokers (Fig. 3). Table 5 shows that BUN levels was little or no difference in results between workers
decreased with smoking and increasing alcohol con- according to their occupational exposure to different
sumption. air contaminants. 6 We found that current smokers had
higher mean hemoglobin levels than nonsmokers and
Discussion exsmokers. This observation has been well docu-
In this study we have analyzed the effects of age, mented by many investigations,13-17-19-23-24-31-32 and the
smoking, and alcohol consumption on a number of majority of the authors1719-31-'52 felt that increased
frequently used laboratory tests. These test subjects carboxyhemoglobin levels in smokers leading to
were relatively healthy working white men, and there compensatory polycythemia is the most probable

Table 4. Effect of Smoking and Alcohol Consumption on Liver Function Tests*

Alcohol Consumption (No. of Drinks/Day)
Test and Smoking
Status 0 <1 1-3 >3 Total
Total bilirubin (mg/dl)
Nonsmoker 0.67 ± 0.29 0.66 ± 0.29 0.73 ± 0.33 0.65 ± 0.31 0.68 ± 0.30
Exsmoker 0.65 ± 0.55 0.61 ± 0.28 0.65 ± 0.29 0.76 ± 0.44 0.65 ± 0.38
Current smoker 0.52 ± 0.23 0.54 ± 0.24 0.57 ± 0.23 0.59 ± 0.26 0.55 ± 0.23
Total 0.60 ± 6.38 0.60 ± 0.27 0.63 ± 0.28 0.64 ± 0.33 0.61 ± 0.31
Alkaline phosphatase (U/l)
Nonsmoker 63.3 ± 17.3 56.9 ± 19.5 60.5 ± 16.5 58.8 ± 17.8 59.6 ± 18.1
Exsmoker 62.7 ± 22.0 59.6 ± 17.7 57.6 ± 15.4 57.9 ± 17.5 60.1 ± 18.0
Current smoker 64.0 ± 16.2 67.2 ± 17.9 65.0 ± 16.7 64.2 ± 17.5 65.3 ± 17.0
Total 63.4 ± 18.7 61.7 ± 18.7 62.1 ± 16.3 61.5 ± 17.7 62.2 ± 17.8
SGOT (U/l)
Nonsmoker 24.2 ± 9.9 24.8 ± 8.3 24.8 ± 8.2 30.0 ± 14.1 25.2 ± 9.4
Exsmoker 26.3 ± 13.7 24.0 ± 9.4 26.3 ± 11.6 35.7 ± 24.7 26.3 ± 13.4
Current smoker 21.9 ± 6.5 22.6 ± 6.6 24.2 ± 9.7 30.7 ± 21.9 24.1 ± 11.5
Total 24.0 ± 10.5 23.6 ± 8.2 25.1 ± 10.3 31.9 ± 21.6 25.2 ±11.9
Total protein (g/dl)
Nonsmoker 7.11 ± 0.35 7.08 ± 0.37 7.18 ± 0.34 7.21 ± 0.32 7.13 ± 0.35
Exsmoker 7.07 ± 0.38 7.11 ± 0.35 7.10 ± 0.39 7.20 ± 0.31 7.10 ± 0.37
Current smoker 7.04 ± 0.32 7.01 ± 0.35 7.04 ± 0.37 7.05 ± 0.36 7.03 ± 0.35
Total 7.07 ± 0.35 7.07 ± 0.36 7.09 ± 0.38 7.12 ± 0.35 7.08 ± 0.36
* For results of statistical analyses, see Table 2.
Vol. 75 . No. 3 AGE. SMOKING, ALCOHOL —LABORATORY TESTS 325
Table 5. Effect of Smoking and Alcohol Consumption on Renal Function*
Alcohol Consumption (No. of Drinks/Day)
Test and Smoking
Status 0 <1 1-3 >3 Total
Creatinine (mg/dl)
Nonsmokers 1.12 ± 0.16 1.09 ± 0.17 1.09 ± 0.14 1.08 ± 0.13 1.10 ± 0.16
Exsmokers 1.11+0.17 1.12 ± 0.18 1.11 ±0.17 1.04 ± 0.13 1.11 ±0.17
Current smokers 1.08 ± 0.15 1.10 ± 0.17 1.10 ± 0.18 1.05 ± 0.14 1.08 ± 0.17
Total 1.10 ±0.16 1.10 ±0.17 1.10 ± 0.17 1.05 ± 0.14 1.10 ± 0.17
BUN (mg/dl)
Nonsmokers 16.1 ± 3.9 17.0 ± 3.6 16.4 ± 3.6 16.4 ± 3.9 16.5 ± 3.7
Exsmokers 16.7 ± 5.0 16.5 ± 3.9 15.6 ± 4.2 15.2 ± 4.0 16.1 ± 4.3
Current smokers 15.1 ±3.8 14.6 ± 3.6 15.1 ±4.1 13.9 ± 3.6 14.7 ± 3.8
Total 15.9 ± 4.4 15.9 ± 3.8 15.5 ± 4.0 14.7 ± 3.9 15.7 ± 4.1

* For results of statistical analyses, see Table 2.

explanation. This would also agree with our findings Hyperbilirubinemia is uncommon in steatosis, but
that the mean hemoglobin was higher among those more common in more severe disease, such as
nonsmokers who were exposed to carbon monoxide alcoholic hepatitis or cirrhosis. 16 Contrary to our

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in their jobs." We found that while alcohol consumption
did not affect the hemoglobin, it significantly in-
creased the mean hematocrit. However, Eschwege and
co-workers 15 failed to find any significant correlation
between alcohol consumption and hematocrit. Macro-
cytic anemia is a common finding in chronic al-
coholics," so it is surprising that in this study there
was no apparent effect of alcohol on hemoglobin
even in the heaviest drinkers (more than three
drinks a day).
We found that the mean leukocyte count was higher
amongst current smokers than nonsmokers and ex-
smokers, confirming the findings of many previous
authors.'•2-'"-17-li'-22-2:i-28':12 The increase in leukocyte
count was related to the quantity smoked, duration
of smoking, and the presence of chronic bronchitis.
Friedman and associates 17 suggested that nicotine-
induced catecholamine release or the chronic irritant
effect of smoke might be the most likely mechanisms
for this effect.
In this study the mean SGOT activity was found to
be significantly higher among those who admitted to
having had more than three drinks a day. However,
there was no apparent effect of alcohol on alkaline
phosphatase activity. Rubin and Lieber,'10 in their study
of the acute effect of alcohol on 12 nonalcoholic
subjects, found that the SGOT increased significantly
in eight of these subjects, and diffuse fat accumulation
was conspicuous in the liver biopsy after two days of
alcohol intake of 270 g per day. Fink and Rosalki1(i
reported that about 40% of patients with alcoholic
steatosis showed increased SGOT, 20% had increased
serum glutamic pyruvate transaminase (SGPT), and
10% had increased serum alkaline phosphatase ac-
tivity. We also found a positive corelation between
the total bilirubin level and alcohol consumption.
findings, Zieve and Hill30 demonstrated a negative
correlation between alcohol consumption and bilirubin
concentration. It is however, pertinent to point out that
they did not take into consideration the effect of
cigarette smoking.
It is of interest to note that cigarette smoking affected
all four liver function tests; total bilirubin, SGOT, and
total protein were decreased in smokers, but alkaline
phosphatase was increased. Bilirubin levels have been
reported to be somewhat lower in neonates born to
smoking rather than nonsmoking mothers, 29 possibly
because of enhanced biotransformation. However,
this was not found in an earlier study, 9 and a report of
adult subjects did not demonstrate any difference in
bilirubin concentration between smokers and non-
smokers. 5 The significance of the enzyme changes
noted in this study is unclear. Dales and colleagues 12
did not find any consistent difference in SGOT levels
between smokers and nonsmokers, and there does not
appear to be a previously published report on serum
alkaline phosphatase activity related to smoking habit.
We have no data on which particular isoenzymes (and
therefore which tissue sources) are most affected by
smoking. It is even possible that the observed effects
could be due to changes in cofactor concentration or
availability. For example, vitamin B 6 is a coenzyme for
SGOT and has been reported to be deficient in
smokers. 14 Similarly, zinc is an activator of alkaline
phosphatase and is present in higher concentration in
certain tissues of smokers than of nonsmokers. 26
The mean creatinine and BUN levels were related to
age, smoking, and alcohol consumption. Both BUN
and creatinine levels increased with age, whereas they
were lower in smokers and the heavier drinking groups.
The effect of alcohol might be explained by an in-
creased clearance of these substances caused by
326 CHAN-YEUNG £7 AL.
alcohol-induced diuresis. It is surprising that this
effect has not been previously described. Decreases in
total protein, BUN, and creatinine in smokers might
be related to hemodilution caused by nicotine-induced
antidiuretic hormone secretion, ,K or to decreased
dietary intake of protein." It is interesting to note that
the mean body weight of smokers in this study was
significantly lower than those of exsmokers (78.2
± 10.8 kg versus 81.1 ± 10.2 kg). These results con-
firm previous reports of decreased total protein 1 " 5
and creatinine 12 in smokers, but an effect of smoking
on BUN concentration has not previously been
reported.
In conclusion, we have found that age, smoking, and
alcohol consumption affected a number of commonly
employed laboratory tests. In some cases, this would
seem to be of sufficient magnitude to warrant taking
these variables into account when establishing normal
values. In other cases, the effects are smaller but
nonetheless statistically significant. While the exact
causes for most of these effects are at present
speculative, they do provide an interesting insight into
the widespread metabolic effects induced by alcohol
and cigarette smoking.
Acknowledgement. The staff of the Laboratory at the Powell
River General Hospital performed the tests.
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