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Letter to the editor: The significant difference between East Asian and Western nondrinkers

To the editor, I read with interest the paper by Kim and colleagues[1] on the genetic backgrounds contributing to the divergence in individual Korean susceptibility to alcoholinduced liver damage. I commend the authors who conducted this study. However, there is one thing that readers should be aware of. When comparing the results of this study with similar studies targeting Westerners, the characteristics of alcohol metabolism in East Asians must be taken into account.[2,3] Ethanol is converted to acetaldehyde by alcohol dehydrogenase in the body, and acetaldehyde is converted to acetic acid by aldehyde dehydrogenase2 (ALDH2). However, in people with a genetically low enzyme activity of ALDH2, the blood level of acetaldehyde soars immediately after drinking even a small amount of alcohol. This causes unpleasant body reactions such as headache, nausea, palpitation, facial flushing, and drowsiness, which is known to be the main cause of nondrinkers.[2,3] Although it is very rare for European descent to have a genetic deficiency of ALDH2, in East Asians represented by people from Korea, China, and Japan, such cases account for as many as 30%– 40% of the total population.[4,5] In other words, it is thought that the group of nondrinkers in this study— the ND group— had a significantly higher proportion of people who were geneticallydeficient with ALDH2, whereas the group of heavy drinkers— the HD group— had a very small proportion. This difference in alcohol metabolism between the two groups, specifically in the ability to metabolize acetaldehyde, is not observed in people with European origin.