Females are more susceptible to alcohol-related liver disease at lower levels of alcohol intake compared to males, which may partly result from sex-related differences in alcohol metabolism (202). Females generally exhibit higher peak BAC than males after consuming the same number of standard drinks or the same amount of alcohol per kilogram of body weight (6, 72, 203, 204). Two key factors likely explain this difference. First, females typically have a lower lean-mass-to-fat ratio than males, so alcohol is distributed in a smaller body-water volume (72, 203). Second, although results are mixed (see (92)), several studies report a reduced alcohol FPM in females, in part due to lower activity of ADH4 (6, 72, 203, 204). Some inconsistencies across studies may arise, in part, from the alcohol concentration used: the sex difference in FPM is evident with 10% (wine-strength) and 40% (spirit-strength) drinks, but not with 5% (beer-strength) beverages (72).
