Chewing areca nut increases the risk of coronary artery disease in Taiwanese men: a case-control study

Association between habitual betel quid chewing and risk of adverse cardiovascular outcomes: A systematic review

INTRODUCTION

Habitual betel quid chewing, a tobacco product, is a leading cause of oral cancer in Asia-Pacific countries where this practice is most prevalent. However, it is not well understood whether betel quid chewing is also a cause of adverse cardiovascular outcomes. To address this gap, we conducted a systematic literature review of peer-reviewed published studies evaluating the association between habitual betel quid use on the risk of adverse cardiovascular outcomes.

METHODS

We searched PubMed for studies assessing the correlation between betel quid chewing and cardiovascular health. We included studies if (i) they included human subjects; (ii) were peer-reviewed articles in indexed journals; and (iii) were in English. We extracted data from eligible studies and stratified them by geographical location, study designs and cardiovascular outcomes. Finally, we did a narrative synthesis of the data to identify adverse cardiovascular outcomes associated with chronic betel quid use.

FINDINGS

We reviewed data from 19 studies that met the inclusion criteria. Habitual betel quid chewing was associated with hypertension, atherosclerosis, inflammation and ischaemic heart disease. In addition, betel quid use was a risk factor for arrhythmias. Interestingly, betel quid use was an independent risk factor for cardiovascular disease in women. Long-term betel quid consumption was associated with higher risks for all-cause mortality and increased overall cardiovascular risk.

CONCLUSIONS

Habitual betel quid chewing is an important cardiovascular risk factor in populations where the practice is prevalent.

Systemic and Local Effects Among Patients With Betel Quid-Related Oral Cancer

The major predisposing factors of developing oral cancer include smoking, alcohol drinking, and betel quid chewing. Betel quid chewing could cause the abrasion and damage of oral mucosa by crude fibers, chemical insults by additive slaked lime, and arecoline from areca nut. These would lead to the local consequence of oral submucosal fibrosis, which is regarded clinically as a precancer lesion and a major cause of trismus. In addition, the components and additives in betel quid contain chemical toxins and carcinogens, which would further affect the oral mucosa and gradually develop a malignancy. Following literature review, aside from having a greater total tumor burden and more local diseases in the oral cavity and digestive tract, patients with betel quid-related oral cancer also have more systemic diseases from metabolic syndrome, hypertension, cardiovascular disease, type II diabetes mellitus, and obesity than those without this habit. In conclusion, those patients who have the history of smoking, alcohol drinking, and betel quid chewing would present much more unique clinical characteristics than those who only have a history of smoking and alcohol drinking. More attention should therefore be paid to pretreatment evaluation, treatment strategy, and posttreatment follow-up among betel quid chewers.

Decoding the link associated with areca nut chewing and cardiovascular disease using hsCRP as a biomarker

Background

Chewing of areca nut is associated with various oral and systemic ill effects. The deleterious oral effects of areca nut have been widely documented to range from reactive lesions, periodontal health compromise to oral pre-cancer and cancerous states and have been described widely in the literature. The reported systemic effects of areca nut chewing are relatively less documented but reported in literature. Areca nut chewing may predispose to cardiovascular disease due to a systemic inflammatory response from the elevated levels of circulating inflammatory mediators. High-sensitivity C-reactive protein (hsCRP) is a systemic inflammatory biomarker to assess the risk of cardiovascular disease.

Materials and Methods

This cross-sectional, observational study was conducted among areca nut chewers (n = 50) and non-chewers (n = 50). Areca nut chewers were considered as chewers/cases. Blood samples were collected from the participants and hsCRP levels were studied. The data were analysed using SPSS software, version 21 for statistical significance. Chi-square test was used to compare categorical variables. Mann-Whitney U test was done to analyse continuous variables. The level of statistical significance was set at P value < 0.05.

Results

hsCRP mean was higher among the chewers (2.3 ± 3.7) compared to non-chewers (0.9 ± 1.3). The difference in hsCRP levels between the study group was statistically significant (P = 0.002).

Conclusion

This study demonstrates the link between areca nut and cardiovascular disease using hsCRP as biomarker.

Betel Nut Chewing Increases the Risk of Metabolic Syndrome and Its Components in a Large Taiwanese Population Follow-Up Study Category: Original Investigation

Betel nut chewing is a popular habit in Taiwan, and it is associated with adverse metabolic effects. The aim of this study was to investigate correlations between betel nut chewing with metabolic syndrome (MetS) and its components in a longitudinal study using data from the Taiwan Biobank. A total of 121,423 participants were included in the baseline study, and 27,002 received follow-up examinations after a median of 4 years. The association between betel nut chewing and MetS was analyzed using multiple logistic regression after controlling for confounders. The baseline prevalence of MetS was 22.5%. Multivariable analysis showed that a history of chewing betel nut was significantly associated with baseline MetS (odds ratio (OR) = 1.629; 95% confidence interval (CI) = 1.535 to 1.730, p < 0.001) and five components of MetS in all participants. A long history of chewing betel nut (per 1 year; OR = 1.008; 95% CI = 1.004 to 1.013, p < 0.001) was associated with baseline MetS, abdominal obesity, hypertriglyceridemia and low high-density lipoprotein (HDL) cholesterol. In addition, high cumulative dose (per 1 year × frequency × daily score; OR = 1.001; 95% CI = 1.001−1.002; p < 0.001) was significantly associated with baseline MetS. At the end of the follow-up, a history of chewing betel nut (OR = 1.352; 95% CI = 1.134 to 1.612, p = 0.001) was significantly associated with MetS and its components including abdominal obesity, hypertriglyceridemia and low HDL-cholesterol in the participants without baseline MetS. In addition, a longer history of betel nut chewing was associated with MetS (per 1 year; OR = 1.021; 95% CI = 1.008 to 1.035, p = 0.002), abdominal obesity and hypertriglyceridemia at follow-up. However, cumulative dose (p = 0.882) was not significantly associated with follow-up MetS. Chewing betel nut and a long history of betel nut chewing were associated with baseline MetS and its components. In the participants without MetS at baseline, chewing betel nut and a long history of chewing betel nut were associated with the development of MetS after 4 years of follow-up. However, a cumulative dose of betel nut chewing was not associated with follow-up MetS. Betel nut chewing cessation programs are important to reduce the incidence of MetS in Taiwan.

Arecoline induces cardiotoxicity by upregulating and activating cardiac hypertrophy-related pathways in Sprague-Dawley rats

Habitual chewing of the areca nut increases the risk of mortality owing to cardiovascular disease, but few reports have revealed the cardiotoxicity mechanism of the areca nut. Arecoline has been reported to be the primary toxic constituent in the areca nut. In order to study the acute cardiotoxicity of the areca nut in the development of pathologic heart hypertrophy, we induced heart injury in rats using arecoline. Arecoline at a low dosage (5 mg/kg/day) or a high dosage (50 mg/kg/day) was intraperitoneally injected to Sprague-Dawley rats for 21 days. The change of heart function and biochemical pathways were investigated with echocardiography and Western blot. The results were presented that heart functions were weakened by arecoline stimulation, and western blotting analysis revealed an elevation in BNP levels in the heart after arecoline exposure. Arecoline induced IL-6-mediated activation of the MEK5/ERK5 and JAK2/STAT3 pathways, as well as mitogen-activated protein kinase signaling cascades. Further, arecoline increased the calcineurin and NFATc3 levels in the heart. In summary, our results suggest that arecoline causes significantly cardiotoxicity and heart damage by inducing several hypertrophy-related signaling pathways, including IL-6-induced MEK5/ERK5, JAK2/STAT3, mitogen-activated protein kinases, and calcineurin signaling pathways. The study elucidated, for the first time, the possible cardiac hypertrophy mechanisms underlying the cardiotoxicity of the areca nut.

Arecoline induces heart injure via Fas/Fas ligand apoptotic pathway in heart of Sprague-Dawley rat

Habitual chewing of areca nut increases the risk of cardiovascular disease mortality, but less report demonstrate the toxic mechanism of areca nut on heart. To investigate toxicity of areca nut on cardiomyocytes, we induced the heart injury with arecoline to evaluate the acute damage of areca nut on heart. Different concentrations of are coline (lowdosage: 5 mg/kg/day and high dosage 50 mg/kg/day) were injected into Sprague-Dawley rat via intra-peritoneal method for 21 days to create negative effects of arecoline on cardiomyocyte. Themyocardial architecture of the rat heart was observed. The arecoline-induced apoptotic proteins were analysed via western blotting. The myocardialarchitecture of heart was injured with arecoline and TUNEL stain was also shown are coline-induced cardiac apoptosis. Arecoline promoted the protein expression of both Fas dependent snd mitochondrial dependent apoptosis. In summary, arecoline induces cardiac toxicity and apoptosis by inducing both death receptor and mitochondria-dependent apoptotic pathways on heart.

Betel-Quid Chewing, Heart Failure, and Premature Ventricular Contractions in Patients with Cardiopulmonary Symptoms

Betel-quid (BQ) is a commonly used psychoactive substance that renders a specific cardiotoxicity. The purpose of this study was to investigate the association between BQ chewing and premature ventricular contractions (PVC) in patients with cardiopulmonary symptoms, and examine the potential influences of cardiovascular and chronic diseases on such relationship. Participants were 146 patients with cardiopulmonary symptoms who participated in 24-h Holter electrocardiogram monitoring during 2012–2018 in a hospital serving residents that lived in a BQ high prevalence area. Data on substance uses and medical histories for cardiovascular and chronic diseases were collected. Baron–Kenny method was employed to evaluate possible mediation. In patients with cardiopulmonary symptoms, 36.3% were BQ users and 63.7% were nonusers. Adjusting for covariates, BQ chewing was significantly associated with heart failure and diabetes mellitus (adjusted odds ratio (aOR) = 3.4 and 2.3, respectively), but only heart failure was significantly correlated with a low and high level of PVC. Additionally controlling for the effect of heart failure, the risk of high PVC for BQ users reduced from 3.60 to 2.88; however, the risk for BQ chewers remained significant (95% CI: 1.06–7.84). Heart failure was found to explain 27.7% of the excessive effect of BQ use on high PVC. In conclusion, BQ use is directly associated with an elevated risk of high PVC in patients with cardiopulmonary symptoms. The higher risk might be elevated among patients who suffered heart failure. Given several research limitations, the findings from this study offer future opportunities for validation.

Environmental tobacco smoke (ETS) and hyperlipidemia modified by perceived work stress

Background

Accumulating evidence has shown that exposure to environmental tobacco smoke (ETS) is associated with cardiovascular diseases (CVDs) However, few studies have assessed both exposure to ETS and high-perceived work stress on hyperlipidemia. The aim of the present study is to assess the interaction effect of ETS exposure and high-perceived work stress on the risk of hyperlipidemia.

Methods

A total of 11,875 middle-aged civil servants from 647 registered institutions employed by the Taiwan government were randomly selected using multistage stratified cluster sampling based on proportional probabilistic sampling. Each participant anonymously and independently filled out a web-based questionnaire and informed consent.

Results

The prevalence of hyperlipidemia in middle-aged civil servants diagnosed by physicians was 11.5% for men and 6.1% for women. Hyperlipidemia was significantly associated with smoking, alcohol consumption, betel nut chewing, weight gain and perceived work stress. In both the obesity and smoking groups, there were consistent interaction effects of ETS exposure and perceived work stress on hyperlipidemia for middle-aged civil servants. Non-obese and non-smoking groups were more at risk for hyperlipidemia from exposure to both ETS and high-perceived work stress.

Conclusion

There is an interaction effect of ETS exposure and high-perceived work stress on hyperlipidemia, regardless of obesity and smoking. It is crucial to immediately reduce ETS exposure and stressful work by enforcing smoke-free policies and reducing pressure for civil servants.

Investigating Betel Nut Use, Antecedents and Consequences: A Review of Literature

Background: Betel nut use is a public health issue in the Asia-Pacific region that is often neglected. To control betel nut use, understanding of the adverse effects of betel nut use and evidence-based policies and strategies is necessary. Objectives: This narrative review aims to characterize the current situation on betel nut use at a global level regarding the epidemiology, pharmacology and toxicology, health effects, treatment options, policies and strategies. Methods: We found 139 existing literature published between 1970-2019 on the Web of Science database and other technical documents to collate the most relevant information on betel nut use. Data were categorized into appropriate themes. Results: The literature demonstrates that there is a lack of up to date statistics on betel nut use. There is limited research on the effect of policies and strategies to control betel nut use. Conclusion: Betel nut-chewing countries should focus on understanding which populations chew betel nut and implement appropriate policies, educational and cessation programs to help control betel nut use.

Relationship of Oxidative Stress, Inflammation, and the Risk of Metabolic Syndrome in Patients with Oral Cancer

Oral cancer is the fifth leading cause of cancer death in Taiwan, and the prevalence of metabolic syndrome (MS) has also increased globally. The purpose of this study was to investigate the correlations between the components of MS and oxidative stress and inflammation in patients with oral cancer based on their areca-nut-chewing habits. Two hundred patients diagnosed with oral cancer were recruited, and metabolic parameters, oxidative stress, antioxidant enzyme activities, and inflammatory markers were measured. 63% of the subjects have concomitant MS. Subjects who had an areca-nut-chewing habit had significantly higher levels of fasting glucose (p = 0.04), oxidative stress (p = 0.02), and inflammatory markers (p = 0.02) than those who never chewed. High-density lipoprotein-cholesterol level (p = 0.03) and superoxidase dismutase activity (p = 0.02) were significantly lower in individuals who had chewed or were currently chewers. Areca-nut-chewing habit was associated with the increased risks for MS and hypertriglyceridemia; the components of MS were positively correlated with oxidative stress and inflammation. In conclusion, patients with oral cancer who had an areca-nut-chewing habit exhibited higher levels of oxidative stress and inflammation, which might be related to an increased risk of MS.

Areca Nut Chewing and the Risk of Re-hospitalization and Mortality Among Patients With Acute Coronary Syndrome in Pakistan

Objectives

Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users.

Methods

A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS.

Results

Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p<0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p<0.001).

Conclusions

The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.

Areca nut chewing is associated with common mental disorders: a population-based study

INTRODUCTION

Forms of habitual substance use including cigarette smoking and alcohol consumption have been documented as risk factors of common mental disorders (CMDs). The effects of areca nut chewing on biophysiological tests, metabolic syndromes, and liver function have been reported previously; however, the relationship between areca nut chewing and CMDs remains unclear. This study examined the association between areca nut chewing and CMDs and explored the relationships between areca nut chewing and biophysiological indicators.

METHODS

A total of 4477 community dwellers who had enrolled in a cohort study and participated in health examinations in 2 consecutive years were selected for analysis in the present study. The community cohort was established in northern Taiwan during 2006-2012. The Chinese health questionnaire (CHQ-12) was used as a self-reported screening instrument to assess the potential for developing psychotic mental disorders (CHQ-12 score ≥ 3) among the community residents. Biophysiological tests performed 1 year before CMD assessment were analyzed to examine the causal pathways between areca nut chewing and CMDs. Multiple logistic regression and stratified analyses were performed.

RESULTS

A total of 18.23% of the participants were diagnosed as having CMDs. Factors including areca nut chewing [odds ratio (OR) 1.828; 95% confidence interval (CI) 1.165-2.869], sex (women; OR 1.828; 95% CI 1.165-2.869), age (30-49; OR 1.302; 95% CI 1.073-1.579), and socioeconomic status (lower status; OR 1.373; 95% CI 1.084-1.738) were associated with CMDs in a multiple logistic regression model. Areca nut chewers exhibited significantly more triglycerides (220.04 vs. 124.16 mg/dL) and white blood cells (65.17 102/μL vs. 60.36 102/μL) and significantly higher diastolic blood pressure (78.83 vs. 75.84 mmHg) and glutamic oxaloacetic transaminase (30.30 vs. 25.45 U/L) than did the controls.

CONCLUSIONS

This study demonstrated the association between areca nut chewing and CMDs and its effects on biophysiological tests in a community-based population in Taiwan. The findings suggest the existence of mechanistic effects of areca nut chewing on CMDs exerted through multiple pathways that may interact with pre-existing biophysiological abnormalities. Lifestyle variables should be considered for the prevention and management of mental disorders in the future.

The ethics of betel nut consumption in Taiwan

The ethics of betel nut use in Taiwan are examined in this article. It first presents scientific facts about the betel quid, its consumption and negative health consequences and then analyses the cultural background and economic factors contributing to its popularity in Asia. Governmental and institutional attempts to curb betel nut cultivation, distribution and sales are also described. Finally, the bioethical implications of this often ignored subject are considered.

Areca Nut Chewing Complicated with Non-Obstructive and Obstructive ST Elevation Myocardial Infarction

Areca nut chewing is one of the most prevalent substance abuse habits in the world, and it is associated with the risk of a variety of medical challenges including hypertension, arrhythmia, and coronary artery disease (CAD). However, ST elevation myocardial infarction (STEMI) is an extremely rare complication of areca nut chewing. Herein we report two cases where patients suffered from STEMI after areca nut chewing. The first case involved a patient with non-obstructive CAD and non-sustained ventricular tachycardia during hospitalization. The second case revealed left circumflex artery total occlusion, and primary percutaneous coronary intervention was performed. Initially, the levels of arecoline and arecaidine plasma were checked in these two cases after admission. Although both cases revealed increased levels, the second case showed substantially higher values than the first case. In general, these two cases remind physicians that areca nut chewing may cause myocardial injury with different severity, although STEMI with true coronary obstruction remains an extremely rare but possible complication after areca nut chewing.

KEY WORDS

Areca nut chewing; Coronary obstruction; ST elevation myocardial infarction.

Associations of cigarette smoking, betel quid chewing and alcohol consumption with high-sensitivity C-reactive protein in early radiographic knee osteoarthritis: a cross-sectional study

OBJECTIVES

High-sensitivity C-reactive protein (hsCRP) is possibly related to osteoarthritis (OA) progression and a variety of OA-related symptoms. This study aimed to examine associations between cigarette smoking, betel quid chewing and alcohol consumption and hsCRP in early radiographic knee OA.

DESIGN

Cross-sectional health examination survey.

SETTING

This primary study was conducted in a health examination centre in China.

PARTICIPANTS

936 (656 men and 280 women) patients with early radiographic knee OA were included in this cross-sectional study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Smoking status was classified into four levels based on daily smoking habit: 0/day, 1-10/day, 11-20/day and >20/day. Betel quid chewing and alcohol consumption status was divided into 'Yes' or 'No'. Early radiographic knee OA was defined as Kellgren Lawrence (K-L) grade 1 or 2 in at least one leg, and elevated hsCRP was assessed as ≥ 3.0 mg/L.

RESULTS

After adjustment for a number of potential confounding factors, a significant positive association between cigarette smoking and hsCRP was observed in the multivariable model. The multivariable-adjusted ORs (95% CI) of elevated hsCRP (≥ 3.0 mg/L) in the second (1-10/day, n=133), third (11-20/day, n=59) and highest (>20/day, n=104) cigarette smoking categories were 1.54 (95% CI 0.91 to 2.61), 1.27 (95% CI 0.57 to 2.79) and 2.09 (95% CI 1.20 to 3.64), respectively, compared with the non-smoker category (n=640). In addition, there was a positive dose-response relationship between cigarette smoking and elevated hsCRP (p for trend=0.01). No significant associations between betel quid chewing and alcohol consumption and hsCRP were observed in the multivariable model.

CONCLUSIONS

This study indicated that cigarette smoking was positively associated with serum hsCRP level in patients with early radiographic knee OA. However, in view of the nature of cross-sectional designs, the results need to be confirmed by further prospective studies.

Metabolic syndrome and health-related behaviours associated with pre-oral cancerous lesions among adults aged 20-80 years in Yunlin County, Taiwan: a cross-sectional study

OBJECTIVES

To explore the associations of health-related behaviours, metabolic syndrome and risk factors in adults with pre-oral cancerous (POC) lesions in rural, disadvantaged communities with a high prevalence of oral cancer.

DESIGN

A cross-sectional observational study.

SETTING

Community-based health survey in the western coastal area of Yunlin County, Taiwan.

PARTICIPANTS

5161 adult residents participated in this study.

OUTCOME MEASURES

Assessed parameters included oral leukoplakia, oral submucous fibrosis, fasting blood glucose, triglycerides, high-density lipoprotein cholesterol, blood pressure and waist circumference. Statistical analyses included descriptive statistics, χ(2) tests and multivariate binary logistic regression.

RESULTS

A high percentage of participants were found to have metabolic syndrome (40%) and POC lesions (7.3%). Participants with POC lesions tended to be male (p<0.001), betel nut chewers (p<0.001) and cigarette smokers (p<0.001); have a low level of education (p<0.001); seldom undergo dental check-ups (p<0.01); irregularly participate in physical activity (p<0.01) and have metabolic syndrome (p<0.01).

CONCLUSIONS

Although male sex and disadvantaged socioeconomic status are non-modifiable factors associated with POC and metabolic syndrome in adults, several factors, notably health behaviours, are modifiable. Clinicians can reduce the incidence and consequences of POC by developing programmes for early detection, encouraging regular dental check-ups, and initiating individualised, health-promoting behaviour modification programmes for reducing risky behaviours associated with oral cancer.

Low bone mineral density among adults with disabilities in Taiwan: A cross-sectional descriptive study

BACKGROUND

Low bone mineral density (BMD) is a silent disease that can lead to osteoporosis and is a serious health problem worldwide. People with disabilities are especially at risk for fall-related death.

OBJECTIVES

To examine the prevalence of low bone mineral density and associated risk factors among adults with disabilities in Taiwan.

METHODS

We conducted a population-based, cross-sectional study in 2013; the participants were 572 community adults with disabilities over the age of 20 years. Statistical analyses used to evaluate the association included chi-squared tests, ANOVA, and logistic regression.

RESULTS

Over one-third of the participants had an intellectual disability, 26% physical disability, and the remainder had a combination of disabilities. Of the participants, 62.5% had abnormal bone mineral density, and 21.8% met the criteria for osteoporosis. After adjusting for potential confounding variables, the determinant risk factors for low bone mineral density were age (β = -.14, p = 0.002), gender (β = -.12, p = 0.004), and level of physical activity (β = .1, p = 0.024). The majority of participants with low BMD were not aware of abnormal bone density, and only 2.4% had received treatment.

CONCLUSIONS

This study identified a high prevalence of low bone mineral density among adults with disabilities; few of the participants possessed awareness of bone health, and very few received early treatment or information on prevention of osteoporosis. The enhancement of osteoporosis interventions and health promotion programs to prevent osteoporosis and related problems are necessary for this population.

Oral submucous fibrosis: an update

Oral submucous fibrosis (OSF) is a premalignant condition caused by betel chewing. It is very common in Southeast Asia but has started to spread to Europe and North America. OSF can lead to squamous cell carcinoma, a risk that is further increased by concomitant tobacco consumption. OSF is a diagnosis based on clinical symptoms and confirmation by histopathology. Hypovascularity leading to blanching of the oral mucosa, staining of teeth and gingiva, and trismus are major symptoms. Major constituents of betel quid are arecoline from betel nuts and copper, which are responsible for fibroblast dysfunction and fibrosis. A variety of extracellular and intracellular signaling pathways might be involved. Treatment of OSF is difficult, as not many large, randomized controlled trials have been conducted. The principal actions of drug therapy include antifibrotic, anti-inflammatory, and antioxygen radical mechanisms. Potential new drugs are on the horizon. Surgery may be necessary in advanced cases of trismus. Prevention is most important, as no healing can be achieved with available treatments.

Cross sectional survey on association between alcohol, betel- nut, cigarette consumption and health promoting behavior of industrial workers in Ghaziabad

BACKGROUND

The work force in industries are at risk of developing unduly high rates of health and behaviour related problems including abuse of alcohol, betel nut and cigarette (alcohol, betel nut and cigarette consumption). This study describes the relationships between alcohol, betel nut and cigarette consumption and health promoting behaviour among industrial workers.

MATERIALS AND METHODS

A cross sectional survey was conducted on workers in various industries of Ghaziabad city with concerned authority permission. A sample size of 732 workers was calculated based on pilot study. Through Simple random sampling 732 workers in 20 to 50 years age group with informed consent were interviewed through structured, pretested, validated questionnaire in vernacular language by one calibrated investigator. Data on socio demography, alcohol, betel nut and cigarette consumption pattern and health behaviour were collected. The association between health promoting behaviour and alcohol, betel nut and cigarette consumption was analysed by Logistic regression and Chi-square test through SPSS 16 at p<0.05 and 95%CI as significant.

RESULTS

Total prevalence of alcohol, betel nut and cigarette consumption in study population was 88%. The prevalence of individual alcohol, betel nut and cigarette consumption were 82%, 68% and 79% respectively. Combined alcohol, betel nut and cigarette prevalence in study population was 58%. Alcohol and cigarette users were significantly higher (p<0.001) in 30 to 40 years age group with lower level of education having poor attitude towards health promoting behaviour, poor oral hygiene practices and rare indulgence in regular physical exercise.

CONCLUSIONS

This study stimulate further research on exploring methods to prevent initiation of health risk behaviour and promote healthy behaviour with cessation help for the current alcohol, betel nut and cigarette users.

Relationship between betel quid chewing and risks of cardiovascular disease in older adults: a cross-sectional study in Taiwan

BACKGROUND

The association between betel quid (BQ) chewing and oral cancer is well established. However, evidence regarding the relationship between BQ chewing and cardiovascular disease (CVD) is still insufficient.

METHODS

This cross-sectional study included 2002 men and 1175 women aged 50 and older in a city-level health examination survey of an agricultural and fishing population in 2013. In addition to anthropometric parameters, CVD risks were estimated using high-sensitivity C-reactive protein (hs-CRP), brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index. Age, gender, smoking and alcohol drinking status were all incorporated into the multivariate logistic regression model to delineate the effect of BQ chewing on CVD risks.

RESULTS

Two hundred forty-one (12%) males and eight (0.7%) females were ever chewers. BQ chewing was an independent risk factor for general obesity (odds ratio [OR] 1.43, 95% confidence interval [CI] 1.07-1.91, p=0.017), central obesity (OR 2.27, 95% CI 1.53-3.37, p<0.001) and an elevated hs-CRP level (OR 1.38, 95% CI 1.03-1.85, p=0.029). Subjects who chewed more frequently had a higher systolic blood pressure (p=0.025) and baPWV (p=0.006). The waist circumference (p=0.015) and waist-to-height ratio (p=0.022) were greater in current chewers than in former chewers.

CONCLUSION

These findings suggest that BQ chewing is associated with obesity and a higher CVD risk as estimated by hs-CRP. Furthermore, potential beneficial effects of BQ chewing cessation on central obesity were also found.

Association between betel quid chewing and carotid intima-media thickness in rural Bangladesh

BACKGROUND

Areca nut, more commonly known as betel nut, is the fourth most commonly used addictive substance in the world. Though recent evidence suggests it may play a role in the development of cardiovascular disease, no studies have investigated whether betel nut use is related to subclinical atherosclerosis.

METHODS

We evaluated the association between betel nut use and subclinical atherosclerosis in 1206 participants randomly sampled from the Health Effects of Arsenic Longitudinal Study (HEALS). Frequency and duration of betel nut use were assessed at baseline, and carotid IMT was measured on average 6.65 years after baseline.

RESULTS

A positive association was observed between duration and cumulative exposure (function of duration and frequency) of betel nut use and IMT, with above-median use for duration (7 or more years) and cumulative exposure (30 or more quid-years) corresponding to a 19.1 μm [95% confidence interval (CI): 5.3-32.8; P ≤ 0.01] and 16.8 μm (95% CI: 2.9-30.8; P < 0.05) higher IMT in an adjusted model, respectively. This association was more pronounced in men [32.8 μm (95% CI: 10.0-55.7) and 30.9 μm (95% CI: 7.4-54.2)]. There was a synergy between cigarette smoking and above-median betel use such that the joint exposure was associated with a 42.4 μm (95% CI: 21.6-63.2; P ≤ 0.01) difference in IMT.

CONCLUSION

Betel nut use at long duration or high cumulative exposure levels is associated with subclinical atherosclerosis as manifested through carotid IMT. This effect is especially pronounced among men and cigarette smokers.

A review of the systemic adverse effects of areca nut or betel nut

Areca nut is widely consumed by all ages groups in many parts of the world, especially south-east Asia. The objective of this review is to systematically review and collate all the published data that are related to the systemic effects of areca nut. The literature search was performed by an electronic search of the Pubmed and Cochrane databases using keywords and included articles published till October 2012. We selected studies that covered the effect of areca nut on metabolism, and a total of 62 studies met the criteria. There is substantial evidence for carcinogenicity of areca nut in cancers of the mouth and esophagus. Areca nut affects almost all organs of the human body, including the brain, heart, lungs, gastrointestinal tract and reproductive organs. It causes or aggravates pre-existing conditions such as neuronal injury, myocardial infarction, cardiac arrhythmias, hepatotoxicity, asthma, central obesity, type II diabetes, hyperlipidemia, metabolic syndrome, etc. Areca nut affects the endocrine system, leading to hypothyroidism, prostate hyperplasia and infertility. It affects the immune system leading to suppression of T-cell activity and decreased release of cytokines. It has harmful effects on the fetus when used during pregnancy. Thus, areca nut is not a harmless substance as often perceived and proclaimed by the manufacturers of areca nut products such as Pan Masala, Supari Mix, Betel quid, etc. There is an urgent need to recognize areca nut as a harmful food substance by the policy makers and prohibit its glamorization as a mouth freshener. Strict laws are necessary to regulate the production of commercial preparations of areca nut.

Areca nut chewing and risk of atrial fibrillation in Taiwanese men: a nationwide ecological study

BACKGROUND

Areca nut chewing is associated with the risk of obesity, metabolic syndrome, hypertension, and cardiovascular mortality. Although a few case reports or case series have suggested the link between areca nut chewing and cardiac arrhythmias, information about the relationship between areca nut chewing and atrial fibrillation (AF) is lacking. Thus, a nationwide ecological study was conducted to investigate this.

METHODS

Two national datasets, the nationwide population-based 2005 Taiwan National Health Insurance Research dataset (NHIRD) and the 2005 National Health Interview Survey (NHIS), were used for analyses. The clinical characteristics, inhabited area and medical histories for 375,360 eligible males were retrieved from the 2005 NHIRD. Health related behaviors including areca nut chewing, cigarette smoking, infrequent vegetable eating, and exercise habit were collected from the 2005 NHIS. The prevalence of AF and the areca nut chewing rate were evaluated by multivariate analysis.

RESULTS

Of the 375,360 males (mean age, 44 years old), 1,326 (0.35%) were diagnosed with AF. The higher areca nut chewing rate, the higher prevalence rate of AF in Taiwan (Spearman correlation coefficient r=0.558, p=0.007). After adjusting for other covariates, the current areca nut chewing rate was found to be independently associated with the prevalence of AF. The adjusted odd ratio for areca nut chewing was 1.02 (95% CI=1.00-1.04) in risk of AF prevalence.

CONCLUSIONS

Areca nut chewing is independently associated with the prevalence of AF in Taiwanese men. However, further exploration of the underlying mechanisms is necessary.

The impact of estradiol and 1,25(OH)2D3 on metabolic syndrome in middle-aged Taiwanese males

In addition to adipocytokines, estradiol (E2) and vitamin D have been reported to affect insulin sensitivity, glucose homeostasis and body weight. However, studies about the impact of E2 and vitamin D on metabolic syndrome (MetS) are still limited. The aim of this study is to clarify the roles of circulating E2 and vitamin D on the risk of MetS in middle-aged Taiwanese males. A total of 655 male volunteers, including 243 subjects with MetS (mean age: 56.7±5.8 years) and 412 normal controls (mean age: 55.1±3.6 years), were evaluated. Subjects with MetS had significantly lower circulating E2, 1,25(OH)₂D₃, and adiponectin, and higher leptin than those without MetS (P<0.001 for all comparisons). E2 and 1,25(OH)₂D₃ were significantly associated with 4 individual components of MetS; more than adiponectin and leptin that were only associated with 3 individual components. In multivariate regression analysis, E2 (beta = −0.216, P<0.001) and 1,25(OH)₂D₃ (beta = 0.067, P = 0.045) were still significant predictors of MetS independent of adiponectin and leptin. Further large studies are needed to confirm our preliminary results and elucidate the possible mechanism.

Alcohol, betel-nut and cigarette consumption are negatively associated with health promoting behaviors in Taiwan: a cross-sectional study

Background

Oral cancer is the 2^nd most common cause of death due to cancer in the south-western coastal region of Taiwan; the standardized mortality of oral cancer is higher than elsewhere in the world. According to the evidence, alcohol, betel-nut and cigarette (ABC) consumption cause oral, nasopharyngeal and related cancers. This study describes the relationships between ABC consumers and health promoting behaviors among community adults living around an area with a high prevalence of oral cancer.

Methods

A population-based, cross-sectional study design was conducted in oral cancer epidemic areas in south-western coastal Taiwan in 2010, 6,203 community residents over 20 years of age participated. Demographic data, ABC habits, and health-promoting behaviors were explored. A logistic regression analyses were used to identify factors associated with ABC consumers.

Results

A high percentage of participants consumed alcohol, betel-nut and cigarettes. Betel-nut and cigarette consumers took low levels of exercise, adopted a poor diet, and had poor oral hygiene. After adjusting for potential confounders, the logistic regression model indicated that middle aged males of poor education and low economic status, who did not exercise regularly and had poor oral hygiene, were more likely to chew betel quid and smoke cigarettes.

Conclusions

It has identified that BC consumers are negatively associated with health promoting behaviors. Further research is required to understand the reasons why the subjects consume ABC, and explore ways to prevent initiation and enhance cessation of ABC habits in this population.