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Jasim A, Li X, Octavia A, Gunardi I, Crocombe L, Sari EF. The association between betel quid use and oral potentially malignant and malignant disorders in Southeast Asian and Pacific regions: a systematic review and meta-analysis with GRADE evidence profile. FRONTIERS IN ORAL HEALTH 2024; 5:1397179. [PMID: 38846318 PMCID: PMC11153687 DOI: 10.3389/froh.2024.1397179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/15/2024] [Indexed: 06/09/2024] Open
Abstract
Background Betel quid (BQ) chewing is a prevalent habit in the Asian and Pacific regions. It is deeply intertwined within cultural customs, and has been reported to result in oral potentially malignant disorders (OPMDs) and malignant disorders (MDs). Objective We aim to present a summative and broad overview of the burden that BQ chewing has imposed on the residents of the Southeast Asian, Pacific, and Australasian regions, allowing us to quantify the level of impact it is currently causing on the risk of people developing oral cancer. Methods This scoping review and meta-analysis screened databases such as PubMed, MEDLINE, and Google Scholar for publications that investigated the association between BQ and OPMDs and MDs. The search strategy involved MeSH headings relating to BQ, OPMDs, and MDs, and a search for results during the period between January 2010 and June 2023 within the set geographical boundaries of the Southeast Asian and Pacific regions. This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for Scoping Reviews (PRISMA-ScR). R software was used to screen outliers. The included studies were further analysed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results Nine articles (n = 19,312 participants) presented odds ratio outcomes from 11 regionally different study groups. We indicated a strong correlation between BQ chewing and the increased risk of OMPDs and MDs. The risk was quantified through meta-analyses with an odds ratio (OR) of 8.18 (5.27-12.72) and an increased OR of 9.93 (7.36-13.39) when the outlier was removed. BQ chewing was further identified within various Australian communities and discovered to be produced locally in North Queensland. Discussion A meta-analysis of two outcomes revealed substantial heterogeneity and minor evidence of publication bias, thus the association effect was included with and without these articles. The overall GRADE quality of evidence ranged from moderate to very high and highlighted five studies with a high level of imprecision. Conclusion The lingering high prevalence of BQ in the Southeast Asia and Pacific regions, as well as its rising acceptance among non-ethnic Australians, is alarming and requires prompt and rigorous intervention to prevent the risk of oral cancer. Systematic Review Registration PROSPERO (CRD42023429694).
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Affiliation(s)
- Aula Jasim
- Dentistry and Oral Health Discipline, Department of Rural Clinical Science, La Trobe Rural Health School, Bendigo, VIC, Australia
| | - Xia Li
- Department of Mathematical and Physical Sciences, La Trobe University, Bundoora, VIC, Australia
| | - Alfini Octavia
- Faculty of Dentistry, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Indrayadi Gunardi
- Department of Oral Medicine, Faculty of Dentistry, Universitas Trisakti, West Jakarta, Indonesia
| | - Leonard Crocombe
- Dentistry and Oral Health Discipline, Department of Rural Clinical Science, La Trobe Rural Health School, Bendigo, VIC, Australia
- Medicine and Health Science, University of Papua New Guinea, Port Moresby, PapuaNew Guinea
| | - Elizabeth Fitriana Sari
- Dentistry and Oral Health Discipline, Department of Rural Clinical Science, La Trobe Rural Health School, Bendigo, VIC, Australia
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Liu WY, Jiesisibieke ZL, Chien CW, Lee EKL, Tung TH. Type 2 diabetes associated with areca nut usage: A systematic review and meta-analysis. Prev Med 2024; 182:107922. [PMID: 38428680 DOI: 10.1016/j.ypmed.2024.107922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
AIMS/HYPOTHESIS This study aimed to evaluate the potential association between chewing areca nuts and the occurrence of type 2 diabetes and to investigate whether chewing status (current chewers or ex-chewers) affects this association. METHODS We searched The Cochrane Library, PubMed, and EMBASE databases for relevant studies up to May 21, 2023, using predefined inclusion and exclusion criteria. Three population-based studies conducted in Taiwan were included in the systematic review and meta-analysis. RESULTS When combined current or ex-chewers were more likely to develop diabetes (Odds Ratio [OR] = 1.45; 95% confidence interval [CI]: 1.30-1.62) compared to the never chewers. Ex-chewers had a higher risk of diabetes (OR: 1.53, 95% CI: 1.45-1.62) compared to never chewers. However, there was no evidence that current chewers were associated with a higher risk of diabetes compared to never chewers. Male current and ex-chewers were associated with higher risk of diabetes compared with never chewers (OR: 1.55, 95% CI: 1.49-1.61). For females there was insufficient evidence. CONCLUSIONS/INTERPRETATION Existing evidence suggests a link between chewing areca nuts and the development of type 2 diabetes. Therefore, areca chewers should monitor diabetes-related biomarkers.
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Affiliation(s)
- Wen-Yi Liu
- Department of Health Policy Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Shanghai Bluecross Medical Science Institute, Shanghai, China; Shanghai International Medical Center, Shanghai, China; Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, Shenzhen, China
| | - Zhu Liduzi Jiesisibieke
- School of Public Health, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, Shenzhen, China.
| | - Eric Kin-Lap Lee
- Department of Pharmacy and Master Program, Tajen University, Taiwan, No. 20, WeiXin Rd, YanPu Township, PingTung County, 90741, Taiwan, ROC.
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
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Osborne PG, Pasupuleti RR, Lee C, Ponnusamy VK. Towards a replacement therapy for stimulant betel quid dependence: A proof of concept study. Addict Biol 2024; 29:e13371. [PMID: 38380696 PMCID: PMC10898838 DOI: 10.1111/adb.13371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/22/2023] [Accepted: 12/19/2023] [Indexed: 02/22/2024]
Abstract
Stimulant betel quid (SBQ) containing Piper betle leaf (L), green unripe Areca catechu nut (AN) and the alkalizing agent, slaked lime, is an addictive, carcinogenic stimulant, with no pharmacotherapy, chewed by millions of people in the Asia/Pacific region. We compared the in vivo physiological profile of chewing (1) non-stimulant P. betle leaf+AN (LAN), (2) SBQ utilizing slaked lime and (3) a novel SBQ utilizing Mg(OH)2 , as an alkalizing agent, by measuring physiological parameters of intoxication and these were correlated with in vitro levels of alkaloids measured by UHPLC-MS/MS. Chewing LAN, which contains high levels of arecoline, had no stimulatory physiological effect. Chewing SBQ containing slaked lime or novel SBQ containing Mg(OH)2 , induced equivalent stimulatory physiological responses. In vitro, slaked lime hydrolyzed muscarinic esters in LAN while Mg(OH)2 did not. The physiological stimulation induced by chewing both SBQ and the lack of physiology to chewing LAN can be explained by changes in lipid solubility of phytochemicals induced by mouth pH during chewing of basic SBQ or acidic LAN. Since antiquity people have added slaked lime to SBQ to enhance absorption of phyto-chemicals across oral membranes to stimulate physiology. The same physiological changes can be induced by substituting slaked lime for less physically and chemically destructive bases. If attitudes regarding SBQ dependence can advance towards the more progressive attitudes already used to help smokers quit tobacco, modern chemistry has the potential to make chewing SBQ safer and quitting programs may become more accessible and efficacious.
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Affiliation(s)
| | - Ragavendra Rao Pasupuleti
- Department of Medicinal and Applied ChemistryKaohsiung Medical University (KMU)Kaohsiung CityTaiwan
- Present address:
Department of ChemistryIndiana University BloomingtonINUSA
| | - Chien‐Hung Lee
- Research Center for Precision Environmental MedicineKaohsiung Medical University (KMU)Kaohsiung CityTaiwan
- Department of Public Health, College of Health SciencesKaohsiung Medical University (KMU)Kaohsiung CityTaiwan
- Department of Medical ResearchKaohsiung Medical University Hospital (KMUH)Kaohsiung CityTaiwan
| | - Vinoth Kumar Ponnusamy
- Department of Medicinal and Applied ChemistryKaohsiung Medical University (KMU)Kaohsiung CityTaiwan
- Research Center for Precision Environmental MedicineKaohsiung Medical University (KMU)Kaohsiung CityTaiwan
- Department of Medical ResearchKaohsiung Medical University Hospital (KMUH)Kaohsiung CityTaiwan
- Department of ChemistryNational Sun Yat‐sen University (NSYSU)Kaohsiung CityTaiwan
- Program of Aquatic Science and Technology, College of Hydrosphere ScienceNational Kaohsiung University of Science and Technology (NKUST)Kaohsiung CityTaiwan
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Diwan P, Nirwan M, Bahuguna M, Kumari SP, Wahlang J, Gupta RK. Evaluating Alterations of the Oral Microbiome and Its Link to Oral Cancer among Betel Quid Chewers: Prospecting Reversal through Probiotic Intervention. Pathogens 2023; 12:996. [PMID: 37623956 PMCID: PMC10459687 DOI: 10.3390/pathogens12080996] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Areca nut and slaked lime, with or without tobacco wrapped in Piper betle leaf, prepared as betel quid, is extensively consumed as a masticatory product in many countries across the world. Betel Quid can promote the malignant transformation of oral lesions as well as trigger benign cellular and molecular changes. In the oral cavity, it causes changes at the compositional level in oral microbiota called dysbiosis. This dysbiosis may play an important role in Oral Cancer in betel quid chewers. The abnormal presence and increase of bacteria Fusobacterium nucleatum, Capnocytophaga gingivalis, Prevotella melaninogenica, Peptostreptococcus sp., Porphyromonas gingivalis, and Streptococcus mitis in saliva and/or other oral sites of the cancer patients has attracted frequent attention for its association with oral cancer development. In the present review, the authors have analysed the literature reports to revisit the oncogenic potential of betel quid and oral microbiome alterations, evaluating the potential of oral microbiota both as a driver and biomarker of oral cancer. The authors have also shared a perspective that the restoration of local microbiota can become a potentially therapeutic or prophylactic strategy for the delay or reversal of lip and oral cavity cancers, especially in high-risk population groups.
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Affiliation(s)
- Prerna Diwan
- Department of Microbiology, Ram Lal Anand College, University of Delhi, New Delhi 110021, India; (M.N.); (M.B.); (S.P.K.); (R.K.G.)
| | - Mohit Nirwan
- Department of Microbiology, Ram Lal Anand College, University of Delhi, New Delhi 110021, India; (M.N.); (M.B.); (S.P.K.); (R.K.G.)
| | - Mayank Bahuguna
- Department of Microbiology, Ram Lal Anand College, University of Delhi, New Delhi 110021, India; (M.N.); (M.B.); (S.P.K.); (R.K.G.)
| | - Shashi Prabha Kumari
- Department of Microbiology, Ram Lal Anand College, University of Delhi, New Delhi 110021, India; (M.N.); (M.B.); (S.P.K.); (R.K.G.)
| | - James Wahlang
- Department of Biochemistry, St. Edmund’s College, Shillong 793003, India;
| | - Rakesh Kumar Gupta
- Department of Microbiology, Ram Lal Anand College, University of Delhi, New Delhi 110021, India; (M.N.); (M.B.); (S.P.K.); (R.K.G.)
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Nokovitch L, Maquet C, Crampon F, Taihi I, Roussel LM, Obongo R, Virard F, Fervers B, Deneuve S. Oral Cavity Squamous Cell Carcinoma Risk Factors: State of the Art. J Clin Med 2023; 12:jcm12093264. [PMID: 37176704 PMCID: PMC10179259 DOI: 10.3390/jcm12093264] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Head and neck (HN) squamous cell carcinomas (SCCs) originate from the epithelial cells of the mucosal linings of the upper aerodigestive tract, which includes the oral cavity, the pharynx, the larynx, and the sinonasal cavities. There are many associated risk factors, including alcohol drinking coupled with tobacco use, which accounts for 70% to 80% of HNSCCs. Human papilloma virus (HPV) is another independent risk factor for oropharyngeal SCC, but it is only a minor contributor to oral cavity SCC (OSCC). Betel quid chewing is also an established risk factor in southeast Asian countries. However, OSCC, and especially oral tongue cancer, incidence has been reported to be increasing in several countries, suggesting risk factors that have not been identified yet. This review summarizes the established risk factors for oral cavity squamous cell carcinomas and examines other undemonstrated risk factors for HNSCC.
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Affiliation(s)
- Lara Nokovitch
- Department of Otolaryngology-Head and Neck Surgery, CHU Rouen, 76000 Rouen, France
| | - Charles Maquet
- Department of Otolaryngology-Head and Neck Surgery, CHU Rouen, 76000 Rouen, France
| | - Frédéric Crampon
- Department of Otolaryngology-Head and Neck Surgery, CHU Rouen, 76000 Rouen, France
| | - Ihsène Taihi
- Oral Surgery Department, Rothschild Hospital, 75012 Paris, France
- URP 2496, Laboratory of Orofacial Pathologies, Imaging and Biotherapies, UFR Odontology, Health Department, Université Paris Cité, 92120 Montrouge, France
| | - Lise-Marie Roussel
- Department of Head and Neck Cancer and ENT Surgery, Centre Henri Becquerel, 76038 Rouen, France
- Rouen Cancer Federation, 76000 Rouen, France
| | - Rais Obongo
- Department of Head and Neck Cancer and ENT Surgery, Centre Henri Becquerel, 76038 Rouen, France
- Rouen Cancer Federation, 76000 Rouen, France
| | - François Virard
- INSERM U1052-CNRS UMR5286, Cancer Research Center, Centre Léon Bérard, University Claude Bernard Lyon 1, 69008 Lyon, France
- Faculté d'Odontologie, Hospices Civils de Lyon, University of Lyon, 69002 Lyon, France
| | - Béatrice Fervers
- Département Prévention Cancer Environnement, Centre Léon Bérard, 69008 Lyon, France
- INSERM UMR 1296, "Radiations: Défense, Santé, Environnement", Centre Léon Bérard, 69008 Lyon, France
| | - Sophie Deneuve
- Department of Otolaryngology-Head and Neck Surgery, CHU Rouen, 76000 Rouen, France
- Rouen Cancer Federation, 76000 Rouen, France
- Quantification en Imagerie Fonctionnelle-Laboratoire d'Informatique, du Traitement de l'Information et des Systèmes Equipe d'Accueil 4108 (QuantIF-LITIS EA4108), University of Rouen, 76000 Rouen, France
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Ko AMS, Tu HP, Ko YC. Systematic Review of Roles of Arecoline and Arecoline N-Oxide in Oral Cancer and Strategies to Block Carcinogenesis. Cells 2023; 12:1208. [PMID: 37190117 PMCID: PMC10137008 DOI: 10.3390/cells12081208] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
Betel quid and areca nut are complex mixture carcinogens, but little is known about whether their derived single-agent arecoline or arecoline N-oxide (ANO) is carcinogenic, and the underlying mechanisms remain unclear. In this systematic review, we analyzed recent studies on the roles of arecoline and ANO in cancer and strategies to block carcinogenesis. In the oral cavity, flavin-containing monooxygenase 3 oxidizes arecoline to ANO, and both alkaloids conjugate with N-acetylcysteine to form mercapturic acid compounds, which are excreted in urine, reducing arecoline and ANO toxicity. However, detoxification may not be complete. Arecoline and ANO upregulated protein expression in oral cancer tissue from areca nut users compared to expression levels in adjacent normal tissue, suggesting a causal relationship between these compounds and oral cancer. Sublingual fibrosis, hyperplasia, and oral leukoplakia were diagnosed in mice subjected to oral mucosal smearing of ANO. ANO is more cytotoxic and genotoxic than arecoline. During carcinogenesis and metastasis, these compounds increase the expression of epithelial-mesenchymal transition (EMT) inducers such as reactive oxygen species, transforming growth factor-β1, Notch receptor-1, and inflammatory cytokines, and they activate EMT-related proteins. Arecoline-induced epigenetic markers such as sirtuin-1 hypermethylation, low protein expression of miR-22, and miR-886-3-p accelerate oral cancer progression. Antioxidants and targeted inhibitors of the EMT inducers used reduce the risk of oral cancer development and progression. Our review findings substantiate the association of arecoline and ANO with oral cancer. Both of these single compounds are likely carcinogenic to humans, and their mechanisms and pathways of carcinogenesis are useful indicators for cancer therapy and prognosis.
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Affiliation(s)
- Albert Min-Shan Ko
- Department of Biomedical Sciences, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan 33302, Taiwan
- Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
- Health Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Ying-Chin Ko
- Department of Medical Research, China Medical University Hospital, China Medical University, No. 2 Yu-Der Road, Taichung 40447, Taiwan
- Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei 106216, Taiwan
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Factors in oral-related quality of life of betel quid users receiving oral mucosal screening: a cross‑sectional study in Taiwan. BMC Oral Health 2023; 23:88. [PMID: 36782200 PMCID: PMC9924842 DOI: 10.1186/s12903-023-02800-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Betel quid (BQ) chewing is associated with poor oral hygiene, psychological impairment, and acute and long-term addictive effects, resulting in worse oral-related quality of life (OHRQoL). The purpose of this study was to characterize the factors associated with OHRQoL among BQ users receiving oral mucosal screening. METHODS A cross-sectional study was conducted. Data were collected by random sampling of BQ users who visited outpatient departments receiving oral mucosal screening in a medical center Taiwan. The oral health assessment tool, the state anxiety inventory, the betel quid dependence scale, and the oral health impact profile were used to measure oral health status, anxiety, BQ dependence, and OHRQoL, respectively. Pearson's product-moment coefficient was used to examine the relationship between OHRQoL and the selected independent variables. Independent-samples t-test was used to compare OHRQoL by annual family income, the presence of chronic disease, and BQ dependence. Hierarchical multiple linear regression analysis was used to identify factors associated with OHRQoL. RESULTS A total of 175 BQ users were surveyed. Factors associated with OHRQoL included oral health status, anxiety, and BQ dependence. BQ users reporting low oral health status, greater anxiety, and more BQ dependence were more likely to have worse OHRQoL. CONCLUSIONS Poor oral health status, anxiety, and BQ dependence negatively impact on OHRQoL among patients with BQ use receiving oral mucosal screening.
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Effects of DSM-5 Betel-Quid-Related Symptoms, Pathological Behaviors, and Use Disorder on Oral Squamous Cell Carcinoma Risk. Cancers (Basel) 2022; 14:cancers14163974. [PMID: 36010966 PMCID: PMC9406538 DOI: 10.3390/cancers14163974] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/07/2022] [Accepted: 08/15/2022] [Indexed: 01/08/2023] Open
Abstract
Simple Summary This is the first study using psychometrics to investigate the association of the DSM-5 betel-quid (BQ)-related symptoms, pathological behaviors, and BQ use disorder (BUD) severity with the risk of oral squamous cell carcinoma (OSCC). This study presents data demonstrating that the symptoms of unsuccessful cutdown of BQ consumption, neglecting major roles, social or interpersonal problems, abandoning or limiting activities, hazardous use, and continued use despite awareness of the dangers were associated with the risk of OSCC. Pathological behavior of risky BQ use enhanced OSCC risk in chewers with moderate-to-severe BUD. BQ chewing is a major risk factor for oral cavity cancers; however, the risk can be mitigated by reducing pathological use. Our study indicates that targeting BUD and establishing a BUD-based strategy is a promising new direction for the prevention of OSCC. Abstract The neuroactive alkaloids in betel quid (BQ) can induce BQ addiction. We conducted a case–control study to investigate the effects of BQ-associated DSM-5 symptoms, pathological behaviors, and BQ use disorder (BUD) on oral squamous cell carcinoma (OSCC) risk. A total of 233 patients with newly diagnosed and histopathologically confirmed OSCC and 301 sex- and age-matched controls were included. BQ-related DSM-5 symptoms in the 12 months prior to disease onset were used to measure psychiatric characteristics and BUD. Compared with nonchewers, chewers with the symptoms of unsuccessful cutdown of BQ consumption, neglecting major roles, social or interpersonal problems, abandoning or limiting activities, hazardous use, and continued use despite the awareness of the dangers had a 54.8-, 49.3-, 49.9-, 40.4-, 86.2-, and 42.9-fold higher risk of developing OSCC, respectively. Mild-to-moderate and severe BUD were, respectively, associated with a 8.2–8.5- and 42.3-fold higher OSCC risk, compared with BQ nonuse. Risky BQ use of pathological behavior was associated with a 12.5-fold higher OSCC risk in chewers with no BUD or mild BUD and a 65.0-fold higher risk in chewers with moderate-to-severe BUD (p for risk heterogeneity between the two BUD groups, 0.041). In conclusion, BQ-associated DSM-5 symptoms, pathological behaviors, and BUD severity are associated with the impact of BQ chewing on OSCC development. The pathological behavior of risky BQ use enhances OSCC risk in chewers with moderate-to-severe BUD. Preventing BUD in new BQ users and treating BUD in chewers who already have the disorder are two priorities in areas where BQ chewing is prevalent.
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Chou YT, Sun ZJ, Shen WC, Yang YC, Lu FH, Chang CJ, Li CY, Wu JS. Cumulative Betel Quid Chewing and the Risk of Significant Liver Fibrosis in Subjects With and Without Metabolic Syndrome. Front Nutr 2022; 9:765206. [PMID: 35223941 PMCID: PMC8873786 DOI: 10.3389/fnut.2022.765206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Betel quid chewing is associated with metabolic disorders, oral cancer, cardiovascular disease, and chronic liver diseases. Metabolic syndrome (MetS) is also a factor associated with liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). However, studies on the relationship between betel quid and liver fibrosis while also considering MetS are lacking. The aim of this study was thus to investigate the association of betel quid chewing and liver fibrosis with MetS. Methods A total of 9,221 subjects were enrolled after excluding subjects <18 years of age, with past history of chronic liver diseases, cancer, significant alcohol consumption, and incomplete data. Betel nut chewing habit was classified into three groups: none, former-chewing, and current-chewing, and cumulative exposure was calculated by multiplying the duration with the quantity. Liver fibrosis was evaluated based on the NAFLD fibrosis score (NFS), which is a composite score of age, hyperglycemia, BMI, platelet count, albumin, and the AST/ALT ratio. Significant liver fibrosis was defined as NFS ≥-1.455. Results After adjusting for other variables, MetS was positively associated with significant liver fibrosis. Subjects with both MetS and betel quid chewing had a higher associated risk of significant liver fibrosis than those with neither MetS nor betel quid chewing (adjusted OR: 3.03, 95% CI: 2.04–4.50, p < 0.001). Betel quid chewing was associated with significant liver fibrosis (adjusted OR: 2.00, 95% CI: 1.14–3.49, p = 0.015) in subjects with MetS, but not in subjects without. Conclusion Metabolic syndrome increased the associated risk of significant liver fibrosis. Cumulative betel quid exposure increased the associated risk of significant liver fibrosis in subjects with MetS, but not in subjects without.
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Affiliation(s)
- Yu-Tsung Chou
- Department of Health Management Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Zih-Jie Sun
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan
| | - Wei-Chen Shen
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Feng-Hwa Lu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Community Healthcare Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Geriatric Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Jen Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- *Correspondence: Jin-Shang Wu
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Adnan Y, Ali SMA, Awan MS, Zahid N, Awan MO, Afzal Kayani H, Farooqui HA. Body Mass Index and Diabetes Mellitus May Predict Poorer Overall Survival of Oral Squamous Cell Carcinoma Patients: A Retrospective Cohort From a Tertiary-Care Centre of a Resource-Limited Country. CLINICAL MEDICINE INSIGHTS: ONCOLOGY 2022; 16:11795549221084832. [PMID: 35342323 PMCID: PMC8943457 DOI: 10.1177/11795549221084832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/15/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction: Oral squamous cell carcinoma (OSCC) is one of the highest-ranking cancers
among both genders in Pakistan. Obesity is linked to a much higher risk for
developing multiple cancer types. Individuals with Diabetes mellitus (DM)
face an increased risk for developing oral cancer. Hence, the objective of
this study was to identify the effect of obesity and DM on the prognosis of
OSCC patients. Methods: This retrospective cohort analysis was conducted on 386 patients diagnosed
and treated for OSCC at The Aga Khan University Hospital, Karachi, Pakistan.
Patient information was obtained from hospital medical records. Obesity was
defined as having a body mass index (BMI) of ⩾25 kg/m2 according
to the WHO Asian cut-offs for BMI. Patient BMI was correlated with diabetes
status, clinicopathological features and overall survival. Kaplan-Meier
survival analysis was performed, along with univariate and multivariate cox
regression analysis to test the effect of obesity and diabetes on overall
survival. Results: In a set of 386 patients, there were 296 males (76.7%) and 90 females
(23.3%). The mean BMI was 24.4 (SD ± 5.25) and 42.7% of patients were found
to be obese (⩾25 BMI). 64 patients (16.6%) were diabetic. The risk of death
was significantly higher in underweight patients (P = .035)
compared with normal weight individuals. Diabetics had a higher mean BMI
compared with non-diabetics. However, DM was not a statistically valid
predictor of survival. Conclusion: Underweight OSCC patients were at a higher risk of death compared with normal
weight OSCC patients.
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Affiliation(s)
- Yumna Adnan
- Office of Academia and Research in Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
- Department of Biosciences, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Karachi, Pakistan
| | - Syed Muhammad Adnan Ali
- Office of Academia and Research in Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Sohail Awan
- Section of Otolaryngology, Head & Neck Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Nida Zahid
- Office of Academia and Research in Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | | | - Hammad Afzal Kayani
- Department of Biosciences, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Karachi, Pakistan
| | - Hasnain Ahmed Farooqui
- Office of Academia and Research in Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
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11
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Chen P, Lin C, Yang S, Chang Y. Oral submucous fibrosis stimulates invasion and epithelial-mesenchymal transition in oral squamous cell carcinoma by activating MMP-2 and IGF-IR. J Cell Mol Med 2021; 25:9814-9825. [PMID: 34528373 PMCID: PMC8505822 DOI: 10.1111/jcmm.16929] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/15/2021] [Accepted: 09/01/2021] [Indexed: 12/11/2022] Open
Abstract
Oral submucous fibrosis (OSF) involves a high risk of malignant transformation and has been implicated in oral cancer. Limited studies have been conducted on the role of OSF in relation to the invasive capabilities and epithelial-mesenchymal transition (EMT) in oral cancer. Herein, we investigated the effects of OSF on the microenvironment of human oral cancer cells. The results showed that the conditioned medium (CM) of fibrotic buccal mucosal fibroblasts (fBMFs) strongly induced the invasion of oral cancer cells and increased the activities of matrix metalloproteinase-2. OSF significantly induced the EMT in oral cancer cells and downregulated epithelial markers, such as E-cadherin, but significantly elevated vimentin, fibronectin, N-cadherin, RhoA, Rac-1 and FAK. Insulin-like growth factor-1 (IGF-1) was elevated in OSF. The protein levels of the IGF-1R were upregulated specifically in fBMF CM treatment for oral cancer cells, and the IGFR gene was confirmed by The Cancer Genome Atlas patient transcriptome data. The Kaplan-Meier curve analysis revealed that patients with oral squamous cell carcinoma and high IGFR expression levels had poorer 5-year survival than those with low IGFR expression (p = 0.004). The fBMF-stimulated EMT cell model may recapture some of the molecular changes during EMT progression in clinical patients with oral cancer.
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Affiliation(s)
- Pei‐Ni Chen
- Clinical LaboratoryChung Shan Medical University HospitalTaichungTaiwan
- Institute of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Chiao‐Wen Lin
- Institute of Oral SciencesChung Shan Medical UniversityTaichungTaiwan
- Department of DentistryChung Shan Medical University HospitalTaichungTaiwan
| | - Shun‐Fa Yang
- Institute of MedicineChung Shan Medical UniversityTaichungTaiwan
- Department of Medical ResearchChung Shan Medical University HospitalTaichungTaiwan
| | - Yu‐Chao Chang
- Department of DentistryChung Shan Medical University HospitalTaichungTaiwan
- School of DentistryChung Shan Medical UniversityTaichungTaiwan
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12
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Yuan F, Yu J, Liao G, Li J, Long T, Li Y, Chen D, Dai Q, Zhu X, Hu S, Qian Z. 18 F-2-fluoro-2-deoxy-D-glucose-positron emission tomography metabolic pattern assessment in the brain of betel quid dependent individuals. Addict Biol 2021; 26:e13043. [PMID: 33908137 DOI: 10.1111/adb.13043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022]
Abstract
The primary objective of this study was to identify the metabolic pattern in the brains of betel quid dependent (BQD) individuals using 18 F-2-fluoro-2-deoxy-D-glucose-positron emission tomography (18 F-FDG-PET). A total of 42 individuals (16 BQD individuals and 26 healthy controls, HCs) enrolled at the Department of Nuclear Medicine of Xiangya Hospital underwent brain 18 F-FDG-PET. Group comparisons using statistical parametric mapping (SPM) were performed to identify the 18 F-FDG-PET patterns. Standardized uptake value ratios of anterior cingulate, frontal, thalamus, parietal, occipital, temporal and cerebellum were calculated by SPM. The characteristics of abnormal metabolism in brain regions were quantified using the xjView toolbox, and a 3-D brain map was drawn using BrainNet Viewer. We found significant metabolic reduction in the bilateral middle prefrontal cortex (PFC) and the left orbital frontal gyrus (OFC). In contrast, hypermetabolism was observed in the inferior cerebellum, fusiform, superior cerebellum, parahippocampal, vermis, lingual and thalamus. However, we found no significant difference between the BQD and HC group in the anterior cingulate, thalamus, cerebellum and frontal, temporal, parietal and occipital lobes. In summary, we found abnormal 18 F-FDG-PET metabolic pattern in BQD individuals, and this pattern may help the treatment of BQD.
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Affiliation(s)
- Fulai Yuan
- Health Management Center, Xiangya Hospital Central South University Changsha China
| | - Jie Yu
- Department of Nuclear Medicine, XiangYa Hospital Central South University Changsha China
| | - Guang Liao
- Department of Nuclear Medicine, XiangYa Hospital Central South University Changsha China
| | - Jian Li
- Department of Nuclear Medicine, XiangYa Hospital Central South University Changsha China
| | - Tingting Long
- Department of Nuclear Medicine, XiangYa Hospital Central South University Changsha China
| | - Yulai Li
- Department of Nuclear Medicine, XiangYa Hospital Central South University Changsha China
| | - Dengming Chen
- Department of Nuclear Medicine, XiangYa Hospital Central South University Changsha China
| | - Qionghai Dai
- Department of Automation, Tsinghua National Laboratory for Information Science and Technology Tsinghua University Beijing China
| | - Xueling Zhu
- Department of Radiology, Xiangya Hospital Central South University Changsha China
| | - Shuo Hu
- Department of Nuclear Medicine, XiangYa Hospital Central South University Changsha China
- Key Laboratory of Biological Nanotechnology of National Health Commission Changsha China
- National Clinical Research Center for Geriatric Diseases (XIANGYA) Changsha China
| | - Zhaoxin Qian
- Department of Emergency, XiangYa Hospital Central South University Changsha China
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13
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Worakhajit P, Fuangtharnthip P, Khovidhunkit SOP, Chiewwit P, Klongnoi B. The Relationship of Tobacco, Alcohol, and Betel Quid with the Formation of Oral Potentially Malignant Disorders: A Community-Based Study from Northeastern Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8738. [PMID: 34444487 PMCID: PMC8392647 DOI: 10.3390/ijerph18168738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 01/05/2023]
Abstract
This study's objective was to describe the relationship between the main risk factors for oral cancer, including tobacco (in the form of cigarettes, smokeless tobacco (SLT), secondhand smoking (SS)), alcohol, and betel quid (BQ), and the occurrence of oral potentially malignant disorders (OPMDs). A community-based case-control study was conducted with a population of 1448 adults aged 40 years or above in northeastern Thailand. Patients aged 60 years or above (OR 1.79, p < 0.001) and female patients (OR 2.17, p < 0.001) had a significant chance of having OPMDs. Our multivariate analysis showed that the most potent risk factor for OPMDs occurrence was betel quid (BQ) (adjusted OR 4.65, p < 0.001), followed by alcohol (OR 3.40, p < 0.001). Even former users were at risk of developing OPMDs. The synergistic effect between these main risk factors was significantly shown in the group exposed to SLT, SS, BQ, and alcohol. The most potent synergistic effect was found in the group exposed to SLT, BQ and alcohol with the OR = 20.96.
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Affiliation(s)
- Prangtip Worakhajit
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand; (P.W.); (P.C.)
| | - Pornpoj Fuangtharnthip
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand; (P.F.); (S.-o.P.K.)
| | | | - Pim Chiewwit
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand; (P.W.); (P.C.)
| | - Boworn Klongnoi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand; (P.W.); (P.C.)
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14
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Chung CM, Kuo TM, Yeh KT, Lee CH, Ko YC. Reduction in and Preventive Effects for Oral-Cancer Risk with Antidepressant Treatment. J Pers Med 2021; 11:jpm11070591. [PMID: 34201475 PMCID: PMC8307663 DOI: 10.3390/jpm11070591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 11/17/2022] Open
Abstract
Areca nut (AN) was identified as carcinogenic to humans. Around 600 million people globally use AN in some form, yet no effective therapeutic drug is available to overcome AN addiction. This preclinical study examines the effects of antidepressants on AN use with animal models. We produced AN powder and dissolved it into drinking water, training 55 C57BL/6 mice in free self-selection to drink AN water or normal water. Then, the mice were randomly divided into four groups. Selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants (TCAs) were given as three treatment groups and one placebo group for four weeks. In the follow-up period, the preference and amount of free selection of AN and normal water, and oral pathological change were evaluated. There was a significant decrease in preference for AN drinking during the first four weeks, and the 36th week after drug withdrawal in the MAOI and SSRI groups (all p < 0.05). The drug-reducing effect of AN water in the 1–4-week period was significant in the MAOI group (p < 0.0001) and was also significant in the 3–4-week period in the SSRI group (p = 0.03). The TCA group did not show a decrease effect. At the endpoint (60 weeks), oral mucosal fibrosis (OSF) levels and risk in the SSRI (p = 0.0081) and MAOI (p = 0.01) groups were significantly lower than those in the control group. Antidepressant drugs MAOIs and SSRIs could reduce the amount of AN use and decrease the early stage of oral fibrosis in mice, but SSRIs may need to be boosted again.
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Affiliation(s)
- Chia-Min Chung
- Center for Drug Abuse and Addiction, China Medical University Hospital, Taichung 40447, Taiwan;
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40447, Taiwan
- Environment-Omics-Diseases Research Centre, China Medical University Hospital, China Medical University, No. 2 Yude Road, Taichung 40447, Taiwan;
| | - Tzer-Min Kuo
- Environment-Omics-Diseases Research Centre, China Medical University Hospital, China Medical University, No. 2 Yude Road, Taichung 40447, Taiwan;
| | - Kun-Tu Yeh
- Department of Pathology, Changhua Christian Hospital, Changhua 50006, Taiwan;
| | - Chien-Hung Lee
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Ying-Chin Ko
- Environment-Omics-Diseases Research Centre, China Medical University Hospital, China Medical University, No. 2 Yude Road, Taichung 40447, Taiwan;
- Correspondence: or ; Tel.: +886-4-2205-2121 (ext. 2028)
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15
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Athukorala IA, Tilakaratne WM, Jayasinghe RD. Areca Nut Chewing: Initiation, Addiction, and Harmful Effects Emphasizing the Barriers and Importance of Cessation. JOURNAL OF ADDICTION 2021; 2021:9967097. [PMID: 34123457 PMCID: PMC8192186 DOI: 10.1155/2021/9967097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 12/05/2022]
Abstract
Areca nut is a highly addictive substance with carcinogenic properties and causes many harmful effects to the human body. Alkaloids are the major chemicals found in areca nut, and their mechanism of action has been studied for several years. About 600 million people around the world use areca nut, and its usage is higher in Asian countries. Areca nut chewers get used to the habit mainly due to social influence, stress, or lack of awareness. Some studies have reported a dependence syndrome related to areca nut chewing. Even though there are many ongoing research studies regarding tobacco addiction, less concern has been given to the areca nut addiction. There are only few studies related to areca nut cessation, and even those few cessation programs are mainly designed using tobacco cessation methodology. Sociocultural influence, behavioral factors, and accessibility are the main barriers to cessation. Behavior changing interventions proved to be more effective in areca nut cessation, but recently studies on pharmacological therapies are also emerging.
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Affiliation(s)
- I. A. Athukorala
- Centre for Research in Oral Cancer, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - W. M. Tilakaratne
- Centre for Research in Oral Cancer, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - R. D. Jayasinghe
- Centre for Research in Oral Cancer, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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16
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Nithiyanantham S, Arumugam S, Hsu HT, Chung CM, Lee CP, Tsai MH, Yeh KT, Luo SY, Ko YC. Arecoline N-oxide initiates oral carcinogenesis and arecoline N-oxide mercapturic acid attenuates the cancer risk. Life Sci 2021; 271:119156. [PMID: 33548289 DOI: 10.1016/j.lfs.2021.119156] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 01/29/2023]
Abstract
Arecoline N-oxide (ANO), an oxidative metabolite of the areca nut, is a predictable initiator in carcinogenesis. The mechanisms of arecoline metabolites in human cancer specimens is still limited. This present study aims to estimate the oral squamous cell carcinoma (OSCC) inductive activity between arecoline metabolites in human cancer specimens/OSCC cells. We have collected 22 pairs (tumor and non-tumor part) of patient's specimens and checked for clinical characteristics. The identification of arecoline and its metabolites levels by using LC-MS/MS. The NOD/SCID mice model was used to check the OSCC inductive activity. The tumor part of OSCC samples exhibited higher levels of arecoline and ANO. Besides, ANO treated mice accelerates the NOTCH1, IL-17a and IL-1β expressions compared to the control mice. ANO exhibited higher cytotoxicity, intracellular ROS levels and decline in antioxidant enzyme levels in OC-3 cells. The protein expression of NOTCH1 and proliferation marker levels are significantly lower in NOM treated cells. Overall, ANO induced initial stage carcinogenesis in the oral cavity via inflammation, ROS and depletion of antioxidant enzymes. Arecoline N-oxide mercapturic acid (NOM) attenuates the initiation of oral carcinogenesis.
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Affiliation(s)
- Srinivasan Nithiyanantham
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Sankar Arumugam
- Department of Chemistry, National Chung Hsing University, Taichung, Taiwan
| | - Hui-Ting Hsu
- Department of Surgical Pathology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-Min Chung
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chi-Pin Lee
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ming-Hsui Tsai
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan
| | - Kun-Tu Yeh
- Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
| | - Shun-Yuan Luo
- Department of Chemistry, National Chung Hsing University, Taichung, Taiwan
| | - Ying-Chin Ko
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.
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17
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Ko AMS, Lee CH, Ko AMJ, Ko YC. Betel quid dependence mechanism and potential cessation therapy. Prog Neuropsychopharmacol Biol Psychiatry 2020; 103:109982. [PMID: 32454163 DOI: 10.1016/j.pnpbp.2020.109982] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Global reports estimate the number of betel quid (BQ) chewers up to 600 million. The proportion of betel quid dependence (BQD) is 20%-90% among current users. BQD mechanisms are not fully understood, and no pharmacological solution exists for its cessation therapy. METHODS We present a systematic review on BQD mechanisms and examine potential cessation therapeutic drugs. We conducted a systematic literature search in PubMed and Web of Science databases and identified the latest 10 years' relevant articles for reviews. RESULTS Functional magnetic resonance imaging results demonstrate that neurological mechanisms link the brain reward, cognitive, and impulsive systems in BQ or BQD users. The use of the areca nut increases both brain serotonin and noradrenaline levels, whereas arecoline, a potentially addictive areca nut component, has monoamine oxidase-A (MAO-A) inhibitor-like properties. MAO-A inhibitors prevent neurotransmitter breakdown and increase dopamine and serotonin concentrations in the brain. A reduction of daily BQ use was observed among patients with depression after antidepressant therapy, including MAO-A inhibitor and selective serotonin reuptake inhibitor (SSRI). Arecoline is a nicotinic acetylcholine receptor agonist expressed in Xenopus oocytes. However, relatively negligible amounts of nicotine are detected in the areca nut. CONCLUSION In conclusion, the current evidence provides a better understanding of the neurological and pharmacological mechanisms behind BQD. Arecoline, an MAO-A inhibitor, may account for BQD. Future translational studies are needed to verify the efficacy of potential BQD cessation drugs. MAO-A inhibitor and SSRI would thus be potentially promising targets for clinical trials.
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Affiliation(s)
- Albert Min-Shan Ko
- Key Laboratory of Vertebrate Evolution and Human Origins of Chinese Academy of Sciences, Institute of Vertebrate Paleontology and Paleoanthropology, Chinese Academy of Sciences, Beijing, China
| | - Chien-Hung Lee
- Department of Public Health and Research Center for Environment Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Allen Min-Jen Ko
- Medical Imaging and Radiology, Alpenglow Australia, Sydney, New South Wales, Australia
| | - Ying-Chin Ko
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan; Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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18
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Warnakulasuriya S, Kujan O, Aguirre-Urizar JM, Bagan JV, González-Moles MÁ, Kerr AR, Lodi G, Mello FW, Monteiro L, Ogden GR, Sloan P, Johnson NW. Oral potentially malignant disorders: A consensus report from an international seminar on nomenclature and classification, convened by the WHO Collaborating Centre for Oral Cancer. Oral Dis 2020; 27:1862-1880. [PMID: 33128420 DOI: 10.1111/odi.13704] [Citation(s) in RCA: 397] [Impact Index Per Article: 99.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/21/2020] [Accepted: 10/25/2020] [Indexed: 12/12/2022]
Abstract
Oral potentially malignant disorders (OPMDs) are associated with an increased risk of occurrence of cancers of the lip or oral cavity. This paper presents an updated report on the nomenclature and the classification of OPMDs, based predominantly on their clinical features, following discussions by an expert group at a workshop held by the World Health Organization (WHO) Collaborating Centre for Oral Cancer in the UK. The first workshop held in London in 2005 considered a wide spectrum of disorders under the term "potentially malignant disorders of the oral mucosa" (PMD) (now referred to as oral potentially malignant disorders: OPMD) including leukoplakia, erythroplakia, proliferative verrucous leukoplakia, oral lichen planus, oral submucous fibrosis, palatal lesions in reverse smokers, lupus erythematosus, epidermolysis bullosa, and dyskeratosis congenita. Any new evidence published in the intervening period was considered to make essential changes to the 2007 classification. In the current update, most entities were retained with minor changes to their definition. There is sufficient evidence for an increased risk of oral cancer among patients diagnosed with "oral lichenoid lesions" and among those diagnosed with oral manifestations of 'chronic graft-versus-host disease'. These have now been added to the list of OPMDs. There is, to date, insufficient evidence concerning the malignant potential of chronic hyperplastic candidosis and of oral exophytic verrucous hyperplasia to consider these conditions as OPMDs. Furthermore, due to lack of clear evidence of an OPMD in epidermolysis bullosa this was moved to the category with limited evidence. We recommend the establishment of a global research consortium to further study the natural history of OPMDs based on the classification and nomenclature proposed here. This will require multi-center longitudinal studies with uniform diagnostic criteria to improve the identification and cancer risk stratification of patients with OPMDs, link them to evidence-based interventions, with a goal to facilitate the prevention and management of lip and oral cavity cancer.
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Affiliation(s)
- Saman Warnakulasuriya
- The WHO Collaborating Centre for Oral Cancer and Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
| | - José M Aguirre-Urizar
- Oral and Maxillofacial Medicine & Pathology Unit, Department of Stomatology II, Faculty of Medicine and Nursery, University of the Basque Country/EHU, Bilbao, Spain
| | - José V Bagan
- Oral Medicine, Valencia University, Valencia, Spain.,Department of Oral and Maxillofacial Surgery, University General Hospital, Valencia, Spain
| | - Miguel Ángel González-Moles
- School of Dentistry, University of Granada, Granada, Spain.,Biohealth Research Institute (IBS), Granada, Spain
| | - Alexander R Kerr
- Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, New York University College of Dentistry, New York, NY, USA
| | - Giovanni Lodi
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Milano, Italy
| | | | - Luis Monteiro
- CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde (IINFACTS), IUCS - Instituto Universitário de Ciências da Saúde, Gandra, Portugal
| | - Graham R Ogden
- Department of Oral Surgery, Dundee Dental School, Dundee, Scotland, UK
| | - Philip Sloan
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Newell W Johnson
- Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Gold Coast, Qld, Australia.,Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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19
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Genetic toxicology and toxicokinetics of arecoline and related areca nut compounds: an updated review. Arch Toxicol 2020; 95:375-393. [PMID: 33097969 DOI: 10.1007/s00204-020-02926-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/05/2020] [Indexed: 01/13/2023]
Abstract
Areca nut (AN) is consumed by more than 600 million of individuals, particularly in some regions of South Asia, East Africa, and tropical Pacific, being classified as carcinogenic to humans. The most popular way of exposure consists of chewing a mixture of AN with betel leaf, slaked lime, and other ingredients that may also contain tobacco named betel quid (BQ). Arecoline is the principal active compound of AN, and, therefore, has been systematically studied over the years in several in vitro and in vivo genotoxicity endpoints. However, much of this information is dispersed, justifying the interest of an updated and comprehensive review article on this topic. In this sense, it is thus pertinent to describe and integrate the genetic toxicology data available as well as to address key toxicokinetics aspects of arecoline. This review also provides information on the effects induced by arecoline metabolites and related compounds, including other major AN alkaloids and nitrosation derivatives. The complexity of the chemicals involved renders this issue a challenge in genetic toxicology. Overall, positive results in several endpoints have been reported, some of them suggesting a key role for arecoline metabolites. Nevertheless, some negative genotoxicity findings for this alkaloid in short-term assays have also been reported in the literature. Finally, this article also collates information on the potential mechanisms of arecoline-induced genotoxicity, and suggests further approaches to tackle this important toxicological issue.
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20
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Betel-Quid Chewing, Heart Failure, and Premature Ventricular Contractions in Patients with Cardiopulmonary Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207472. [PMID: 33066687 PMCID: PMC7602392 DOI: 10.3390/ijerph17207472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/03/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022]
Abstract
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.
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21
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Hung CC, Lee CH, Ko AMS, Lane HY, Lee CP, Ko YC. Effect of antidepressants for cessation therapy in betel-quid use disorder: a randomised, double-blind, placebo-controlled trial. Epidemiol Psychiatr Sci 2020; 29:e125. [PMID: 32370818 PMCID: PMC7216045 DOI: 10.1017/s2045796020000384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/23/2020] [Accepted: 04/04/2020] [Indexed: 12/26/2022] Open
Abstract
AIMS More than one-half of betel-quid (BQ) chewers have betel-quid use disorder (BUD). However, no medication has been approved. We performed a randomised clinical trial to test the efficacy of taking escitalopram and moclobemide antidepressants on betel-quid chewing cessation (BQ-CC) treatment. METHODS We enrolled 111 eligible male BUD patients. They were double-blinded, placebo-controlled and randomised into three treatment groups: escitalopram 10 mg/tab daily, moclobemide 150 mg/tab daily and placebo. Patients were followed-up every 2 weeks and the length of the trial was 8 weeks. The primary outcome was BQ-CC, defined as BUD patients who continuously stopped BQ use for ⩾6 weeks. The secondary outcomes were the frequency and amount of BQ intake, and two psychological rating scales. Several clinical adverse effects were measured during the 8-week treatment. RESULTS Intention-to-treat analysis shows that after 8 weeks, two (5.4%), 13 (34.2%) and 12 (33.3%) of BUD patients continuously quit BQ chewing for ⩾6 weeks among placebo, escitalopram, moclobemide groups, respectively. The adjusted proportion ratio of BQ-CC was 6.3 (95% CI 1.5-26.1) and 6.8 (95% CI 1.6-28.0) for BUD patients who used escitalopram and moclobemide, respectively, as compared with those who used placebo. BUD patients with escitalopram and moclobemide treatments both exhibited a significantly lower frequency and amount of BQ intake at the 8th week than those with placebo. CONCLUSIONS Prescribing a fixed dose of moclobemide and escitalopram to BUD patients over 8 weeks demonstrated treatment benefits to BQ-CC. Given a relatively small sample, this study provides preliminary evidence and requires replication in larger trials.
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Affiliation(s)
- Chung-Chieh Hung
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
| | - Chien-Hung Lee
- Department of Public Health and Research Center for Environment Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Albert Min-Shan Ko
- Key Laboratory of Vertebrate Evolution and Human Origins of Chinese Academy of Sciences, Institute of Vertebrate Paleontology and Paleoanthropology, Chinese Academy of Sciences, Beijing, China
| | - Hsien-Yuan Lane
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
- Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Chi-Pin Lee
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ying-Chin Ko
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
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22
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Betel quid-associated cancer: Prevention strategies and targeted treatment. Cancer Lett 2020; 477:60-69. [PMID: 32112902 DOI: 10.1016/j.canlet.2020.02.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/13/2022]
Abstract
Betel quid (BQ) and areca nut use are at risk of cancer. This review includes the latest evidence of carcinogenesis caused by BQ exposure, suggests possible prevention strategies. We conducted a systematic literature search in the PubMed and Web of Science databases to identify relevant articles published in the past 10 years according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Arecoline N-oxide, a metabolite of areca nut, is likely an initiator in carcinogenesis and is detoxified by N-acetylcysteine. Oral potentially malignant disorder and reactive oxygen species involved in carcinogenesis pathways may be treatable using antioxidants. Screening programs conducted by trained physicians are useful for identifying patients with early stages of oral cancer in high-risk groups. Anti-inflammatory medications may be used as chemopreventive agents in the disease-free stage after surgery. The association between survival and tumor somatic mutations in patients who chew BQ should be addressed in cancer studies. Current evidence on the natural course from BQ exposure to cancer occurrence and development provides information for developing primary, secondary, and tertiary prevention strategies against BQ-associated cancer at clinical or translational levels.
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Joo YJ, Newcombe D, Nosa V, Bullen C. Investigating Betel Nut Use, Antecedents and Consequences: A Review of Literature. Subst Use Misuse 2020; 55:1422-1442. [PMID: 31549570 DOI: 10.1080/10826084.2019.1666144] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Ye Jin Joo
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David Newcombe
- Centre for Addiction Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Vili Nosa
- Pacific Health Section, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Chris Bullen
- National Institute for Health Innovation (NIHI), School of Population Health, The University of Auckland, Auckland, New Zealand
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24
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Orlan E, Duncan K, Amtha R, Parascandola M. Characteristics of Current Betel Quid/Chewing Tobacco Users, Smokers and Dual Users in Indonesia: An Analysis of GATS 2011 Data. Subst Use Misuse 2020; 55:1509-1512. [PMID: 32569546 DOI: 10.1080/10826084.2020.1762649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Indonesia has the third largest population of smokers in the world, however, little is known about the use of chewing tobacco/betel quid in Indonesia. This paper describes the characteristics of chewing tobacco/betel quid users in Indonesia, to understand the user population and inform future research. Methods: The 2011 Indonesia GATS included 8,176 adults ages 15 and older. These data are weighted to be nationally representative. Weighted descriptive statistics and multivariate logistic regression were run using SAS 9.4. Results: Estimated national prevalence for exclusive chewing tobacco/betel quid use was 0.9%, for exclusive smoked tobacco use was 33.9% and for dual use was 0.8%. Multivariate logistic regression analyses showed that exclusive chewing tobacco/betel quid users were significantly more likely to be female, and to be older adults (45-64); while smokers are more likely to be male and younger (25-44). Conclusions/Importance: These results provide information on the different characteristics of users by product type, and show that users' demographics vary by their product of choice. This study helps to inform researchers and practitioners of the burden of chewing tobacco/betel quid use in Indonesia. These data, especially specific data on chewing tobacco/betel quid use patterns, are limited in this context, and this knowledge can help to identify populations who need quit tobacco interventions.
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Affiliation(s)
- Elizabeth Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, CA, USA
- Center for Global Health, National Cancer Institute, National Institute of Health, Bethesda, MD, USA
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | - Kalina Duncan
- Center for Global Health, National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | - Rahmi Amtha
- Oral Medicine Department, Faculty of Dentistry, University of Trisakti, Jakarta, Indonesia
| | - Mark Parascandola
- Center for Global Health, National Cancer Institute, National Institute of Health, Bethesda, MD, USA
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institute of Health, Bethesda, MD, USA
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25
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Hung CC, Lee CH, Chung CM, Nithiyanantham S, Lane HY, Ko YC. Antidepressant-induced reduction in betel-quid use in patients with depression: A pioneer clinical study. Medicine (Baltimore) 2020; 99:e18672. [PMID: 31895834 PMCID: PMC6946344 DOI: 10.1097/md.0000000000018672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/17/2019] [Accepted: 12/08/2019] [Indexed: 12/20/2022] Open
Abstract
Betel-quid is commonly used around the world and is listed as a Group I carcinogen. Prior research has suggested a possible association between antidepressants and betel-quid use. We aimed to clarify the effects of antidepressant therapy in betel-quid chewers in the population of patients with depression.We enrolled 204 patients with depressive disorders, collected their demographic information, and administered the Substance Use Severity Rating Scale for alcohol, cigarettes, and betel-quid and the Hamilton Depression Rating Scale. We compared betel-quid and non-betel-quid chewers and examined the effects of antidepressant therapy on betel-quid abstinence after previous exposure to betel-quid.Patients with depression were reported a higher prevalence of 26% betel-quid chewing habits and patients who chewed betel-quid showed more severe depressive symptoms. After antidepressant therapy, the addictiveness of betel-quid was significantly reduced by 4 times.This was a pioneering study showing that antidepressants could be a candidate for betel-quid cessation therapy. Future clinical trials are needed to verify their efficacy in reducing consumption for betel-quid addiction treatment.
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Affiliation(s)
- Chung-Chieh Hung
- Graduate Institute of Clinical Medical Science, China Medical University
- Department of Psychiatry, China Medical University Hospital, Taichung
| | - Chien-Hung Lee
- Department of Public Health, Environmental Medicine Research Center, College of Health Sciences, Kaohsiung Medical University, Kaohsiung
| | - Chia-Min Chung
- Graduate Institute of Clinical Medical Science, China Medical University
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University
| | - Srinivasan Nithiyanantham
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University
| | - Hsien-Yuan Lane
- Graduate Institute of Clinical Medical Science, China Medical University
- Department of Psychiatry, China Medical University Hospital, Taichung
- Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Ying-Chin Ko
- Graduate Institute of Clinical Medical Science, China Medical University
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University
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26
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Sariah A, Pu W, Xue Z, Liu Z, Huang X. Reduced Cortical Thickness in the Right Caudal Middle Frontal Is Associated With Symptom Severity in Betel Quid-Dependent Chewers. Front Psychiatry 2020; 11:654. [PMID: 32754064 PMCID: PMC7366340 DOI: 10.3389/fpsyt.2020.00654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/24/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Findings from brain structural imaging studies on betel quid dependence have supported relations between betel quid chewing and alterations in gray matter volume and white matter integrity. However, the effect of betel quid chewing on cortical thickness and the link between cortical thickness and symptom severity remains unascertained. METHODS In this observational study, we compared cortical thickness measures from 24 male betel quid-dependent chewers with 27 male healthy controls. Using FreeSufer, we obtained three-dimensional T1-weighted images that were used to compute the thickness of the cerebral cortex throughout the cortical layer. RESULTS Compared to healthy controls, betel quid dependent chewers displayed significant decreased cortical thickness in the precuneus, entorhinal, right paracentral, middle temporal, and caudal middle frontal gyri. Betel quid dependence scale scores negatively correlated (r = -0.604; p = 0.002) with reduced cortical thickness in the right caudal middle frontal of betel quid-dependent chewers. CONCLUSION The findings provide evidence for cortical thickness abnormality in betel dependent chewers and further propose that the severity of betel quid symptoms may be a critical aspect associated with the cortical alterations. The observed alterations may serve as potential mechanisms to explain why BQ chewing behavior is persistent among individuals with betel quid dependence.
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Affiliation(s)
- Adellah Sariah
- National Clinical Research Centre for Mental Disorders, Institute of Mental Health and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Mental Health and Psychiatric Nursing, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Weidan Pu
- Medical Psychological Institute, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhimin Xue
- National Clinical Research Centre for Mental Disorders, Institute of Mental Health and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhening Liu
- National Clinical Research Centre for Mental Disorders, Institute of Mental Health and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaojun Huang
- National Clinical Research Centre for Mental Disorders, Institute of Mental Health and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
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Shwetha KM, Ranganath K, Pushpanjali K. Attitude of Accredited Social Health Activists towards Creating Awareness on Oral Cancer in Rural Community of Chikkaballapur District, Karnataka. Indian J Community Med 2019; 44:S46-S49. [PMID: 31728090 PMCID: PMC6824180 DOI: 10.4103/ijcm.ijcm_37_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Accredited social health activists (ASHAs) form a link between rural community and health system in India; hence, it is important to understand their attitude to render health services. Objectives: The objectives of the study were to develop a tool for measuring the attitude to create awareness on oral cancer (OC) using theory of reasoned action and planned behavior (TRA/PB) to the community and to assess the attitude of ASHAs about the same. Methodology: A culturally relevant self-administered questionnaire was developed based on TRA/PB which was subjected to validity and reliability and then pilot tested. The sample size was estimated to be 278. A cross-sectional research design was used to assess the attitude of ASHAs. Multistage sampling technique was carried out to include ASHAs from three of six taluks of Chikkaballapur district. Results: The content validity ratio of the items was in the range of 0.6–0.7, and Cronbach's alpha was 0.762. Exploratory factor analysis provided three factors with eigenvalue >1. The mean age of study participants was 31.8 years. The mean work experience was 5.7 years. The attitude of ASHAs was favorable (82.45%) as they believed that it was their responsibility to contribute in disease prevention (normative belief). Some had seen suffering of OC patients closely (behavioral beliefs) and few opted to follow their authority instructions (perceived behavioral control). Conclusion: The developed tool with good validity and reliability was used to assess the attitude of ASHAs. Their attitude was favorable to educate the community about OC and contribute in disease prevention.
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Affiliation(s)
- K M Shwetha
- Department of Public Health Dentistry, Faculty of Dental Sciences, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - K Ranganath
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - K Pushpanjali
- Department of Public Health Dentistry, Faculty of Dental Sciences, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
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28
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Chiang WF, Liu SY, Lin JF, Chiu SF, Gou SB, Chiou CT, Chang CH. Malignant development in patients with oral potentially malignant disorders detected through nationwide screening: Outcomes of 5-year follow-up at a single hospital. Head Neck 2019; 42:67-76. [PMID: 31589002 DOI: 10.1002/hed.25973] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/04/2019] [Accepted: 09/10/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Although survival rate and quality of life are improved if patients with oral carcinoma can be detected early, however, such lesions are usually asymptomatic; therefore, it is hard to raise awareness. Screening has proved to be cost-effective for early detection. METHODS Sixty-two patients with oral carcinomas and 555 patients with oral potentially malignant disorders (OPMDs) who were detected through screening were examined the relationship between clinicopathological features and follow-up outcomes. RESULTS The 5-year cumulative cancer-free interval rate was 94.1%, and the annual malignant transformation rate was 1.16%. The rate of interval carcinoma development from Candida hyperplasia, oral submucous fibrosis, homogeneous leukoplakia, non-homogenous leukoplakia, and verrucous hyperplasia, was 13.6%, 5.7%, 4.6%, 12.1%, and 21.3%, respectively. Significant independent risk factors for interval carcinoma development were heavy betel quid chewing, verrucous hyperplasia, and surgery refusal. CONCLUSIONS Well-designed risk assessment, treatment, and surveillance program could lead to earlier cancer detection and thereby reduce mortality and morbidity.
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Affiliation(s)
- Wei-Fan Chiang
- Department of Oral and Maxillofacial Surgery, Chi-Mei Medical Center, Liouying, Taiwan.,School of Dentistry, National Yang-Ming University, Taipei, Taiwan
| | - Shyun-Yeu Liu
- Department of Oral and Maxillofacial Surgery, Chi-Mei Medical Center, Yongkang, Taiwan
| | - Jen-Fen Lin
- Cancer Center, Chi-Mei Medical Center, Liouying, Taiwan
| | - Sheng-Fu Chiu
- Department of Oral and Maxillofacial Surgery, Chi-Mei Medical Center, Liouying, Taiwan
| | - Shin-Bin Gou
- Department of Oral and Maxillofacial Surgery, Chi-Mei Medical Center, Liouying, Taiwan
| | - Chang-Ta Chiou
- Department of Oral and Maxillofacial Surgery, An-Nan Hospital, Tainan, Taiwan
| | - Chi-Hua Chang
- Department of Oral and Maxillofacial Surgery, Chang-Chung Memorial Hospital, Kaohsiung, Taiwan
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29
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Application of simulation-based CYP26 SNP-environment barcodes for evaluating the occurrence of oral malignant disorders by odds ratio-based binary particle swarm optimization: A case-control study in the Taiwanese population. PLoS One 2019; 14:e0220719. [PMID: 31465460 PMCID: PMC6715230 DOI: 10.1371/journal.pone.0220719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/22/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction Genetic polymorphisms and social factors (alcohol consumption, betel quid (BQ) usage, and cigarette consumption), both separately or jointly, play a crucial role in the occurrence of oral malignant disorders such as oral and pharyngeal cancers and oral potentially malignant disorders (OPMD). Material and methods Simultaneous analyses of multiple single nucleotide polymorphisms (SNPs) and environmental effects on oral malignant disorders are essential to examine, albeit challenging. Thus, we conducted a case-control study (N = 576) to analyze the risk of occurrence of oral malignant disorders by using binary particle swarm optimization (BPSO) with an odds ratio (OR)-based method. Results We demonstrated that a combination of SNPs (CYP26B1 rs887844 and CYP26C1 rs12256889) and socio-demographic factors (age, ethnicity, and BQ chewing), referred to as the combined effects of SNP-environment, correlated with maximal risk diversity of occurrence observed between the oral malignant disorder group and the control group. The risks were more prominent in the oral and pharyngeal cancers group (OR = 10.30; 95% confidence interval (CI) = 4.58–23.15) than in the OPMD group (OR = 5.42; 95% CI = 1.94–15.12). Conclusions Simulation-based “SNP-environment barcodes” may be used to predict the risk of occurrence of oral malignant disorders. Applying simulation-based “SNP-environment barcodes” may provide insight into the importance of screening tests in preventing oral and pharyngeal cancers and OPMD.
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30
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Lin WT, Lee CY, Tsai S, Huang HL, Wu PW, Chin YT, Seal DW, Chen T, Chao YY, Lee CH. Clustering of Metabolic Risk Components and Associated Lifestyle Factors: A Nationwide Adolescent Study in Taiwan. Nutrients 2019; 11:nu11030584. [PMID: 30857325 PMCID: PMC6471895 DOI: 10.3390/nu11030584] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/22/2019] [Accepted: 03/01/2019] [Indexed: 02/06/2023] Open
Abstract
Clustering of metabolic syndrome (MetS) risk components in childhood has been linked to a higher risk of diabetes and cardiovascular diseases in adulthood. By using data from the 2010⁻2011 Nutrition and Health Survey in Taiwan, this study investigated epidemic patterns and correlates for the clustering of MetS risk components. A total of 1920 adolescents aged 12⁻18 years were included in this study. The MetS diagnostic criteria defined by the Taiwan Pediatric Association (TPA) and International Diabetes Federation (IDF) for adolescents and the criteria defined by the Joint Interim Statement for adults (JIS-Adult) were used to evaluate MetS and its abnormal components. The prevalence of TPA-, IDF-, and JIS-Adult-defined MetS was 4.1%, 3.0%, and 4.0%, with 22.1%, 19.3%, and 17.7%⁻18.1% of adolescents having high fasting glucose, low high-density lipoprotein cholesterol, and central obesity, respectively. A 0.4-to-0.5-fold decreased risk of having ≥2 MetS abnormal components was detected among adolescents who consumed ≥1 serving/week of dairy products and fresh fruits. Boys who consumed ≥7 drinks/week of soda and girls who consumed ≥7 drinks/week of tea had a 4.6- and 5.2-fold risk of MetS, respectively. In conclusion, our findings revealed significant dimensions of adolescent MetS, including detecting population-specific prevalent patterns for MetS risk components and their clustering, and emphasized on health promotion activities that reduce sugar-sweetened beverage intake.
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Affiliation(s)
- Wei-Ting Lin
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
| | - Chun-Ying Lee
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
| | - Sharon Tsai
- Department of Laboratory Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung 812, Taiwan.
| | - Hsiao-Ling Huang
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
| | - Pei-Wen Wu
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
| | - Yu-Ting Chin
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
| | - David W Seal
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
| | - Ted Chen
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
| | - Yu-Ying Chao
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
| | - Chien-Hung Lee
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
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Kuo TM, Nithiyanantham S, Lee CP, Hsu HT, Luo SY, Lin YZ, Yeh KT, Ko YC. Arecoline N-oxide regulates oral squamous cell carcinoma development through NOTCH1 and FAT1 expressions. J Cell Physiol 2019; 234:13984-13993. [PMID: 30624777 DOI: 10.1002/jcp.28084] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/18/2018] [Indexed: 12/11/2022]
Abstract
Areca nut has been evaluated as a group I carcinogen to humans. However, the exact compounds of areca nut causing oral cancer remain unproven. Previous findings from our lab revealed that arecoline N-oxide (ANO), a metabolite of arecoline, exhibits an oral fibrotic effect in immune-deficient NOD/SCID mice. The aim of this study is to investigate the oral potentially malignant disorders (OPMD) inductive activity between areca-alkaloid arecoline and its metabolite ANO in C57BL/6 mice. Our findings show that ANO showed higher activity in inducing hyperplasia with leukoplakia and collagen deposition in C57BL/6 mice compared with the arecoline treated groups. Importantly, immunohistochemical studies showed significant upregulation of NOTCH1, HES1, FAT1, PCNA, and Ki67 expressions in the pathological hyperplastic part. In addition, in vitro studies showed that upregulation of NOTCH1 and FAT1 expressions in ANO treated HGF-1 and DOK cell models. We found that NOTCH1 regulates TP53 expression from NOTCH1 knockdown oral cancer cells. The DNA damage was significantly increased after arecoline and ANO treatment. Further, we found that arecoline-induced H2AX expression was regulated by FMO3. Altogether, our findings show that ANO exhibited higher toxicity in OPMD activity and play a significant role in the induction of areca nut mediated oral tumorigenesis.
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Affiliation(s)
- Tzer-Min Kuo
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Srinivasan Nithiyanantham
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chi-Pin Lee
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hui-Ting Hsu
- Department of Surgical Pathology, Changhua Christian Hospital, Changhua, Taiwan
| | - Shun-Yuan Luo
- Department of Chemistry, National Chung Hsing University, Taichung, Taiwan
| | - You-Zhe Lin
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Kun-Tu Yeh
- Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
| | - Ying-Chin Ko
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
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32
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Sariah A, Liu Z, Pu W, Liu H, Xue Z, Huang X. Structural and Functional Alterations in Betel-Quid Chewers: A Systematic Review of Neuroimaging Findings. Front Psychiatry 2019; 10:16. [PMID: 30761025 PMCID: PMC6361845 DOI: 10.3389/fpsyt.2019.00016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/11/2019] [Indexed: 12/21/2022] Open
Abstract
Background: A number of neuroimaging studies have investigated structural, metabolic, and functional connectivity changes in betel quid (BQ) chewers. We present a systematic review of neuroimaging studies with emphasis on key brain systems affected by BQ chewing to bring a better understanding on the neuro mechanisms involved in BQD. Methods: All BQ neuroimaging studies were identified by searching PubMed, EMBASE, and Google scholar for English articles published until March 2018 using the key words: Betel-quid, resting state, functional MRI, structural MRI, diffusion tensor imaging (DTI), and betel quid dependence basing on the PRISMA criteria. We also sought unpublished studies, and the rest were obtained from reference lists of the retrieved articles. All neuroimaging studies investigating brain structural, and functional alterations related to BQ chewing and BQ dependence were included. Our systematic review registration number is CRD42018092669. Results: A review of 12 studies showed that several systems in the brain of BQ chewers exhibited structural, metabolic, and functional alterations. BQ chewing was associated with alterations in the reward [areas in the midbrain, and prefrontal cortex (PFC)], impulsivity (anterior cingulate cortex, PFC) and cognitive (PFC, the default mode, frontotemporal, frontoparietal, occipital/temporal, occipital/parietal, temporal/limbic networks, hippocampal/hypothalamus, and the cerebellum) systems in the brain. BQ duration and severity of betel quid dependence were associated with majority of alterations in BQ chewers. Conclusion: Betel quid chewing is associated with brain alterations in structure, metabolism and function in the cognitive, reward, and impulsivity circuits which are greatly influenced by duration and severity of betel quid dependence.
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Affiliation(s)
- Adellah Sariah
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,Department of Mental Health and Psychiatric Nursing, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Zhening Liu
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Weidan Pu
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Haihong Liu
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, China
| | - Zhimin Xue
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaojun Huang
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China
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Hussain A, Zaheer S, Shafique K. Betel Quid Dependency and Associated Intrapersonal, Interpersonal, and Environmental Factors among Adolescents: A School-Based Cross-Sectional Survey. Subst Use Misuse 2018. [PMID: 29533120 DOI: 10.1080/10826084.2018.1447964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Betel quid (BQ) is one of the fourth most commonly used substance globally. Though BQ is a psycho-active substance, yet little has been explored regarding dependency on it particularly among adolescents. OBJECTIVES Therefore, in this study, we aimed to determine adolescents' dependency on BQ, along with their intrapersonal, interpersonal and environmental determinants of dependency. METHODS This cross-sectional study focused on 2200 school-going adolescents of Karachi, Pakistan in 2016. Primary outcome was dependency on BQ among adolescents. Both univariate and multivariate regressions were used to estimate crude and adjusted odds ratios (after adjustments for all intrapersonal, interpersonal, and environmental factors) with 95% confidence level. RESULTS Out of 2200 students, 874 (39.7%) were found to be BQ users amongst whom 69 (7.9%) were dependent on BQ. Comparing the groups with only areca nut users as reference category, betel quid with tobacco additives chewers were considerably dependent (OR = 14.08, 95% CI 3.64-54.16). The individuals who chewed >5 chews per day (OR = 1.87, 95% CI 1.08-3.29) and chronic users (>1year) (OR = 2.02, 95% CI 1.09-3.74) were more likely to be dependent. Older students (>12 years) (OR = 2.12, 95% CI 1.06-4.23), and who studied in government schools were significantly dependent (OR = 3.32, 95% CI 1.80-6.10) than those who studied in private schools. CONCLUSIONS In conclusion, intrapersonal characteristics like more than 5 chews per day, chronic chewers of more than a year, BQ with tobacco chewers, older adolescents and children studying in government schools were significantly associated with BQ dependency.
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Affiliation(s)
- Azmina Hussain
- a Dr. Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences , Gulzar e Hijri , Karachi , Pakistan
| | - Sidra Zaheer
- b School of Public Health, Dow University of Health Sciences , Gulzar e Hijri , Karachi , Pakistan
| | - Kashif Shafique
- b School of Public Health, Dow University of Health Sciences , Gulzar e Hijri , Karachi , Pakistan.,c Institute of Health and Wellbeing, Public Health, University of Glasgow , Glasgow , UK
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Lee CH, Ko AMS, Yang FM, Hung CC, Warnakulasuriya S, Ibrahim SO, Zain RB, Ko YC. Association of DSM-5 Betel-Quid Use Disorder With Oral Potentially Malignant Disorder in 6 Betel-Quid Endemic Asian Populations. JAMA Psychiatry 2018; 75:261-269. [PMID: 29417149 PMCID: PMC5885949 DOI: 10.1001/jamapsychiatry.2017.4307] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Betel-quid (BQ) is the fourth most popular psychoactive agent worldwide. An emerging trend across Asia is the addictive consumption of BQ, which is associated with oral cancer and other health consequences. OBJECTIVE To investigate the validity and pattern of DSM-5-defined BQ use disorder (BUD) and its association with oral potentially malignant disorder (OPMD) among Asian populations. DESIGN, SETTING, AND PARTICIPANTS In-person interviews were conducted from January 1, 2009, to February 28, 2010, among a random sample of 8922 noninstitutionalized adults from the Asian Betel-quid Consortium study, an Asian representative survey of 6 BQ-endemic populations. Statistical analysis was performed from January 1, 2015, to December 31, 2016. MAIN OUTCOMES AND MEASURES Participants were evaluated for BUD using DSM-5 criteria for substance use disorder and for OPMD using a clinical oral examination. Current users of BQ with 0 to 1 symptoms were classified as having no BUD, those with 2 to 3 symptoms as having mild BUD, those with 4 to 5 symptoms as having moderate BUD, and those with 6 or more symptoms as having severe BUD. RESULTS Among the 8922 participants (4564 women and 4358 men; mean [SD] age, 44.2 [0.2] years), DSM-5 symptoms showed sufficient unidimensionality to act as a valid measure for BUD. The 12-month prevalence of DSM-5-defined BUD in the 6 study populations was 18.0% (mild BUD, 3.2%; moderate BUD, 4.3%; and severe BUD, 10.5%). The 12-month proportion of DSM-5-defined BUD among current users of BQ was 86.0% (mild BUD, 15.5%; moderate BUD, 20.6%; and severe BUD, 50.0%). Sex, age, low educational level, smoking, and drinking were significantly associated with BUD. Among individuals who used BQ, family use, high frequency of use, and amount of BQ used were significantly linked to moderate to severe BUD. Compared with individuals who did not use BQ, those who used BQ and had no BUD showed a 22.0-fold (95% CI, 4.3-112.4) risk of OPMD (P < .001), whereas those with mild BUD showed a 9.6-fold (95% CI, 1.8-56.8) risk (P = .01), those with moderate BUD showed a 35.5-fold (95% CI, 4.3-292.3) risk (P = .001), and those with severe BUD showed a 27.5-fold (95% CI, 1.6-461.4) risk of OPMD (P = .02). Individuals with moderate to severe BUD who used BQ and had the symptom of tolerance had a 153.4-fold (95% CI, 33.4-703.6) higher risk of OPMD than those who did not use BQ, and those with moderate to severe BUD who used BQ and had a larger amount or longer history of BQ use had an 88.9-fold (95% CI, 16.6-476.5) higher risk of OPMD than those who did not use BQ. CONCLUSIONS AND RELEVANCE This international study gathered data about BQ users across 6 Asian populations, and it demonstrates that DSM-5 symptoms could fulfill a BUD construct. Most current Asian users of BQ already have BUD, which is correlated with risk of OPMD. Among individuals with moderate to severe BUD who used BQ, tolerance and a larger amount or longer history of BQ use are the key symptoms that correlated with enhanced risk of OPMD. These findings play an important role in providing a new indication of an additional psychiatric management plan for users of BQ who have BUD.
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Affiliation(s)
- Chien-Hung Lee
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Albert Min-Shan Ko
- Key Laboratory of Vertebrate Evolution and Human Origins, Institute of Vertebrate Paleontology and Paleoanthropology, Chinese Academy of Sciences, Beijing, China
| | - Frances M. Yang
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta
| | - Chung-Chieh Hung
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
| | - Saman Warnakulasuriya
- Department of Oral Medicine, King’s College London, World Health Organization Collaborating Centre for Oral Cancer and Precancer, London, United Kingdom
| | | | - Rosnah Binti Zain
- Faculty of Dentistry, MAHSA University, Kuala Lumpur, Malaysia,Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Ying-Chin Ko
- Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Prevalence and correlates of alcohol use in a central Nepal district: secondary analysis of a population-based cross-sectional study. Glob Ment Health (Camb) 2018; 5:e37. [PMID: 30637110 PMCID: PMC6315279 DOI: 10.1017/gmh.2018.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND As reported from studies conducted in Nepal, between 15% and 57% of adults had ever consumed alcohol and between 1.5% and 25% of adults have alcohol use disorders (AUD). Few studies in Nepal have identified the correlates of consumption or described the help-seeking patterns and stigma among those affected with AUD. METHODS Interviewers administered the Alcohol Use Disorders Identification Test (AUDIT) as part of population-based surveys of adults in Chitwan District between 2013 and 2017. We conducted a secondary analysis to identify sociodemographic and health-related correlates of recent alcohol consumption using the χ2 test, to identify correlates of total AUDIT scores among men who drink using negative binomial regression, and to describe the treatment-seeking and stigma beliefs of men with AUD. RESULTS Over half (53.7%, 95% CI 50.4-57.0) of men (n = 1130) recently consumed alcohol, and there were associations between being a drinker with age, religion, caste, education, occupation and tobacco use. Nearly one in four (23.8%, 95% CI 20.2-27.8%) male drinkers screened positive for AUD, and AUDIT scores were associated with age, caste, marital status, occupation, tobacco use, depression, functional status and suicidal ideation. Few (13.3%, 95% CI 11.7-15.0) women (n = 2352) recently consumed alcohol, and 5.3% (95% CI 3.0-9.1) of female drinkers screened positive for AUD. Among AUDIT-positive men, 38% spoke to another person about their problems and 80% had internalized stigma. CONCLUSIONS This study revealed that nearly one in four men who drink likely have AUD. Higher AUDIT scores were associated with depression, suicidality, dysfunctionality and internalized stigma.
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Chen PH, Mahmood Q, Mariottini GL, Chiang TA, Lee KW. Adverse Health Effects of Betel Quid and the Risk of Oral and Pharyngeal Cancers. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3904098. [PMID: 29376073 PMCID: PMC5742426 DOI: 10.1155/2017/3904098] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/01/2017] [Accepted: 05/18/2017] [Indexed: 02/06/2023]
Abstract
Global reports estimate 600 million betel quid (BQ) chewers. BQ chewing has been demonstrated not only to be a risk factor for cancers of the oral cavity and pharynx and oral potentially malignant disorders (OPMD) but also to cause other cancers and adverse health effects. Herein, we summarized the international comparison data to aid in the understanding of the close relationship between the prevalence of BQ chewing, the occurrence of oral and pharyngeal cancers, and adverse health effects. Potential biomarkers of BQ carcinogens, such as areca nut, alkaloids, and 3-methylnitrosaminopropionitrile (MNPN), are closely associated with human health toxicology. Molecular mechanisms or pathways involving autophagy, hypoxia, COX-2, NF-κB activity, and stemness are known to be induced by BQ ingredients and are very closely related to the carcinogenesis of cancers of oral and pharynx. BQ abuse-related monoamine oxidase (MAO) gene was associated with the occurrence and progress of oral and pharyngeal cancers. In summary, our review article provides important insights into the potential roles of environmental BQ (specific alkaloid biomarkers and nitrosamine products MNPN) and genetic factors (MAO) and offers a basis for studies aiming to reduce or eliminate BQ-related OPMD and oral/pharyngeal cancer incidences in the future.
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Affiliation(s)
- Ping-Ho Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, No. 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
- Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, No. 70 Lienhai Road, Kaohsiung 80424, Taiwan
| | - Qaisar Mahmood
- Department of Environmental Sciences, COMSATS Institute of Information Technology, Abbottabad, Pakistan
| | - Gian Luigi Mariottini
- Department of Earth, Environment and Life Sciences (DISTAV), University of Genova, Viale Benedetto XV 5, 16132 Genova, Italy
| | - Tai-An Chiang
- College of Human Science and Technology, Chung Hwa University of Medical Technology, No. 89, Wenhwa 1st St., Rende Shiang, Tainan 71703, Taiwan
| | - Ka-Wo Lee
- Department of Otolaryngology, Kaohsiung Medical University Hospital, No. 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan
- Department of Otolaryngology, College of Medicine, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
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Cheng SJ, Ko HH, Lee JJ, Kok SH. Comparison of long-term outcomes between pull-through resection and mandibular lip-split surgery for T4a tongue/floor of mouth cancers. Head Neck 2017; 40:144-153. [DOI: 10.1002/hed.24994] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/23/2017] [Accepted: 09/15/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Shih-Jung Cheng
- Graduate Institute of Clinical Dentistry, School of Dentistry; National Taiwan University; Taipei Taiwan
- Department of Dentistry, School of Dentistry; National Taiwan University; Taipei Taiwan
- Department of Dentistry; National Taiwan University Hospital, College of Medicine; Taipei Taiwan
| | - Hui-Hsin Ko
- Graduate Institute of Clinical Dentistry, School of Dentistry; National Taiwan University; Taipei Taiwan
- Department of Dentistry; National Taiwan University Hospital, College of Medicine; Taipei Taiwan
| | - Jang-Jaer Lee
- Department of Dentistry, School of Dentistry; National Taiwan University; Taipei Taiwan
- Department of Dentistry; National Taiwan University Hospital, College of Medicine; Taipei Taiwan
| | - Sang-Heng Kok
- Graduate Institute of Clinical Dentistry, School of Dentistry; National Taiwan University; Taipei Taiwan
- Department of Dentistry, School of Dentistry; National Taiwan University; Taipei Taiwan
- Department of Dentistry; National Taiwan University Hospital, College of Medicine; Taipei Taiwan
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Lymph node density as a prognostic predictor in patients with betel nut-related oral squamous cell carcinoma. Clin Oral Investig 2017; 22:1513-1521. [PMID: 29038963 PMCID: PMC5866838 DOI: 10.1007/s00784-017-2247-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/10/2017] [Indexed: 11/04/2022]
Abstract
Objectives Lymph node metastasis in oral squamous cell carcinoma (OSCC) is a poor prognostic factor. The histopathologic stage (e.g., pN) is used to evaluate the severity of lymph node metastasis; however, the current staging system insufficiently predicts survival and recurrence. We investigated clinical outcomes and lymph node density (LND) in betel nut-chewing individuals. Material and methods We retrospectively analyzed 389 betel nut-exposed patients with primary OSCC who underwent surgical resection in 2002–2015. The prognostic significance of LND was evaluated by overall survival (OS) and disease-free survival (DFS) using the Kaplan-Meier method. Results Kaplan-Meier analyses showed that the 5-year OS and DFS rates in all patients were 60.9 and 48.9%, respectively. Multivariate analysis showed that variables independently prognostic for OS were aged population (hazard ratio [HR] = 1.6, 95% confidence interval [95% CI] = 1.1–2.5; P = .025), and cell differentiation classification (HR = 2.4, 95% CI = 1.4–4.2; P = .002). In pathologic N-positive patients, a receiver operating characteristic (ROC) curve for OS was used and indicated the best cutoff of 0.05, and the multivariate analysis showed that LND was an independent predictor of OS (HR = 2.2, 95% CI = 1.3–3.7; P = .004). Conclusions Lymph node density, at a cutoff of 0.05, was an independent predictor of OS and DFS. OS and DFS underwent multiple analyses, and LND remained significant. The pathologic N stage had no influence in the OS analysis. Clinical relevance LND is a more reliable predictor of survival in betel nut-chewing patients for further post operation adjuvant treatment, such as reoperation or adjuvant radiotherapy.
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Osborne PG, Ko YC, Wu MT, Lee CH. Intoxication and substance use disorder to Areca catechu nut containing betel quid: A review of epidemiological evidence, pharmacological basis and social factors influencing quitting strategies. Drug Alcohol Depend 2017; 179:187-197. [PMID: 28787696 DOI: 10.1016/j.drugalcdep.2017.06.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 06/12/2017] [Accepted: 06/12/2017] [Indexed: 11/21/2022]
Abstract
AIM We present a systematic review of substance use disorder (SUD) to Areca catechu nut (AN) and AN containing betel quid (ANcBQ) with emphasis on dependence resulting from chewing of tobacco-free ANcBQ. We examined pharmacology of intoxication and addiction, and factors influencing quitting strategies. METHODS Epidemiological publications of SUD were included according to PRISMA criteria. Pharmacological publications were retrieved from the PUBMED database and websites of the WHO, United Nations, and Sigma-Aldrich. RESULTS Nine epidemiological studies show clear evidence of abuse and dependence in tobacco-free ANcBQ and/or ANcBQ+Tobacco chewers. Dependency is greater if ANcBQ contains tobacco. In both groups higher dependency scores were positively correlated with higher frequency of chewing. Dependency on AN+Lime is associated with altered brain morphology, resting state brain activity, neurochemistry and deterioration of working spatial memory. ANcBQ contains a complex mixture of neuroactive compounds that have the potential to act directly upon all major cerebral neurotransmitter systems. Of these compounds, only arecoline (muscarinic agonist) has been the focus of limited pharmacological investigation. In animal studies, arecoline increases dopamine transmission in the mesocorticolimbic circuit and this action may be one factor contributing to ANcBQ dependency in humans. Societal and familial acceptance of ANcBQ consumption is paramount for commencement and persistence of chewing. CONCLUSIONS ANcBQ SUD remains an orphan disease. The limited understanding of pharmacological basis of intoxication and SUD determines there are no pharmacological replacement therapies for ANcBQ SUD. The addictive properties of ANcBQ coupled with social acceptance of ANcBQ chewing limits the effectiveness of counseling-based quitting programs.
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Affiliation(s)
- Peter G Osborne
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia; Graduate Institute of Clinical Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Ying-Chin Ko
- Environment-Omics-Diseases Research Centre, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Ming-Tsang Wu
- Graduate Institute of Clinical Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Community Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Hung Lee
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Role of areca nut induced JNK/ATF2/Jun axis in the activation of TGF-β pathway in precancerous Oral Submucous Fibrosis. Sci Rep 2016; 6:34314. [PMID: 27708346 PMCID: PMC5052620 DOI: 10.1038/srep34314] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/09/2016] [Indexed: 11/08/2022] Open
Abstract
Oral submucous fibrosis (OSF) is potentially premalignant with progressive and irreversible extracellular matrix deposition accompanied by epithelial atrophy and like other fibrotic disorders, is primarily a TGF-β driven disease. OSF is caused by prolonged chewing of areca nut. Our previous studies reported a pivotal role for TGF-β activation and its effects contributing to OSF. However, the mechanism for activation of TGF-β signaling in OSF is still unknown. In this study we demonstrate activation of TGF-β signaling with sub-cytotoxic dose of areca nut in epithelial cells and discovered a key role for pJNK in this process. In good correlation; pJNK was detected in OSF tissues but not in normal tissues. Moreover, activation of JNK was found to be dependent on muscarinic acid receptor induced Ca2+/CAMKII as well as ROS. JNK dependent phosphorylation of ATF2/c-Jun transcription factors resulted in TGF-β transcription and its signaling. pATF2/p-c-Jun were enriched on TGF-β promoter and co-localized in nuclei of epithelial cells upon areca nut treatment. In corroboration, OSF tissue sections also had nuclear pATF2 and p-c-Jun. Our results provide comprehensive mechanistic details of TGF-β signaling induced by etiological agent areca nut in the manifestation of fibrosis which can lead to new therapeutic modalities for OSF.
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Ko HH, Cheng SL, Lee JJ, Chen HM, Wang CW, Cheng SJ, Kok SH. Factors influencing the incidence and prognosis of second primary tumors in patients with oral squamous cell carcinoma. Head Neck 2016; 38:1459-66. [DOI: 10.1002/hed.24457] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 12/07/2015] [Accepted: 02/09/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hui-Hsin Ko
- Graduate Institute of Clinical Dentistry; School of Dentistry, National Taiwan University; Taipei Taiwan
- Department of Dentistry; National Taiwan University Hospital, College of Medicine; Taipei Taiwan
| | - Shih-Lung Cheng
- Department of Internal Medicine; Far Eastern Memorial Hospital; Taipei Taiwan
- Department of Chemical Engineering and Materials Science; Yuan-Ze University; Chung-Li Taiwan
| | - Jang-Jaer Lee
- Department of Dentistry; School of Dentistry, National Taiwan University; Taipei Taiwan
- Department of Dentistry; National Taiwan University Hospital, College of Medicine; Taipei Taiwan
| | - Hsin-Ming Chen
- Graduate Institute of Clinical Dentistry; School of Dentistry, National Taiwan University; Taipei Taiwan
- Department of Dentistry; School of Dentistry, National Taiwan University; Taipei Taiwan
- Department of Dentistry; National Taiwan University Hospital, College of Medicine; Taipei Taiwan
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University; Taipei Taiwan
| | - Chun-Wei Wang
- Department of Radiation Oncology; National Taiwan University Hospital, College of Medicine; Taipei Taiwan
| | - Shih-Jung Cheng
- Graduate Institute of Clinical Dentistry; School of Dentistry, National Taiwan University; Taipei Taiwan
- Department of Dentistry; School of Dentistry, National Taiwan University; Taipei Taiwan
- Department of Dentistry; National Taiwan University Hospital, College of Medicine; Taipei Taiwan
| | - Sang-Heng Kok
- Graduate Institute of Clinical Dentistry; School of Dentistry, National Taiwan University; Taipei Taiwan
- Department of Dentistry; School of Dentistry, National Taiwan University; Taipei Taiwan
- Department of Dentistry; National Taiwan University Hospital, College of Medicine; Taipei Taiwan
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The prognostic value of Tiam1 protein expression in head and neck squamous cell carcinoma: a retrospective study. CHINESE JOURNAL OF CANCER 2015; 34:614-21. [PMID: 26369827 PMCID: PMC4593337 DOI: 10.1186/s40880-015-0053-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/02/2015] [Indexed: 12/25/2022]
Abstract
Introduction Head and neck squamous cell carcinoma (HNSCC) is a common cancer worldwide and has a poor prognosis. A biomarker predicting the clinical outcome of HNSCC patients could be useful in guiding treatment planning. Overexpression of the T lymphoma invasion and metastasis 1 (Tiam1) protein has been implicated in the migration and invasion of neoplasms. However, its role in HNSCC progression needs to be further validated. We detected the expression of Tiam1 in normal and tumor tissues and determined its association with clinical outcomes in patients with HNSCC. Methods We measured the expression of Tiam1 in normal and cancerous tissue samples from the patients with HNSCC treated at Sun Yat-sen University Cancer Center between 2001 and 2008. The Tiam1 expression was scored from 0 to 12 based on the percentage of positively stained cells and the staining intensity. We then determined the diagnostic performance of this score in predicting overall survival (OS) and disease-free survival (DFS). Results Of the 194 evaluable patients, those with advanced disease, lymph node metastasis at diagnosis, and recurrence or metastasis during follow-up had a higher tendency of having high Tiam1 expression as compared with their counterparts (P < 0.05). The proportion of samples with high Tiam1 expression was also higher in cancerous tissues than in non-cancerous tissues (57.7% vs. 13.9%, P < 0.001). Cox proportional hazards regression analysis revealed that Tiam1 expression scores of 5 and greater independently predicted short OS and DFS. Conclusion The Tiam1 expression is shown as a promising biomarker of clinical outcomes in patients with HNSCC and should be evaluated in prospective trials.
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Kavarodi AM, Thomas M, Kannampilly J. Prevalence of oral pre-malignant lesions and its risk factors in an Indian subcontinent low income migrant group in Qatar. Asian Pac J Cancer Prev 2015; 15:4325-9. [PMID: 24935392 DOI: 10.7314/apjcp.2014.15.10.4325] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The expatriate population in Qatar largely comprises workers from the Indian subcontinent which has a very high rate of oral malignancy. Social and cultural habits and as well premalignant risk factors in this population remain prevalent even after migration. MATERIALS AND METHODS This cross sectional study assessed the prevalence of risk factors and occurrence of oral precancerous lesions in a low income group expatriate community from the Indian subcontinent residing in Qatar. RESULTS Among the 3,946 participants screened for oral premalignant lesions 24.3% (958) were smokers and 4.3 % (169) were pan chewers while 6.3% (248) were users of both smoked and smokeless forms of tobacco. Significantly higher proportion of industrial laborers (49.9%) followed by drivers (24.1%) were found to be smokers (p=0.001). The prevalence of white lesions was higher in smokers versus non-smokers 3.5% versus 2.3% (p=0.111), however this difference was statistically non-significant. Red and white lesions were highly significant (i.e. 1.2 % and 10.9% respectively) in the subjects with pan chewing and smoking habits (p=0.001). A significant proportion (8.9%) of the subjects with pan chewing habit showed evidence of oral precancerous lesions (p=0.001). CONCLUSIONS Even though smoking and pan chewing were two significant risk factors detected in this population, their prevalence and occurrence of premalignant lesions are low as compared to the studies conducted in their home countries.
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Affiliation(s)
- Abdul Majeed Kavarodi
- Maxillofacial Surgery King Fahd Military Medical Complex, 2Periodontology, Hamad Medical Corporation, 3Orthodontology, Dr. Johnny's Dental Clinic, Doha, Qatar E-mail :
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Lee CP, Chiang SL, Lee CH, Tsai YS, Wang ZH, Hua CH, Chen YC, Tsai EM, Ko YC. AURKA Phe31Ile polymorphism interacted with use of alcohol, betel quid, and cigarettes at multiplicative risk of oral cancer occurrence. Clin Oral Investig 2015; 19:1825-32. [DOI: 10.1007/s00784-015-1432-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 02/10/2015] [Indexed: 11/24/2022]
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Type 2 diabetes mellitus and risk of oral cancer and precancerous lesions: a meta-analysis of observational studies. Oral Oncol 2015; 51:332-40. [PMID: 25650271 DOI: 10.1016/j.oraloncology.2015.01.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/22/2014] [Accepted: 01/02/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Associations between type 2 diabetes mellitus (type 2 DM) and risk of oral cancer and precancerous lesions have been reported with controversial findings. We performed a meta-analysis to explore these associations. METHODS We identified studies by a literature search of MEDLINE and EMBASE through May 31, 2014, and by searching the reference lists of pertinent articles. Summary relative risk (SRR) with 95% confidence interval (CI) was calculated with a random-effects model. Between- study heterogeneity was assessed using the Cochran's Q and I(2) statistics. RESULTS A total of 13 studies (4 case-control and 9 cohort studies) on the association between type 2 DM and oral cancer were included. Overall analysis found that compared with non-diabetic individuals, individuals with type 2 DM had a significantly elevated incidence of oral cancer (SRR=1.15, 95% CI: 1.02-1.29; Pheterogeneity=0.277, I(2)=15.4%; 10 studies). Subgroup analyses found that duration of follow-up (⩾11years) significantly altered this positive association. Type 2 DM was associated with increased oral cancer mortality (SRR=1.41, 95% CI: 1.16-1.72; 4 studies). Meta-analysis of the four case-control studies showed a positive association between type 2 DM and risk of oral precancerous lesions (SRR=1.85, 95%CI: 1.23-2.80; Pheterogeneity=0.038, I(2)=57.5%). No significant public bias was found across these studies. CONCLUSIONS These findings of this meta-analysis indicate that compared with non-diabetic individuals, individuals with type 2 DM have an elevated risk of oral cancer and precancerous lesions development.
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Chen FL, Chen PY, Tung TH, Huang YC, Tsai MC. The role of betel-quid chewing in smoking cessation among workers in Taiwan. BMC Public Health 2014; 14:755. [PMID: 25065303 PMCID: PMC4131024 DOI: 10.1186/1471-2458-14-755] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/18/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Current smokers exhibit a higher rate of betel-quid chewing than non-smokers. However, little is known regarding the extent to which betel-quid chewing may affect attempts to quit smoking and smoking cessation. The aim of the present study is to examine the association between betel-quid chewing and patterns of quitting smoking. Specifically, we explore whether betel-quid chewing is associated with (1) current smokers who have never attempted to quit versus those who have attempted to quit and have failed, those who are in the process of quitting, and successful cessation smokers, and (2) current smokers who have attempted to quit and have failed versus those who have successfully quit smoking. METHODS A telephone survey of 7,215 workers was conducted and obtained an 88.6% response rate. In the survey, the respondents' smoking and betel-quid chewing statuses were recorded and a list of covariates was assessed. RESULTS After controlling for the effect of the covariates, betel-quid chewing was found to be more highly associated with current smokers who have never attempted to quit, compared to current smokers who are in the process of quitting (OR = 12.72; 95% CI = 1.05-154.26), successful cessation smokers (OR = 3.62; 95% CI = 2.32-5.65), and smokers who have attempted to quit and have failed (OR = 1.37; 95% CI = 1.06-1.77), respectively. In addition, betel-quid chewing is more highly associated with a failure to quit smoking than with successfully quitting smoking (OR = 3.46; 95% CI = 2.17-5.51). CONCLUSION The findings support four plausible reasons why betel-quid chewing may dissuade smokers from quitting. These reasons highlight additional avenues for potentially reducing the smoking population in workplaces, such as considering work contexts and social norms, and product sales in smoking-cessation campaigns.
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Affiliation(s)
- Fu-Li Chen
- />Department of Public Health, College of Medicine, Fu Jen Catholic University, No.510, Jongjheng Rd., Sinjhuang, New Taipei city, Taiwan
| | - Peter Y Chen
- />Department of Psychology, Auburn University, Auburn, Alabama USA
| | - Tao-Hsin Tung
- />Department of Public Health, College of Medicine, Fu Jen Catholic University, No.510, Jongjheng Rd., Sinjhuang, New Taipei city, Taiwan
- />Department of Medical Research and Education, Cheng-Hsin General Hospital, Taipei city, Taiwan
| | - Yu-Ching Huang
- />Department of Public Health, College of Medicine, Fu Jen Catholic University, No.510, Jongjheng Rd., Sinjhuang, New Taipei city, Taiwan
| | - Min-Chien Tsai
- />Department of Public Health, College of Medicine, Fu Jen Catholic University, No.510, Jongjheng Rd., Sinjhuang, New Taipei city, Taiwan
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Lee CH, Chiang SL, Ko AMS, Hua CH, Tsai MH, Warnakulasuriya S, Ibrahim SO, Sunarjo, Zain RB, Ling TY, Huang CL, Lane HY, Lin CC, Ko YC. Betel-quid dependence domains and syndrome associated with betel-quid ingredients among chewers: an Asian multi-country evidence. Addiction 2014; 109:1194-204. [PMID: 24650227 DOI: 10.1111/add.12530] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/08/2013] [Accepted: 02/20/2014] [Indexed: 11/28/2022]
Abstract
AIMS Betel-quid (BQ) contains biologically psychoactive ingredients; however, data are limited concerning the symptoms and syndrome of BQ dependence among chewers. The aims of this study were to evaluate the ingredients-associated BQ dependence syndrome and country-specific chewing features and behaviour for BQ dependence among chewers from six Asian communities. DESIGN An intercountry Asian Betel-quid Consortium study. SETTING Six Asian general communities in Taiwan, Mainland China, Indonesia, Malaysia, Sri Lanka and Nepal. PARTICIPANTS Six multi-stage random samples of BQ chewers in the Asian Betel-quid Consortium study (n = 2078). MEASUREMENTS All chewers were evaluated for BQ dependence using the DSM-IV and ICD-10 criteria. FINDINGS The 12-month BQ dependence rate was 12.5-92.6% and 47.9-99.3% (P = 0.023) among tobacco-free and tobacco-added BQ chewers across the six Asian communities, with a higher dependence rate in chewers who used tobacco-free BQ with lime added than without (23.3-95.6% versus 4.0%, P ≤ 0.001). Taiwanese and Hunanese BQ chewers both notably endorsed the dependency domain of 'time spent chewing'. 'Tolerance' and 'withdrawal' were the major dependence domains associated with the Nepalese and Indonesian chewers, with high BQ dependence rates. Malaysian and Sri Lankan chewers formed a BQ dependence cluster linked closely to 'craving'. In Sri Lanka, the quantity consumed explained 90.5% (P < 0.001) of the excess dependence risk for tobacco-added use, and could be a mediator between tobacco-derived psychoactive effect and BQ dependence development. CONCLUSIONS DSM-IV criteria for dependence apply to a significant proportion of betel quid users in Asian communities, more so if they use it with tobacco or lime.
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Affiliation(s)
- Chien-Hung Lee
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan; Centre of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Zhang L, Xiang Z, Hao R, Li R, Zhu Y. N-acetyltransferase 2 genetic variants confer the susceptibility to head and neck carcinoma: evidence from 23 case-control studies. Tumour Biol 2013; 35:3585-95. [PMID: 24338712 DOI: 10.1007/s13277-013-1473-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 11/26/2013] [Indexed: 02/04/2023] Open
Abstract
Previous evidence indicated that N-acetyltransferase 2 (NAT2) polymorphisms might be a risk factor for several cancers. A number of studies have been conducted on the association between NAT2 polymorphisms and head and neck cancer (HNC) risk. Nevertheless, the results were conflicting. Published meta-analysis on this issue has generated inconclusive results. Thus, we aimed to derive a more precise estimation of the relationship by conducting an updated meta-analysis. Published data prior to August 2013 have been searched and screened. Subgroup analysis on ethnicity, source of controls, sample size, and genotyping method were also performed. As a result, a total of 23 case-control studies including 4,028 cases and 4,872 controls were selected for analysis. Interestingly, the results showed that NAT2 polymorphisms might increase HNC risk for the overall data (OR 1.23, 95% CI 1.01-1.49). Moreover, in subgroup analyses according to ethnicity, data showed that slow acetylators might increase HNC susceptibility among Asians (OR 1.78, 95% CI 1.27-2.49), but not among Caucasians or mixed ethnicities. In conclusion, NAT2 polymorphism might be a low-penetrant risk factor for HNC among Asians.
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Affiliation(s)
- Liang Zhang
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
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Kassim S, Croucher R, al'Absi M. Khat dependence syndrome: a cross sectional preliminary evaluation amongst UK-resident Yemeni khat chewers. JOURNAL OF ETHNOPHARMACOLOGY 2013; 146:835-841. [PMID: 23454606 DOI: 10.1016/j.jep.2013.02.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 02/01/2013] [Accepted: 02/02/2013] [Indexed: 06/01/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Khat is a natural psychostimulant that has pharmacological effects similar to that of amphetamine. The behaviour of khat chewing is embedded within a cultural context. Meanwhile khat chewing is associated with psychological and physiologically burden, as a 'dependence producing' substance. AIMS OF THE STUDY To assess the applicability of the construct of substance dependence syndrome (DSM-IV, 1994) to khat chewing and to examine psychosocial and behavioural correlates of this syndrome including tobacco use. MATERIALS AND METHODS A sample of 204 khat chewers was recruited during random visits to khat sale outlets. A face to face interview that assessed socio-demographic, psychosocial dependence, substance dependence syndrome and behavioural characteristics was conducted. Descriptive, exploratory psychometric and multivariate analyses were employed. RESULTS Approximately a third (31%) of khat chewers reported symptoms consistent with dependence syndrome including increased khat chewing (13%) and cessation attempts (19%) while 17% reported withdrawal symptoms including depression (61%), increase in appetite (74%) and interrupted sleep (58%). Thirty-eight percent reported continued khat chewing despite impacts on their health. Psychometric assessment of the DSM-IV criteria for khat chewing dependence identified two factors; factor 1 consisted of bio-behavioural items and factor 2 withdrawal items, accounting for 67% of the variance and Cronbach's alpha coefficient at 0.78. In multivariate logistic regression modelling, there was an association between intensity of psychological khat dependence (SDS-Khat) and nicotine dependence with the likelihood of exhibiting khat chewing dependence syndrome (p=0.0005, OR=1.51, 95%CI=1.33-1.71; p=0.043, OR=2.87, 95%CI=1.03-7.98, respectively). CONCLUSIONS The substance dependence syndrome criteria are applicable to khat chewing and associated with increased intensity of nicotine and psychological khat dependence. The applicability of khat dependence syndrome and exploration of its dimensions and associated factors should be extended in future research. Concurrent validation of these findings using specific objective measures for self-report khat chewing is also recommended.
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Affiliation(s)
- Saba Kassim
- Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Institute of Dentistry, 4 Newark Street, London E1 2AT, UK.
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