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Islam MR, Aktar S, Pervin J, Rahman SM, Rahman M, Rahman A, Ekström EC. Maternal betel quid use during pregnancy and child growth: a cohort study from rural Bangladesh. Glob Health Action 2024; 17:2375829. [PMID: 38979658 PMCID: PMC11234907 DOI: 10.1080/16549716.2024.2375829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/29/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Chewing betel quid (BQ) - a preparation commonly containing areca nut and slaked lime wrapped in betel leaf - is entrenched in South Asia. Although BQ consumption during pregnancy has been linked to adverse birth outcomes, its effect on postnatal growth remains largely unexplored. OBJECTIVE We examined the associations of BQ use during pregnancy with children's height-for-age and body mass index-for-age z-scores (HAZ and BAZ, respectively) and fat and fat-free mass along with sex-based differences in association in rural Bangladesh. METHODS With a prospective cohort design, we assessed BQ use among mothers enrolled in the Preterm and Stillbirth Study, Matlab (n = 3140) with a structured questionnaire around early third trimester. Children born to a subset of 614 women (including 134 daily users) were invited to follow-up between October 2021 and January 2022. HAZ and BAZ were calculated from anthropometric assessment, and fat and fat-free mass were estimated using bioelectric impedance. Overall and sex-specific multiple linear regression models were fitted. RESULTS Growth data were available for 501 children (mean age 4.9 years): 43.3% of them were born to non-users, 35.3% to those using prior to or less-than-daily during the survey, and 21.3% to daily users. No statistically significant associations were observed after adjusting for sex, parity, maternal height and education, and household wealth. CONCLUSIONS There was no effect of BQ use during pregnancy on postnatal growth in this study. Longitudinal studies following up those born to heavy users beyond childhood are warranted for capturing long-term implications of prenatal BQ exposure.
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Affiliation(s)
- Mohammad Redwanul Islam
- Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Shaki Aktar
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jesmin Pervin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Syed Moshfiqur Rahman
- Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Monjur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Anisur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Eva-Charlotte Ekström
- Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Kaur J, Rinkoo AV, Richardson S. Trends in smokeless tobacco use and attributable mortality and morbidity in the South-East Asia Region: implications for policy. Tob Control 2024; 33:425-433. [PMID: 36596709 DOI: 10.1136/tc-2022-057669] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/08/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To describe the prevalence of smokeless tobacco (SLT) use and number of users by year, in addition to trends in mortality and attributable disease burden in countries of the WHO South-East Asia Region (SEAR), to inform policies for SLT control in the Region. METHODS For each SEAR country, we obtained data from Global Adult Tobacco Surveys, WHO STEPwise Approach to NCD Risk Factor Surveillance surveys and Demographic and Health Surveys conducted since 2010 to estimate prevalence of SLT use by country, sex and year. Using data from the World Population Prospects database we estimated the number of users by country. Next, using the results of previous meta-analyses and prevalence results, we estimated the population attributable fractions and attributable mortality and morbidity in terms of annual deaths and disability-adjusted life years lost. We then characterised trends in attributable deaths and disease burden for countries with comparable data. RESULTS There were wide differences in SLT use prevalence by country. We estimated that, during 2015-2019, there were 165 803 900 SLT users across SEAR, with 479 466 attributable deaths annually of which India accounted for 79.9% with 383 248. Attributable annual deaths increased in some countries during 2015-2019. CONCLUSIONS Annual deaths and disease burden attributable to SLT remain high across SEAR and have only declined modestly in recent years. Effective implementation of all WHO Framework Convention on Tobacco Control measures, addressing both supply-side and demand-side issues, in relation to SLT and areca nut products must be prioritised to ensure reductions in mortality and disease burden are sustained and accelerated.
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Affiliation(s)
- Jagdish Kaur
- Tobacco Free Initiative, World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Arvind Vashishta Rinkoo
- Tobacco Free Initiative, World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Itaki R, Taufa S. Association between habitual betel quid chewing and risk of adverse cardiovascular outcomes: A systematic review. Trop Med Int Health 2024; 29:447-453. [PMID: 38556799 DOI: 10.1111/tmi.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Habitual betel quid chewing, a tobacco product, is a leading cause of oral cancer in Asia-Pacific countries where this practice is most prevalent. However, it is not well understood whether betel quid chewing is also a cause of adverse cardiovascular outcomes. To address this gap, we conducted a systematic literature review of peer-reviewed published studies evaluating the association between habitual betel quid use on the risk of adverse cardiovascular outcomes. METHODS We searched PubMed for studies assessing the correlation between betel quid chewing and cardiovascular health. We included studies if (i) they included human subjects; (ii) were peer-reviewed articles in indexed journals; and (iii) were in English. We extracted data from eligible studies and stratified them by geographical location, study designs and cardiovascular outcomes. Finally, we did a narrative synthesis of the data to identify adverse cardiovascular outcomes associated with chronic betel quid use. FINDINGS We reviewed data from 19 studies that met the inclusion criteria. Habitual betel quid chewing was associated with hypertension, atherosclerosis, inflammation and ischaemic heart disease. In addition, betel quid use was a risk factor for arrhythmias. Interestingly, betel quid use was an independent risk factor for cardiovascular disease in women. Long-term betel quid consumption was associated with higher risks for all-cause mortality and increased overall cardiovascular risk. CONCLUSIONS Habitual betel quid chewing is an important cardiovascular risk factor in populations where the practice is prevalent.
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Affiliation(s)
- Rodney Itaki
- American Samoa Government, Department of Public health, Pago Pago, American Samoa, USA
| | - Shalon Taufa
- Department of Basic Medical Sciences, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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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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Wang C, Chiu S, Wu S, Pan L, Yen Y, Lai Y, Chen C. Treatment and mortality risk of older adults with non-small cell cancer in Taiwan: A population-based cohort study. Thorac Cancer 2023; 14:2687-2695. [PMID: 37551918 PMCID: PMC10493478 DOI: 10.1111/1759-7714.15055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Older patients tend to have decreased physical functions and more comorbidities than younger patients. At present, the best management for very elderly patients with lung cancer is not known. In this study, we aimed to investigate treatment and mortality risk of older adults with non-small cell cancer (NSCLC) in Taiwan. METHODS This study analyzed data from the Taiwan Cancer Registry database. Patients aged ≥80 years with newly diagnosed NSCLC between 2010 and 2017 were included. Treatment options were categorized as curative, palliative, and no treatment. Patients were followed up until death or December 31, 2020. Univariable and multivariable Cox proportional hazards models were used to estimate mortality risk, and Kaplan-Meier survival curves were drawn. RESULTS A total of 11 941 patients, aged ≥80 years, with newly diagnosed NSCLC between 2010 and 2017 were identified from the Taiwan Cancer Registry and followed up until 2020. The mean age was 84.4 ± 3.7 years old, and 7468 (62.54%) were men. The Kaplan-Meier survival curves showed significant differences across the three treatment options (log-rank p < 0.001). Results from multivariate Cox regression demonstrated that patients on palliative treatment (adjusted HR: 0.52, 95% CI: 0.48-0.56, p < 0.001) and curative treatment (adjusted HR: 0.45, 95% CI: 0.42-0.48, p < 0.001) had a significantly lower mortality risk than those with no treatment. The subgroup analyses stratified by cancer stages also showed consistent findings. CONCLUSION Elderly patients with NSCLC had significantly decreased mortality risk when receiving curative or palliative treatment compared with those without treatment. In the future, further studies are warranted to investigate complications and quality of life of elderly patients with NSCLC during palliative or curative treatment.
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Affiliation(s)
- Chun‐Chieh Wang
- Division of Chest Medicine, Department of Internal MedicinePuli Branch of Taichung Veterans General HospitalNantouTaiwan
- Department of EldercareCentral Taiwan University of Science and TechnologyTaichungTaiwan
| | - Shao‐Wen Chiu
- Healthcare Technology Business Division, Healthcare DepartmentInternational Integrated SystemsTaipeiTaiwan
| | - Shang‐Jung Wu
- Department of NursingPuli Branch of Taichung Veterans General HospitalNantouTaiwan
| | - Lung‐Kwang Pan
- Department of Medical Imaging and Radiological ScienceCentral Taiwan University of Science and TechnologyTaichungTaiwan
| | - Yung‐Feng Yen
- Section of Infectious Diseases, Taipei City Hospital, Taipei City GovernmentTaipeiTaiwan
- Institute of Hospital and Health Care AdministrationNational Yang‐Ming UniversityTaipeiTaiwan
- Department of Health Care ManagementNational Taipei University of Nursing and Health SciencesTaipeiTaiwan
| | - Yun‐Ju Lai
- Department of Health Care ManagementNational Taipei University of Nursing and Health SciencesTaipeiTaiwan
- School of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
- Department of Exercise Health ScienceNational Taiwan University of SportTaichungTaiwan
- Division of Endocrinology and Metabolism, Department of Internal MedicinePuli Branch of Taichung Veterans General HospitalNantouTaiwan
| | - Chu‐Chieh Chen
- Department of Health Care ManagementNational Taipei University of Nursing and Health SciencesTaipeiTaiwan
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Dangore-Khasbage S, Bhowate RR, Khubchandani M. Chemical Composition of Areca Nut and Its Adverse Effects on Human Health. Cureus 2023; 15:e43739. [PMID: 37731445 PMCID: PMC10507371 DOI: 10.7759/cureus.43739] [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: 05/29/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023] Open
Abstract
Areca nut (AN) is one of the addictive substances consumed widely in the world. The composition of AN is very complex, and each component has variable properties. This study aims to review the composition of AN and its adverse effects on humans. For this review, the literature search was performed by an electronic search of the Pubmed/Medline, Scopus, and Google Scholar databases using proper MESH headings and retrieved the articles published from 1997 to 2022. The eligibility criteria included human studies, a form of AN, the composition of AN, harmful effects of AN, the effect of AN on the oral cavity, the effect of AN on vital organs, and articles published in English. Data were extracted regarding the composition of AN, forms of AN, and harmful effects of AN on the oral cavity and on other systems. A total of 449 articles were identified from various databases, and 36 studies were selected that met the inclusion criteria. The active components of AN, which produce harmful effects, are primarily alkaloids, polyphenols, tannins, and certain trace elements. AN is consumed in different forms, and based on the form, its composition also varies. AN is known to cause deleterious effects on the oral cavity as well as various body organs. The most dangerous and widely reported impacts of AN on the oral cavity are the development of oral submucous fibrosis, a premalignant condition, and oral malignancy. However, during the chewing process, excretory products of AN are released and circulate in the body of "chronic habitual" and affect the other body parts. Thus, AN consumption may contribute to cardiac, liver, endocrinal, metabolic, respiratory, and reproductive system disorders also. AN composition is complex, and its consumption is harmful to human health. In regard to controlling the issue of the harmful effects of this habit, preventive measures should be established.
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Affiliation(s)
- Suwarna Dangore-Khasbage
- Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rahul R Bhowate
- Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Monika Khubchandani
- Pediatric Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Sawane HB, Shetiya SH. Smokeless Tobacco as a Risk Factor for Type 2 Diabetes Mellitus in South East Asia Region: Systematic Review and Meta-Analysis. Indian J Community Med 2023; 48:579-587. [PMID: 37662127 PMCID: PMC10470557 DOI: 10.4103/ijcm.ijcm_937_22] [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: 11/19/2022] [Accepted: 05/23/2023] [Indexed: 09/05/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder of which prevalence has been increasing steadily all over the world. There is a need of understanding the role of tobacco products in diabetes mellitus, especially smokeless tobacco (ST) products. Objective To analyze if ST is a determinant for T2DM among patients in South East Asia Region (SEAR) and secondly to obtain the pooled prevalence of use of ST in T2DM patients/participants from these studies. Materials and Methods PubMed, Google Scholar, EBSCO, and Scopus are the databases that were searched to find desired manuscripts, which fulfilled the inclusion criteria to undertake this systematic review and meta-analysis (SRMA). Meta-analysis was carried out to determine the pooled effect size for the odds ratio of ST use in T2DM with 95% CI. MedCalc statistical software was used followed by the DerSimonian and Laird method under the random effect model. Results A total of 8 manuscripts were involved in the systematic review and 7 in the meta-analysis. Odds of 1.39 indicating increased frequency of using ST among T2DM patients or survey participants was observed, which was not significant with C.I. 95% (0.843-2.288) and P < 0.001 with high heterogeneity. The pooled prevalence of use of ST in T2DM is 24.08% (CI 15.67 to 33.64) under random effect model with I2 inconsistency of 97.16% in 8 studies from India and Bangladesh. Conclusion This pooled analysis shows that ST use is not a risk factor for T2DM. The number of studies included in the SRMA from SEAR is limited having no representation from Myanmar, Bhutan, Timor Leste, and Sri Lanka.
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Affiliation(s)
- Harshawardhan B. Sawane
- Department of Public Health Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Sahana H. Shetiya
- Department of Public Health Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
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Sznajder KK, Wander K, Mattison S, Medina-Romero E, Alam N, Raqib R, Kumar A, Haque F, Blumenfield T, Shenk MK. Labor migration is associated with lower rates of underweight and higher rates of obesity among left-behind wives in rural Bangladesh: a cross-sectional study. Global Health 2021; 17:81. [PMID: 34275481 PMCID: PMC8286616 DOI: 10.1186/s12992-021-00712-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Among Bangladeshi men, international labor migration has increased ten-fold since 1990 and rural to urban labor migration rates have steadily increased. Labor migration of husbands has increased household wealth and redefined women's roles, which have both positively and negatively impacted the health of wives "left behind". We examined the direct and indirect effects of husband labor migration on chronic disease indicators and outcomes among wives of labor migrants. METHODS We collected survey, anthropometric, and biomarker data from a random sample of women in Matlab, Bangladesh, in 2018. We assessed associations between husband's migration and indicators of adiposity and chronic disease. We used structural equation modeling to assess the direct effect of labor migration on chronic disease, undernutrition, and adiposity, and the mediating roles of income, food security, and proportion of food purchased from the bazaar. Qualitative interviews and participant observation were used to help provide context for the associations we found in our quantitative results. FINDINGS Among study participants, 9.0% were underweight, 50.9% were iron deficient, 48.3% were anemic, 39.6% were obese, 27.3% had a waist circumference over 35 in., 33.1% had a high whole-body fat percentage, 32.8% were diabetic, and 32.9% had hypertension. Slightly more women in the sample (55.3%) had a husband who never migrated than had a husband who had ever migrated (44.9%). Of those whose husband had ever migrated, 25.8% had a husband who was a current international migrant. Wives of migrants were less likely to be underweight, and more likely to have indicators of excess adiposity, than wives of non-migrants. Protection against undernutrition was attributable primarily to increased food security among wives of migrants, while increased adiposity was attributable primarily to purchasing a higher proportion of food from the bazaar; however, there was a separate path through income, which qualitative findings suggest may be related to reduced physical activity. CONCLUSIONS Labor migration, and particularly international labor migration, intensifies the nutrition transition in Bangladesh through increasing wealth, changing how foods are purchased, and reducing physical activity, which both decreases risk for undernutrition and increases risk for excess adiposity.
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Affiliation(s)
- Kristin K Sznajder
- Pennsylvania State University College of Medicine Department of Public Health Sciences, Hershey, USA.
| | - Katherine Wander
- Binghamton University State University of New York Department of Anthropology, Binghamton, USA
| | - Siobhan Mattison
- University of New Mexico Department of Anthropology, Albuquerque, USA
| | | | | | | | | | | | - Tami Blumenfield
- University of New Mexico Department of Anthropology, Albuquerque, USA
| | - Mary K Shenk
- Pennsylvania State University Department of Anthropology, State College, USA.
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Yoshikawa K, Yamada H, Matsushima M. Betel quid chewing and its associated factors in Myanmar: A quantitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103047. [PMID: 33268051 DOI: 10.1016/j.drugpo.2020.103047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Betel quid is more widely consumed than tobacco in Myanmar. It brings adverse health effects regardless of whether it contains tobacco; however, Myanmar has no clear prevention strategy. This study aims to show a broader picture of the prevalence of betel quid chewing and the observable characteristics of its consumers in Myanmar by comparing it to tobacco usage. METHODS This study used the 2015-2016 Myanmar Demographic and Health Survey data. First, we identified characteristics of betel quid consumers by a logit model. Next, we focused on exploring who would be likely to become heavy users, conditioned on being a betel quid consumer by controlling for possible sample selection bias. RESULTS We found differences in characteristics for betel chewers and tobacco smokers, and for betel quid users and heavy users. CONCLUSION These results suggest that betel quid consumption should be regulated by a specific prevention strategy rather than by Myanmar's existing tobacco prevention strategy.
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Affiliation(s)
- Kanako Yoshikawa
- Osaka School of International Public Policy, Osaka University, 1-31 Machikaneyamacho, Toyonaka, Osaka 560-0043, Japan.
| | - Hiroyuki Yamada
- Faculty of Economics, Graduate School of Economics. Keio University, 2-15-45 Mita, Minato-ku, Tokyo, 108-8345 Japan
| | - Midori Matsushima
- Faculty of Humanities and Social Sciences, Graduate School of Humanities and Social Sciences, International Public Policy, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577 Japan
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Tsuji JS, Lennox KP, Watson HN, Chang ET. Essential concepts for interpreting the dose-response of low-level arsenic exposure in epidemiological studies. Toxicology 2021; 457:152801. [PMID: 33905760 DOI: 10.1016/j.tox.2021.152801] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022]
Abstract
Scientifically robust selections of epidemiological studies and assessments of the dose-response of inorganic arsenic in the low-dose range must consider key issues specific to arsenic in order to reduce risk of bias. The abundance of toxicological, mechanistic, and epidemiological evidence on arsenic enables a nuanced assessment of risk of bias in epidemiological studies of low-level arsenic, as opposed to a generic evaluation based only on standard principles. Important concepts in this context include 1) arsenic metabolism and mode of action for toxicity and carcinogenicity; 2) effects of confounding factors such as diet, health status including nutritional deficiencies, use of tobacco and other substances, and body composition; 3) strengths and limitations of various metrics for assessing relevant exposures consistent with the mode of action; and 4) the potential for bias in the positive direction for the observed dose-response relationship as exposure increases in the low-dose range. As an example, evaluation of a recent dose-response modeling using eight epidemiological studies of inorganic arsenic and bladder cancer demonstrated that the pooled risk estimate was markedly affected by the single study that was ranked as having a high risk of bias, based on the above factors. The other seven studies were also affected by these factors to varying, albeit lesser, degrees that can influence the apparent dose-response in the low-dose range (i.e., drinking water concentration of 65 µg/L or dose of approximately ≤1 µg/kg-day). These issues are relevant considerations for assessing health risks of oral exposures to inorganic arsenic in the U.S. population, and setting evidence-based regulatory limits to protect human health.
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Liu S, Liu Z, Shan Z, Liu Y, Chen T, Fang L, Quan H. Skewed Th17/Treg balance during progression and malignant transformation of oral submucous fibrosis. Oral Dis 2021; 28:2119-2130. [PMID: 33749974 DOI: 10.1111/odi.13853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/01/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of our study was to determine the impact of Th17/Treg imbalance on the progression and malignant transformation of oral submucosal fibrosis (OSF). MATERIALS AND METHODS To assess Th17 and Treg expression, overall 52 peripheral blood samples from OSF, oral squamous cell carcinoma (OSCC) patients, and healthy donors were analyzed by flow cytometry. Thirty normal oral mucosa, 72 OSF, and 90 OSCC samples were analyzed by immunohistochemistry. RESULTS In peripheral blood samples, in OSCC with OSF, Th17 and Treg expression were significantly higher than those in OSF and OSCC without OSF as confirmed by immunohistochemistry. During OSF progression, Th17 and Th17/Treg ratio showed an increasing trend, while Treg expression showed a decreasing trend. Treg expression was significantly higher in OSCC with OSF than in OSF and OSCC without OSF, whereas the Th17/Treg ratio was significantly lower in OSCC with OSF. Treg expression was significantly correlated with smoking and clinical stage. Th17/Treg ratio was significantly associated with tumor size, lymph node metastasis, and clinical stage. A low Th17/Treg ratio was significantly associated with poor prognosis. CONCLUSIONS Th17/Treg ratio is a potential diagnostic indicator for OSF occurrence and malignant transformation and was an independent prognostic factor for OSCC.
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Affiliation(s)
- Sixuan Liu
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China.,Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, China
| | - Ziyi Liu
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China.,Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, China
| | - Zhongyan Shan
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China.,Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, China
| | - Yuxin Liu
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China.,Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, China
| | - Tianjun Chen
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China.,Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, China
| | - Liangjuan Fang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Hongzhi Quan
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, China.,Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, China
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12
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Quan H, Liu S, Shan Z, Liu Z, Chen T, Hu Y, Yao Z, Fang L. Differential expression of programmed death-1 and its ligand, programmed death ligand-1 in oral squamous cell carcinoma with and without oral submucous fibrosis. Arch Oral Biol 2020; 119:104916. [PMID: 32977151 DOI: 10.1016/j.archoralbio.2020.104916] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of our study was to investigate the expression of programmed death ligand-1 (PD-L1)/programmed death-1 (PD-1) between oral squamous cell carcinoma (OSCC) patients with and without oral submucous fibrosis (OSF), and its correlation with clinic-pathologic features and its prognostic value. METHODS PD-L1 and PD-1 expression was evaluated by immunohistochemical staining, double immunofluorescent staining and real-time PCR, and the correlation of PD-L1/PD-1 expression with clinical outcome was assessed. RESULTS The level of PD-L1 expression was significantly higher in OSCC with OSF than in OSCC without OSF (p = 0.006). Moreover, PD-L1 expression was strongly correlated with lymph node metastasis (p = 0.016), and advanced tumor stage (p = 0.030). Increased PD-L1 expression was positively correlated with the incidence of OSCC with OSF (p = 0.006, p = 0.008, respectively). PD-L1 expression was an independent marker of unfavorable prognosis (p = 0.035, p = 0.048, respectively). High PD-L1 expression had a significantly worse outcome in OSCC patients with OSF (p = 0.014). Double immunofluorescent staining showed that OSCC with OSF were more strongly expressed both PD-L1 and PD-1 than OSCC without OSF. Moreover, the expression of PD-L1 were upregulated in OSCC tissues than normal control (p = 0.0422), and both PD-L1 and PD-1 was significantly higher in OSCC with OSF than OSCC without OSF tissues (p = 0.0043 and, p = 0.0012, respectively). CONCLUSIONS The present study suggested that PD-L1 may be an unfavorable indicator for prognosis. PD-L1/PD-1 signaling might play an important role in the malignant transformation of OSF, and targeting PD-L1/PD-1 signaling may be a new therapeutic strategy for OSCC, especially in OSCC patients with OSF.
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Affiliation(s)
- Hongzhi Quan
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, PR China; Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, Hunan, 410008, PR China.
| | - Sixuan Liu
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, PR China; Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, Hunan, 410008, PR China
| | - Zhongyan Shan
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, PR China; Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, Hunan, 410008, PR China
| | - Ziyi Liu
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, PR China; Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, Hunan, 410008, PR China
| | - Tianjun Chen
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, PR China; Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, Hunan, 410008, PR China
| | - Yanjia Hu
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, PR China; Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, Hunan, 410008, PR China
| | - Zhigang Yao
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, PR China; Department of Oral Pathology, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, Hunan, 410008, PR China
| | - Liangjuan Fang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, PR China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan 410008, PR China.
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13
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Yang WF, Qin N, Song X, Jiang C, Li T, Ji P, Li Y, Ding D, Wang C, Dai J, Jin G, Chen TW, Chang YS, Ouyang DQ, Liao GQ, Hu Z, Chang KP, Su YX, Ma H. Genomic Signature of Mismatch Repair Deficiency in Areca Nut-Related Oral Cancer. J Dent Res 2020; 99:1252-1261. [PMID: 32527169 DOI: 10.1177/0022034520930641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Areca nut (AN) chewing contributes to an increase of oral squamous cell carcinoma (OSCC) cases in South and Southeast Asia; however, genomic events underlying the carcinogenesis process of AN-related OSCC remain unclear. Here, we comprehensively describe the genomic and transcriptome alterations of 113 Chinese OSCC patients (89 AN related and 24 AN negative) by whole-exome sequencing and RNA sequencing, and we compared the genomic differences between AN-related and AN-negative samples by integrating sequencing data of 325 OSCC patients from The Cancer Genome Atlas database and 50 from a published Taiwanese study. We identified 11 significantly mutated genes for OSCC, including 4 novel ones (ATG2A, WEE1, DST, and TSC2), of which WEE1 and ATG2A mutated with significantly higher rates in AN-related samples (P = 0.04 and P = 0.003, respectively). Mutational signature analysis revealed that AN-related OSCCs were specially characterized by the genomic signature of mismatch repair deficiency (dMMR), which could also predict the prognosis status of AN-related OSCC. In addition, an elevated PD-L1 expression was also observed in both AN-related patients (P = 3.71 × 10-11) and those with a high dMMR level (P = 1.99 × 10-4). Further differential expression analysis and in vitro experiments confirmed the role of dMMR in the development of OSCC induced by AN exposure. Taken together, this study first revealed the molecular profiles and highlighted the role of dMMR in AN-related OSCC among the Chinese population and identified that AN-related OSCC may represent a potential cohort for effective anti-PD-1/L1 immunotherapy.
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Affiliation(s)
- W F Yang
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - N Qin
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - X Song
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - C Jiang
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, Mainland China
| | - T Li
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, Mainland China
| | - P Ji
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - Y Li
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - D Ding
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - C Wang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China.,Department of Bioinformatics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Mainland China
| | - J Dai
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - G Jin
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - T W Chen
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Y S Chang
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - D Q Ouyang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Mainland China
| | - G Q Liao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Mainland China
| | - Z Hu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
| | - K P Chang
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Y X Su
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - H Ma
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Mainland China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Mainland China
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14
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A valuable experience. Br Dent J 2020; 228:905. [DOI: 10.1038/s41415-020-1807-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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15
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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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16
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Abstract
Background: Few traditions in South Asia have the antiquity and universal acceptance of betel quid and areca nut chewing. Its popularity dates back to ancient times in the South-Asian community with a foundation based on four factors, i.e. social acceptability, religious beliefs, perceived health benefits and addiction. We aim to provide an overview of its use in the South Asian region. Methods: We performed an electronic search on Medline, Embase and Google Scholar to identify the origins of the various betel quid and areca nut practices pertaining to the South Asian region along with their social and cultural influences. We also studied the prevalence across the region and the health effects, especially carcinogenic, along with the impact of diverse immigration today. Results: Other than the debate of where it originates, there is a diverse plethora of terms and methods of use of areca nut and betel quid in the region. Although established as a known carcinogen, the incidence is high, especially in the Indian subcontinent, with very few studies focusing on its use alone (without tobacco). The effect of globalization and increased movement of Asians across borders is resulting in changes in the patterns of diseases as well due to wider dissemination of areca nut and betel quid use. Conclusions: There is a huge loss of lives due to the addiction that areca nut causes. Governments need to tightly regulate the laws and set up tailored programs to tackle this specific issue in this region.
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Affiliation(s)
- Arjun Singh
- Department of Head and Neck Oncology, Tata Memorial Center, Mumbai, India
| | - Rajesh Dikshit
- Centre for Cancer Epidemiology, Tata Memorial Center, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Oncology, Tata Memorial Center, Mumbai, India
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17
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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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18
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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: 39] [Impact Index Per Article: 5.6] [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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19
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Wu F, Chen Y, Demmer RT, Parvez F, Paul RR, Shaheen I, Sarwar G, Ahmed A, Eunus M, Ahsan N, Habibullah NM, Islam T, Rundek T, Ahsan H, Desvarieux M. Periodontal diseases and carotid intima-media thickness in Bangladesh. J Clin Periodontol 2016; 43:909-917. [PMID: 27394059 DOI: 10.1111/jcpe.12597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 12/17/2022]
Abstract
AIM To evaluate the relationship between periodontal diseases and subclinical atherosclerosis in a younger and lean South Asian population. METHODS We conducted a cross-sectional study in 917 subjects (mean age 46 years and mean body mass index 21.1 kg/m2 ) from the Health Effects of Arsenic Longitudinal Study in Bangladesh. Multivariate linear regression models were used to assess the associations between multiple clinical measures of periodontal diseases and carotid intima-media thickness (IMT). RESULTS Mean attachment loss (AL) and percentage of sites with AL ≥ 4 mm (% AL ≥ 4) were associated with increased IMT. The IMT was 20.0-μm (95% CI: 2.2, 37.8) and 26.5-μm (95% CI: 8.9, 44.1) higher in subjects in the top quartile of mean AL (>3.72 mm) and % AL ≥ 4 (>58.4%), respectively, compared to those in the bottom quartile. In a subset of 366 subjects, mean AL was positively associated with plasma levels of matrix metalloproteinase-9 (p < 0.05) and soluble intercellular adhesion molecule-1 (p < 0.01). CONCLUSIONS Attachment loss was associated with subclinical atherosclerosis in this young and lean Bangladeshi population. Future prospective studies are needed to confirm this association.
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Affiliation(s)
- Fen Wu
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Yu Chen
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA.
| | - Ryan T Demmer
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Faruque Parvez
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | - Golam Sarwar
- U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh
| | | | - Mahbub Eunus
- U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh
| | - Nafiz Ahsan
- U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh
| | | | - Tariqul Islam
- U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh
| | - Tatjana Rundek
- Departments of Neurology and Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Habibul Ahsan
- Department of Health Studies, Center for Cancer Epidemiology and Prevention, The University of Chicago, Chicago, IL, USA
| | - Moise Desvarieux
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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