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de la Monte SM, Moriel N, Lin A, Abdullah Tanoukhy N, Homans C, Gallucci G, Tong M, Saito A. Betel Quid Health Risks of Insulin Resistance Diseases in Poor Young South Asian Native and Immigrant Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186690. [PMID: 32937888 PMCID: PMC7558723 DOI: 10.3390/ijerph17186690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 01/30/2023]
Abstract
Betel quid, traditionally prepared with areca nut, betel leaf, and slaked lime, has been consumed for thousands of years, mainly in the form of chewing. Originally used for cultural, medicinal, and ceremonial purposes mainly in South Asian countries, its use has recently spread across the globe due to its psychoactive, euphoric, and aphrodisiac properties. Now it is widely used as a social lubricant and source of financial profit. Unfortunately, the profit motive has led to high rates of habitual consumption with eventual conversion to addiction among young girls and boys. Moreover, the worrisome practice of including tobacco in quid preparations has grown, particularly among pregnant women. Major health concerns include increased rates of malignancy, oral pathology, and cardiovascular, hepatic, fertility, metabolic, and neuropsychiatric disorders. Metabolic disorders and insulin resistance disease states such as type 2 diabetes, obesity, and metabolic syndrome contribute to cognitive decline and neurodegeneration. Mechanistically, the constituents of areca nut/betel quid are metabolized to N-nitroso compounds, i.e., nitrosamines, which are carcinogenic at high doses and cause insulin resistance following chronic low-level exposures. From an epidemiological perspective, the rising tide of insulin resistance diseases including obesity, diabetes, and dementias that now disproportionately burden poor countries has been propagated by rapid commercialization and enhanced access to betel quid. Public health measures are needed to impose socially and ethically responsible barriers to yet another cause of global health disparity.
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Affiliation(s)
- Suzanne M. de la Monte
- Department of Pathology and Laboratory Medicine, Providence VA Medical Center, Providence, RI 02808, USA
- Women & Infants Hospital of Rhode Island, Providence, RI 02808, USA
- Alpert Medical School, Brown University, Providence, RI 02808, USA
- Departments of Medicine, Rhode Island Hospital, Providence, RI 02808, USA; (G.G.); (M.T.)
- Neurology, Neurosurgery and Neuropathology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Correspondence:
| | - Natalia Moriel
- Department of Molecular Pharmacology and Physiology at Brown University, Providence, RI 02912, USA; (N.M.); (A.L.); (N.A.T.)
| | - Amy Lin
- Department of Molecular Pharmacology and Physiology at Brown University, Providence, RI 02912, USA; (N.M.); (A.L.); (N.A.T.)
| | - Nada Abdullah Tanoukhy
- Department of Molecular Pharmacology and Physiology at Brown University, Providence, RI 02912, USA; (N.M.); (A.L.); (N.A.T.)
| | - Camille Homans
- Department of Neuroscience, Brown University, Providence, RI 02912, USA;
| | - Gina Gallucci
- Departments of Medicine, Rhode Island Hospital, Providence, RI 02808, USA; (G.G.); (M.T.)
| | - Ming Tong
- Departments of Medicine, Rhode Island Hospital, Providence, RI 02808, USA; (G.G.); (M.T.)
| | - Ayumi Saito
- Department of Epidemiology in the School of Public Health, Brown University, Providence, RI 02912, USA;
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Gunjal S, Pateel DGS, Yang YH, Doss JG, Bilal S, Maling TH, Mehrotra R, Cheong SC, Zain RBM. An Overview on Betel Quid and Areca Nut Practice and Control in Selected Asian and South East Asian Countries. Subst Use Misuse 2020; 55:1533-1544. [PMID: 32569533 DOI: 10.1080/10826084.2019.1657149] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Areca nut (AN) and betel quid (BQ) chewing are ancient practices followed by an extensive proportion of the world's population. These practices are endemic in larger parts of South and Southeast Asia and selected Western Pacific countries. The prevalence of these habits varies across regions, age, gender, cultural practice, and socioeconomic status groups. Considerable variations exist between countries with respect to prevention/intervention programs, and policy guidelines of BQ usage. Objectives: (1) To provide an overview of the BQ chewing prevalence, practices, preventive interventions and policies in selected Asian and Western Pacific countries. (2) To explore the different terminologies associated with BQ use. Method: A narrative review of the current literature related to BQ, AN, and oral cancer was conducted by searching PUBMED, CINAHL, and GOOGLE databases. Results: The literature review revealed that the prevalence of BQ was found to be highest in Papua New Guinea, followed by Bangladesh, India, Pakistan, Myanmar and Sri Lanka. While, Cambodia, Malaysia, Indonesia and Taiwan had comparatively lower prevalence. Smokeless tobacco, BQ with tobacco, BQ without tobacco, AN were some of the terminologies used for BQ in various studies. Conclusions: The prevalence, and the interventional policies related to BQ and AN chewing habits varies widely among the selected countries. With the increasing awareness and association of BQ with oral cancer, there is a need to have better awareness, prevention and interventional strategies in place. We also found considerable variation in the use of terminologies associated with BQ.
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Affiliation(s)
- Shilpa Gunjal
- Department of Dental Public Health, Faculty of Dentistry, MAHSA University, Selangor, Malaysia
| | | | - Yi-Hsin Yang
- Division of Medical Statistics and Bioinformatics, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Jennifer Geraldine Doss
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Selangor, Malaysia
| | - Sobia Bilal
- Department of Children and Community Oral Health, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | | | - Ravi Mehrotra
- ICMR-National Institute of Cancer Prevention and Research, WHO-FCTC Global Knowledge Hub on Smokeless Tobacco, Noida, National Capital Region, India
| | - Sok Ching Cheong
- Head and Neck Cancer Team, Cancer Research Malaysia, Subang Jaya, Malaysia
| | - Rosnah Binti Mohd Zain
- Department of Oral Pathology Oral Medicine, Faculty of Dentistry, MAHSA University, Selangor, Malaysia.,Faculty of Dentistry, University of Malaya, Wilayah Persekutuan, Kuala Lumpur, Malaysia.,Faculty of Dentistry, University of Airlangga, Suarabaya, East Java, Indonesia
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