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

Abstract

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

Substance use and incidence of metabolic syndrome before midlife among military adults: the CHIEF cohort study

“…Similarly, betel nut chewing has been associated with low HDL-C levels, and this effect may be more prominent than its influence on other MetS features, e.g. elevated TG and BP ( 7 ). For alcohol use, the association with reduced HDL-C was inconsistent.…”

“…The prevalence of MetS has been on the rise globally, and it has become a significant public health concern (4,5). Numerous studies have investigated the association between various lifestyle factors, such as alcohol consumption, smoking, and betel nut chewing, and the development of MetS (6)(7)(8)(9)(10). However, the synergistic effect of these unhealthy lifestyle behaviors on the incidence of MetS, particularly among physically active young adults, has not been thoroughly explored.…”

“…Similarly, cigarette smoking has been linked to a higher prevalence of MetS, possibly related to its effects on lipid metabolism, insulin sensitivity, and abdominal obesity ( 3 , 11 , 17 – 19 ). Betel nut chewing, a common practice in many Asian countries, has also been associated with an increased risk of MetS, as it may lead to obesity, insulin resistance, and impaired glucose tolerance ( 6 , 7 , 9 , 20 – 23 ).…”

Association of Metabolic Syndrome and Other Factors with the Presence of Diabetic Nephropathy in Type 2 Diabetic Patients

“…Chewing betel nuts, also known as betel quid or areca nuts, is widespread throughout South and Southeast Asia, East Africa, and the Western Pacific and plays an important role in the sociocultural identity [27]. Moreover, the consumption of betel quid is associated with MetS, diabetes, hypertension, obesity, cardiovascular disease [28][29][30], and cancer of the oral cavity, pharynx, and esophagus [31]. A cross-sectional research of 667 male Taiwanese participants found a link between betel nut consumption and CKD, with an adjusted odds ratio of 2.572 (95%CI 1.917, 3.451) [32], which is consistent with our finding.…”