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ORIGINAL RESEARCH COMMUNICATION |
1 From the Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (AM-FY, L-SC, C-CH, and TH-HC); the Taiwan Association of Medical Screening. Taipei, Taiwan (AM-FY, L-SC, H-MW, C-CH, and TH-HC); the Health Bureau of Keelung City, Keelung City, Taiwan (Y-HC); the Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan (H-MW); the Center for Diabetes & Metabolic Medicine, Queen Mary School of Medicine & Dentistry, Royal London Hospital, London, United Kingdom (BJB)
Background: Betel-quid chewing, an established risk factor for oropharyngeal malignancy, is associated with hyperglycemia and obesity. Associations with other characteristics of the metabolic syndrome have not been reported.
Objective: This study examined associations between betel-quid chewing and the metabolic syndrome, allowing for recognized risk factors and exploring dose-response effects in a population-based study.
Design: Age-specific prevalence rates of the metabolic syndrome were examined in betel-quid chewing and nonchewing men (n = 19 839) recruited into the Keelung Community-based Integrated Screening program in 2001–2003. The independent effect of betel-quid chewing on metabolic syndrome risk was examined by using multiple logistic regression with control for well-recognized risk factors (eg, education, physical activity, and dietary factors) and dose-response effects were examined by using trend tests.
Results: The age-adjusted prevalence of the metabolic syndrome was highest in current chewers (25.13%), next highest in ex-chewers (22.04%), and lowest in nonchewers (15.73%) (P < 0.0001). Odds ratios (95% CIs) for the metabolic syndrome were 1.38 (1.19, 1.60) and 1.78 (1.53, 2.08) in ex-chewers and current chewers, respectively, adjusted for other significant correlates such as a family history of hypertension and diabetes mellitus. Meaningful odds ratios for the metabolic syndrome components ranged from 1.24 for hyperglycemia (95% CI: 1.09, 1.64) to 1.90 (95% CI: 1.66, 2.19) for hypertriacylglycerolemia. Increasing odds ratios for the metabolic syndrome with higher consumption of betel quid (whether by rate of use, duration of use, or cumulative exposure) suggest dose-response effects.
Conclusions: After adjustment for well-established risk factors, our study showed independent predictive dose-response effects of betel-quid chewing for the metabolic syndrome and its components in a population-based study of men with a 15% prevalence of betel-nut chewing.
Key Words: Metabolic syndrome • betel quid • Areca catechu • chewing • dose-response effect • community-based integrated screening • risk factors
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