Betel Chewing and Risk of Metabolic Disease, Cardiovascular Disease, and All-Cause Mortality: A Meta-Analysis
Asia already has 60% of the world’s diabetic population and diabetes is increasing more rapidly in Asia than anywhere else. Betel nut (Areca nut) is the fruit of the Areca catechu tree. Approximately 600 million individuals regularly chew it in Asia and it is thought to be the fourth most commonly used psychoactive substance in the world. Betel quid (BQ) is a known risk factor for oral cancer and esophageal cancer. Several recent studies have shown that chewing BQ is associated with the risk of various systemic diseases. We performed a meta-analysis to confirm the influence of chewing BQ on metabolic disease, cardiovascular disease, and all-cause mortality.
METHODS:
We searched Medline, Cochrane Library, Web of Science, and Science Direct for pertinent articles published by 2013. The adjusted relative risk (RR) and 95% confidence interval were calculated using the random effect model. Sex was used as an independent category for comparison.
RESULTS:
Of 675 potentially relevant studies, 21 studies from Asia (5 cohort studies and 16 case-control studies) covering 434,423 subjects were selected. Seven studies (N=121,585) showed significant dose-response relationships between betel quid consumption and the risk of events. According to pooled analysis, the adjusted RR of betel quid chewers vs. non-chewers was 1.47 (P<0.001) for obesity, 1.51 (P=0.01) for metabolic syndrome, 1.47 (P<0.001) for diabetes, 1.45 (P=0.06) for hypertension, 1.63 (P=0.04) for hypertriglyceridemia, 1.55 (P=0.004) for chronic kidney disease, 1.2 (P=0.02) for cardiovascular disease, and 1.21 (P=0.02) for all-cause mortality.
CONCLUSIONS:
BQ chewing is associated with an increased risk of metabolic disease, cardiovascular disease, and all-cause mortality. In addition to preventing oral cancer, stopping BQ use would be beneficial in view of the rapidly increasing prevalence of metabolic diseases in South-East Asia and the Western Pacific.