Pattern of areca (betel) nut chewing and obesity measures in Guam and Saipan, Mariana Islands

Tuesday, 19 August 2014
Exhibit hall (Dena'ina Center)
Yvette C Paulino, PhD , University of Guam, Mangilao, Guam
Eric L Hurwitz, PhD , University of Hawaii-Manoa, Honolulu, HI
Lynne R Wilkens, DrPH , University of Hawaii Cancer Center, Honolulu, HI
Rachel Novotny, PhD , University of Hawaii-Manoa, Honolulu, HI
Mary Jane Miller , University of Guam, Mangilao, Guam
Katrina Marie G Quinata , University of Guam, Mangilao, Guam

Areca (betel) nut is chewed by 600 million people worldwide, and is the fourth most frequently used substance following nicotine, ethanol, and caffeine. Chewing patterns vary among populations. The practice has been shown to be associated with chronic diseases, including obesity.  The purpose of this study is to estimate associations between chewing patterns and obesity measures among residents of the Mariana Islands.


A cross-section of 300 betel nut chewers (157 males; 143 females) ≥18 years old were recruited in Guam and Saipan between January 2011and June 2012. Information on demographics, betel nut use and related behaviors, and anthropometry were collected.  Height and weight measurements were used to calculate body mass index (BMI) for weight status, and waist and hip measurements were used to calculate waist-to-hip ratio (WHR) for central adiposity.  Sex-specific adjusted associations using both the logistic and log-binomial models were used to estimate the prevalence of obesity (BMI ≥30 kg/m2) and high central adiposity (WHR >1.0 in males, >0.85 in females) and their association with betel nut chewing pattern, which was classified into two patterns by cluster analysis.


The majority (n=222; 74%) of the participants were Class 2 chewers who chewed with tobacco; the remainder were Class 1 chewers who chewed the areca nut without tobacco.  Compared to male and female Class 2 chewers, obesity [males: prevalence ratio (PR)=1.12; confidence interval (CI)=0.78-1.62 / females: PR=1.09; CI=0.84-1.43] and high central adiposity [males: PR=1.68; CI=1.07-2.65 / females: PR=1.00; CI=0.80-1.23] were more prevalent  in Class 1 chewers. The adjusted associations were stronger in males than in females for Class and obesity [males: odds ratio (OR)=1.76; CI=0.75-4.09 / females: OR=1.31; CI=0.43-4.01] and Class and high central adiposity [males: OR=2.92; CI=1.21-7.07 / females: OR=0.90; CI=0.24-3.41].

CONCLUSIONS:  The findings suggest that Class 1 chewing pattern is associated with high central adiposity among males, but not among females in the Mariana Islands.