Relationship between Betel Quid Chewing and Metabolic Risk Markers

Abstract

The preparation of betel quid (BQ) is diverse among countries and reports on relationship between BQ chewing and metabolic risk markers are still contradictory. Metabolic syndrome is now recognized as one of the major health challenges. The prevalence of smokeless tobacco use in Myanmar is the highest among ASEAN countries. The majority of smokeless tobacco users are BQ chewers but some people still prefer BQ without tobacco chewing. Therefore, the present study aimed to study the relationship between BQ chewing and metabolic risk markers.

The study was a cross-sectional analytical study including 162 subjects (70 non-chewer control subjects and 92 BQ chewers) between 20-45 years of age. Anthropometric assessments including waist circumference (WC) and measurement of resting blood pressure were done. Fasting plasma glucose (FPG) concentration was determined by glucose oxidase, phenol, 4-aminophenazone method, serum triglyceride (TG) level by glycerol phosphate oxidase/ phenol aminophenazone method and serum high density lipoprotein cholesterol (HDLc) concentration by precipitation method. Daily physical activity was assessed by the Global Physical Activity Questionnaire.

When compared with non-chewer control subjects, BQ chewers had significantly higher WC (p = 0.01), FPG (p < 0.001), TG (p = 0.02) and lower HDLc (p = 0.04). However, there was no significant difference in metabolic risk markers between BQ tobacco chewers and BQ without tobacco chewers (p > 0.05).

Presence of metabolic syndrome was found in 26.1% of BQ chewers and in 5.7% of control subjects. There was a significant association between BQ chewing and metabolic syndrome (p < 0.001). Among BQ chewers, 21.4% of BQ tobacco chewers and 40.9% of BQ without tobacco chewers had metabolic syndrome.Both BQ tobacco chewing (p = 0.007) and BQ without tobacco chewing (p < 0.001) were significantly associated with metabolic syndrome. However, there was no significant association between gender and metabolic syndrome among BQ chewers as well as among BQ tobacco chewers.

Betel quid tobacco chewers had 4.5 times increased risk of having metabolic syndrome compared to control subjects (95% CI: 1.41, 14.35, p = 0.01). Betel quid chewers also had 5.8 times increased risk of having metabolic syndrome compared to control subjects (95% CI: 1.92, 17.7, p = 0.002).

In conclusion, findings of the present study indicate that there is significant relationship between metabolic syndrome and BQ chewing regardless of tobacco added. BQ chewing with or without tobacco is associated with metabolic syndrome irrespective of gender. Both BQ tobacco chewers and BQ without tobacco chewers have increased risk of having metabolic syndrome compared to control group.

Comments from the Editor

This research addresses the issue of betel nut chewing, which is a common practice in the country, as a contributing factor to development of metabolic syndrome, which is a pre diabetic state. People desirous of stopping smoking use betel nut chewing as an alternative, and this may not be advisable.

Hla Yee Yee, MBBS(Rgn) ; MSc(Mdy);PhD(Lond);FRCP(Edin)(Hon); Cert.in Leadership for Physician Educators (Harvard Business School)