A population-based study of the association between betel-quid chewing and the metabolic syndrome in men

Amy Ming Fang Yen, Yueh Hsia Chiu, Li Sheng Chen, Hui Min Wu, Chih Chung Huang, Barbara J. Boucher, Tony Hsiu Hsi Chen

Research output: Contribution to journalArticlepeer-review

92 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1153-1160
Number of pages8
JournalAmerican Journal of Clinical Nutrition
Issue number5
Publication statusPublished - May 1 2006
Externally publishedYes


  • Areca catechu
  • Betel quid
  • Chewing
  • Community-based integrated screening
  • Dose-response effect
  • Metabolic syndrome
  • Risk factors

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Medicine (miscellaneous)


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