The role of Physical activity in harm reduction among betel quid chewers from a prospective cohort of 419,378 individuals

Feng En Lo, Po Jung Lu, Min Kuang Tsai, June Han Lee, Christopher Wen, Chi Pang Wen, Jackson Pui Man Wai, Chwen Keng Tsao, Po Huang Chiang, Shu Yu Lyu, Ko Luma, Ying Chen Chi, Chu Shiu Li, Chwen Chi Liu, Xifeng Wu

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4 Citations (Scopus)


Objective: To assess the benefits of regular exercise in reducing harms associated with betel quid (BQ) chewing. Methods: The study cohort, 419,378 individuals, participated in a medical screening program between 1994 and 2008, with 38,324 male and 1,495 female chewers, who consumed 5-15 quids of BQ a day. Physical activity of each individual, based on "MET-hour/week", was classified as "inactive" or "active", where activity started from a daily 15 minutes/day or more of brisk walking (≥3.75 MET-hour/week). Hazard ratios for mortality and remaining years in life expectancy were calculated. Results: Nearly one fifth (18.7%) of men, but only 0.7% of women were chewers. Chewers had a 10-fold increase in oral cancer risk; and a 2-3-fold increase in mortality from lung, esophagus and liver cancer, cardiovascular disease, and diabetes, with doubling of all-cause mortality. More than half of chewers were physically inactive (59%). Physical activity was beneficial for chewers, with a reduction of all-cause mortality by 19%. Inactive chewers had their lifespan shortened by 6.3 years, compared to non-chewers, but being active, chewers improved their health by gaining 2.5 years. The improvement, however, fell short of offsetting the harms from chewing. Conclusions: Chewers had serious health consequences, but being physically active, chewers could mitigate some of these adverse effects, and extend life expectancy by 2.5 years and reduce mortality by one fifth. Encouraging exercise, in addition to quitting chewing, remains the best advice for 1.5 million chewers in Taiwan.

Original languageEnglish
Article numbere0152246
JournalPLoS ONE
Issue number4
Publication statusPublished - Apr 2016

ASJC Scopus subject areas

  • General


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