Abstract
The prevalence of betel nut chewing in Taiwan is high at approximately 7%, however, few studies have evaluated the relationship between betel nut chewing and lung disease. Therefore, the aim of this study was to investigate associations between betel nut chewing and lung function in 80,877 participants in the Taiwan Biobank (TWB). We further investigated correlations between betel nut chewing characteristics such as years of use, frequency, daily amount, and accumulative dose, with obstructive lung disease. We used data from the TWB. Lung function was assessed using spirometry measurements of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). The participants were classified into normal lung function and obstructive lung function (FEV1/FVC < 70%) groups. The participants were asked questions about betel nut chewing, including years of use, frequency, and daily amount. After multivariable analysis, betel nut chewing (odds ratio [OR] = 1.159; p < 0.001) was significantly associated with FEV1/FVC < 70% in all participants (n = 80,877). Further, in the participants who chewed betel nut (n = 5135), a long duration of betel nut chewing (per 1 year; OR = 1.008; p = 0.012), betel nut use every day (vs. 1–3 days/month; OR = 1.793; p = 0.036), 10–20 quids a day (vs. <10 quids; OR = 1.404; p = 0.019), 21–30 quids a day (vs. <10 quids; OR = 1.662; p = 0.010), ≥31 quids a day (vs. <10 quids; OR = 1.717; p = 0.003), and high cumulative dose (per 1 year × frequency × daily score; OR = 1.001; p = 0.002) were significantly associated with FEV1/FVC < 70%. In this large population-based cohort study, chewing betel nut was associated with obstructive lung disease. Furthermore, a long duration of betel nut chewing, more frequent use, higher daily amount, and high cumulative dose were associated with obstructive lung disease. This suggests that preventing betel nut chewing should be considered to reduce obstructive lung disease in Taiwan.
Highlights
Chronic lung disease has attracted increasing attention due to the high global prevalence of around 545 million people, among which chronic pulmonary obstructive disease (COPD) has the highest global prevalence of 3.9% [1]
The participants were divided into normal lung function (FEV1/forced vital capacity (FVC) ≥ 70%; n = 65,199, 80.6%) and obstructive lung function (FEV1/FVC < 70%; n = 15,678; 19.4%) groups
Wang et al found a positive correlation between asthma and betel nut chewing in 1800 subjects, which they suggested could be due to an increase in arecoline inducing eotaxin-1 activation
Summary
Chronic lung disease has attracted increasing attention due to the high global prevalence of around 545 million people, among which chronic pulmonary obstructive disease (COPD) has the highest global prevalence of 3.9% [1] This high burden may be related to environmental exposure and inhalation of toxins. Long-term exposure to noxious particles causes irreversible chronic inflammation resulting in small airway fibrosis, mucus hypersecretion, tissue destruction, increased lung compliance, and progressive airflow obstruction [2]. These pathological changes impair perfusion and lead to the development of COPD. The association between betel nut chewing and obstructive lung disease remains poorly defined
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