Abstract
BackgroundBetel quid chewing is associated with metabolic disorders, oral cancer, cardiovascular disease, and chronic liver diseases. Metabolic syndrome (MetS) is also a factor associated with liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). However, studies on the relationship between betel quid and liver fibrosis while also considering MetS are lacking. The aim of this study was thus to investigate the association of betel quid chewing and liver fibrosis with MetS.MethodsA total of 9,221 subjects were enrolled after excluding subjects <18 years of age, with past history of chronic liver diseases, cancer, significant alcohol consumption, and incomplete data. Betel nut chewing habit was classified into three groups: none, former-chewing, and current-chewing, and cumulative exposure was calculated by multiplying the duration with the quantity. Liver fibrosis was evaluated based on the NAFLD fibrosis score (NFS), which is a composite score of age, hyperglycemia, BMI, platelet count, albumin, and the AST/ALT ratio. Significant liver fibrosis was defined as NFS ≥-1.455.ResultsAfter adjusting for other variables, MetS was positively associated with significant liver fibrosis. Subjects with both MetS and betel quid chewing had a higher associated risk of significant liver fibrosis than those with neither MetS nor betel quid chewing (adjusted OR: 3.03, 95% CI: 2.04–4.50, p < 0.001). Betel quid chewing was associated with significant liver fibrosis (adjusted OR: 2.00, 95% CI: 1.14–3.49, p = 0.015) in subjects with MetS, but not in subjects without.ConclusionMetabolic syndrome increased the associated risk of significant liver fibrosis. Cumulative betel quid exposure increased the associated risk of significant liver fibrosis in subjects with MetS, but not in subjects without.
Highlights
Betel quid chewing has been recognized as a traditional oriental habit in South and Southeast Asia as well as the Asia-Pacific region [1, 2] for hundreds of years
Among all the subjects recruited (n = 9,221), 2,240 (32.1%) participants met the diagnosis of metabolic syndrome (MetS), and 1,757 (19.1%) participants were diagnosed with significant liver fibrosis
Model 2 showed that, after adjusting those potential confounders such as age, gender, alcohol consumption, cigarette smoking, and regular exercise, there was still an increased associated risk of liver fibrosis in subjects with MetS who chewed betel quid and in those with MetS alone
Summary
Betel quid chewing has been recognized as a traditional oriental habit in South and Southeast Asia as well as the Asia-Pacific region [1, 2] for hundreds of years. The betel quid chewing is associated with an increased risk of oral cancer [4, 10] as well as several metabolic disorders, including obesity, hypertension, metabolic syndrome (MetS), diabetes, and cardiovascular disease [11, 12]. Several previously reported studies have demonstrated the relationship between and betel quid chewing and liver diseases such as liver fibrosis, liver cirrhosis, and even hepatocellular carcinoma (HCC) [13,14,15]. Betel quid chewing is associated with metabolic disorders, oral cancer, cardiovascular disease, and chronic liver diseases. Studies on the relationship between betel quid and liver fibrosis while considering MetS are lacking.
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