Betel Nut Consumption Research Articles

Areca (betel) nut chewing habit among high-school children in the Commonwealth of the Northern Mariana Islands (Micronesia).

To investigate the prevalence of its use by high-school children in Saipan in Micronesia. Usage of the areca nut is indigenous to south Asia and the western and south Pacific. Some serious health effects of areca nut chewing are recognized and the International Agency for Research on Cancer has recently classified regular use of areca nut as being carcinogenic to humans. Information on usage by young people, however, is scarce. Data on consumption of areca nut were obtained by a self-administered questionnaire. Following an oral mucosal examination using WHO criteria any detectable oral mucosal diseases were recorded. Of 309 schoolchildren surveyed (mean age 16.3 +/- 1.5 years), 63.4% claimed regular use, the highest level recorded in any school population survey. Significant oral diseases detected were oral leukoplakia in 13% and oral submucous fibrosis in 8.8% of children. These findings from Saipan suggest that areca nut chewing starts at a young age in Micronesia. As many users develop dependency this raises important concerns regarding its consequences for oral health.

Evaluation of Risk Factors for Nasopharyngeal Carcinoma in High-Risk Nasopharyngeal Carcinoma Families in Taiwan

A study of nasopharyngeal carcinoma (NPC) families with two or more affected members was conducted in Taiwan (265 families with 2,444 individuals, 502 affected and 1,942 unaffected) to determine the association between NPC and potential etiologic factors in NPC high-risk families. Similar to results from a previous case-control study in Taiwan, Guangdong salted fish consumption during childhood, exposure to wood, and betel nut consumption were all associated with elevated NPC risk using conditional logistic regression, although these associations were not as strong as in the case-control study possibly due to shared environment among family members. Risk associated with cumulative wood exposure and salted fish consumption before age 10 was stronger in families with early NPC age-onset [odds ratio (OR(wood)), 5.10; 95% confidence interval (95% CI), 1.50-17.34; OR(fish), 3.94; 95% CI, 1.47-10.55] or three or more affected members (OR(wood), 4.41; 95% CI, 1.58-12.30; OR(fish), 4.27; 95% CI, 1.10-16.47). In contrast, a tendency for elevated risk was noted for betel nut use in late age-onset families (OR, 2.44; 95% CI, 1.16-5.13) and the CYP2E1 c2 allele in families with less than three affected members (OR, 2.06; 95% CI, 1.04-3.35). Risk estimates associated with these exposures were similar when the analyses were restricted to EBV-seropositive subjects. To better adjust for degree of relationship among family members and residual genetic correlations, we also calculated ORs using a variance components model. The results from the two methods were similar indicating that the risk estimates from conditional logistic regression were unbiased.

Correlates of tobacco-use pattern amongst adolescents in two schools of New Delhi, India

As adolescent tobacco use has been found to be a major predictor of future use, preventive efforts need to be focused on this section of population. To assess the role of knowledge regarding tobacco, risk-taking attitude, peers, and other influencers on tobacco and areca nut use, amongst adolescents. A school-based cross-sectional study covering two schools. Students of classes IX and XI, of selected schools, participated in the study (n = 596). A pretested and validated, close ended, self-administered questionnaire was used. Sociodemographic factors, awareness regarding tobacco, risk-taking attitudes, role of peers and other influencers, and tobacco, areca nut and alcohol use, were studied. Point estimates, 98% Confidence Intervals, tests of significance, bivariate and multivariate analysis (multiple logistic regression). Almost 42% of tobacco users started before the age of 12 years. Peer pressure, general stress, and media were important influencers. Logistic regression analysis showed that students in public school were using more tobacco [Odds ratio (OR) = 1.85, P = 0.174] and tobacco/areca nut (OR = 1.14, P = 0.02). The difference in use between the genders and class in which studying was statistically not significant. Lesser proportion of those possessing adequate knowledge regarding tobacco used it as compared to those without adequate knowledge (OR = 0.13, P < 0.001) however, possession of adequate knowledge was not a good predictor of areca nut consumption (OR = 0.86, P = 0.585). The most important correlate for tobacco use (OR = 6.41, P < 0.001) and areca nut use (OR = 11.17, P < 0.001) was risk-taking attitude. Multi-pronged and concerted efforts targeting children at an early age are required to prevent tobacco and areca nut use among adolescents.

Lifestyle, parity, menstrual and reproductive factors and risk of gallbladder cancer.

Together with thyroid cancer, cancer of the gallbladder is the only non-sex hormone-related cancer displaying a female preponderance, with incidence being 3-4 times more common among women. We carried out this study to evaluate the role of menstrual, reproductive and lifestyle factors in gallbladder carcinogenesis. A case-control study involving 64 newly diagnosed cases of gallbladder cancer and 101 cases of cholelithiasis was carried out. A detailed menstrual and reproductive history was illustrated beside detailed lifestyle history, in particular consumption of betel nut, tobacco and alcohol and smoking, odds ratio was calculated. Mean age of the patients with cancer was 51+/-1.2 years while it was 40.9+/-1.2 years for gallstones; 69% of cancer patients and 90% of gallstones patients were females. More than half of the cancer patients (53%) and 43% of the gallstone patients were illiterate. A past history of typhoid was present in 22% of cancer patients and 13% of gallstone patients, while 35% of cancer and 25% of gallstone patients were chewers, 18.1 and 9.9% were smokers, and 10% of cancer and 2% of gallstone patients consumed alcohol. Mean age of menarche was 13.4+/-1.2 years among female patients with cancer while it was 14.0+/-1.4 years for gallstone patients. Higher age at menarche (>13 years, OR 2.48, 95% confidence interval (CI) 1.16-5.3), higher number of childbirths(>3 births, OR 3.92; 95% CI 1.4-10.3), higher number of pregnancies (>3 pregnancies, OR 6.66, 95% CI 1.8-23.4), and higher age at last childbirth (>25 years, OR 2.97, 95% CI 1.04-8.5) were found to have significantly higher risk of developing gallbladder cancer. In conclusion, tobacco chewing and smoking are associated with increased odds of gallbladder cancer. Similarly early menarche, late menopause, multiple pregnancies and childbirth increased the risk of gallbladder cancer.

Quantification of arecoline (areca nut alkaloid) in neonatal biological matrices by high-performance liquid chromatography/electrospray quadrupole mass spectrometry.

A high-performance liquid chromatography (HPLC) method with mass spectrometric detection is described for determination of arecoline in newborn meconium, urine and cord serum, using pilocarpine as internal standard. The analytes were extracted from neonatal biological matrices with chloroform/isopropanol (95:5, v/v) at alkaline pH. Extracts were analyzed by HPLC coupled to an electrospray (ESI) interface and a quadrupole mass spectrometer. Chromatography was performed on a C(8) reversed-phase column using 10 mM ammonium acetate (pH 4.3)/acetonitrile (90:10, v/v) as mobile phase. The mass spectrometer was operated in selected ion monitoring mode. The method was validated over the concentration range 0.005-1.00 micro g/g meconium, 0.004-1.00 micro g/mL cord serum and 0.001-1.00 micro /mL urine. Mean recoveries ranged between 86.5 and 90.7% for arecoline in the different biological matrices, with precision always better than 10%. The quantification limits of arecoline were 0.005 micro g/g meconium, 0.004 micro g/mL cord serum, and 0.001 micro g/mL urine. The method was applied to the analysis of neonatal biological matrices to assess eventual fetal exposition to arecoline. Two newborns from Asian mothers who declared areca nut consumption presented arecoline in meconium with concentrations in the range 0.006-0.008 micro g/g; also the urine from one neonate tested positive for the drug.

Prevalence and factors associated with the consumption of betel-nut among military conscripts in Taiwan.

This study evaluates the prevalence of betel-nut chewing among military personnel stationed on Taiwan's offshore islands. Furthermore, this study examines variables to identify which may predict a greater predilection toward betel-nut chewing among the conscript population studied. A cross-sectional mass screening was conducted of compulsory military service personnel stationed on Taiwan's offshore islands between August 1 and December 31, 2001. A total of 7574 military employees were included in this survey. Information regarding betel-nut chewing habits were ascertained using a standard structured questionnaire, which including the level and duration of betel-nut chewing as well as respondents' knowledge, attitude and practices with regard to consumption of this product. Conscripts were found to be less likely to chew betel-nut regularly while performing military service. There are 1535 (20.3%) of respondents reporting to habitually chew betel-nut prior to active duty shrank to 1048 (13.8%) after going on active-duty. The most reasons to chew betel-nut among the recruits after military services are curiosity (33.3%) and as a stimulant (29.8%). About 46% of military employees who currently chew betel-nut report an interest to quit in the future. The risk factors for betel-nut chewing include individual factors (e.g., age, education, knowledge, and attitude toward betel-nut chewing), lifestyle habits (e.g., cigarette smoking), and familial factors (e.g., consumption of betel-nut by parents). More interesting, the recruits had the habit of cigarette smoking associated with increase risk for betel-nut chewing (OR: 7.18; 95% CI: 5.66-9.20). Although the military has made considerable progress in reducing betel-nut chewing on military campuses, the prevalence of betel-nut chewing is still relatively high and, in 2001, affected about one quarter of all military personnel stationed on the abovementioned offshore islands. In future efforts to lower betel-nut consumption among high risk groups, targeting the group of conscripted military personnel described in this study should be considered.

Areca nut use following migration and its consequences.

Areca nut use is widespread in the Oriental countries, affecting approximately 20% of the world's population. The combined use of areca nut and smokeless tobacco (ST) is practiced particularly in the Indo-Chinese continents. While there is considerable global variation in the use of these products, migrant studies relevant to areca nut use is of considerable interest to epidemiologists in suggesting the extent to which these environment exposures are important in the aetiology of different cancers and other health-related consequences. Studies on Indian migrants to the Malay peninsula, South and east Africa and various Asian ethnic groups resident in several parts of the United Kingdom have shown that the consumption of areca nut (often mixed with ST) is highly prevalent in these communities. Available data on the prevalence of areca chewing among these migrant populations are reviewed here. The carriage of these risk factors from South Asia to other countries has resulted in excess risk of oral cancer in these new settlements. There is also a high incidence of cardiovascular disease, hypertension and late onset diabetes among Indians living in the United Kingdom and there is new evidence to suggest that the combined roles of areca and ST may be contributory. Because of their enhanced financial situation, substance abuse may increase in their new country of domicile. The two products are psychologically addictive and a dependency syndrome related to their use among Asian immigrants to the United Kingdom has been described recently.

Three-year survey of blood lead levels in 8828 Taiwanese adults

The purpose of this study was to investigate environmental lead exposure in the general Taiwanese population. A total of 8828 Taiwanese adults selected by a multistage sampling method were investigated. Characteristics of the participants were ascertained by questionnaire and 10 ml venous blood was drawn by public health nurses. The blood specimens were distributed to six laboratories for blood lead level (BLL) measurement. A quality control program was applied during the analysis of the BLLs in order to improve precision and accuracy. The arithmetic mean BLL of the 8828 Taiwanese adults was 7.70 +/- 5.23 micrograms/dl, with a maximal level of 69.1 micrograms/dl. The median was 6.5 micrograms/dl and the 90th percentile was 14.0 micrograms/dl. After logarithmic transformation, the geometric mean was 1.84 +/- 0.67 microgram/dl. This study also found that elevated BLLs were associated with certain personal characteristics, i.e., gender, ethnic group, and education level; life-style factors, such as smoking, alcohol consumption, Chinese herbal drug consumption, milk consumption, and sources of drinking water; residential location, i.e., level of urbanization; and occupational history of lead exposure. However, age, floor level of residence, distance from house to road, and betel nut consumption were not associated with elevated BLLs. These results showed that BLLs in the Taiwanese population were not higher than those in developed and developing countries. Most of the influencing factors were also found in other studies; however, local factors such as ethnic group, Chinese herbal drug consumption, and sources of drinking water are important considerations in Taiwan when examining ways to prevent overexposure to lead in the general population.

Anthropometric Markers for Risk of Type 2 Diabetes Mellitus in Relation to Betel Nut Consumption in East London Asians

Anthropometric Markers for Risk of Type 2 Diabetes Mellitus in Relation to Betel Nut Consumption in East London Asians

Blood lead levels in the general population of Taiwan, Republic of China.

The purpose of this study was to investigate the environmental lead exposure of the general population in Taiwan. A total of 2919 residents of Taiwan were selected by multistage sampling methods. The participants were characterized by questionnaires and 10 ml venous blood was collected for blood lead measurement. A quality assurance/quality control program was designed during the analysis of blood lead levels. The mean blood lead level of 2719 residents without occupational lead exposure was 8.29 +/- 5.92 micrograms/dl. After adjustment for age and sex distribution to the Taiwan general population, the mean blood lead level was 8.10 micrograms/dl. Adjusted for an 11% underestimation of blood lead levels among the six laboratories, the mean blood lead level was estimated to be 8.99 micrograms/dl. This study also found that blood lead levels were associated with personal characteristics, i.e., gender, ethnic group, education level; lifestyle factors, i.e., smoking, alcohol consumption, sources of drinking water; and residential location, i.e., levels of urbanization, distance of house from the road. However, age, floor of residence, milk consumption, betel nut consumption, and Chinese herbal drug consumption were not found to be associated with blood lead levels. These results show that blood lead levels in Taiwan residents were not higher than in most developed and developing countries. Environmental lead pollution does not seem to be a serious problem in Taiwan.

Betel nut (Areca catechu) consumption and the induction of glucose intolerance in adult CD1 mice and in their F1 and F2 offspring.

Many mutagenic nitroso compounds are also diabetogenic. Betel-nut (Areca catechu) chewing populations have an increased incidence of foregut cancers related to betel-nut nitrosamines which suggests that betel consumption could be diabetogenic. Young adult CD1 mice with a low spontaneous incidence of diabetes were fed betel nut in standard feed for 2-6 days. Single point (90 min) intra-peritoneal glucose tolerance tests were used to follow glucose tolerance up to 6 months of age. Glucose intolerance was defined as over 3 SD above mean control values. Glucose intolerance was found in 3 of 51 male and 4 of 33 female adult mice which were fed the betel diet (p < 0.01). Studies on the progeny of these mice are presented separately for animals studied in Aberdeen (Group 1) and London (Group 2). In matings of Group 1 betel-fed parents glucose intolerance was found in 4 of 25 male and 1 of 22 female F1 offspring, with significant hyperglycaemia in F1 males born to hyperglycaemic but not to normoglycaemic mothers (p < 0.01). In the F2 generation 4 of 23 males and 1 of 16 females and in the F3 generation 1 of 16 males and 0 of 20 females were glucose intolerant. In the Group 2 studies where betel-fed parents were mated to normal controls glucose intolerance was found in 10 of 35 male and 10 of 33 female F1 progeny (p < 0.005), and mean islet areas were increased in offspring of betel-fed parents (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Betel nut (Areca catechu) consumption and the induction of glucose intolerance in adult CD1 mice and in their F1 and F2 offspring

Betel nut (Areca catechu) consumption and the induction of glucose intolerance in adult CD1 mice and in their F1 and F2 offspring

Role of areca nut consumption in the cause of oral cancers. A cytogenetic assessment

Role of areca nut consumption in the cause of oral cancers. A cytogenetic assessment

In vitro genotoxic effects of areca nut extract and arecoline.

The genotoxic potential of the aqueous extract of areca nut as well as arecoline, the major alkaloid of the areca nut, was tested with the help of cytogenetic markers such as sister-chromatid exchanges and chromosome aberrations, utilizing Chinese hamster ovary (CHO) cells. The continuous-treatment and pulse-treatment schedules yielded dose-dependent elevations in the frequencies of sister-chromatid exchange and chromosomal aberration in CHO cells, indicating a genotoxic effect of both the extract and arecoline. The results also imply that, besides arecoline, there may be some other water-extractable substances in the areca nut that make the extract more genotoxic. The chromosome damage was found to be more severe on treating the cells with low concentrations and for longer duration, which mimic the effects of chronic areca nut consumption.

Betel nut‐induced extrapyramidal syndrome: An unusual drug interaction

Two cases are described of chronic schizophrenic patients maintained on depot neuroleptics, who developed severe extrapyramidal symptoms following a period of heavy betel nut consumption. A mechanism for this effect is proposed based on the pharmacological antagonism of the anticholinergic agent, procyclidine, by the active alkaloid ingredient of the betel, arecoline.

Betel nut constituents as inhibitors of gamma-aminobutyric acid uptake.

THE pharmacological properties of betel nut, the dried seed of Areca catechu which is consumed in immense quantities in the East as a masticatory, are usually interpreted in terms of the cholinomimetic effects of the major alkaloid component, arecoline. Betel nut contains lesser amounts of the related alkaloid guvacoline and the amino acids arecaidine and guvacine. According to popular tradition, a mixture of crushed betel nut and lime is enveloped in leaves of Piper betle before chewing. This treatment with lime has been shown to hydrolyse almost quantitatively arecoline to arecaidine1, a well tolerated substance which lacks the typical parasympathomimetic effects of arecoline, including tremor and salivation1,2. Studies on the effects of arecaidine on the behaviour of mice indicate that this substance participates in producing some of the psychic changes ascribed to the betel mixture1,2. These betel constituents are tetrahydronicotinic acid derivatives (Fig. 1) and we have shown that nipecotic acid, ‘hexahydronicotinic acid’, is a potent inhibitor of the uptake of the central inhibitory transmitter γ-aminobutyric acid (GABA) in rat brain slices3. Nipecotic acid potentiates the depressant action of microelectrophoretically administered GABA on the firing of feline spinal neurones4. As the uptake of GABA is likely to be concerned with the inactivation of this transmitter, interference with GABA uptake could result in behavioural changes. The structural similarities between nipecotic acid and the betel nut constituents together with the above mentioned findings prompted us to examine the influence of these compounds on GABA uptake. We have found that arecaidine and guvacine are competitive inhibitors of GABA uptake in rat brain slices and we propose that some of the psychic effects of betel nut consumption may be the result of inhibition of GABA uptake.