Betel Use Research Articles

Betel quid use and mortality in Bangladesh: a cohort study.

ObjectiveTo evaluate the potential effects of betel quid chewing on mortality. (A quid consists of betel nut, wrapped in betel leaves; tobacco is added to the quid by some users).MethodsProspective data were available on 20 033 individuals aged 18–75 years, living in Araihazar, Bangladesh. Demographic and exposure data were collected at baseline using a standardized questionnaire. Cause of death was defined by verbal autopsy questionnaires administered to next of kin. We estimated hazard ratios (HR) and their 95% confidence intervals (CI) for associations between betel use and mortality from all causes and from specific causes, using Cox proportional hazards models. We adjusted for age, sex, body mass index, educational attainment and tobacco smoking history.FindingsThere were 1072 deaths during an average of 10 years of follow-up. Participants who had ever used betel were significantly more likely to die from all causes (HR: 1.26; 95% CI: 1.09–1.44) and cancer (HR: 1.55; 95% CI: 1.09–2.22); but not cardiovascular disease (HR: 1.16; 95% CI: 0.93–1.43). These findings were robust to adjustment for potential confounders. There was a dose–response relationship between mortality from all causes and both the duration and the intensity of betel use. The population attributable fraction for betel use was 14.1% for deaths from all causes and 24.2% for cancer.ConclusionBetel quid use was associated with mortality from all causes and from cancer in this cohort.

A shifting paradigm in the aetiology of oral and pharyngeal cancer in Sri Lanka: a case-control study providing serologic evidence for the role of oncogenic HPV types 16 and 18.

BackgroundOral and pharyngeal cancer (OPC) of multifactorial aetiology is a major health problem globally. Ranking first in all cancers, OPC poses a significant impact on the Sri Lankan male population. As Human Papillomavirus (HPV) high risk (HR) types are found to be significant risk factors for OPC globally, the current study was undertaken to examine the association between HR-HPV16 and 18 types with OPC in Sri Lanka.Materials and methodsSerum samples of 78 OPC patients and 51 non-cancer controls were assayed for the presence of anti-HPV16 and anti-HPV18 IgG antibodies using in-house established Enzyme Linked Immunosorbent Assays (ELISAs). The association between OPC and its risk factors i.e. HPV, smoking, alcohol, betel quid, poor dentition, was established using Chi-square test. Logistic regression was used to calculate odds ratios (OR), adjusted for the influence of other risk factors.ResultsThis prototype study in Sri Lanka showed a significant risk of 15 fold in developing OPC due to HPV16/18 seropositivity after removing variability due to other factors. Oncogenic HPV18 showed a higher rate of seropositivity being detected in 32% of OPC patients, and also in 2% of non-cancer control subjects. HR-HPV16 was detected in 23% of OPC patients and in 5.88% of controls. Moreover, seven OPC patients were detected with both anti-HPV16 and anti-HPV18 antibodies. According to the logistic regression models HPV18 seropositivity was associated with a 28 fold risk in developing OPC while that of HPV16 was associated with a 6 fold increase in risk for the development of OPC. A 5 fold risk of developing OPC was also pronounced among smokers while alcohol, betel and poor dentition was not significantly associated with OPC. Statistically significant differences with regard to age, gender, smoking, alcohol, betel use, poor dentition and site specificity of the tumour was not observed between HPV seropositive and seronegative OPC patients.ConclusionsBoth in-house developed ELISAs detected significant proportions of HPV seropositives within the OPC study population suggestive of HPV as a strong risk factor for oral and pharyngeal carcinogenesis in Sri Lanka.

Use of Betel Leaves in Pediatric Stoma Care

Background: To find out a practicable, cost effective and easily available alternative of commercial stoma care devices for pediatric patients in a developing country.Methods: The study was conducted in the department of Pediatric Surgery in Dhaka Medical College Hospital, Bangladesh, during two years period from May 2009 to April 2011. Number of patients was 162 with age range 2 days to 7 years, mean age 2.3 years. As early as a colostomy or ileostomy had started functioning, a central hole was made in a betel leaf. The hole could just snugly accommodate the stoma. After applying a layer of zinc oxide paste over the peristomal skin the leaf was placed as such the stoma rotrudes through the hole. The smooth shiny surface of the leaf would face upwards and rough surface downwards. Another intact betel leaf with the shiny surface also facing upwards would cover the stoma. The leaves did not act as a reservoir rather simply acted as a barrier between the effluent and the peristomal skin. Fifty seven patients with colostomy and 11 with leostomy used stoma appliances (wafer with bag). Eighty six patients with colostomy and 8 patients with ileostomy used betel leaves and zinc oxide paste. Mean length of time between creation and closure of a colostomy was 9 months and that of an ileostomy was three months. It was ensured that each individual patient had used his or her respective stoma care method till closure of the stomas. Two parameters were used to evaluate the outcome of the above mentioned stoma care methods: (a) peristomal skin excoriation and (b) insultto the stomal mucosa in the form of ulceration.Results: Among the patients who used stoma appliances 21.53% developed peristomal skin excoriation, 7.69% developed mucosal ulceration and 6.34% patients developed local hypersensitivity reaction to stoma adhesive. On the contrary, patients who were managed with betel leaves 20.93% developed peristomal skin excoriation and 8.13% developed mucosal ulceration. No incidence of allergic reaction to local application of betel leaf and zinc oxide occurred. Average cost for betel leaves was less than 0.50 US$ per month in comparison to about 30 US$ for ostomy appliances.Conclusion: Betel leaves may be used as a cheap, easily available, non irritant and effective alternative of commercial appliances to protect the stomas and peristomal skin in pediatric patients.DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19534

Association between betel quid chewing and carotid intima-media thickness in rural Bangladesh

Areca nut, more commonly known as betel nut, is the fourth most commonly used addictive substance in the world. Though recent evidence suggests it may play a role in the development of cardiovascular disease, no studies have investigated whether betel nut use is related to subclinical atherosclerosis. We evaluated the association between betel nut use and subclinical atherosclerosis in 1206 participants randomly sampled from the Health Effects of Arsenic Longitudinal Study (HEALS). Frequency and duration of betel nut use were assessed at baseline, and carotid IMT was measured on average 6.65 years after baseline. A positive association was observed between duration and cumulative exposure (function of duration and frequency) of betel nut use and IMT, with above-median use for duration (7 or more years) and cumulative exposure (30 or more quid-years) corresponding to a 19.1 μm [95% confidence interval (CI): 5.3-32.8; P ≤ 0.01] and 16.8 μm (95% CI: 2.9-30.8; P < 0.05) higher IMT in an adjusted model, respectively. This association was more pronounced in men [32.8 μm (95% CI: 10.0-55.7) and 30.9 μm (95% CI: 7.4-54.2)]. There was a synergy between cigarette smoking and above-median betel use such that the joint exposure was associated with a 42.4 μm (95% CI: 21.6-63.2; P ≤ 0.01) difference in IMT. Betel nut use at long duration or high cumulative exposure levels is associated with subclinical atherosclerosis as manifested through carotid IMT. This effect is especially pronounced among men and cigarette smokers.

Betel nut chewing and its deleterious effects on oral cavity.

The habit of chewing betel nut has a long history of use. Betel nut and products derived from it are widely used as a masticatory product among various communities and in several countries across the world. Over a long period, several additives have been added to a simple betel nut preparation; thus, creating the betel quid (BQ) and encompassing chewing tobacco in the preparation. Betel nut has deleterious effects on oral soft tissues. Its effects on dental caries and periodontal diseases, two major oral diseases are less well-documented. Betel-induced lichenoid lesions mainly on buccal mucosa have been reported at quid retained sites. In chronic chewers, a condition called betel chewers mucosa is often found where the quid is placed. Betel nut chewing is implicated in oral submucous fibrosis (OSF) and its use along with tobacco can cause leukoplakia, both of which are potentially malignant in the oral cavity. Oral cancer often arises from such precancerous changes. Thus, public health measures to quit betel use are recommended to control disabling conditions such as OSF and oral cancer.

Cadmium May Affect Newborn Girls More than Boys: Maternal Exposure Linked to Smaller Birth Size

Vol. 120, No. 2 News | Science SelectionsOpen AccessCadmium May Affect Newborn Girls More than Boys: Maternal Exposure Linked to Smaller Birth Sizeis accompanied byMaternal Cadmium Exposure during Pregnancy and Size at Birth: A Prospective Cohort Study Julia R. Barrett Julia R. Barrett Search for more papers by this author Published:1 February 2012https://doi.org/10.1289/ehp.120-a76bCited by:2AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit Chronic exposure to cadmium, which primarily occurs through diet and smoking, damages the kidneys, weakens bones, and may increase cancer risk. The metal is also an endocrine disrupter and may adversely affect reproduction and child development. Animal studies indicate cadmium induces multiple defects in developing embryos, but it is unknown whether similar effects occur in humans. However, a new study shows that maternal cadmium exposure is associated with reduced head circumference and birth weight in newborn girls [EHP 120(2):284–289; Kippler et al.].The study used data collected from more than 1,600 pregnant women participating in the Maternal and Infant Nutrition Interventions, a food and micronutrient supplementation trial in Matlab, Bangladesh. The women provided urine samples and completed clinical examinations in early pregnancy. Information on demographics and tobacco and betel use during pregnancy also was collected, along with newborns’ sex and physical measurements.Average adult daily intakes of cadmium were estimated on the basis of rice consumption to be 25–35 µg, similar to those in other Asian countries where rice is a staple but higher than levels reported in U.S. and European women. Statistical analyses, controlled for confounding by maternal, birth, and newborn factors, suggested that for each 1-µg/L increase in maternal urinary cadmium, head circumference decreased by 0.26 cm and weight dropped by 45 g on average among newborn girls. Far smaller associations were seen for boys.Cadmium may affect fetal growth by several mechanisms, including impaired nutrient transport and endocrine disruption. Sex-based differences in specific hormone levels as well as in cadmium uptake and mechanisms of action—which have been reported in experimental studies—may have played a role in the current findings. The authors say the estimated average reductions in head circumference and weight are unlikely to be clinically significant for individual children but could have public health implications given widespread dietary cadmium exposure and adverse effects associated with reduced birth size.The main strengths of the study are its prospective design, large number of participants, wide range of exposure, and consideration of numerous confounding factors. However, the potential for unmeasured or residual confounding remained, as in all observational studies, and infants’ cadmium exposure was not directly assessed (for instance, by measuring cadmium levels in cord blood). Continuing research should follow the children to determine if growth effects are sustained through childhood and whether other health changes appear later in childhood.Asian diets high in rice consumption may lead to elevated cadmium intake, which has been linked to reduced birth size in girls.© 2012 G.M.B. Akash/Panos PicturesFiguresReferencesRelatedDetailsCited by Real M, Azam H and Majed N (2017) Consumption of heavy metal contaminated foods and associated risks in Bangladesh, Environmental Monitoring and Assessment, 10.1007/s10661-017-6362-z, 189:12, Online publication date: 1-Dec-2017. Tang M, Xu C, Lin N, Liu K, Zhang Y, Yu X and Liu W (2016) Lead, mercury, and cadmium in umbilical cord serum and birth outcomes in Chinese fish consumers, Chemosphere, 10.1016/j.chemosphere.2016.01.058, 148, (270-275), Online publication date: 1-Apr-2016. Related articlesMaternal Cadmium Exposure during Pregnancy and Size at Birth: A Prospective Cohort Study23 August 2011Environmental Health Perspectives Vol. 120, No. 2 February 2012Metrics About Article Metrics Publication History Originally published1 February 2012Published in print1 February 2012 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

Correlates of anti-EBV EBNA1 IgA positivity among unaffected relatives from nasopharyngeal carcinoma multiplex families

Background:To determine whether non-viral nasopharyngeal carcinoma (NPC) risk factors might be associated with (and mediated through) Epstein–Barr virus (EBV) serological responses linked to NPC risk, we evaluated predictors of risk of anti-EBNA1 IgA seropositivity and other markers among unaffected relatives from a large NPC family study in Taiwan.Methods:Multivariate logistic regression conditioned on family was used to examine the associations between sociodemographic, dietary, lifestyle, and occupational variables and risk of anti-EBV EBNA1 IgA positivity, anti-VCA IgA, and anti-DNase positivity.Results:Among 2393 unaffected relatives from 319 multiplex families, 1180 (49.3%) were anti-EBV EBNA1 IgA seropositive. None of the associations with anti-EBNA1 IgA were statistically significant, except for being 31–50 years of age (vs <30, adjusted ORs 0.51–0.57). For one or more EBV serological markers, there were suggestive associations for older age, GuangDong firm salted fish, betel use, current alcohol use, and male gender.Conclusion:Overall, we found little evidence to suggest that non-viral NPC risk factors significantly alter EBV serological patterns, suggesting that non-viral NPC risk factors act through pathways independent of EBV serological responses.

PD1. Premalignant lesions

Oral cancer appears to be increasing in incidence, and mortality has scarcely improved over past decades. Better understanding of aetiopathogenesis should lead to more accurate and earlier diagnosis and more effective treatments with fewer adverse effects, providing the best chance of a cure. Cancer is the result of DNA mutations arising spontaneously and from the action of various mutagens, especially in tobacco and alcohol. Cancer is a consequence of an interaction of many factors. A sequence of genetic changes leads eventually to loss of growth control and autonomy, but countering these changes are mechanisms to metabolise carcinogens, repair DNA damage, control growth, and defend against cancer. Potentially malignant (premalignant or precancerous) disorders which precede some neoplasms include erythroplasia (erythroplakia) – the most likely lesion to progress to severe dysplasia or carcinoma, leukoplakia, lichen planus and submucous fibrosis. Risk factors include tobacco, betel and alcohol use. Clinical features which suggest a potentially malignant lesion is likely to transform, or has transformed, to carcinoma include: the presence of red lesions (erythroplasia); a verrucous, speckled or granular appearance or an ulcer with fissuring or raised exophytic margins; induration; fixation of the lesion to deeper tissues or to overlying skin or mucosa; cervical lymph node enlargement. Single ulcers, lumps, red patches, or white patches – particularly if any of these are persisting for more than three weeks, may be manifestations of frank malignancy. There should be a high index of suspicion, especially of a solitary lesion present for over 3 weeks: biopsy is invariably indicated. The whole oral mucosa should be examined as there may be widespread dysplastic mucosa (‘‘field change’’) or even a second neoplasm and the cervical lymph nodes must always be examined. Laboratory diagnostic aids increasingly look to detect cellular and now molecular changes. Molecular techniques are being introduced for prognostication.

Prevalence of Betel Chewing Among Males in Colombo and Polonnaruwa Districts

Objectives To assess the prevalence of betel chewing among adult males in a rural and urban district in Sri Lanka and describe the demographic characteristics of betel chewers. Methods Betel use among 2684 males aged >18 years resident in a rural (Polonnaruwa) and urban (Colombo) district in Sri Lanka was assessed using multistage cluster sampling. Data on quantity and frequency of use was obtained using an interviewer administered questionnaire. Results Prevalence of betel chewing was 17.6% in the rural and 1.7% in the urban district. In the rural district prevalence was significantly associated with age (p 65 years (36%). In both districts prevalence was significantly associated with income (p Rs. 25000 a month chewed betel. Conclusions There was a significant difference in prevalence of betel chewing between rural and urban areas. Betel chewing now remains mainly a habit of the elderly in rural areas. Key words: Betel chewing; Sri Lanka; oral cancer DOI: 10.4038/jccpsl.v14i1.2944 Journal of the College of Community Physicians of Sri Lanka Vol.14(1) 2009 20-23

Associations between betel nut ( Areca catechu) and symptoms of schizophrenia among patients in Nepal: A longitudinal study

Betel nut is one of the mostly widely used substances in the world, particularly across Asia. Arecoline, a partial muscarinic agonist, has been hypothesized to have beneficial effects on both positive and negative symptoms of schizophrenia. This study aims to further explore associations between betel use and symptoms of schizophrenia in a 4-month longitudinal study in Nepal. Sixty Nepali patients with schizophrenia were recruited from regional outpatient clinics. The Positive and Negative Syndrome Scale (PANSS) and the Social Adaptation Self-Evaluation Scale were used to assess symptoms and social functioning in regular betel users and non-users. No significant group differences or dose–response relationships were noted on either initial or follow-up assessments. Stratifying by sex also failed to reveal an association between symptoms and betel use, which stands in contrast with previously reported data from Micronesia. There were no differences seen in social functioning other than a significantly higher proportion of betel users holding jobs. It was also noted that significantly fewer betel chewers were taking anti-cholinergic medication, which may tentatively indicate a potentially therapeutic role in the future for partial muscarinic agonists in the treatment of medication-induced movement disorders.

Availability and Characteristics of Betel Products in the U.S.

Betel use involves oral placement of shards of areca nut (Areca catechu palm seed containing the cholinergic agonist arecoline) wrapped with slaked lime in a betel leaf (Piper betle plant) or various chopped or powdered products containing areca nut and/or parts of the betel plant. Additives to this mixture include catechu (areca palm extract), spices/sweeteners (e.g., saccharin, cloves), and/or tobacco. Betel use is most common in Asia and East India; however, little is known about the availability and characteristics of these products outside of this region. Thus, a representative sample of betel products and additives was purchased in the Richmond, Virginia area. Five venues were visited between March and May, 2006. Products successfully purchased were those containing betel alone (seven), betel/tobacco (three), tobacco alone (four), and additives (four). Most betel products listed ingredients on the packaging, though some did not explicitly distinguish between those with versus without tobacco. Importantly, seven of seven betel alone and one of three betel/tobacco products omitted any health-related warnings. All products were inexpensive and relatively obtainable in the groceries visited. More research is warranted in order to accurately estimate product emergence into the U.S. and other world markets, and the consequent impact on public health.

Palm‐nut problem: Asian chewing habit linked to oral cancer

quid consisting of nut pieces from an Areca catechu palm mixed with powdered lime (calcium hydroxide) and wrapped in the leaf of the pepper plant Piper betle. Betel used primarily as a stimulant. Areca nuts contain alkaloids that induce euphoria and raise a person's heart rate and skin temperature. Some chewers say a cheekful of betel aids digestion. Over the past decade, avarietyof evidence has linked betel chewing to several types of oral cancer. Although the custom falling out offashion in several countries, such as Thailand and Cambodia, it's growing in popularity in other areas. Especially troubling that many new betel users are adolescents and children, say Asian health officials. Some governments in Asia are taking steps to reduce betel use. Oral cancer relatively rare in Western countries. In some south Asian countries, however, it ranks first among malignancies. According to the World Health Organization (WHO), a disproportionate number of the world's cases of oral cancer in men occurs in regions of Asia where betel chewing common. Once diagnosed mainly in adults, such cancers are now on the rise in young people. Saman Warnakulasuriya, an oral pathologist at the Guy's, King's, and St. Thomas' Dental Institute in London, says that greater commercialization of areca-nut products extendingbetel use. What used to be homegrown and sold by farmers now a big industry in most parts of Asia, he says. Packaged betel mixtures, known by several names, are now widely available in Asian countries and some regions of the world with large populations of Asian immigrants. Many of these products contain tobacco, spices, sweeteners, and other additives to make them more flavorful, potent, and addictive. Aggressive advertising, targeted at the middle class and adolescents since the early 1980s, has largely enhanced the sales, notes Beatrice Secretan, a health researcher who contributed to the 300-page Monograph on Betel-quid andAreca-nut Chewing published in October 2004 by WHO's International Agency for Research on Cancer, based in Lyon, France. The situation, she says, is similarto the real start ofthe tobacco epidemic, with industrially manufactured cigarettes, at the beginning of the 20th century.

Microvascular density and vascular endothelial growth factor immunoreactivity as predictors of regional lymph node metastasis from betel-associated oral squamous cell carcinoma

Purpose: Neovascularization has profound effects on tumor growth and metastasis. Vascular endothelial growth factor (VEGF) is a mitogen that acts exclusively on endothelial cells. The roles of miscrovascularity density (MVD) and VEGF expression in the progression of oral squamous cell carcinoma (OSCC) have been controversial. The purpose of the present study was to measure the MVD and VEGF expression in a cohort of patients with betel-associated OSCC and to evaluate for possible clinicopathologic correlations. Patients and Methods: The paraffin sections from 49 subjects with OSCC were subjected to immunohistochemical studies to measure the highest MVD (h-MVD) and cytoplasmic immunoreactivity of VEGF. The findings in the tissue samples were analyzed with regard to the patients’ risk factors and clinical course. Results: The OSCC samples had an average h-MVD score of 27.7/mm 2. VEGF immunoreactivity was positive in 75.5% of samples. Both h-MVD and VEGF immunoreactivity were statistically associated with lymph node metastasis ( P = .012 and .037, respectively). A marginally significant association was also noted between the h-MVD and patient survival ( P = .056). The age and oral habits of patients, as well as the tumor site and size, did not appear to be correlated with h-MVD or VEGF immunoreactivity. Conclusion: The data suggest that both h-MVD and VEGF immunoreactivity may be useful predictors for the progression of a subset of OSCC associated mostly with betel use. Antiangiogenesis therapy might have a role in reducing regional metastasis.

Periodontal conditions among adults in Southern Thailand.

To describe the periodontal conditions among 30-39- and 50-59-year-old rural Thais from the Province of Songkhla, Southern Thailand. A total of 359 dentate persons were given a clinical examination comprising recordings of plaque and calculus in six teeth, and bleeding on probing, attachment level and pocket depth in six sites of all teeth present, except third molars. The same examiner carried out all examinations. Information on religious faith, smoking habits and use of betel was obtained by interview. A subset consisting of 60 persons was reexamined for attachment level 6 months later by another examiner. The oral hygiene conditions were poor with abundant amounts of both plaque and calculus. Gingival bleeding was essentially ubiquitous. The prevalence of attachment loss > or = 4 mm was 92% among 30-39-year-olds and 100% among 50-59-year-olds. The average percentage of sites affected in the two age groups was 23.9% and 63.9%. Pockets > or = 4 mm were seen in 84% of the 30-39-year-olds and in 93% of the 50-59-year-olds. Older age, Thai Buddhist faith and a high percentage of sites with calculus were significant positive predictors of a high percentage of sites with attachment loss > or = 4 mm, whereas older age and Thai Buddhist faith were the only statistically significant predictors of a high percentage of sites with attachment loss > or = 7 mm. The results indicate that this Thai population may have more widespread and severe periodontal destruction than other Asian populations, but failed to confirm the contention that Muslim faith is associated with more severe periodontal destruction.

Chromosomal changes in betel-associated oral squamous cell carcinomas and their relationship to clinical parameters.

To investigate the chromosomal imbalances that occur in oral carcinoma associated primarily with betel use and their clinical implications, we performed chromosomal analysis using comparative genomic hybridization on 47 patients with this disease. The most common gains of chromosome arms were 8q, 9q and 11q, and the most frequent losses were of chromosomal arms 3p and 4q. The clinical parameters significantly associated with the numbers of chromosomal imbalances per tumor were the age of the patients and nodal metastasis. The preliminary findings of a lower incidence of loss of 4q and gain of 8q in betel-associated tumors compared to non-betel-associated tumors might provide insight into the carcinogenic effect of betel. Deletion of 3p and the gain of 11q alterations were more prevalent in carcinomas with lymph node metastasis than in node-negative tumors, indicating possible loci for metastasis suppressor or metastasis enhancing genes, respectively. Losses of 3p and 4q and gain of 9q were associated with poor outcome for the patients. These data demonstrated that the frequent aberrations in 4q and 9q sites can be used as novel prognostic predictors.

Multiple molecular alterations of FHIT in betel-associated oral carcinoma.

To determine the alterations of the FHIT (fragile histidine triad) gene in oral squamous cell carcinoma (OSCC), this study examined mutation, promoter methylation, mRNA transcription, and protein expression of FHIT in OSCC associated mostly with the use of betel and/or tobacco. Analyses of the coding exons (exons 5-9) identified a deletion of one base in intron 4 in one tumour and a deletion of exon 7 in two tumours. Using bisulphite genomic sequencing, 28% of the informative subjects exhibited promoter methylation. An aberrant FHIT transcript spanning from exon 3 to exon 10, which was verified by RT-PCR analysis, was identified in 36% of the OSCC subjects, 50% of the oral pre-invasive lesions, and 5% of the non-cancerous match tissue. An abnormal immunohistochemical level of Fhit was detected in 41% of OSCC subjects. A statistically significant association was found between aberrant transcription of the FHIT gene and an abnormal level of Fhit immunoreactivity. The results indicated that alteration of FHIT is a frequent occurrence in OSCC and thus suggests that the aberrance in FHIT transcription could be an early event of oral carcinogenesis.

Determinants of dental status and caries among adults in southern Thailand

This study describes the tooth mortality and the prevalence and severity of dental caries among 30- to 39- and 50- to 59-year-old rural Thais from the Province of Songhkla, Thailand. Three hundred and sixty-three persons were given a clinical examination, including assessment of dental status, dental caries, and periodontal recordings. Information on religious faith, smoking, and betel use was obtained by means of an interview. The prevalence of edentulism was low (< 2% among 50- to 59-year-olds). The mean number of teeth present was high, 29.4 among the 30- to 39-year-olds and 24.3 among the 50- to 59-year-olds. The prevalence of caries was high (91% among 30- to 39-year-olds and 84% among 50- to 59-year-olds). The mean DFT values were 5.7 and 5.8, respectively, and a substantial part of the DFT consisted of deep dentin lesions. The results did not corroborate the hypothesis that persons of Muslim faith have worse dental conditions than do Thai Buddhist or that dental disease levels are higher among the Thai population than among other Southeast Asian populations.

Increased waist size and weight in relation to consumption of Areca catechu (betel-nut); a risk factor for increased glycaemia in Asians in east London.

Type 2 diabetes is commoner in Asians than Caucasians. Many nitrosamines are diabetogenic, causing both type 2 and type 1 diabetes. Of CD1 mice fed with betel-nut or associated nitrosamines 8.5% develop glucose intolerance with marked obesity. Glycaemia and anthropometric risk markers for type 2 diabetes were therefore examined in relation to betel usage in 993 'healthy' Bangladeshis by one bilingual research-worker (N.M.). Of these, 12% had known diabetes. A further 145 of 187 subjects 'at-risk' of diabetes (spot glucose > 6.5 mmol/l < 2 h after food, or > 4.5 mmol/l > 2 h after food) had a second blood glucose sample taken; sixty-one were confirmed as 'at-risk', and had an oral glucose tolerance test; nine new diabetics were identified. Multiple regression analysis showed that spot blood glucose values decreased with time after eating (P = 0.0005) and increased independently with waist size (P = 0.0005) and age (P = 0.0005) without relationships to other aspects of the diet, season or smoking. Waist size was strongly related to betel usage independent of other factors such as age. Betel use interacted with sex, relating to increasing glycaemia only in females. Since waist and age were the major markers of increasing glycaemia we suggest that betel chewing, a habit common to about 10% of the world population (more than 200 million people) may contribute to the risk of developing type 2 diabetes mellitus.

Betel: Consumption and consequences

Betel is a compound of natural substances chewed for its psychostimulating effects. Betel is composed of the nut of the areca palm (Areca catechu), the leaf of the betel pepper (Piper betle), and lime (calcium hydroxide). Approximately 200 million persons chew betel regularly throughout the western Pacific basin and south Asia. Only three drugs (nicotine, ethanol, and caffeine) are consumed more widely than betel. When betel is chewed, it produces mild psychoactive and cholinergic effects. There is copious production of a blood-red saliva that can stain oral structures. After years of chewing, the teeth may become red-brown to nearly black. Betel use is associated with oral leukoplakia, submucous fibrosis, and squamous cell carcinoma. Use of betel is discouraged in Western countries because of its alleged carcinogenic and perceived dysesthetic properties; nevertheless, betel is widely available in the West. (J Am Acad Dermatol 1997;37:81-8.)

Consuming Habits: Drugs in History and Anthropology.

Notes on contributors Preface Introduction: Culture, consumption and society Andrew Sherratt, University of Oxford 1. Alcohol and its alternatives: symbol and substance in pre-industrial cultures Andrew Sherratt 2. Coca, beer, cigars and yag'e: meals and anti-meals in an Amerindinian community Stephen Hugh-Jones, University of Cambridge 3. Nicotian Dreams: the prehistory and early history of tobacco in eastern North America Alexander von Gernet, University of Toronto 4. Efficacy and concentration: analogies in betel use among the Fuyage (Papua New Guinea) Eric Hirsch, Brunel University 5. Kola nuts: the 'coffee' of the central Sudan Paul E. Lovejoy, York University, Canada 6. EXCITANTIA: Or, how enlightenment Europe took to soft drugs Jordan Goodman, University of Manchester Institute of Science and Technology 7. From coffeehouse to parlour: the consumption of coffee, tea and sugar in northwestern Europe in the seventeenth and eighteenth centuries Woodruf D. Smith, University of Texas at San Antonio 8. Tobacco use and tobacco taxation: a battle of interests in early modern Europe Jacob M. Price, University of Michigan 9. Japan and the world narcotics traffic Kathryn Meyer, Lafayette College, Pennsylvania 10. The rise and fall and rise and fall of cocaine in the United States David T. Courtwright, University of North Florida Afterword Jordan Goodman and Paul E. Lovejoy Selected bibliography Index