Skip to main content
Log in

Areca-nut chewing habit is a significant risk factor for metabolic syndrome: A systematic review

  • Published:
The journal of nutrition, health & aging

Abstract

Background

Areca-nut (AN) chewing habit has been associated with oral diseases including oral cancer, oral submucous fibrosis and periodontal disease; however, some authors have reported that the ANchewing abuse may also jeopardize the systemic health among its users.

Objectives

The objective was to review any reported association between AN-chewing and the metabolic syndrome (MetS).

Methods

To address the research question “Is there an association between areca-nut chewing habit and the MetS?” the MEDLINE and PubMed databases were searched from 1991 up to and including April 2010. The search criteria included: human studies, metabolic syndrome, diabetes, areca nut (AN). Only articles published in English were included.

Results

Eight cohort studies were included in the review. The sample size of the selected studies ranged from 210 to 56,116 individuals (age range 15–83 years). The daily frequencies of AN-chewing reported by the users ranged between once a day to 76 times daily. The duration of use ranged from 6 years to ≥ 20 years. Two studies associated AN-chewing habit with hyperglycemia and type 2 diabetes while five studies studies reported an association between AN-chewing and metabolic syndrome. Four studies related AN-chewing with obesity and an increased body mass index. Higher triacylglycerol levels were reported in one study among AN-chewers compared to non-chewers. Though the numbers of publications on this subject are limited, the available studies indicate that AN-chewing could be associated with the metabolic syndrome, and individually with two of the recognized components of the syndrome i.e. diabetes mellitus and central obesity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. International Agency for Research on Cancer (2004) IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Vol 85: Betel Quid and Areca Nut Chewing and some Areca-nut derived nitrosamines. Lyon: IARC

    Google Scholar 

  2. Gupta PC, Warnakulasuriya S. Global epidemiology of areca nut use. Addict Biol. 2002; 7: 77–83.

    Article  PubMed  CAS  Google Scholar 

  3. Warnakulasuriya S. Areca nut use following migration and its consequences. Addict Biol. 2002; 7: 127–132.

    Article  PubMed  CAS  Google Scholar 

  4. Auluck A, Hislop G, Poh C, Zhang L, Rosin MP. Areca nut and betel quid chewing among South Asian immigrants to Western countries and its implications for oral cancer screening. Rural Remote Health. 2009; 9: 1118.

    PubMed  Google Scholar 

  5. Strickland SS. Anthropological perspectives on use of the areca nut. Addict Biol. 2002; 7: 85–97

    Article  PubMed  CAS  Google Scholar 

  6. Tilakaratne WM, Klinikowski MF, Saku T, Peters TJ, Warnakulasuriya S. Oral submucous fibrosis: review on aetiology and pathogenesis. Oral Oncol. 2006; 42: 561–568.

    Article  PubMed  CAS  Google Scholar 

  7. Daftary DK, Bhonsle RB, Murti PR, Pindborg JJ, Mehta FS. An oral lichen planuslike lesion in Indian betel -tobacco chewers. Scand J Dent Res. 1980; 88: 244–249.

    PubMed  CAS  Google Scholar 

  8. Javed F, Altamash M, Klinge B, Engström PE. Periodontal conditions and oral symptoms in gutka-chewers with and without type 2 diabetes. Acta Odontol Scand. 2008; 66: 268–273.

    Article  PubMed  Google Scholar 

  9. World Health Organization. WHO consultation: definition, diagnosis and classification of diabetes mellitus and its complications Geneva: WHO. 1999.

    Google Scholar 

  10. Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the Study of Insullin resistance (EGIR) Diabet Med. 1999; 16: 442–443.

    CAS  Google Scholar 

  11. Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholestrol in Adults (Adult treatment Panel lll). JAMA. 2001; 285: 2486–2497.

  12. Alberti KGMM, Zimmet PZ, Shaw JE. The metabolic syndrome—a new world-wide definition from the International Diabetes Federation Consensus. Lancet. 2005; 366: 1059–1062.

    Article  PubMed  Google Scholar 

  13. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C; American Heart Association; National Heart, Lung, and Blood Institute. Definition of metabolic syndrome. Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004; 109: 433–438

    Article  PubMed  Google Scholar 

  14. Bruce KD, Bryne CD. The metabolic syndrome: common origins of a multifactorial disorder. Postgrad Med J. 2009; 85: 614–621.

    Article  PubMed  CAS  Google Scholar 

  15. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004; 27: 1047–1053.

    Article  PubMed  Google Scholar 

  16. Boucher BJ, Mannan N. Metabolic effects of the consumption of areca catechu. Addict Biol. 2002; 7: 103–110.

    Article  PubMed  CAS  Google Scholar 

  17. Ogunkolade WB, Boucher BJ, Bustin SA, Burrin JM, Noonan K, Mannan N, Hitman GA. Vitamin D metabolism in peripheral blood mononuclear cells is influenced by chewing “betel nut” (Areca catechu) and vitamin D status. J Clin Endocrinol Metab. 2006; 91: 2612–2617.

    Article  PubMed  CAS  Google Scholar 

  18. Holick MF. Vitamin D deficiency. NEJM. 2007; 357: 266–281.

    Article  PubMed  CAS  Google Scholar 

  19. Boucher BJ, Mannan N, Noonan K, Hales CN, Evans SJW. Glucose intolerance and imparement of insulin resistance in relation to vitamin D deficiency in East London Asians. Diabetologica. 1995; 38: 1239–1245.

    Article  CAS  Google Scholar 

  20. Mannan N, Boucher BJ, Evans SJ. 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. Br J Nutr. 2000; 83: 267–275.

    PubMed  CAS  Google Scholar 

  21. Strickland SS, Veena GV, Houghton PJ, Stanford SC, Kurpad AV. Areca nut, energy metabolism and hunger in Asian men. Ann Hum Biol. 2003; 30: 26–52.

    Article  PubMed  CAS  Google Scholar 

  22. Boucher B. Diabetes in British South Asians: nature, nurture, and culture. Diabet Med. 1997; 14: 707–708.

    Article  PubMed  CAS  Google Scholar 

  23. Boucher BJ, Ewen SWB, Stowers JM. Betel nut (Areca catechu) consumption and induction of glucose intolerance in adult CD1 mice and their F1 and F2 offspring. Diabetologica. 1994; 37: 49–55.

    Article  CAS  Google Scholar 

  24. Lin WY, Pi-Sunyer FX, Liu CS, Li TC, Li CI, Huang CY, Lin CC. Betel nut chewing is strongly associated with general and central obesity in Chinese male middle-aged adults. Obesity (Silver Spring). 2009; 17: 1247–1254.

    CAS  Google Scholar 

  25. Lin WY, Chiu TY, Lee LT, Lin CC, Huang CY, Huang KC. Betel nut chewing is associated with increased risk of cardiovascular disease and all-cause mortality in Taiwanese men. Am J Clin Nutr. 2008; 87: 1204–1211.

    PubMed  CAS  Google Scholar 

  26. Chang WC, Hsiao CF, Chang HY, Lan TY, Hsiung CA, Shih YT, Tai TY. Betel nut chewing and other risk factors associated with obesity among Taiwanese male adults. Int J Obes (Lond). 2006; 30: 359–363.

    Article  CAS  Google Scholar 

  27. Guh JY, Chuang LY, Chen HC. Betel-quid use is associated with the risk of the metabolic syndrome in adults. Am J Clin Nutr. 2006; 83: 1313–1320.

    PubMed  CAS  Google Scholar 

  28. Yen AM, Chiu YH, Chen LS, Wu HM, Huang CC, Boucher BJ, Chen TH. A population-based study of the association between betel-quid chewing and the metabolic syndrome in men. Am J Clin Nutr. 2006; 83: 1153–1160.

    PubMed  CAS  Google Scholar 

  29. Benjamin AL, Margis D. Betelnut chewing: a contributing factor to the poor glycaemic control in diabetic patients attending Port Moresby General Hospital, Papua New Guinea. P N G Med J. 2005; 48: 174–182.

    PubMed  Google Scholar 

  30. Tung TH, Chiu YH, Chen LS, Wu HM, Boucher BJ, Chen TH; Keelung Communitybased Integrated Screening programme No. 2. A population-based study of the association between areca nut chewing and type 2 diabetes mellitus in men (Keelung Community-based Integrated Screening programme No. 2). Diabetologia. 2004; 47: 1776–1781

    Article  PubMed  Google Scholar 

  31. Javed F, Klingspor L, Sundin U, Altamash M, Klinge B, Engström PE. Periodontal conditions, oral Candida albicans and salivary proteins in type 2 diabetic subjects with emphasis on gender. BMC Oral Health. 2009; 9: 12.

    PubMed  Google Scholar 

  32. Lee CH, Ko AM, Warnakulasuriya S et al. Population Burden of Betel-Quid Abuse and Its Relation to Oral Premalignant Disorders in South, Southeast and Eastern Asia: An Asian Betel-Quid Consortium (ABC) Study. Int J Cancer 2011 [Epub ahead of print]

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to F. Javed.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Javed, F., Al-Hezaimi, K. & Warnakulasuriya, S. Areca-nut chewing habit is a significant risk factor for metabolic syndrome: A systematic review. J Nutr Health Aging 16, 445–448 (2012). https://doi.org/10.1007/s12603-011-0353-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-011-0353-5

Key words

Navigation