title: 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).
abstract: OBJECTIVE
  The aim of this study was to assess whether the diabetogenicity of areca nut (Areca catechu or 'betel-nut'), which has previously been demonstrated experimentally in mice, independently contributes to the risk of hyperglycaemia or type 2 diabetes in men in Taiwan, where the habit has become established relatively recently.
  
  
  METHODS
  We used data from a population-based cross-sectional survey and a multiple-disease-screening programme that tested for hyperglycaemia, type 2 diabetes and risk factors related to type 2 diabetes. Data on habitual areca nut chewing were available for 14,816 men. Multiple logistic regression models were used to determine whether areca nut chewing was an independent risk factor for type 2 diabetes.
  
  
  RESULTS
  Compared with non-chewers, areca nut chewers had higher age-adjusted prevalence rates for hyperglycaemia (11.4% vs 8.7%) and type 2 diabetes (10.3% vs 7.8%). Areca nut chewing independently increased the risk of hyperglycaemia (adjusted odds ratio [OR] 1.19, 95% CI 0.97-1.45) and type 2 diabetes (adjusted OR 1.29, 95% CI 1.04-1.60). The independent effects of duration of chewing were dose-dependent for type 2 diabetes (adjusted OR 1.32 for the duration of 10-19 years and 1.41 for the duration of > or =20 years), as were the effects of increased rates of areca nut chewing (adjusted OR 1.14 for <10 pieces/day, 1.30 for 10-19 pieces/day and 2.02 for > or =20 pieces/day); similar findings were noted for hyperglycaemia.
  
  
  CONCLUSIONS
  The habit of chewing areca nut independently contributes to the risk of both hyperglycaemia and type 2 diabetes in Taiwanese men. This association is dose-dependent with respect to the duration of areca nut use and the quantity of areca nut chewed per day.
authors.affiliation: Department of Medicine Research and Education, Cheng Hsin Rehabilitation Center, Taipei, Taiwan.
authors.forename: T-H
authors.initials: TH
authors.lastname: Tung
authors.forename: Y-H
authors.initials: YH
authors.lastname: Chiu
authors.forename: L-S
authors.initials: LS
authors.lastname: Chen
authors.forename: H-M
authors.initials: HM
authors.lastname: Wu
authors.forename: B J
authors.initials: BJ
authors.lastname: Boucher
authors.forename: T H-H
authors.initials: TH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003710:Demography; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009754:Nuts; D012307:Risk Factors; D012959:Socioeconomic Factors; D013624:Taiwan / Q000453:epidemiology