title: A population-based study of the association between betel-quid chewing and the metabolic syndrome in men.
abstract: BACKGROUND
  Betel-quid chewing, an established risk factor for oropharyngeal malignancy, is associated with hyperglycemia and obesity. Associations with other characteristics of the metabolic syndrome have not been reported.
  
  
  OBJECTIVE
  This study examined associations between betel-quid chewing and the metabolic syndrome, allowing for recognized risk factors and exploring dose-response effects in a population-based study.
  
  
  METHODS
  Age-specific prevalence rates of the metabolic syndrome were examined in betel-quid chewing and nonchewing men (n = 19,839) recruited into the Keelung Community-based Integrated Screening program in 2001-2003. The independent effect of betel-quid chewing on metabolic syndrome risk was examined by using multiple logistic regression with control for well-recognized risk factors (eg, education, physical activity, and dietary factors) and dose-response effects were examined by using trend tests.
  
  
  RESULTS
  The age-adjusted prevalence of the metabolic syndrome was highest in current chewers (25.13%), next highest in ex-chewers (22.04%), and lowest in nonchewers (15.73%) (P < 0.0001). Odds ratios (95% CIs) for the metabolic syndrome were 1.38 (1.19, 1.60) and 1.78 (1.53, 2.08) in ex-chewers and current chewers, respectively, adjusted for other significant correlates such as a family history of hypertension and diabetes mellitus. Meaningful odds ratios for the metabolic syndrome components ranged from 1.24 for hyperglycemia (95% CI: 1.09, 1.64) to 1.90 (95% CI: 1.66, 2.19) for hypertriacylglycerolemia. Increasing odds ratios for the metabolic syndrome with higher consumption of betel quid (whether by rate of use, duration of use, or cumulative exposure) suggest dose-response effects.
  
  
  CONCLUSIONS
  After adjustment for well-established risk factors, our study showed independent predictive dose-response effects of betel-quid chewing for the metabolic syndrome and its components in a population-based study of men with a 15% prevalence of betel-nut chewing.
authors: Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Amy Ming-Fang
authors: AM
authors: Yen
authors: Yueh-Hsia
authors: YH
authors: Chiu
authors: Li-Sheng
authors: LS
authors: Chen
authors: Hui-Min
authors: HM
authors: Wu
authors: Chih-Chung
authors: CC
authors: Huang
authors: Barbara J
authors: BJ
authors: Boucher
authors: Tony Hsiu-Hsi
authors: TH
authors: Chen