title: Areca-nut chewing habit is a significant risk factor for metabolic syndrome: a systematic review.
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 AN-chewing abuse may also jeopardize the systemic health among its users.
  
  
  OBJECTIVE
  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.
authors.affiliation: Eng. A. B. Research Chair for Growth Factors and Bone Regeneration, College of Dentistry, King Saud University, P.O.Box 60169, Riyadh 11545, Kingdom of Saudi Arabia. fawjav@gmail.com
authors.forename: F
authors.initials: F
authors.lastname: Javed
authors.forename: K
authors.initials: K
authors.lastname: Al-Hezaimi
authors.forename: S
authors.initials: S
authors.lastname: Warnakulasuriya
mesh_terms: D001114:Areca; D015992:Body Mass Index; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology*; D006184:Habits; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D008409:Mastication; D024821:Metabolic Syndrome / Q000209:etiology*; D009754:Nuts; D009765:Obesity / Q000209:etiology*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications*