title: Areca nut chewing and metabolic syndrome: evidence of a harmful relationship.
abstract: BACKGROUND
  There is some evidence which suggests that areca nut chewing has a relationship with metabolic syndrome. Areca nut chewing is continue to increase and so is the metabolic syndrome which is a major cause of cardiovascular mortality in developing countries. The aim of this study was to determine the relationship of raw areca nut and areca nut chewing with tobacco additives and metabolic syndrome.
  
  
  METHODS
  This cross sectional study was conducted on population of Karachi, Pakistan. Simple random sampling was implied using the voter list as a sampling frame. A detailed questionnaire about the demographic details of all subjects was filled and an informed consent obtained for blood sampling. Logistic regression analyses were carried out to investigate the relationship between areca nut chewing and metabolic syndrome.
  
  
  RESULTS
  Of the 1070 individuals, 192(17.9%) had metabolic syndrome with significantly higher (p-value <0.001) prevalence among females (26.3%) compared with males (11.4%). Eight individuals (11.1%) among non users had metabolic syndrome while significantly higher (p-value <0.001) proportion of both, raw areca nut users (n = 67, 29%) and areca users with tobacco additives (n = 45, 38.5%) had metabolic syndrome.The crude odds ratio for central obesity among raw areca nut users was 1.46 (95% CI 1.07-1.98) and among areca nut users with tobacco additives was 2.02 (95% CI 1.36-3.00), hypertension among raw areca nut users group was 1.31(0.96-1.78) and among areca nut users with tobacco additives group was 2.05 (95% CI 1.38-3.04). A significant positive association of raw areca nut chewing and metabolic syndrome was found among males (crude OR 2.74, 95% CI 1.52-4.95) and females (crude OR 3.80, 95% CI 2.32-6.20). Similarly, a significant positive association was found with regard to raw areca nut with tobacco additives chewing among males (crude OR 5.46, 95% CI 2.73-10.91) and females (crude OR 4.32, 95% CI 2.41-7.72). These associations remained significant adjustment for age, social class.
  
  
  CONCLUSIONS
  This study suggests a harmful relationship between areca nut chewing and metabolic syndrome. The deleterious effects were even stronger among areca nut chewer with tobacco additives. Further research with longitudinal data might help to understand the temporal relationship between areca nut chewing and metabolic syndrome.
authors.affiliation: Department of Community Medicine, Dow University of Health Sciences, Karachi, Pakistan. k.shafique.1@research.gla.ac.uk
authors.forename: Kashif
authors.initials: K
authors.lastname: Shafique
authors.forename: Mubashir
authors.initials: M
authors.lastname: Zafar
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Ahmed
authors.forename: Naveed Ali
authors.initials: NA
authors.lastname: Khan
authors.forename: Muhammad Akbar
authors.initials: MA
authors.lastname: Mughal
authors.forename: Fauzia
authors.initials: F
authors.lastname: Imtiaz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001114:Areca / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008409:Mastication; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009754:Nuts / Q000009:adverse effects*; D009765:Obesity / Q000453:epidemiology / Q000209:etiology; D016017:Odds Ratio; D010154:Pakistan; D015995:Prevalence; D012307:Risk Factors; D012923:Social Class; D011795:Surveys and Questionnaires; D014030:Tobacco, Smokeless / Q000009:adverse effects; D055815:Young Adult