title: Relationship between betel quid chewing and risks of cardiovascular disease in older adults: a cross-sectional study in Taiwan.
abstract: BACKGROUND
  The association between betel quid (BQ) chewing and oral cancer is well established. However, evidence regarding the relationship between BQ chewing and cardiovascular disease (CVD) is still insufficient.
  
  
  METHODS
  This cross-sectional study included 2002 men and 1175 women aged 50 and older in a city-level health examination survey of an agricultural and fishing population in 2013. In addition to anthropometric parameters, CVD risks were estimated using high-sensitivity C-reactive protein (hs-CRP), brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index. Age, gender, smoking and alcohol drinking status were all incorporated into the multivariate logistic regression model to delineate the effect of BQ chewing on CVD risks.
  
  
  RESULTS
  Two hundred forty-one (12%) males and eight (0.7%) females were ever chewers. BQ chewing was an independent risk factor for general obesity (odds ratio [OR] 1.43, 95% confidence interval [CI] 1.07-1.91, p=0.017), central obesity (OR 2.27, 95% CI 1.53-3.37, p<0.001) and an elevated hs-CRP level (OR 1.38, 95% CI 1.03-1.85, p=0.029). Subjects who chewed more frequently had a higher systolic blood pressure (p=0.025) and baPWV (p=0.006). The waist circumference (p=0.015) and waist-to-height ratio (p=0.022) were greater in current chewers than in former chewers.
  
  
  CONCLUSIONS
  These findings suggest that BQ chewing is associated with obesity and a higher CVD risk as estimated by hs-CRP. Furthermore, potential beneficial effects of BQ chewing cessation on central obesity were also found.
authors.affiliation: Department of Internal Medicine, New Taipei City Hospital, No. 3, Section 1, New Taipei Boulevard, San-Chong District, New Taipei 24141, Taiwan; Department of Respiratory Therapy, Fu-Jen Catholic University, No. 510, Zhong-Zheng Road, Xin-Zhuang District, New Taipei 24205, Taiwan.
authors.forename: Sheng-Hsiang
authors.initials: SH
authors.lastname: Lin
authors.affiliation: Department of Prosthodontic, Chang-Gung Memorial Hospital, No. 199, Tung-Hwa North Road, Song-Shan District, Taipei 10507, Taiwan.
authors.forename: Yu-Shu
authors.initials: YS
authors.lastname: Liao
authors.affiliation: Department of Surgery, New Taipei City Hospital, No. 3, Section 1, New Taipei Boulevard, San-Chong District, New Taipei 24141, Taiwan.
authors.forename: Shih-Horng
authors.initials: SH
authors.lastname: Huang
authors.affiliation: Department of Family Medicine, New Taipei City Hospital, No. 3, Section 1, New Taipei Boulevard, San-Chong District, New Taipei 24141, Taiwan; Department of Family Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Zhong-Zheng District, Taipei 10002, Taiwan. Electronic address: liaowh1976@gmail.com.
authors.forename: Wan-Hsiu
authors.initials: WH
authors.lastname: Liao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001114:Areca / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008409:Mastication; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D012306:Risk; D012907:Smoking / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology
keywords: Betel quid; Cardiovascular disease; High-sensitivity C-reactive protein; Obesity