title: Short-term acute effects of gutkha chewing on heart rate variability among young adults: A cross-sectional study.
abstract: OBJECTIVE
  An increase in the consumption of smokeless tobacco has been noticed among high school, college students, and adults. Despite the antiquity and popularity of chewing tobacco in India, its effects have not been investigated systematically in humans. The aim of this study was to investigate acute effects of gutkha chewing on heart rate variability (HRV) among healthy young adults.
  
  
  METHODS
  A total of 60 young adult males were included in the study. Each individual was asked to chew tobacco and subjected to HRV analysis. HRV analysis using short-term electrocardiogram recording was used to measure HRV parameters before gutkha chewing and at 5, 15, and 30 min after chewing tobacco. One-way analysis of variance and paired t-test was used to assess changes over time.
  
  
  RESULTS
  There was a significant increase in heart rate (HR) during tobacco chewing. Mean HR at baseline measured 73.0 ± 6.2 bpm. There was a rise in mean HR to 83.7 ± 9.1 bpm at 5 min during tobacco chewing and gradual reduction to baseline observed after 15 min followed by no significant change till 30 min. The normalized low-frequency power and LF/high-frequency (HF) power ratio were elevated after 5 min; however, normalized HF power was reduced after 5 min tobacco chewing.
  
  
  CONCLUSIONS
  Gutkha is closely associated with traditional cardiovascular risk factors as detected by a transient enhancing sympathetic activity during tobacco chewing in the form of increased HRV parameters or an imbalance between sympathetic and parasympathetic neural activity among healthy young adults.
authors.affiliation: Department of Physiology, C.M. Medical College and Hospital, Durg, Chhattisgarh, India.
authors.forename: Afreen Begum H
authors.initials: AB
authors.lastname: Itagi
authors.affiliation: Department of Physiology, C.M. Medical College and Hospital, Durg, Chhattisgarh, India.
authors.forename: Dimple
authors.initials: D
authors.lastname: Arora
authors.affiliation: Department of Pharmacology, K. M. C., Manipal University, Manipal, Karnataka, India.
authors.forename: Navin A
authors.initials: NA
authors.lastname: Patil
authors.affiliation: Department of Paediatric Dentistry, MAHSA University, Kuala Lumpur, Malaysia.
authors.forename: Sandeep Anant
authors.initials: SA
authors.lastname: Bailwad
authors.affiliation: Department of Public Health Dentistry, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India.
authors.forename: G Y
authors.initials: GY
authors.lastname: Yunus
authors.affiliation: Department of Public Health Dentistry, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India.
authors.forename: Ankit
authors.initials: A
authors.lastname: Goel
keywords: Electrocardiogram; gutkha; heart rate variability; smokeless tobacco; young adult