Aims/hypothesis. The aim of this study was to assess whether the diabetogenicity of areca nut (Areca catechu or 'betel-nut'), which has previously been demonstrated experimentally in mice, independently contributes to the risk of hyperglycaemia or Type 2 diabetes in men in Taiwan, where the habit has become established relatively recently. Methods. We used data from a population-based cross-sectional survey and a multiple-disease-screening programme that tested for hyperglycaemia, Type 2 diabetes and risk factors related to Type 2 diabetes. Data on habitual areca nut chewing were available for 14,816 men. Multiple logistic regression models were used to determine whether areca nut chewing was an independent risk factor for Type 2 diabetes. Results. Compared with non-chewers, areca nut chewers had higher age-adjusted prevalence rates for hyperglycaemia (11.4% vs 8.7%) and Type 2 diabetes (10.3% vs 7.8%). Areca nut chewing independently increased the risk of hyperglycaemia (adjusted odds ratio [OR] 1.19, 95% CI 0.97-1.45) and Type 2 diabetes (adjusted OR 1.29, 95% CI 1.04-1.60). The independent effects of duration of chewing were dose-dependent for Type 2 diabetes (adjusted OR 1.32 for the duration of 10-19 years and 1.41 for the duration of ≥20 years), as were the effects of increased rates of areca nut chewing (adjusted OR 1.14 for <10 pieces/day, 1.30 for 10-19 pieces/day and 2.02 for ≥20 pieces/day); similar findings were noted for hyperglycaemia. Conclusions/interpretation. The habit of chewing areca nut independently contributes to the risk of both hyperglycaemia and Type 2 diabetes in Taiwanese men. This association is dose-dependent with respect to the duration of areca nut use and the quantity of areca nut chewed per day.

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