Habitual Betel Quid Chewing as a Risk Factor for Cirrhosis

Abstract

Betel quid chewing, part of traditional Taiwanese culture, is common in 10%-20% of the human population worldwide. In this case-control study we assessed the independent and interactive role of habitual betel quid chewing and chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection on risk of cirrhosis. Subjects enrolled included 210 pairs of sex- and age-matched cirrhotic patients and healthy controls. Information on risk factors was obtained through serologic examination of hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C virus (anti-HCV), and a standardized personal interview with a structured questionnaire. Univariate analysis indicated that betel quid chewing, HBsAg+, anti-HCV+, alcohol drinking, and smoking are significant risk factors for cirrhosis. Multivariate analysis indicated that betel quid chewing (odds ratio [OR], 3.56), HBsAg (OR 20.37), and anti-HCV (OR 31.43) are independent risk factors for cirrhosis. Most betel quid chewers habitually drink alcohol. Although our analysis indicates that betel quid chewing acts independently from alcohol as a risk factor for cirrhosis, the confounding effect of alcohol cannot be excluded entirely by our study. There was an additive effect of the interaction between betel quid chewing and the presence of either HBsAg or anti-HCV. Moreover, a higher risk of cirrhosis was associated with longer duration of betel quid chewing and greater amount of betel quid consumed (each p for trend <0.0001). In conclusion, betel quid chewing appears to be an independent risk factor for cirrhosis. There is an additive interaction between betel quid chewing and chronic HBV/HCV infection.

Impact of chewing betel-nut (Areca catechu) on liver cirrhosis and hepatocellular carcinoma: a population-based study from an area with a high prevalence of hepatitis B and C infections

“…Betel chewing is hepatotoxic and hepatocarcinogenic, owing to the high concentration of aflatoxin B1 in A. catechu nuts (8) , the high concentration of safrole in P. betle plants (4) and the specific carcinogenic nitrosamines formed from arecal alkaloids and bacterial nitrite products during betel chewing and after acidification of swallowed chew materials in the stomach (2) . Previous case-control and cohort studies have demonstrated positive associations between betel chewing, LC (3) and HCC (4)(5)(6) . However, hospital-based, age-and gender-matched case-control studies are liable to recall bias with possible overestimation of associations.…”

“…Taiwan, with high prevalence rates of both cirrhosis and liver cancer, has an increasing rate of betel (Areca catechu) chewing; the nuts are chopped and, with Piper betle vine flower heads, used as betel-chews by a tenth of the 23 million inhabitants currently (2) . This habit is recognized to be carcinogenic in man (2) and has been reported to be associated with LC and with HCC in Taiwan (3)(4)(5)(6) .…”

Impact of Chronic Hepatitis B and Hepatitis C on Adverse Hepatic Fibrosis in Hepatocellular Carcinoma Related to Betel Quid Chewing

“…We designed a structured questionnaire, as described previously (Tsai et al, 2003), to obtain information on age, sex, habits of smoking (the quantity of cigarettes smoked per day and the duration of smoking), alcohol drinking (the quantity and duration of drinking, types of alcoholic beverage), and BQ chewing practice (the duration of habit, daily amount consumed, type of BQ consumed). A habitual BQ chewer was defined as chewing one quid or more daily for at least one year.…”

“…On the other hand, animals feeding BQ in the long term developed both chronic hepatocyte necroinflammation (Sarma et al, 1992) and liver cancer (Bhide et al, 1979;Nishikawa et al, 1992). Epidemiological data indicated that habitual BQ chewing is an independent risk factor for liver cirrhosis (Tsai et al, 2003;Hsiao et al, 2007). Cirrhosis itself is a preneoplastic lesion of HCC.…”

Association between betel nut consumption and folate deficiency among pregnant women in rural Bangladesh

“…Some studies found that use of betel nut/quid was associated with thiamine defi ciency, [22,23] aggravated effects of vitamin-D defi ciency, [24] and was associated with central obesity, hyperglycemia, diabetes mellitus, [13,25] cirrhosis, [26] and goiter. [27] Various studies have shown that betel nut use during pregnancy has adverse effect on birth outcomes, including low birth weight, shorter birth length, and preterm delivery.…”