Perspectives on areca nut with some global implications: Symposium report

Abstract

Areca nut and products made from the nut, evaluated by the International Agency for Research on Cancer as carcinogenic to humans since 2004, are being increasingly used in India and South East Asia and exported to many countries. There is thus an urgent need to identify best control policies and research gaps. On 1 February 2018, a group of experts shared their latest knowledge and perspectives on areca nut at Healis-Seksaria Institute for Public Health in Navi Mumbai, Maharashtra, India. By itself, areca nut has been implicated in oral and oesophageal cancer. Areca nut users are also at high risk of oral submucous fibrosis, a debilitating and potentially malignant condition. Users may also suffer adverse health outcomes due to smokeless tobacco, commonly mixed with areca nut. The use of areca nut commonly begins in childhood and often proceeds to use with tobacco. Gutka, a widely consumed, industrially made areca nut product containing tobacco, has been banned in all states and union territories of India, but it is still widely available. Areca nuts contain arecoline, an alkaloid that stimulates various brain receptors, promoting physical dependence. Areca nut alkaloids have also been implicated in carcinogenesis. Other chemicals, introduced during cultivation and processing of areca nuts, contribute to oral submucous fibrosis and cancer. The wide variety of products, different storage conditions and lack of regulation can lead to significant variation in the content of toxicants, carcinogens and alkaloids, making the psychological and physical dependence issues even more challenging. Regulation of product contents is needed as a part of control measures to supplement product bans.

Key Drivers to Implement an Evidence-based Tobacco Control Programme in Schools of India: A Mixed-Methods Study

“…Globally, approximately 8 million people die each year from diseases due to tobacco consumption (WHO, 2020). If effective steps are not taken to control, by 2030 tobacco attributable deaths is expected to rise to more than 10 million per year, with 70% of them occurring in low and being the largest consumer (WHO, 2004;Gupta et al, 2018;Warnakulasuriya and Peters, 2002). It is consumed in South East Asia, China and the Pacific Islands.…”

Areca nut consumption with and without tobacco among the adult population: a nationally representative study from India

“…Thus, considering the wide range of adverse health impacts, effective implementation on banning of tobacco as an ingredient with areca nut products under regulation 2.3.4 of the Food Safety and Standards Regulation, 2011 and ban on manufacture and sale of areca nut products, as implemented in some of the states, is urgently needed. 1 We found considerable regional and socioeconomic differences in the consumption of areca nut. In four states, Meghalaya, Assam, Mizoram and Manipur, over half of the population consume areca nut.…”

“…Thus, considering the wide range of adverse health impacts, effective implementation on banning of tobacco as an ingredient with areca nut products under regulation 2.3.4 of the Food Safety and Standards Regulation, 2011 and ban on manufacture and sale of areca nut products, as implemented in some of the states, is urgently needed. 1 …”

“…Furthermore, use of tobacco and nicotine as an ingredient in any food item is also prohibited under FSSA regulations, thereby restricting mixing of tobacco in areca nut products and vice versa. 1 Although tobacco control policies are applicable to areca nut products which contain tobacco a considerable number of people now consume areca nut without tobacco, which poses greater public health challenges in controlling and regulating the substance. 13 A comprehensive search of the literature revealed that studies on areca nut use in India lack representativeness and published studies were restricted to a specific geographical area or population groups.…”

“…Areca nut is one of the most widely consumed substances globally, after nicotine, ethanol and caffeine. 1 2 Owing to its addictive properties, areca nut is estimated to be consumed by hundreds of millions of people across various countries. 3 However, addiction to areca nut is primarily prevalent in many Asia-Pacific countries and by emigrants from these countries in other parts of world.…”