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Tobacco Smoking and Association between Betel Nut Chewing and Metabolic Abnormalities Among Military Males: The CHIEF Study

[ Vol. 21 , Issue. 2 ]


Yen-Po Lin, Kun-Zhe Tsai, Chih-Yu Chang, Fang-Ying Su, Chih-Lu Han and Gen-Min Lin*   Pages 298 - 304 ( 7 )


Aim: To investigate the effect of smoking and alcohol intake on the association between betel nut chewing and each metabolic abnormality.

Background: Betel nut chewing has been associated with metabolic syndrome.

Objective: Whether the association is affected by tobacco or alcohol use is not clarified so far.

Methods: The authors conducted a cross-sectional study using 6,657 military males, aged 18-50 years in eastern Taiwan in 2013-2014. Metabolic syndrome was defined according to the International Diabetes Federation’s ethnic criteria for Asians. The population was classified as non-betel nut chewers (N =5,749), current chewers with both tobacco and alcohol use (N =615), and current chewers without tobacco and/or alcohol use (N =293). Multiple logistic regression analyses were stepwise adjusted for the confounders including alcohol and tobacco use to determine the association of betel chewing with the metabolic abnormalities.

Results: As compared to the non-current chewers, the current chewers with both tobacco/alcohol use and those without had a higher risk of metabolic syndrome (odds ratios (OR) and 95% confidence intervals: 2.46 (2.00-3.02), and 2.04 (1.53-2.73), respectively) after controlling for age, service specialty, total cholesterol levels ≥200 mg/dL and exercise frequency (model 1). The association did not change much in the two chewing groups after additionally adjusting for alcohol consumption (model 2) (OR: 2.49 (1.99-3.12), and 2.04 (1.52-2.73), respectively), whereas the relationship reduced significantly in the chewers with both tobacco/alcohol use rather than those without after further adjusting for smoking (model 3) (OR: 2.18 (1.71-2.78) and 2.02 (1.51-2.71), respectively). This was in parallel with the pattern for the association of betel nut chewing with serum triglycerides >150 mg/dL in the chewers with both tobacco/alcohol use and those without in model 1 (OR: 2.90 (2.40-3.51) and 1.90 (1.45-2.49), respectively, p =0.011), in model 2 (OR: 2.82 (2.30-3.46) and 1.89 (1.44-2.49), respectively, p =0.040), and in model 3 (2.26 (1.81-2.81) and 1.87 (1.42-2.45), respectively, p =0.76).

Conclusion: Our findings suggest that tobacco smoking but not alcohol intake could increase the relationship of betel nut chewing with metabolic syndrome, which is likely mediated by a synergic effect on increasing serum triglycerides levels.


Alcohol consumption, betel nut chewing, metabolic syndrome, tobacco smoking, military males, serum triglycerides levels.


Department of Critical Care Medicine, Taipei Tzu Chi Hospital, New Taipei City, Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien, Departments of Internal Medicine, Tri-Service General Hospital, Taipei, Institute of Statistics, National Chiao Tung University, Hsinchu City, Department of Medicine, Taipei Veterans General Hospital, Taipei, Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien

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