ciated HLA genotypes in women with ges-tational diabetes mellitus. Diabetes Care 25:68 –71, 2002
Areca Nut Chewing Is
Associated With
Metabolic Syndrome
Role of tumor necrosis factor-
␣,
leptin, and white blood cell count
in betel nut chewing–related
metabolic derangements
A
reca nut (Areca catechu)/betel quid (BQ) is said to be the fourth most commonly used psychoactive sub-stance in the world and is chewed regu-larly by at least 10% of the world’s population (1). High prevalences of BQ chewing were observed especially in South and Southeast Asia (1). High preva-lences of insulin resistance and metabolic syndrome were also observed in this area (2). Specific areca alkaloids act as compet-itive inhibitors of␥-aminobutyric acid re-ceptors in the brain, cardiovascular system, and pancreas, which may pro-mote one’s appetite or altered insulin se-cretion (3). Moreover, BQ components have recently been shown to induce ker-atinocytes to secrete tumor necrosis fac-tor-␣ (TNF-␣) and interleukin-6, as well as induce reactive oxygen species and ac-tivate nuclear factor-B expression (4), which may potentially provoke chronic inflammation. Recently, we confirmed that BQ chewing was associated with a higher risk of type 2 diabetes and central obesity in Taiwanese men (5). The detri-mental effects of BQ chewing on selected components of the metabolic syndrome, and the induction of inflammatory cyto-kines and factors, raise the possibility that BQ chewing may increase the risk of met-abolic syndrome.In this study, a total of 1,466 aborig-inal subjects of Southern Taiwan, 30 –95 years of age, were enrolled. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III definition. The age-adjusted prevalence of metabolic syn-drome in the aborigines studied was 41.1% in men and 42.4% in women. BQ-chewing subjects had significantly higher prevalences of central obesity, hypertri-glyceridemia, dysglycemia, and metabolic syndrome than those of nonchewers. Pe-ripheral leukocyte count also significantly
increased in chewers of both sexes, with plasma TNF-␣ level increased in men and plasma leptin level elevated in women. All were parallel to the number of compo-nents of the metabolic syndrome. Multi-ple logistic regression modeling adjusted for age, educational level, socioeconomic level, exercise, drinking, and smoking status showed that BQ chewing is an in-dependent risk factor for the metabolic syndrome. The adjusted OR (95% CI) for male BQ chewers was 1.92 (1.15–3.27) and that of female chewers was 1.60 (1.03–2.50). The study shows that chronic BQ chewing is an independent contributor of metabolic syndrome. TNF-␣, leptin, and leukocyte count are involved in BQ chewing–related meta-bolic derangements. FU-MEICHUNG,MS1,2 DAO-MINGCHANG,MD1,5 MIAO-PEICHEN,MS1 JACKC.-R. TSAI,MD, MPH1,3 YI-HSINYANG,PHD4 TIEN-YUSHIEH,PHD4
SHYI-JANGSHIN,MD, PHD3
TONYHSIU-HSICHEN,PHD5
TONG-YUANTAI,MD, PHD6
YAU-JIUNNLEE,MD, PHD1 From the1
Department of Clinical Research, Ping-tung Christian Hospital, PingPing-tung, Taiwan; the
2
Graduate Institute of Dental Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; the3
Grad-uate Institute of Medicine, Kaohsiung Medical Uni-versity, Kaohsiung, Taiwan; the4Graduate Institute
of Oral Health Sciences, Kaohsiung Medical Univer-sity, Kaohsiung, Taiwan; the5Institute of Preventive
Medicine and Public Health, National Taiwan Uni-versity, Taipei, Taiwan; and the6Department of
In-ternal Medicine, Ren-Ji Hospital, Taipei, Taiwan. Address correspondence to Dr. Yau-Jiunn Lee, Department of Clinical Research, Pingtung Chris-tian Hospital, No. 60 Da-Lien Rd., Pingtung, 90000, Taiwan. E-mail: [email protected].
DOI: 10.2337/dc06-0628
© 2006 by the American Diabetes Association.
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References
1. Gupta PC, Ray CS: Epidemiology of betel quid usage. Ann Acad Med Singapore 33: 31–36, 2004
2. Abate N, Chandalia M: Ethnicity and type 2 diabetes: focus on Asian Indians. J Dia-betes Complications 15:320 –327, 2001 3. Johnston GA, Krogsgaard-Larsen P,
Stephanson A: Betel nut constituents as inhibitors of gamma-aminobutyric acid uptake. Nature 258:627– 628, 1975 4. Lin SC, Lu SY, Lee SY, Lin CY, Chen CH,
Chang KW: Areca (betel) nut extract acti-vates mitogen-activated protein kinases and NF-kappaB in oral keratinocytes. Int J Cancer 116:526 –535, 2005
5. Tung TH, Chiu YH, Chen LS, Wu HM, Boucher BJ, Chen TH: A population-based study of the association between areca nut chewing and type 2 diabetes mellitus in men (Keelung Community-based Integrated Screening programme No. 2). Diabetologia 47:1776 –1781, 2004
An Epidemiologic
Study on the
Prevalence of
Diabetes, Glucose
Intolerance, and
Metabolic Syndrome
in the Adult
Population of the
Republic of Cyprus
T
he study was conducted in Cyprus(November 2003 through January 2005). Stratified random sampling was used to select 1,200 individuals aged 20 – 80 years (from a total population of 477,000). In all subjects, anthropometri-cal measurements were taken, fasting lip-ids were measured, eating habits were evaluated according to a standardized questionnaire, and an oral glucose toler-ance test (OGTT) was performed (except in known diabetic patients).
In the absence of OGTT-diagnosed diabetes or impaired glucose tolerance (IGT), impaired fasting glucose (IFG) was defined by fasting plasma glucoseⱖ110 mg/dl and ⬍126 mg/dl, whereas “new” IFG was defined by fasting plasma glu-coseⱖ100 and ⬍126 mg/dl. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria.
Of the 1,200 subjects, 78 (6.5%) had known diabetes and 45 (3.8%) were newly diagnosed by the OGTT, which brought the total prevalence of diabetes to 123 (10.3%). Another 78 (6.5%) subjects had IGT, 36 (3.0%) had IFG, and 171 (14.2%) had “new” IFG. Logistic regres-sion showed that significant risk factors for diabetes were age, male sex, family history of diabetes (P⬍ 0.001), hyperten-sion (P ⫽ 0.004), and obesity (P ⫽ 0.003). Risk factors for IGT were age and family history of diabetes (P⬍ 0.01). Risk factors for IFG and “new” IFG were age and obesity (P⬍ 0.01).
The prevalence of metabolic syn-drome was 22.2% overall, 68.5% among subjects with diabetes, 43.6% among
Letters
