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:
We made a cross-sectional study using 6,657 military males, aged 18-50 years in eastern Taiwan in 2013-2014. Metabolic syn-drome was defined according to the International Diabetes Federation 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 regressions analyses were stepwise adjusted for the confounders including alcohol and tobacco use to de-termine the associations of betel chewing with the metabolic abnormalities.
Results:
As compared with the non-current chewers, the current chewers with both tobacco/alcohol use and those without had 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), respective-ly), whereas the relationship reduced significantly in the chewers with both tobacco/alcohol use rather than those without after further ad-justing 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 associ-ation 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.