Association Between Betel-Nut Chewing and Chronic Kidney Disease in Men
Association Between Betel-Nut Chewing and Chronic Kidney Disease in Men
Association Between Betel-Nut Chewing and Chronic Kidney Disease in Men
1017/S1368980008003339
Submitted 3 April 2007: Accepted 19 May 2008: First published online 23 July 2008
Abstract
Background: Betel-nut use is associated with metabolic syndrome and obesity.
However, the association between betel-nut chewing and risk for chronic kidney
disease (CKD) is unknown. The present study was conducted to determine the
association between betel-nut chewing and CKD in men.
Methods: We retrospectively reviewed health-check records of 3264 men in a
hospital-based cross-sectional screening programme from 2003 to 2006. CKD
was defined as estimated glomerular filtration rate less than 60 ml/min/1?73 m2
calculated by the Modification of Diet in Renal Disease formula. Risk factors for
CKD including diabetes, hypertension, BMI, smoking, alcohol consumption and
age were also considered.
Results: A total of 677 (20?7 %) men were found to have CKD and 427 (13?1 %)
participants reported a history of betel-nut use. The prevalence (24?8 %) of CKD
in betel-nut users was significantly higher than that (11?3 %) of participants
without betel-nut use (P 5 0?026). In multivariate logistic regression analysis with Keywords
Betel nut
adjustments for age, hypertension, diabetes and hyperlipidaemia, betel-nut use
Body mass index
was independently associated with CKD (P , 0?001). The adjusted odds ratio for Chronic kidney disease
betel-nut use was 2?572 (95 % CI 1?917, 3?451). Diabetes
Conclusions: Betel-nut use is associated with CKD in men. The association Hypertension
between betel-nut use and CKD is independent of age, BMI, smoking, alcohol Men
consumption, hypertension, diabetes and hyperlipidaemia. Metabolic syndrome
The incidence of end-stage renal disease (ESRD) is high metabolic syndrome(8) and increase in urinary albumin
and growing rapidly in adults younger than 65 years of excretion(9). Betel-nut chewing may be a risk factor for
age in Taiwan(1). Outcomes of ESRD treatment tend to be CKD. However, the association between betel-nut chewing
poor; however, the cost of treatment is relatively high(2,3). and CKD is unknown. We conducted the present cross-
Early detection of possible risk factors and early treatment sectional retrospective study to determine the association
of chronic kidney disease (CKD) may not only slow the between betel-nut chewing and CKD in Taiwanese men.
decline of renal function, but also prevent the develop-
ment of severe cardiovascular complications(4). Apart
from well-known risk factors for CKD including age, Methods
hypertension, diabetes, obesity and metabolic syndrome,
the identification of other possible risk factors associated A total of 8027 (3264 men and 4763 women) records in a
with CKD is a key for early detection and treatment as general health-check programme in China Medical Uni-
well. The prevalence of betel-nut use is about 10 %, with versity Beigang Hospital, Yunlin County, Taiwan, were
about 600 million users all over the world(5,6), and most reviewed from 2003 to 2006. The prevalence of betel-nut
betel-nut chewers in Taiwan are male. The prevalence of use (as chews of fresh Areca catechu nuts with Piper betle
betel-nut use is rising gradually in Taiwan, especially in leaves and lime) was 13?8 % in men and 0?8 % in women.
rural areas(5). Evidence has shown that betel-nut chewing In view of the lower prevalence of betel-nut use in
is associated with oral cancer(7), hyperglycaemia, obesity, women, data analysis was limited to 3264 men. CKD was
Table 1 Demographic and biochemical data of study participants by chronic kidney disease (CKD) status: retrospective review of health-
check records of 3264 men in a hospital-based cross-sectional screening programme, Yunlin County, Taiwan, 2003 to 2006
CKD(2) CKD(1)
Overall (n 2587) (n 677)
n % n % n %
Co-morbidity
Hypertension 749 22?9 501 19?4 248 36?6*
Diabetes 406 12?4 304 11?5 102 15?1*
Hyperlipidaemia 127 3?9 101 3?9 26 3?8
Lifestyle
Smoking 855 26?2 792 30?6 166 24?5*
Alcohol consumption 958 29?4 746 28?8 109 16?1*
Betel-nut use 427 13?1 321 12?4 106 15?7*
eGFR, estimated glomerular filtration rate by Modification of Diet in Renal Disease formula; SBP, systolic blood pressure; DBP, diastolic blood pressure; AST,
aspartate aminotransferase; ALT, alanine aminotransferase; BUN, blood urea nitrogen.
*P , 0?05 v. CKD(–) in independent t test, Mann–Whitney U test or x2 test.
Betel nut and CKD in men 725
Table 2 Demographic and biochemical data of participants by Table 3 Unadjusted odds ratios and 95 % confidence intervals for
history of betel-nut use: retrospective review of health-check association of chronic kidney disease with various risk factors in
records of 3264 men in a hospital-based cross-sectional screening univariate logistic regression analysis: retrospective review of health-
programme, Yunlin County, Taiwan, 2003 to 2006 check records of 3264 men in a hospital-based cross-sectional
screening programme, Yunlin County, Taiwan, 2003 to 2006
Betel nut(2) Betel nut(1)
(n 2837) (n 427) OR 95 % CI P