The Association between Betel Quid Chewing and Metabolic Syndrome among Urban Adults in Mandalay District of Myanmar



Betel quid chewing, Metabolic syndrome


Background. As the prevalence of metabolic syndrome, obesity and diabetes increase worldwide, the need to identify modifiable lifestyle risk factors also increases, especially those that may be relatively unique to a specific population. To explore a possible association between betel quid chewing and metabolic syndrome, a community-based cross-sectional study was conducted.

Methodology. Three hundred ninety-one (391) adults were interviewed and the following parameters were measured: triglycerides, HDL-cholesterol, glucose, waist circumference, body mass index and blood pressure. Multiple logistic regression was used to determine the association between betel quid chewing and metabolic syndrome while controlling for confounders.

Results. The prevalence of metabolic syndrome was similar in chewers and non-chewers, 50% and 49%, respectively. After controlling for other factors, development of metabolic syndrome was positively associated with number of betel quid chewed per day, age greater than  40 years , and a positive family history of hypertension  and diabetes. Regarding the duration of betel chewing, when analyzed by sex, the risk was doubled in men compared to non-chewers (OR 2.15; 95% CI[1.21, 3.84]). As a result, a man chewing more than 10 pieces (OR 2.49; 95% CI[1.36, 4.57]) of betel quids per day for more than 10 years had a two-fold increased chance of developing the metabolic syndrome.

Conclusions. Frequency and duration of betel quid chewing may represent a behavioral lifestyle target for approaches to reduce the incidence of metabolic syndrome.


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Author Biographies

Aye Aye Aung, University of Medicine,Mandalay, Myanmar

Professor, Department of Endocrinology

Vice President of MSEM

Sai Ni Soe Zin, University of Medicine, Mandalay, Myanmar

Department of Endocrinology

Aung Ko Ko, University of Medicine, Mandalay, Myanmar

Department of Endocrinology

Aung Cho Thet, University of Medicine, Mandalay, Myanmar

Department of Endocrinology


IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Betel-quid and areca-nut chewing and some areca-nut derived nitrosamines. IARC Monogr Eval Carcinog Risks Hum. 2004;85:1-334.

Yen AM, Chiu YH, Chen LS, et al. A population-based study of the association between betel-quid chewing and the metabolic syndrome in men. Am J Clin Nutr. 2006;83(5):1153-60.

Hsieh TJ, Hsieh PC, Wu MT, et al. Betel nut extract and arecoline block insulin signaling and lipid storage in 3T3-L1 adipocytes. Cell Biol Toxicol. 2011;27(6):397-411.

Hsu HF, Tsou TC, Chao HR, et al. Effects of arecoline on adipogenesis, lipolysis, and glucose uptake of adipocytes - A possible role of betel-quid chewing in metabolic syndrome. Toxicol Appl Pharmacol. 2010;245(3):370-7.

Chen SH, Lee JM, Liu HH, Wang HC, Ye CY. The cross-effects of cigarette and betel nut consumption in Taiwan: have tax increases made a difference? Health Policy Plan. 2011;26(3):266-73.

Sein T, Swe T, Toe MM, Zaw KK, Sein TO. Challenges of smokeless tobacco use in Myanmar. Indian J Cancer. 2014;51(Suppl 1):S3-7.

WHO Team (Ministry of Health). 2014 STEPS Survey Report from Myanmar. Accessed 24 September, 2020.

Zaw KK, Ohnmar M, Hlaing MM, et al. Betel quid and oral potentially malignant disorders in a Periurban Township in Myanmar. PLoS One. 2016;11(9):e0162081.

Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640-5.

Alberti KG, Zimmet P, Shaw J. Metabolic syndrome -- a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006;23(5):469-80.

Ministry of Health NZ. Definitions of smoking status. 2015. Accessed: July 6, 2019.

Saklayen MG. The global epidemic of the metabolic syndrome. Curr Hypertens Rep. 2018;20(2):12.

Aung WP, Htet AS, Bjertness E, et al. Urban-rural differences in the prevalence of diabetes mellitus among 25-74 year-old adults of the Yangon Region, Myanmar: Two cross-sectional studies. BMJ Open. 2018;8(3):e020406.

Latt TS, Zaw KK, Ko K, et al. Measurement of diabetes, prediabetes and their associated risk factors in Myanmar 2014. Diabetes Metab Syndr Obes. 2019;12:291-8.

Mehrtash H, Duncan K, Parascandola M, et al. Defining a global research and policy agenda for betel quid and areca nut. Lancet Oncol. 2017;18(12):e767-75.

Moe T, Boonmongkon P, Lin CF, Guadamuz TE. Yaukgyarmann yin (Be a man!): masculinity and betel quid chewing among men in Mandalay, Myanmar. Cult Health Sex. 2016;18(2):129-43. .

Yi Y, An J . Sex Differences in risk factors for metabolic syndrome in the Korean population. Int. J. Environ Res Public Health. 2020;17(24):9513.

Kim SW, Kim HJ, Min K, et al. The relationship between smoking cigarettes and metabolic syndrome: A cross-sectional study with non-single residents of Seoul under 40 years old. PLoS ONE 16(8): e0256257.

Hernández‑Rubio A, Sanvisens A, Bolao F, et al. Prevalence and associations of metabolic syndrome in patients with alcohol use disorder. Sci Rep. 2022;12(1):2625.




How to Cite

Aung, A. A., Zin, S. N. S., Ko Ko, A., & Thet, A. C. (2023). The Association between Betel Quid Chewing and Metabolic Syndrome among Urban Adults in Mandalay District of Myanmar. Journal of the ASEAN Federation of Endocrine Societies. Retrieved from



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