Background: Betel quid is chewed by 600 million people worldwide and it has been linked to obesity and cardiovascular disease. The purpose of our study was to examine the prevalence and predictors of betel quid chewing in a rural area of Bangladesh, and determine its effects on body mass index (BMI) and blood pressure. Methods: In this population-based prospective study, we analysed data on 19 934 Bangladeshi adults. Linear and multivariate logistic regression was used to determine the socio-demographic predictors of betel quid chewing and the effect of betel quid on change in BMI and on systolic and diastolic blood pressure, pulse pressure, arterial pressure, overweight or obesity, and hypertension. Results: At baseline, betel quid was chewed by 33.2% of the cohort (35.5% of men, 31.6% of women). In a subsample in which we collected methods of use, 17.5% chewed it without tobacco and 82.5% chewed it with tobacco. In multivariate analysis, betel quid chewing was associated with female sex, older age, tobacco smoking and lower socio-economic status, as measured by fewer years of formal education and not owning land. Betel quid was chewed more times per day among women and older persons. At follow-up, persons who chewed betel quid without tobacco had higher systolic blood pressure, diastolic blood pressure and arterial pressure in comparison with never users. After controlling for other explanatory variables, chewing betel quid without tobacco was associated with general hypertension [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.04-2.10] and systolic hypertension (OR 1.55, 95% CI 1.01-2.37). We did not observe associations of betel quid chewing with BMI or overweight. Conclusions: Betel quid chewing is likely contributing to high blood pressure in Bangladesh, particularly among women. Published by Oxford University Press on behalf of the International Epidemiological Association
Bibliographical noteFunding Information:
This work was supported by the US National Institutes of Health (P42ES10349, P30ES09089, R01CA107431, R01ES017541, P30ES000260, R01CA102484 and R21ES018960, R21ES019986 to J.E.H.). The authors would like to thank Dr Julie Will for her comments on the manuscript. J.E.H. conceptualized the study, led the analyses and wrote the manuscript. E.L.M. contributed to conducting statistical analyses and writing revisions of the manuscript. M.A. contributed to the interpretation of data and reviewed drafts of the manuscript. F.P., A.A., G.S., T.I. and R.H. contributed to study design and data management. H.A. and Y.C. designed the study and wrote the study protocol. All authors contributed to and approved the final manuscript.
- Arterial pressure
- Pulse pressure
- Smokeless tobacco