Clinical Research Papers:

The risk of cirrhosis in non-alcohol drinkers is greater in female than male betel nut chewers

Yu-Hua Chu _, Lee Wang, Pei-Chieh Ko, Shou-Jen Lan and Yung-Po Liaw

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Oncotarget. 2018; 9:8731-8737. https://doi.org/10.18632/oncotarget.23885

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Yu-Hua Chu1, Lee Wang2, Pei-Chieh Ko2, Shou-Jen Lan1,3,* and Yung-Po Liaw2,4,*

1Department of Healthcare Administration, Asia University, Wufeng District, Taichung City, Taiwan

2Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan

3Department of Medical Research, China Medical Hospital, China Medical University, Taichung, Taiwan

4Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan

*These authors contributed equally to this work

Correspondence to:

Yung-Po Liaw, email: [email protected]

Shou-Jen Lan, email: [email protected]

Keywords: cirrhosis; betel nut; non-alcohol drinker; public health; Taiwan

Received: May 07, 2017     Accepted: November 09, 2017     Published: January 03, 2018


Background and Aim: The association of betel nut with liver cirrhosis among alcohol drinkers has been clearly shown. However, very few studies have shown such an association among non-alcohol drinkers. The aim of this study was to assess the relationship between betel nut chewing and cirrhosis among non-alcohol drinkers.

Materials and Methods: This study retrospectively analyzed data retrieved from the 2012 Adult Preventive Medical Services and the National Health Insurance Research Datasets in Taiwan. Participants’ information included physical examination and lifestyle, alongside laboratory tests. Betel nut chewers were grouped into three categories: never, occasional and frequent. Diseases were diagnosed using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Initially, 1573024 adults aged 40 years and above who engaged in the free adult preventive medical services in 2012 were recruited. However, only 1065246 of them were included in the analysis. Chi-square test and logistic regression were used for the analyses.

Results: After multivariable adjustments, there were significant relationships between cirrhosis and betel nut chewing in both sexes (P-trend < 0.0001). The risk of cirrhosis was greater in females than males. The odds ratios of cirrhosis in occasional and frequent female chewers were respectively 2.91; 95% C.I: 1.75–4.83 and 3.06; 95% C.I: 1.69–5. However, they were respectively 1.76; 95% C.I: 1.47–2.10 and 2.32; 95% C.I: 1.90–2.85 in occasional and frequent male chewers.

Conclusions: This study demonstrated significant relationships between betel nut chewing and cirrhosis in both male and female non-alcohol drinkers. The risk of cirrhosis was greater in female than male chewers.

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