Association Between Betel Nut Chewing and Body Mass Index: A Cross-Sectional Study in Guam

Areca nut/betel quid (AN/BQ), a stimulant consumed across the Asia and Pacific region, has been associated with metabolic risks including obesity. This study investigated the association between AN/BQ use and obesity in Guam. Participants included 120 men and women 18+ years old. Recruitment and interviews were conducted at a central dental clinic in Guam between July 2013 and October 2014. Multivariate general linear models were utilized to estimate the association of AN/BQ chewing with body mass index (BMI). Of the participants with a mean BMI of 30.4 (SD 6.9) kg/m², 82.5% reported ever chewing AN/BQ. The mean adjusted BMI among AN/BQ chewers was 4.53 kg/m² (95% CI 1.19, 7.87) higher than among non-chewers in the minimally adjusted model; 4.72 kg/m² (95% CI 1.09, 8.35) higher with additional adjustment for annual household income, tobacco smoking, and alcohol use (n = 108); and non-significantly higher by 0.55 kg/m² (95% CI -3.92, 5.02) after additional adjustment for ethnicity. Although AN/BQ chewing was not associated with BMI after considering ethnicity, our results do not exclude the possibility that AN/BQ chewing can be considered a risk factor for obesity.