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Inverse Association Between Betel Quid Use and Diabetes in Rural Bangladesh.

Kristin K Sznajder1, Mary K Shenk2, Laura Perez1,2

  • 1Pennsylvania State University, College of Medicine, Department of Public Health Sciences, Hershey, Pennsylvania, USA.

American Journal of Human Biology : the Official Journal of the Human Biology Council
|February 13, 2026
PubMed
Summary
This summary is machine-generated.

Betel quid use may lower diabetes risk, especially in Bangladeshi men, contrary to some previous findings. This study suggests a potential protective effect, possibly mediated by food sources.

Keywords:
Bangladeshareca nutbetel nutevolutionary medicineinsulin resistancesubstance use

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Area of Science:

  • Public Health
  • Epidemiology
  • Metabolic Diseases

Background:

  • Betel quid is a common stimulant in South and East Asia.
  • Observational studies link betel quid use to increased diabetes risk, but animal models suggest a potential risk reduction.

Purpose of the Study:

  • To investigate the association between betel quid use and diabetes in a Bangladeshi population.
  • To explore potential sex-based differences in this association.

Main Methods:

  • Cross-sectional study of 410 men and 717 non-pregnant women in Matlab, Bangladesh.
  • Assessed diabetes using glycated hemoglobin (HbA1c ≥ 6.5%).
  • Employed multivariable logistic regression and structural equation modeling.

Main Results:

  • Betel quid use was inversely associated with diabetes in men (aOR: 0.45) but not women (aOR: 0.88).
  • A dose-response relationship was observed for men regarding frequency of use.
  • Inverse association with diabetes risk was found in both sexes when analyzed ordinally (aOR: 0.55 for men, 0.66 for women).
  • Food source partially mediated the inverse association.

Conclusions:

  • Findings support betel quid use potentially decreasing diabetes risk in Bangladesh, particularly for men.
  • Differences from other studies may be due to betel quid preparation, multifactorial effects, and publication bias.