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

Michelle Nagata (), Lindsey E. Merifield, Gabriela Cruz-Mattos, Allen Oamil, Xavier Heidelberg, Gertraud Maskarinec, Thaddeus A. Herzog, Yurii B. Shvetsov, Yvette C. Paulino and Brenda Y. Hernandez
Additional contact information
Michelle Nagata: Population Sciences in the Pacific, University of Hawai’i Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
Lindsey E. Merifield: Population Sciences in the Pacific, University of Hawai’i Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
Gabriela Cruz-Mattos: Population Sciences in the Pacific, University of Hawai’i Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
Allen Oamil: Population Sciences in the Pacific, University of Hawai’i Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
Xavier Heidelberg: Population Sciences in the Pacific, University of Hawai’i Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
Gertraud Maskarinec: Population Sciences in the Pacific, University of Hawai’i Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
Thaddeus A. Herzog: Population Sciences in the Pacific, University of Hawai’i Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
Yurii B. Shvetsov: Population Sciences in the Pacific, University of Hawai’i Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
Yvette C. Paulino: School of Health, University of Guam, 303 University Drive, Mangilao, GU 96913, USA
Brenda Y. Hernandez: Population Sciences in the Pacific, University of Hawai’i Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA

IJERPH, 2025, vol. 22, issue 7, 1-10

Abstract: 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/m 2 , 82.5% reported ever chewing AN/BQ. The mean adjusted BMI among AN/BQ chewers was 4.53 kg/m 2 (95% CI 1.19, 7.87) higher than among non-chewers in the minimally adjusted model; 4.72 kg/m 2 (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/m 2 (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.

Keywords: betel quid; areca nut; obesity; BMI; pacific islands (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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