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      Metabolic syndrome and health-related behaviours associated with pre-oral cancerous lesions among adults aged 20–80 years in Yunlin County, Taiwan: a cross-sectional study

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          Abstract

          Objectives

          To explore the associations of health-related behaviours, metabolic syndrome and risk factors in adults with pre-oral cancerous (POC) lesions in rural, disadvantaged communities with a high prevalence of oral cancer.

          Design

          A cross-sectional observational study.

          Setting

          Community-based health survey in the western coastal area of Yunlin County, Taiwan.

          Participants

          5161 adult residents participated in this study.

          Outcome measures

          Assessed parameters included oral leukoplakia, oral submucous fibrosis, fasting blood glucose, triglycerides, high-density lipoprotein cholesterol, blood pressure and waist circumference. Statistical analyses included descriptive statistics, χ 2 tests and multivariate binary logistic regression.

          Results

          A high percentage of participants were found to have metabolic syndrome (40%) and POC lesions (7.3%). Participants with POC lesions tended to be male (p<0.001), betel nut chewers (p<0.001) and cigarette smokers (p<0.001); have a low level of education (p<0.001); seldom undergo dental check-ups (p<0.01); irregularly participate in physical activity (p<0.01) and have metabolic syndrome (p<0.01).

          Conclusions

          Although male sex and disadvantaged socioeconomic status are non-modifiable factors associated with POC and metabolic syndrome in adults, several factors, notably health behaviours, are modifiable. Clinicians can reduce the incidence and consequences of POC by developing programmes for early detection, encouraging regular dental check-ups, and initiating individualised, health-promoting behaviour modification programmes for reducing risky behaviours associated with oral cancer.

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          Most cited references20

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          Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan.

          A hospital-based case-control study of matched pairs was conducted to explore (a) the relationship between the use of betel quid chewing, cigarette smoking, alcohol drinking and oral cancer and (b) synergism between these factors. The case group consisted of 104 male and 3 female oral cancer patients and these were compared with 194 male and 6 female matched controls. We found by univariate analysis that alcohol consumption, smoking, betel quid chewing, educational level and occupation were associated with oral cancer. The adjusted odds ratios were to be found elevated in patients who were smoking and betel quid chewing. After adjusting for education and occupation covariates, the incidence of oral cancer was computed to be 123-fold higher in patients who smoked, drank alcohol and chewed betel quid than in abstainers. The synergistic effects of alcohol, tobacco smoke and betel quid in oral cancer were clearly demonstrated, but there was a statistically significant association between oral cancer and betel quid chewing alone. Swallowing betel quid juice (saliva extract of betel quid produced by chewing) or including unripened betel fruit in the quid both seemed to enhance the risks of contracting oral cancer.
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            The precancer risk of betel quid chewing, tobacco use and alcohol consumption in oral leukoplakia and oral submucous fibrosis in southern Taiwan

            In areas where the practise of betel quid chewing is widespread and the chewers also often smoke and drink alcohol, the relation between oral precancerous lesion and condition to the three habits is probably complex. To explore such association and their attributable effect on oral leukoplakia (OL) and oral submucous fibrosis (OSF), a gender–age-matched case–control study was conducted at Kaohsiung, southern Taiwan. This study included 219 patients with newly diagnosed and histologically confirmed OL or OSF, and 876 randomly selected community controls. All information was collected by a structured questionnaire through in-person interviews. A preponderance of younger patients had OSF, while a predominance of older patients had OL. Betel quid chewing was strongly associated with both these oral diseases, the attributable fraction of OL being 73.2% and of OSF 85.4%. While the heterogeneity in risk for areca nut chewing across the two diseases was not apparent, betel quid chewing patients with OSF experienced a higher risk at each exposure level of chewing duration, quantity and cumulative measure than those who had OL. Alcohol intake did not appear to be a risk factor. However, cigarette smoking had a significant contribution to the risk of OL, and modified the effect of chewing based on an additive interaction model. For the two oral premalignant diseases combined, 86.5% was attributable to chewing and smoking. Our results suggested that, although betel quid chewing was a major cause for both OL and OSF, its effect might be difference between the two diseases. Cigarette smoking has a modifying effect in the development of oral leukoplakia.
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              Malignant transformation rate in oral submucous fibrosis over a 17-year period.

              Sixty-six patients with oral submucous fibrosis were followed-up for a period of 17 yr (median observation 10 yr) in Ernakulam District, Kerala, India. Oral cancer developed in five (7.6%) patients. The malignant transformation rate in the same sample was 4.5% over a 15-yr observation period (median 8 yr). These findings impart a high degree of malignant potential to this condition.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2015
                18 December 2015
                : 5
                : 12
                : e008788
                Affiliations
                [1 ]Division of Plastic Surgery, Head and Neck Cancer Team, Chang Gung Memorial Hospital , Chiayi, Taiwan
                [2 ]Division of Cardiology, Chang Gung Memorial Hospital , Yunlin, Taiwan
                [3 ]Department of Dermatology, Shuang Ho Hospital, Taipei Medical University , Taipei, Taiwan
                [4 ]School of Public Health, College of Public Health and Nutrition, Taipei Medical University , Taipei, Taiwan
                [5 ]Division of Dentistry, Cancer Center, Chang Gung Memorial Hospital , Chiayi, Taiwan
                [6 ]Nursing Department, Chang Gung University of Science and Technology , Taoyuan, Taiwan
                [7 ]Graduate Institute of Nursing, Chang Gung University of Science and Technology , Chiayi, Taiwan
                Author notes
                [Correspondence to ] Dr Mei-Yen Chen; meiyen@ 123456gw.cgust.edu.tw

                C-CC, M-SL and Y-TC contributed equally.

                Article
                bmjopen-2015-008788
                10.1136/bmjopen-2015-008788
                4691787
                26685025
                385d8ceb-8320-44e4-9f18-651830edb1c9
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 16 May 2015
                : 19 November 2015
                : 23 November 2015
                Categories
                Public Health
                Research
                1506
                1724
                1715
                1717

                Medicine
                oral medicine
                Medicine
                oral medicine

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