Sznajder Kristin K, Shenk Mary K, Alam Nurul, Raqib Rubhana, Kumar Anjan, Haque Farjana, Blumenfield Tami, Mattison Siobhán M, Wander Katherine
Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, United States of America.
Department of Anthropology, Pennsylvania State University, University Park, Pennsylvania, United States of America.
PLOS Glob Public Health. 2023 Jun 14;3(6):e0001677. doi: 10.1371/journal.pgph.0001677. eCollection 2023.
Anemia accounts for 8.8% of total disability burden worldwide. Betel quid use among pregnant women has been found to increase anemia risk. Betel quid is prepared by wrapping the betel (or areca) nut, with spices and other additions, in betel or tobacco leaf and it is chewed or placed in the mouth. We explored the association between betel quid use and anemia among men and non-pregnant women. We collected data from a random sample of women and their husbands in Matlab, Bangladesh. Participants reported their current betel quid use and individual characteristics. We assessed hemoglobin (a biomarker of anemia) with a hemoglobinometer and soluble transferrin receptor (a biomarker of iron deficiency) and C-reactive protein (a biomarker of inflammation) in dried blood spots via enzyme immunoassay. We estimated logistic regression models to evaluate the association between betel quid use and anemia and structural equation models (SEM) to evaluate mediating roles of iron deficiency and elevated inflammation. A total of 1133 participants (390 men and 743 non-pregnant women) were included. After controlling for important confounders, any betel quid use was positively associated with anemia among men (OR: 1.80; 95% CI: 1.12, 2.89). Among women, betel quid use was associated with anemia only among the most frequent users (OR: 1.62; 95% CI: 1.03, 2.53). SEM did not reveal indirect paths through inflammation or iron deficiency. Betel quid use may contribute to the burden of anemia among adults in Bangladesh. Our findings suggest the burden of disease attributed to betel quid use has been underestimated.
贫血占全球总残疾负担的8.8%。研究发现，孕妇嚼食槟榔会增加贫血风险。槟榔是将槟榔（或槟榔果）与香料及其他添加物用槟榔叶或烟草叶包裹起来，然后咀嚼或含在口中食用。我们探讨了男性和非孕妇嚼食槟榔与贫血之间的关联。我们从孟加拉国马特莱的女性及其丈夫的随机样本中收集数据。参与者报告了他们当前嚼食槟榔的情况和个人特征。我们通过血红蛋白仪评估血红蛋白（贫血的生物标志物）、通过酶免疫测定法评估干血斑中的可溶性转铁蛋白受体（缺铁的生物标志物）和C反应蛋白（炎症的生物标志物）。我们估计了逻辑回归模型以评估嚼食槟榔与贫血之间的关联，并估计了结构方程模型（SEM）以评估缺铁和炎症加剧的中介作用。总共纳入了1133名参与者（390名男性和743名非孕妇）。在控制了重要的混杂因素后，男性中任何嚼食槟榔的行为都与贫血呈正相关（比值比：1.80；95%置信区间：1.12，2.89）。在女性中，只有最频繁嚼食槟榔的人群中，嚼食槟榔与贫血有关（比值比：1.62；95%置信区间：1.03，2.53）。结构方程模型未揭示通过炎症或缺铁的间接路径。嚼食槟榔可能会加重孟加拉国成年人的贫血负担。我们的研究结果表明，归因于嚼食槟榔的疾病负担被低估了。
