Summary: A plant genus of the family ARECACEAE. Members contain ARECOLINE and CATECHIN. The leaves and nuts have been used as masticatories, stimulants, and astringents in traditional medicine. The common name of betel is also used for PIPER BETLE. The common name of catechu is sometimes used for ACACIA CATECHU.

Top Publications

  1. Shieh T, Tu H, Ku T, Chang S, Chang K, Liu C. Association between lysyl oxidase polymorphisms and oral submucous fibrosis in older male areca chewers. J Oral Pathol Med. 2009;38:109-13 pubmed publisher
    b>Areca use is the major cause for oral squamous cell carcinoma and oral submucous fibrosis (OSF) in South Asians...
  2. Yap S, Ho P, Kuo H, Yang Y. Comparing factors affecting commencement and cessation of betel quid chewing behavior in Taiwanese adults. BMC Public Health. 2008;8:199 pubmed publisher
    ..The cessation rates of betel quid chewing were decreasingly associated with the daily consumption of betel quid. Hence, reducing of daily amount in betel quid cessation program may be associated with future stopping habit. ..
  3. Hsu H, Tsou T, Chao H, Shy C, Kuo Y, Tsai F, et al. Effects of arecoline on adipogenesis, lipolysis, and glucose uptake of adipocytes-A possible role of betel-quid chewing in metabolic syndrome. Toxicol Appl Pharmacol. 2010;245:370-7 pubmed publisher
    ..of betel-quid chewing in adipocyte dysfunction, we determined the effects of arecoline, a major alkaloid in areca nuts, on adipogenic differentiation (adipogenesis), lipolysis, and glucose uptake by fat cells...
  4. Gunaseelan R, Sankaralingam S, Ramesh S, Datta M. Areca nut use among rural residents of Sriperambudur Taluk: a qualitative study. Indian J Dent Res. 2007;18:11-4 pubmed
    ..of the study was to understand the perceptions of the residents of rural part of Sriperambudur Taluk, regarding areca nut use...
  5. Ihsan R, Chattopadhyay I, Phukan R, Mishra A, Purkayastha J, Sharma J, et al. Role of epoxide hydrolase 1 gene polymorphisms in esophageal cancer in a high-risk area in India. J Gastroenterol Hepatol. 2010;25:1456-62 pubmed publisher
    ..616, P = 0.001), betel quid chewers (OR 0.434, 95% CI = 0.236-0.797, P = 0.007), and alcohol users. EPHX1 exon 4 139His/Arg, and 139Arg/Arg genotypes were associated with a higher risk of esophageal cancer in a high-risk area of India. ..
  6. Wen C, Tsai M, Chung W, Hsu H, Chang Y, Chan H, et al. Cancer risks from betel quid chewing beyond oral cancer: a multiple-site carcinogen when acting with smoking. Cancer Causes Control. 2010;21:1427-35 pubmed publisher
    ..They were responsible for the recent increases in oral, esophageal, pancreatic, and liver cancer in Taiwan. Chewing and smoking shortened their life span by nearly 6 years. ..
  7. Chang I, Jiang R, Wong Y, Wu S, Chen F, Liu S. Visual screening of oral cavity cancer in a male population: experience from a medical center. J Chin Med Assoc. 2011;74:561-6 pubmed publisher
    ..We suggest that individuals aged ?40 years or who are habitual cigarette smokers, alcohol consumers, and betel quid chewers should receive oral screening regularly so that potential oral cancer can be detected as early as possible. ..
  8. Lin Y, Huang H, Wang L, Tsai C, Lung O, Dai C, et al. Polymorphisms of COX-2 -765G>C and p53 codon 72 and risks of oral squamous cell carcinoma in a Taiwan population. Oral Oncol. 2008;44:798-804 pubmed publisher
    ..94) and OL (OR=6.73, 95%CI=2.84-19.87). We suggest that COX-2 -765G>C polymorphisms play a different role in OSCC development than in malignant potential of OSF and OL. However, p53 codon 72 polymorphisms show no such correlation. ..
  9. Chen J, Hung C, Huang K, Chen Y, Liu S, Chiang W, et al. Src family kinases mediate betel quid-induced oral cancer cell motility and could be a biomarker for early invasion in oral squamous cell carcinoma. Neoplasia. 2008;10:1393-401 pubmed
    ..Furthermore, we identified that areca nut, a major component of BQ, is the key factor accounting for BQ-induced cell migration and invasion through SFKs-..

More Information


  1. Sumeth Perera M, Gunasinghe D, Perera P, Ranasinghe A, Amaratunga P, Warnakulasuriya S, et al. Development of an in vivo mouse model to study oral submucous fibrosis. J Oral Pathol Med. 2007;36:273-80 pubmed
    Epidemiological data have shown an association of areca nut chewing with oral submucous fibrosis (OSF). Experimental evidence to confirm this has been limited. Fibrosis-promoting activity of areca nut was tested in an animal model...
  2. Tsai Y, Lin C, Chiang S, Lee C, Lee K, Ko Y. Areca nut induces miR-23a and inhibits repair of DNA double-strand breaks by targeting FANCG. Toxicol Sci. 2011;123:480-90 pubmed publisher
    Previous investigations have shown that areca nut extracts (ANE) or arecoline (ARE) causes DNA damage, which in turn contributes to oral cell carcinogenesis...
  3. Yuan J, Yang D, Liang Y, Gao W, Ren Z, Zeng W, et al. Alkaloids from areca (betel) nuts and their effects on human sperm motility in vitro. J Food Sci. 2012;77:T70-8 pubmed publisher
    ..was established to rapidly and simultaneously determine 3 main alkaloids (arecoline, arecaidine, and guvacine) in areca (betel) nuts (AN), and 12 AN samples from the main betel palm growing areas on the Chinese Mainland were collected ..
  4. Zavras A, Yoon A, Chen M, Lin C, Yang S. Metallothionein-1 genotypes in the risk of oral squamous cell carcinoma. Ann Surg Oncol. 2011;18:1478-83 pubmed publisher epidemiologic information on covariates or "risk factors" for OSCC, including tobacco, alcohol, and areca quid use...
  5. Yen T, Lin W, Wang C, Wang C, Liu S. The association of smoking, alcoholic consumption, betel quid chewing and oral cavity cancer: a cohort study. Eur Arch Otorhinolaryngol. 2008;265:1403-7 pubmed publisher
  6. Blank M, Deshpande L, Balster R. Availability and characteristics of betel products in the U.S. J Psychoactive Drugs. 2008;40:309-13 pubmed
    Betel use involves oral placement of shards of areca nut (Areca catechu palm seed containing the cholinergic agonist arecoline) wrapped with slaked lime in a betel leaf (Piper betle plant) or various chopped or powdered products ..
  7. Lee S, Tsai C, Ho Y, Chang Y. The upregulation of heat shock protein 70 expression in areca quid chewing-associated oral squamous cell carcinomas. Oral Oncol. 2008;44:884-90 pubmed publisher
    Heat shock protein 70 (HSP70) is an important stress-induced protein. Areca quid chewing is a major risk factor of oral squamous cell carcinoma (OSCC)...
  8. Kumar A, Bagewadi A, Keluskar V, Singh M. Efficacy of lycopene in the management of oral submucous fibrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:207-13 pubmed
    ..These values were statistically found to be highly significant. The observed effects suggest that lycopene can and should be used as a first line of therapy in the initial management of oral submucous fibrosis. ..
  9. Lin K, Lin C, Liu C, Chou M, Lin J. Arecoline N-oxide: its mutagenicity and possible role as ultimate carcinogen in areca oral carcinogenesis. J Agric Food Chem. 2011;59:3420-8 pubmed publisher
    The areca nut is the most widely consumed psychoactive substance in Taiwan, India, and Southeast Asia. It is considered to be an environmental risk factor for the development of oral submucous fibrosis and cancer...
  10. Hou Y, Ou H, Chu S, Wu P, Lu P, Chi C, et al. NAT2 slow acetylation haplotypes are associated with the increased risk of betel quid-related oral and pharyngeal squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112:484-92 pubmed publisher
    ..001). The interactions on risk of OPSCC were found for NAT2 acetylation haplotypes with status of age, BQ chewing, and alcohol drinking. The NAT2 acetylation haplotypes might be genetic markers for risk of BQ-related OPSCC. ..
  11. Yang Y, Ho P, Lu H, Huang I, Chen C. Comparing dose-response measurements of oral habits on oral leukoplakia and oral submucous fibrosis from a community screening program. J Oral Pathol Med. 2010;39:306-12 pubmed publisher
    ..These results are useful for comparing statistics, but may not be informative for personal disease-related information...
  12. Wang Y, Tsai Y, Huang J, Lee K, Kuo C, Wang C, et al. Arecoline arrests cells at prometaphase by deregulating mitotic spindle assembly and spindle assembly checkpoint: implication for carcinogenesis. Oral Oncol. 2010;46:255-62 pubmed publisher
    ..In Asia, betel quid (BQ) chewing is one of such risk factors for oral cancer. Areca nut is an essential constitute of BQ and is declared as a group I carcinogen by the International Agency for ..
  13. Chiu C, Tsai M, Tseng H, Wang C, Wang C, Wu C, et al. A novel single nucleotide polymorphism in XRCC4 gene is associated with oral cancer susceptibility in Taiwanese patients. Oral Oncol. 2008;44:898-902 pubmed publisher
    ..Our results firstly suggest that the XRCC4 intron 3 del genotype may be associated with oral oncology and may be a novel useful marker for primary prevention and anticancer intervention. ..
  14. Chakraborty P, Mandal J, Sarkar E, Chowdhury I, Gupta Bhattacharya S. Clinico-immunochemical studies on airborne Areca catechu L. Pollen, a probable risk factor in emergency asthma hospitalization from Eastern India. Int Arch Allergy Immunol. 2009;149:305-14 pubmed publisher
    The pollen grain of the Areca catechu L. tree is airborne and allergenic...
  15. Chen S, Lee J, Liu H, Wang H, Ye C. The cross-effects of cigarette and betel nut consumption in Taiwan: have tax increases made a difference?. Health Policy Plan. 2011;26:266-73 pubmed publisher
    ..Results from a simulated comparative analysis indicate that the Betel Nut Health Tax reduces cigarette consumption to a much greater extent than the Tobacco Health and Welfare Taxes reduce betel nut consumption. ..
  16. Lee J. The synergistic effect of cigarette taxes on the consumption of cigarettes, alcohol and betel nuts. BMC Public Health. 2007;7:121 pubmed
    ..Revenues generated by the tax can be used to fund city and county smoking control programs as well as to meet the health insurance system's current financial shortfall. ..
  17. Tseng Y, Yang C, Lin S, Cheng C, Lin S, Liu C, et al. Areca nut extract upregulates vimentin by activating PI3K/AKT signaling in oral carcinoma. J Oral Pathol Med. 2011;40:160-6 pubmed publisher
    b>Areca nut is a group I carcinogen. Areca nut extract (ANE) is known to activate signaling pathways in oral epithelial cells...
  18. Kuo P, Hsu Y, Huang M, Chiang S, Ko Y. Bronchial epithelium-derived IL-8 and RANTES increased bronchial smooth muscle cell migration and proliferation by Kr├╝ppel-like factor 5 in areca nut-mediated airway remodeling. Toxicol Sci. 2011;121:177-90 pubmed publisher
    This study is first to analyze the inflammatory cytokines, produced by the bronchial epithelium after exposure to areca nut extract (ANE), which contribute to airway remodeling by increasing human bronchial smooth muscle cells (BSMC) ..
  19. Mirza S, Shafique K, Vart P, Arain M. Areca nut chewing and dependency syndrome: is the dependence comparable to smoking? a cross sectional study. Subst Abuse Treat Prev Policy. 2011;6:23 pubmed publisher
    b>Areca nut is the seed of fruit oriental palm known as Areca catechu. Many adverse effects of nut chewing have been well documented in the medical literature...
  20. Reichart P, Zhang X. Misconceptions related to the areca nut chewing habits of Mainland China. Oral Oncol. 2007;43:958-9 pubmed
  21. Ho P, Yang Y, Shieh T, Huang I, Chen Y, Lin K, et al. Consumption of areca quid, cigarettes, and alcohol related to the comorbidity of oral submucous fibrosis and oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:647-52 pubmed
    ..The aim of this study was to identify the effects of areca quid, cigarette, and alcohol on the coexistence of oral cancer and OSF. This is a case-control study...
  22. Tsai W, Wu M, Wang G, Lee K, Lee C, Lu Y, et al. Chewing areca nut increases the risk of coronary artery disease in Taiwanese men: a case-control study. BMC Public Health. 2012;12:162 pubmed publisher
    b>Areca nut chewing has been reported to be associated with obesity, metabolic syndrome, hypertension, and cardiovascular mortality in previous studies...
  23. Lu H, Liu C, Liu T, Kao S, Lin S, Chang K. Areca-treated fibroblasts enhance tumorigenesis of oral epithelial cells. J Dent Res. 2008;87:1069-74 pubmed
    Several hundred million Asians chew areca nut, which is strongly associated with oral carcinogenesis in people of this region. The impacts of areca nut extract on oral target cells are largely unclear...
  24. Lin W, Pi Sunyer F, Liu C, Li T, Li C, Huang C, et al. Betel nut chewing is strongly associated with general and central obesity in Chinese male middle-aged adults. Obesity (Silver Spring). 2009;17:1247-54 pubmed publisher
    ..Dose-response effects of the association between betel nut consumption and general obesity as well as central obesity were found. ..
  25. Choudhury Y, Sharan R. Altered BRCA1 and BRCA2 responses and mutation of BRCA1 gene in mice exposed chronically and transgenerationally to aqueous extract of betel nut (AEBN). Environ Toxicol Pharmacol. 2011;31:57-69 pubmed publisher
    ..Thus, the genomic instability arising due to the lowering in the levels of Brca1 and Brca2 proteins and mutation in exon 11 of Brca1 gene contributed to the increased risk of cancer in mice exposed transgenerationally to AEBN. ..
  26. Tseng Y, Chang K, Yang C, Liu C, Kao S, Liu T, et al. Association between areca-stimulated vimentin expression and the progression of head and neck cancers. Head Neck. 2012;34:245-53 pubmed publisher
    b>Areca nut chewing is a common oral habit of Asians that is closely associated with the high incidence of head and neck carcinoma...
  27. Lu H, Kao S, Liu T, Liu S, Huang W, Chang K, et al. Areca nut extract induced oxidative stress and upregulated hypoxia inducing factor leading to autophagy in oral cancer cells. Autophagy. 2010;6:725-37 pubmed
    b>Areca (betel) chewing was tightly linked to oral tumorigenesis in Asians. Areca nut was a recently confirmed group I carcinogen and a popular addictive substance used by Asians...
  28. Kang I, Chou C, Tseng Y, Huang C, Ho W, Shih C, et al. Association between betelnut chewing and chronic kidney disease in adults. J Occup Environ Med. 2007;49:776-9 pubmed
    ..026 and P = 0.038). Betelnut use is associated with chronic kidney disease in adults younger than 65. ..
  29. Thomas S, Bain C, Battistutta D, Ness A, Paissat D, Maclennan R. Betel quid not containing tobacco and oral cancer: a report on a case-control study in Papua New Guinea and a meta-analysis of current evidence. Int J Cancer. 2007;120:1318-23 pubmed
    ..14 (95% CI 1.06, 4.32) in betel quid chewers and in studies that adjusted for smoking the combined OR was 3.50 (95% CI 2.16, 5.65) in betel quid chewers. Preventive efforts should discourage betel quid chewing as well as smoking. ..
  30. Liu H, Lu H, Lui M, Yu E, Shen W, Chen Y, et al. Detection of copy number amplification of cyclin D1 (CCND1) and cortactin (CTTN) in oral carcinoma and oral brushed samples from areca chewers. Oral Oncol. 2009;45:1032-6 pubmed publisher
    Oral squamous cell carcinoma (OSCC) in Asians is highly associated with the abuse of areca (betel) chewing. There are several hundred million Asians who chew areca and are therefore at high risk of OSCC...
  31. Wu Q, Yang Y, Simon J. Qualitative and quantitative HPLC/MS determination of proanthocyanidins in areca nut (Areca catechu). Chem Biodivers. 2007;4:2817-26 pubmed
    Proanthocyanidins (PACs) in areca nut (Areca catechu L.) were analyzed by high-performance liquid chromatography (HPLC) combined with electrospray-ionization mass spectrometry (ESI-MS) and compared to grape seed extract...
  32. Wang C, Liu T, Wey S, Wang F, Jan T. Areca nut extract suppresses T-cell activation and interferon-gamma production via the induction of oxidative stress. Food Chem Toxicol. 2007;45:1410-8 pubmed
    b>Areca quid chewing is a major risk factor associated with oral submucous fibrosis (OSF) and oral cancer. Experimental evidence indicates that immune deterioration is associated with the pathophysiology of OSF and oral cancer...
  33. Tsou Y, Hua C, Tseng H, Hsu C, Tsai C, Sun S, et al. The joint effect of hOGG1 single nucleotide polymorphism and betel quid chewing on oral cancer in Taiwan. Anticancer Res. 2010;30:4205-8 pubmed
    ..0149), not in the non-chewer group (p=0.8028). Our results provide evidence that the C allele of hOGG1 codon 326 may have a joint effect with betel quid chewing on the development of oral cancer. ..
  34. Tseng Y, Chang C, Liu T, Kao S, Chang K, Lin S. Areca nut extract treatment down-regulates involucrin in normal human oral keratinocyte through P13K/AKT activation. Oral Oncol. 2007;43:670-9 pubmed
    b>Areca (betel) is an important etiological factor linked to the high prevalence of oral carcinoma and other oral diseases in South Asians. Involucrin is a key component of the cornified envelop and a differentiation marker of keratinocyte...
  35. Lee C, Ko A, Warnakulasuriya S, Yin B, Sunarjo -, Zain R, et al. Intercountry prevalences and practices of betel-quid use in south, southeast and eastern Asia regions and associated oral preneoplastic disorders: an international collaborative study by Asian betel-quid consortium of south and east Asia. Int J Cancer. 2011;129:1741-51 pubmed publisher
    ..1-24.7%), where Hunan chewers have the unique practice of using the dried husk of areca fruit rather than the solid nut universally used by others...
  36. Lee S, Tseng L, Li Y, Tsai C, Chang Y. Heat shock protein 47 expression in oral squamous cell carcinomas and upregulated by arecoline in human oral epithelial cells. J Oral Pathol Med. 2011;40:390-6 pubmed publisher
    ..5, a region frequently amplified in human cancers. Areca quid chewing is a major risk factor of oral squamous cell carcinoma (OSCC)...
  37. Chaudhuri S, Mukherjee S, Paul R, Haldar A, Chaudhuri K. CYP1AI and CYP2E1 gene polymorphisms may increase susceptibility to oral submucous fibrosis among betel quid chewers of eastern India. Gene. 2013;513:268-71 pubmed publisher
    ..88 (1.57-5.24)] and CYP2E1 PstI site [OR=3.16 (1.10-9.04)] revealed significant association with OSF. Our results suggest that polymorphism in CYP1A1 and CYP2E1 may confer an increased risk for Oral Submucous Fibrosis. ..
  38. Chen P, Tsai C, Lin Y, Ko Y, Yang Y, Shieh T, et al. Ingredients contribute to variation in production of reactive oxygen species by areca quid. J Toxicol Environ Health A. 2006;69:1055-69 pubmed
    b>Areca quid (AQ) chewing has been implicated an independent risk factor for the development of oral cancer. Taiwanese areca quid (AQ) refers to a combination of areca nut (AN), lime, and inflorescence of Piper betle Linn...
  39. Sujatha D, Hebbar P, Pai A. Prevalence and correlation of oral lesions among tobacco smokers, tobacco chewers, areca nut and alcohol users. Asian Pac J Cancer Prev. 2012;13:1633-7 pubmed
    ..1028 patients with tobacco, alcohol and areca nut habits attending our Department of Oral Medicine and Radiology formed the study sample...
  40. Secretan B, Straif K, Baan R, Grosse Y, El Ghissassi F, Bouvard V, et al. A review of human carcinogens--Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet Oncol. 2009;10:1033-4 pubmed
  41. Lin M, Hsieh W, Chiang W, Hong W, Hsu Y, Cheng Y, et al. Autophagy induction by the 30-100kDa fraction of areca nut in both normal and malignant cells through reactive oxygen species. Oral Oncol. 2010;46:822-8 pubmed publisher
    b>Areca nut (AN) is an addictive carcinogen used by about 200-600 million people worldwide...
  42. Kaushal M, Chattopadhyay I, Phukan R, Purkayastha J, Mahanta J, Kapur S, et al. Contribution of germ line BRCA2 sequence alterations to risk of familial esophageal cancer in a high-risk area of India. Dis Esophagus. 2010;23:71-5 pubmed publisher
    ..No sequence alterations were found in 80 nonfamilial ESCC cases (P=0.01) and 100 healthy controls (P=0.0037), suggesting that germ line BRCA2 gene mutation may play a role in familial aggregation of ESCC in high-risk region of India. ..
  43. Lin C, Wang J, Chen P, Chang S, Yang Y, Ko Y. Predictors of betel quid chewing behavior and cessation patterns in Taiwan aborigines. BMC Public Health. 2006;6:271 pubmed
    ..Alcohol use is strongly association with betel quid chewing. Efforts to reduce habitual alcohol consumption might be of benefit in cessation of betel quid chewing. ..
  44. Yang C, Hou Y, Chiu Y, Chen H, Chu S, Chi C, et al. Interaction between tumour necrosis factor-? gene polymorphisms and substance use on risk of betel quid-related oral and pharyngeal squamous cell carcinoma in Taiwan. Arch Oral Biol. 2011;56:1162-9 pubmed publisher
    ..BQ-chewers who carry the G allele or G/G genotype in TNFA -308 may have an increased risk of OPSCC. The intensity of cigarette smoking modulates the effect of the combined TNFA genotypes on risk of BQ-related OPSCC. ..
  45. Tsai Y, Wong T, Chen S. Prevalence and related risk factors of areca quid chewing among junior high students in eastern Taiwan. Public Health. 2002;116:190-4 pubmed
    b>Areca quid chewing is a serious problem in eastern Taiwan. The prevalence and related risk factors of areca quid chewing among junior high students were studied...
  46. Khan I, Kumar N, Pant I, Narra S, Kondaiah P. Activation of TGF-? pathway by areca nut constituents: a possible cause of oral submucous fibrosis. PLoS ONE. 2012;7:e51806 pubmed publisher
    ..fibrosis (OSF) is a chronic inflammatory disease characterized by the accumulation of excess collagen, and areca nut chewing has been proposed as an important etiological factor for disease manifestation...
  47. Lin W, Chiu T, Lee L, Lin C, Huang C, Huang K. Betel nut chewing is associated with increased risk of cardiovascular disease and all-cause mortality in Taiwanese men. Am J Clin Nutr. 2008;87:1204-11 pubmed
    ..Regular screening for betel nut chewing history may help prevent excess deaths in the future. An anti-betel nut chewing program is urgently warranted for current chewers. ..
  48. Napier S, Speight P. Natural history of potentially malignant oral lesions and conditions: an overview of the literature. J Oral Pathol Med. 2008;37:1-10 pubmed
    ..The vast majority of PMD in which OSCC develop are non-homogenous although 5% of homogenous PMD will develop carcinoma. Large lesions covering several intraoral subsites also appear more at risk...
  49. Yen L, Chiu C, Wu W, Pan L. Aggregation of health behaviors among fourth graders in northern Taiwan. J Adolesc Health. 2006;39:435-42 pubmed
    ..It was suggested that health and educational organizations need to place importance on behavioral problems in children and adopt early prevention measures. ..
  50. Chen P, Lee K, Chen C, Shieh T, Ho P, Wang S, et al. CYP26B1 is a novel candidate gene for betel quid-related oral squamous cell carcinoma. Oral Oncol. 2011;47:594-600 pubmed publisher
    ..88; 95% CI, 1.07-7.74). Increased expression of CYP26B1 was observed in tumor tissue compared with adjacent normal tissue. The CYP26B1 gene plays a novel role in the BQ dependent pathogenesis of OSCC. ..
  51. Deng Y, Chang J, Yeh C, Cheng S, Kuo M. Arecoline stimulated Cyr61 production in human gingival epithelial cells: inhibition by lovastatin. Oral Oncol. 2011;47:256-61 pubmed publisher
    ..b>Areca nut (AN) chewing is the most important etiological factor in the pathogenesis of oral cancer in India and many ..
  52. Hsu Y, Liu W, Chen W, Kuo Y, Hsiao C, Hung P, et al. Association of betel nut chewing with chronic kidney disease: a retrospective 7-year study in Taiwan. Nephrology (Carlton). 2011;16:751-7 pubmed publisher
    ..The association between BN chewing and CKD seemed conditional on demographics, health behaviours, and underlying co-morbidities. This association should be interpreted cautiously. ..
  53. Chang L, Wan H, Lai Y, Kuo Y, Liu T, Chen Y, et al. Areca nut extracts increased expression of inflammatory cytokines, tumor necrosis factor-alpha, interleukin-1beta, interleukin-6 and interleukin-8, in peripheral blood mononuclear cells. J Periodontal Res. 2009;44:175-83 pubmed publisher
    ..This study investigated the effects of areca nut extracts on the expression of inflammatory cytokines, tumor necrosis factor-alpha, interleukin-1beta, ..