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Association of betel nut chewing with exercise performance in a military male cohort: the CHIEF study
  1. Kun-Zhe Tsai1,
  2. J-W Lin1,2,
  3. F Lin1,
  4. F-Y Su3,
  5. Y-H Li3,
  6. Y-P Lin4,
  7. Y-K Lin1,5,
  8. C-L Han6,
  9. C-B Hsieh1,5 and
  10. G-M Lin1,5
  1. 1 Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan
  2. 2 Department of Dentistry, National Yang-Ming Univeristy, Taipei, Taiwan
  3. 3 Department of Public Health, Tzu-Chi University, Taipei, Taiwan
  4. 4 Department of Critical Care Medicine, Yonghe Cardinal Tien Hospital , Fu-Jen Catholic University, New Taipei City, Taiwan
  5. 5 Department of Medicine, National Defense Medical Center, Taipei, Taiwan
  6. 6 Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  1. Correspondence to Dr G-M Lin, Hualien 97144, Taiwan; farmer507{at}


Introduction Betel nut chewing may cause obesity, neurohormonal activation and inflammation, possibly impairing exercise performances.

Methods We examined the cross-sectional association in 4388 military male adults aged 18–50 years from the cardiorespiratory fitness in armed forces study in Taiwan between 2013 and 2014. The status of betel nut chewing was classified as current and former/never based on each participant’s response to a questionnaire. Physical fitness was evaluated by three basic exercise tests including 3000 m running, 2 min sit-ups and 2 min push-ups. Multiple logistic regression for the best 10% and the worst 10% performers in each exercise, and linear regression were used to determine the relationship.

Results There were 564 current chewers and 3824 non-current chewers for the analysis. The linear regression shows that current betel nut chewing was positively correlated with 3000 m running duration (r=0.37, p=0.042) after adjusting for age, service specialty, body mass index, exercise frequency and alcohol intake. In addition, the logistic regression shows that as compared with non-current chewers, current chewers had lower odds of being the top 10% performers in 2 min push-ups and higher odds of being the bottom 10% performers in 2 min sit-ups (ORs and 95% CIs: 0.71 (0.50 to 0.99) and 1.32 (1.00 to 1.75), respectively). However, the associations between betel nut chewing and physical fitness were all insignificant after further adjusting for current smoking.

Conclusions Our findings suggest that the impairment of physical fitness associated with betel nut chewing of military young men might be mainly mediated or moderated by the coexisted cigarette smoking.

  • betel nut chewing
  • military men
  • physical fitness
  • cigarette smoking
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  • Contributors KZT wrote the paper. YPL, YKL, CLH and CBH made critical suggestions and revisions on the study. FL and JWL collected the data. FYS and YHL analysed the data. GML conceived, designed and corresponded to the study.

  • Funding The study was funded by Hualien Armed Forces General Hospital (805-C105-10, 805-C107-5).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was reviewed and approved by the Institutional Review Board of the Mennonite Christian Hospital (No 16-05-008) in Taiwan.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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