Editing Areca nut (section)

==Toxicity==

Chewing areca nut increases the risk of multiple forms of cancer and cardiovascular disease, with or without added tobacco.<ref name="WHOCancer2">{{cite book |author=IARC Working Group |url=http://monographs.iarc.fr/ENG/Monographs/vol85/mono85.pdf |title=Betel-quid and areca-nut chewing and some areca-nut-derived Nitrosamines |publisher=The World Health Organization |isbn=9789283215851 |access-date=13 October 2011 |archive-url=https://web.archive.org/web/20180329043217/http://monographs.iarc.fr/ENG/Monographs/vol85/mono85.pdf |archive-date=29 March 2018 |url-status=live}}</ref><ref>{{cite journal |last1=Warnakulasuriya |first1=S. |last2=Trivedy |first2=C |last3=Peters |first3=TJ |year=2002 |title=Areca nut use: An independent risk factor for oral cancer |journal=The BMJ |volume=324 |issue=7341 |pages=799–800 |doi=10.1136/bmj.324.7341.799 |pmc=1122751 |pmid=11934759}}</ref><ref>{{cite journal |last1=Dave |first1=Bhavana J. |last2=Trivedi |first2=Amit H. |last3=Adhvatyu |first3=Siddharth G. |year=1992 |title=Role of areca nut consumption in the cause of oral cancers. A cytogenetic assessment |journal=Cancer |volume=70 |issue=5 |pages=1017–23 |doi=10.1002/1097-0142(19920901)70:5<1017::AID-CNCR2820700502>3.0.CO;2-# |pmid=1515978 |s2cid=196365532}}</ref>

Betel nut chewing causes an increased risk of [[head and neck cancer]]s and [[esophageal cancer]].<ref name="NCI2">{{cite web |date=22 November 2019 |title=Oropharyngeal Cancer Treatment (Adult) (PDQ®)–Patient Version |url=https://www.cancer.gov/types/head-and-neck/patient/adult/oropharyngeal-treatment-pdq |access-date=28 November 2019 |website=National Cancer Institute |language=en}}</ref><ref>{{cite journal |last1=Secretan |first1=Béatrice |last2=Straif |first2=Kurt |last3=Baan |first3=Robert |last4=Grosse |first4=Yann |last5=El Ghissassi |first5=Fatiha |last6=Bouvard |first6=Véronique |last7=Benbrahim-Tallaa |first7=Lamia |last8=Guha |first8=Neela |last9=Freeman |first9=Crystal |last10=Galichet |first10=Laurent |last11=Cogliano |first11=Vincent |author12=WHO International Agency for Research on Cancer Monograph Working Group |display-authors=8 |year=2009 |title=A review of human carcinogens—Part E: Tobacco, areca nut, alcohol, coal smoke, and salted fish |journal=The Lancet Oncology |volume=10 |issue=11 |pages=1033–4 |doi=10.1016/S1470-2045(09)70326-2 |pmid=19891056}}</ref><ref>{{cite journal |vauthors=Jeng JH, Chang MC, Hahn LJ |date=September 2001 |title=Role of areca nut in betel quid-associated chemical carcinogenesis: current awareness and future perspectives |journal=Oral Oncology |volume=37 |issue=6 |pages=477–492 |doi=10.1016/S1368-8375(01)00003-3 |pmid=11435174}}</ref> Betel quid affects almost all parts of the human body, including the brain, heart, lungs, [[gastrointestinal tract]] and reproductive organs. It can cause [[myocardial infarction]], [[cardiac arrhythmia]]s, [[Hepatotoxicity|liver damage]], [[asthma]], [[type II diabetes]], [[hyperlipidemia]], [[metabolic syndrome]], [[hypothyroidism]], [[Benign prostatic hyperplasia|prostate hyperplasia]] and [[infertility]].<ref name="Garg-20143">{{cite journal |vauthors=Garg A, Chaturvedi P, Gupta PC |date=January 2014 |title=A review of the systemic adverse effects of areca nut or betel nut |journal=Indian Journal of Medical and Paediatric Oncology |volume=35 |issue=1 |pages=3–9 |doi=10.4103/0971-5851.133702 |pmc=4080659 |pmid=25006276 |doi-access=free}}</ref> Habitual chewing of areca nuts increases the risk of [[cirrhosis]] and [[hepatocellular carcinoma]].<ref name="stich">{{cite web <!-- "No authors listed" |display-authors=3 |last=HF |first=Stich |last2=MP |first2=Rosin |last3=KD |first3=Brunnemann |last4=U |first4=Nair |last5=H |first5=Bartsch |last6=J |first6=Nair |last7=M |first7=Blank |last8=L |first8=Deshpande |last9=RL |first9=Balster |last10=RV |first10=Prabhu |last11=V |first11=Prabhu |last12=L |first12=Chatra |last13=P |first13=Shenai |last14=N |first14=Suvarna |last15=S |first15=Dandekeri--> |date=2012 |orig-date=Updated: 2023-03-22 |title=Areca nut |url=https://www.ncbi.nlm.nih.gov/books/NBK590486/ |access-date=2023-11-02 |work=LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet] |publisher=National Institute of Diabetes and Digestive and Kidney Diseases |place=Bethesda, MD |pmid=37043595}}</ref> Chewing areca nuts is a cause of [[oral submucous fibrosis]], a condition which may progress to [[mouth cancer]].<ref name="Ray2019">{{cite journal |vauthors=Ray JG, Chatterjee R, Chaudhuri K |date=2019 |title=Oral submucous fibrosis: A global challenge. Rising incidence, risk factors, management, and research priorities |journal=Periodontology 2000 |volume=80 |issue=1 |pages=200–212 |doi=10.1111/prd.12277 |pmid=31090137 |s2cid=155089425}}</ref> It has also been linked to [[throat cancer]].<ref name="indonesia" />

When chewed with additional tobacco in its preparation (like in [[gutka]]), there is an even higher risk for cancer, especially for [[Oral cancer|oral]] and [[oropharyngeal cancer]]s.<ref name=":62">{{Cite journal |last1=Gormley |first1=Mark |last2=Creaney |first2=Grant |last3=Schache |first3=Andrew |last4=Ingarfield |first4=Kate |last5=Conway |first5=David I. |date=2022-11-11 |title=Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors |journal=British Dental Journal |language=en |volume=233 |issue=9 |pages=780–786 |doi=10.1038/s41415-022-5166-x |issn=0007-0610 |pmc=9652141 |pmid=36369568}}</ref> With tobacco it also raises the risk of fatal [[coronary artery disease]], fatal [[stroke]] and non-fatal ischaemic heart disease<ref name="VidyasagaranSiddiqi20163">{{cite journal |last1=Vidyasagaran |first1=A. L. |last2=Siddiqi |first2=K. |last3=Kanaan |first3=M. |year=2016 |title=Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis |url=http://eprints.whiterose.ac.uk/101100/1/EJPC_D_16_00085_R1_2016.pdf |journal=European Journal of Preventive Cardiology |volume=23 |issue=18 |pages=1970–1981 |doi=10.1177/2047487316654026 |issn=2047-4873 |pmid=27256827 |s2cid=206820997}}</ref><ref name=":22">{{Cite journal |last1=Gupta |first1=Ruchika |last2=Gupta |first2=Sanjay |last3=Sharma |first3=Shashi |last4=Sinha |first4=Dhirendra N |last5=Mehrotra |first5=Ravi |date=2019-01-01 |title=Risk of Coronary Heart Disease Among Smokeless Tobacco Users: Results of Systematic Review and Meta-Analysis of Global Data |url=https://academic.oup.com/ntr/article/21/1/25/4793346 |journal=Nicotine & Tobacco Research |language=en |volume=21 |issue=1 |pages=25–31 |doi=10.1093/ntr/nty002 |issn=1469-994X |pmc=6941711 |pmid=29325111}}</ref>

Women who chew areca nut formulations, such as ''paan'', during pregnancy significantly increase adverse outcomes for the baby. Betel quid chewing can cause [[stillbirth]], [[Preterm birth|premature birth]], and [[low birth weight]].<ref name="VidyasagaranSiddiqi201622">{{cite journal |last1=Vidyasagaran |first1=A. L. |last2=Siddiqi |first2=K. |last3=Kanaan |first3=M. |year=2016 |title=Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis |url=http://eprints.whiterose.ac.uk/101100/1/EJPC_D_16_00085_R1_2016.pdf |journal=European Journal of Preventive Cardiology |volume=23 |issue=18 |pages=1970–1981 |doi=10.1177/2047487316654026 |issn=2047-4873 |pmid=27256827 |s2cid=206820997}}</ref><ref>{{cite journal |last1=Senn |first1=M. |last2=Baiwog |first2=F. |last3=Winmai |first3=J. |last4=Mueller |first4=I. |last5=Rogerson |first5=S. |last6=Senn |first6=N. |year=2009 |title=Betel nut chewing during pregnancy, Madang province, Papua New Guinea |journal=Drug and Alcohol Dependence |volume=105 |issue=1–2 |pages=126–31 |doi=10.1016/j.drugalcdep.2009.06.021 |pmid=19665325}}</ref><ref>{{cite journal |last1=Yang |first1=Mei-Sang |last2=Lee |first2=Chien-Hung |last3=Chang |first3=Shun-Jen |last4=Chung |first4=Tieh-Chi |last5=Tsai |first5=Eing-Mei |last6=Ko |first6=Allen Min-Jen |last7=Ko |first7=Ying-Chin |year=2008 |title=The effect of maternal betel quid exposure during pregnancy on adverse birth outcomes among aborigines in Taiwan |journal=Drug and Alcohol Dependence |volume=95 |issue=1–2 |pages=134–9 |doi=10.1016/j.drugalcdep.2008.01.003 |pmid=18282667}}</ref>

The harm caused by consumption of areca nuts worldwide was classified in 2017 as a "neglected global [[public health]] emergency".<ref name=Mehrtash-2017>{{cite journal|vauthors=Mehrtash H, Duncan K, Parascandola M, David A, Gritz ER, Gupta PC, Mehrotra R, Amer Nordin AS, Pearlman PC, Warnakulasuriya S, Wen CP, Zain RB, Trimble EL |title=Defining a global research and policy agenda for betel quid and areca nut |journal=Lancet Oncology |volume=18 |issue=12 |pages=e767–e775 |date=1 December 2017 |pmid=29208442 |doi=10.1016/S1470-2045(17)30460-6}}</ref>

=== During pregnancy ===
Using tobacco or areca nuts during pregnancy significantly increases [[Teratogenic|adverse]] outcomes for the baby.<ref name=Kumar-2013>{{cite journal |last=Kumar | first=S |title=Tobacco and areca nut chewing—reproductive impairments: an overview |journal=Reproductive Toxicology (Elmsford, N.Y.) |volume=36 |pages=12–7 |date=April 2013  |pmid=23207167 |doi=10.1016/j.reprotox.2012.11.007 | bibcode=2013RepTx..36...12K }}</ref> The habit is associated with higher incidences of [[preterm birth]] and low [[birth weight]] and height.<ref name="Garg-20143"/> Biologically, these effects may be a consequence of the arecoline that is found in areca nuts.<ref name=Javed-2010>{{cite journal |vauthors=Javed F, Bello Correra FO, Chotai M, Tappuni AR, Almas K |title=Systemic conditions associated with areca nut usage: a literature review |journal=Scandinavian Journal of Public Health |volume=38 |issue=8 |pages=838–44 |date=December 2010  |pmid=20688790 |doi=10.1177/1403494810379291 |s2cid=32865681 |url=https://www.researchgate.net/publication/45508189}}</ref> The habit also exposes the fetus to various other toxic components [[Carcinogen|linked to cancer]].<ref name="Garg-20143"/>