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Open Access Research article

Prevalence and determinants of biochemical dysfunction of the liver in Atayal Aboriginal community of Taiwan: Is betel nut chewing a risk factor?

Ching-Feng Lin125, Tun-Jen Shiau1, Ying-Chin Ko34, Ping-Ho Chen4 and Jung-Der Wang1*

Author Affiliations

1 Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, College of Public Health and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

2 Department of Health, Executive Yuan, Taiwan

3 Department of Public Health, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

4 Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Taiwan

5 School of Public Health, Taipei Medical University, Taiwan

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BMC Gastroenterology 2008, 8:13  doi:10.1186/1471-230X-8-13

Published: 27 April 2008



We address the independent and interactive roles of habitual betel quid chewing and other known risk factors for biochemical dysfunction and cirrhosis of the liver.


To determine the prevalence rates and risk factors associated with biochemical dysfunction of the liver, a total of 3,010 adult residents in an Atayal Aboriginal community were invited to participate in the study. Abdominal ultrasonography was used to diagnose liver cirrhosis.


There were 2,063 Atayal Aboriginal and 947 non-Aboriginal in this study. The result showed overall prevalence rates for hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) were 21.2 % and 2.9 %, respectively. There were 16.5 %, 15.1 % and 22.4 % subjects with abnormal alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma glutamyl transpeptidase (GGT), accordingly. Multiple logistic regression analysis showed that combined infections with HBV and HCV presented with the highest risks with OR (odds ratio) and 95% CI (confidence interval) of 4.2 (1.2–17.4) and 3.8 (1.0–14.1), respectively for elevation of ALT and AST; followed by alcohol (1.7 and 3.1), male gender (1.7 and 1.6), betel quid (1.5 and 1.3), smoking (1.4 and 1.8), and aboriginal (1.4 and 1.3). There is effect-measure modification between viral infection and betel quid chewing for increased severity of abnormal ALT elevation. Among 1,382 subjects consenting to abdominal ultrasonography, 41(3.0%) were found to have liver cirrhosis with the same factors associated with higher risks.


In addition to infections with viral hepatitis B and/or C, we found Atayal Aboriginal, males, current smokers, drinkers and betel quid chewers were independently associated with biochemical dysfunction and probably cirrhosis of the liver. Further study is needed to corroborate the above hypothesis.