U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption
description
Transcript of U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption
![Page 1: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/1.jpg)
Slide 1
Allen L. Mozek, MPHIFPTI 2012-13 Fellow
New York State Department of AgricultureDivision of Food Safety & Inspection
U.S. Food Regulators’ Perceptions of ArecaNut as Food and Religious Exemption
![Page 2: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/2.jpg)
Slide 2
• Processed edible seed kernel
Areca catechu
• Fruiting palm tree
![Page 3: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/3.jpg)
Slide 3
• Areca nut• Betel leaf• Slaked lime (calcium
hydroxide)
Triune of Paan (Betel Quid)
![Page 4: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/4.jpg)
Slide 4
Food Condiments and Tobacco Are Optional
![Page 5: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/5.jpg)
Slide 5
Religious Ritual (puja) Non-Food Item in Hinduism, Buddhism, and Animism
![Page 6: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/6.jpg)
Slide 6
Background
• Areca nut and betel quid (with and without tobacco) cause oral cancer, oral submucous fibrosis (OSF) and other precancerous lesions. (WHO International Agency for Research on Cancer, 2004).
• OSF is an unconventional chronic foodborne disease.
• OSF has a 7 to 30% malignant transfer rate.
• Areca nut is only etiologic agent for OSF.
![Page 7: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/7.jpg)
Slide 7
Constant irritation causes chronic inflammation;Alkaloid absorption in the mouth causes fibrosis
![Page 8: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/8.jpg)
Slide 8
OSF is observable—scarlet stained teeth and restrictive mouth opening (trismus)
Role of areca alkaloids in OSF (Ghom & Mhaske, 2008).
![Page 9: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/9.jpg)
Slide 9
• 600 million people (10 – 20 % of the world’s population) practice areca nut chewing culture on the subcontinent of India and in South East Asia—including immigrants and refugees in the U.S.
• Areca nut (with natural alkaloids including arecoline) is the fourth most common addictive substance in the world after; alcohol, tobacco, and caffeine.
Background (continued)
![Page 10: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/10.jpg)
Slide 10
• U.S. food regulators may not be aware of areca nut or paan.
• May not consider areca nut or paan as food.
• May not consider areca nut exempt from adulteration if labeled: For Religious Purposes Only – Not For Human Consumption.
Problem Statement
![Page 11: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/11.jpg)
Slide 11
Methodology
• Food regulators in 20 metro areas (22 states) with largest Asian populations surveyed.
• (19 of 108 (17.6%) responded).
Questions:• Have you heard of betel nut (areca nut)?• Have you heard of paan (betel quid)?• Do you consider betel nut a food?• Do you consider paan a food?• Would you consider a religious exemption?
![Page 12: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/12.jpg)
Slide 12
Heard of Betel Nut/Paan? Are They Food? (%)
![Page 13: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/13.jpg)
Slide 13
Religious Exemption if Labeled?
![Page 14: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/14.jpg)
Slide 14
• There is a lack of awareness amongst U.S. food regulators regarding areca nut and paan (betel quid).
• Regulators are unsure if areca nut and paan are food.
• Only 10.5% of regulators would consider a religious exemption.
Conclusions
![Page 15: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/15.jpg)
Slide 15
• Provide food regulators with evidence of the serious harm caused by areca nut chewing; with and without tobacco.
• Examine oral submucous fibrosis (OSF) as an unconventional chronic foodborne disease caused by consumption of areca nut.
• Educate immigrants and refugees concerning the health effects from consuming areca nut products.
Recommendations
![Page 16: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/16.jpg)
Slide 16
• Inform health providers, serving at risk populations, about the likelihood of diagnosing OSF and other precancerous lesions and conditions.
• Regulate areca nut as an adulterated food.
• Exempt whole areca nut for religious worship when packaged and labeled; Not For Human Consumption – Religious Purposes Only.
Recommendations (continued)
![Page 17: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/17.jpg)
Slide 17
• Cultural anthropology meets food safety.• The definition of food is challenged. • Religious exemption is unique.• Areca nut addiction (betelmania) meets tobacco
addiction.• U.S. food regulators can mitigate oral cancer and oral
sub mucous fibrosis (OSF) disease worldwide insofar as U.S. policy has a ripple effect worldwide.
Ancient Areca Nut (Betel Nut) Chewing Culture is where…
![Page 18: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/18.jpg)
Slide 18
1. Auluck, A., Hislop, G., Poh, C., Zhang, L., & Rosin, M. P. (2009). Areca nut and betel quid chewing among South Asian immigrants to western countries and its implications for oral cancer screening. Rural Remote Health, 9,1118–1125.
2. Awang, M. N. (1986). Estimation of arecoline contents in commercial areca (betel) nuts and its relation to oral precancerous lesions. Singapore Medical Journal, 27, 317-320.
3. Aziz, S. R. (2010). Coming to America: Betel nut and oral submucous fibrosis. Journal of the American Dental Association, 141(4), 423-428.
4. Changrani, J., Gany, F. M., Cruz, G., Kerr, R., & Katz, R. (2006). Paan and gutka use in the United States: A pilot study in Bangladeshi and Indian-Gujarati immigrants in New York City. Journal of Immigrant & Refugee Studies, 4(1), 99-109.
References
![Page 19: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/19.jpg)
Slide 19
5. Gupta, P. C. & Warnakulasuriya, S. (2002). Global epidemiology of areca nut usage. Addiction Biology, 7, 77-83.
6. International Agency for Research on Cancer. (2004). Betel-quid and areca-nut chewing and some areca nut related nitrosamines. IARC Monograph, 85, 1-334.
7. Stanley, J. (2010). Confessions of a white, middle-aged paan eater. Retrieved from http://nypress.com/confessions-of-a-white-middle-aged-paan-eater/
8. Sullivan, R. J. & Hagen, E. H. (2002). Psychotropic substance-seeking: Evolutionary pathology or adaptation? Addiction, 97, 389-400.
9. U.S. Census Bureau. (2012). The Asian population: 2010. Retrieved from http://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf
References (continued)
![Page 20: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/20.jpg)
Slide 20
• IFPTI mentors; James Sevchik, Dr. Preston Hicks, and Joseph Corby
• Erin Sawyer, NYS Department of Agriculture, Division of Food Safety and Inspection
• Dr. Ross Kerr, Director, Oral Mucosal Disease Service, NYU College of Dentistry
• Prakash C. Gupta, Director, Healis – Sekhsaria Institute for Public Health, Navi, Mumbai, India
• Dr Pankaj Chaturvedi, Head and Neck Surgeon, Tata Memorial Hospital, Parel, Mumbai, India
Acknowledgements
![Page 21: U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption](https://reader036.fdocuments.in/reader036/viewer/2022062315/568164e1550346895dd7430c/html5/thumbnails/21.jpg)
Slide 21
Questions?