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Ingestion of Nitrate and Nitrite and Risk of Stomach and Other Digestive System Cancers in the Iowa Women’s Health Study

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  • Ian D. Buller

    (Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
    Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD 20850, USA)

  • Deven M. Patel

    (Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA)

  • Peter J. Weyer

    (Center for Health Effects of Environmental Contamination, University of Iowa, Iowa City, IA 52242, USA)

  • Anna Prizment

    (Masonic Cancer Center, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55455, USA)

  • Rena R. Jones

    (Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA)

  • Mary H. Ward

    (Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA)

Abstract

Nitrate and nitrite are precursors in the endogenous formation of N-nitroso compounds (NOC) which are potent animal carcinogens for the organs of the digestive system. We evaluated dietary intakes of nitrate and nitrite, as well as nitrate ingestion from drinking water (public drinking water supplies (PWS)), in relation to the incidence (1986–2014) of cancers of the esophagus (n = 36), stomach (n = 84), small intestine (n = 32), liver (n = 31), gallbladder (n = 66), and bile duct (n = 58) in the Iowa Women’s Health Study (42,000 women aged from 50 to 75 in 1986). Dietary nitrate and nitrite were estimated using a food frequency questionnaire and a database of nitrate and nitrite levels in foods. Historical nitrate measurements from PWS were linked to the enrollment address by duration. We used Cox regression to compute hazard ratios (HR) and 95% confidence intervals (CI) for exposure quartiles (Q), tertiles (T), or medians, depending on the number of cancer cases. In adjusted models, nitrite intake from processed meats was associated with an increased risk of stomach cancer (HR Q4vsQ1 = 2.2, CI: 1.2–4.3). A high intake of total dietary nitrite was inversely associated with gallbladder cancer (HR Q4vsQ1 = 0.3, CI: 0.1–0.96), driven by an inverse association with plant sources of nitrite (HR Q4vsQ1 = 0.3, CI: 0.1–0.9). Additionally, small intestine cancer was inversely associated with a high intake of animal nitrite (HR T3vsT1 = 0.2, CI: 0.1–0.7). There were no other dietary associations. Nitrate concentrations in PWS (average, years ≥ 1/2 the maximum contaminant level) were not associated with cancer incidence. Our findings for stomach cancer are consistent with prior dietary studies, and we are the first to evaluate nitrate and nitrite ingestion for certain gastrointestinal cancers.

Suggested Citation

  • Ian D. Buller & Deven M. Patel & Peter J. Weyer & Anna Prizment & Rena R. Jones & Mary H. Ward, 2021. "Ingestion of Nitrate and Nitrite and Risk of Stomach and Other Digestive System Cancers in the Iowa Women’s Health Study," IJERPH, MDPI, vol. 18(13), pages 1-14, June.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:13:p:6822-:d:582034
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    References listed on IDEAS

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    1. Mary H. Ward & Rena R. Jones & Jean D. Brender & Theo M. De Kok & Peter J. Weyer & Bernard T. Nolan & Cristina M. Villanueva & Simone G. Van Breda, 2018. "Drinking Water Nitrate and Human Health: An Updated Review," IJERPH, MDPI, vol. 15(7), pages 1-31, July.
    2. Doyle, T.J. & Zheng, W. & Cerhan, J.R. & Hong, C.-P. & Sellers, T.A. & Kushi, L.H. & Folsam, A.R., 1997. "The association of drinking water source and chlorination by-products with cancer incidence among postmenopausal women in Iowa: A prospective cohort study," American Journal of Public Health, American Public Health Association, vol. 87(7), pages 1168-1176.
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