Source-specific nitrate intake and all-cause mortality in the Danish Diet, Cancer, and Health Study,European Journal of Epidemiology

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Source-specific nitrate intake and all-cause mortality in the Danish Diet, Cancer, and Health Study
European Journal of Epidemiology ( IF 7.7 ) Pub Date : 2024-05-28 , DOI: 10.1007/s10654-024-01133-5
Nicola P Bondonno _{1,

2} , Pratik Pokharel _{1,

2} , Catherine P Bondonno _{2,

3} , Dorit W Erichsen ₁ , Liezhou Zhong _{2,

4} , Jörg Schullehner _{5,

6} , Kirsten Frederiksen ₁ , Cecilie Kyrø ₁ , Peter Fjeldstad Hendriksen ₁ , Jonathan M Hodgson _{2,

3} , Frederik Dalgaard ₇ , Lauren C Blekkenhorst _{2,

3} , Ole Raaschou-Nielsen _{1,

8} , Torben Sigsgaard _{6,

9} , Christina C Dahm ₆ , Anne Tjønneland _{1,

10} , Anja Olsen _{1,

6}

Affiliation

The Danish Cancer Institute, Copenhagen, Denmark.
Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
Medical School, The University of Western Australia, Royal Perth Hospital, Perth, WA, Australia.
Institute of Agriculture, The University of Western Australia, Royal Perth Hospital, Perth, WA, Australia.
Department of Groundwater and Quaternary Geology Mapping, Geological Survey of Denmark and Greenland, Aarhus, Denmark.
Department of Public Health, Aarhus University, Aarhus, Denmark.
Department of Cardiology, Herlev & Gentofte University Hospital, Copenhagen, Denmark.
Department of Environmental Science, Aarhus University, Roskilde, Denmark.
Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark.
Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Introduction

Nitrate and nitrite are naturally occurring in both plant- and animal-sourced foods, are used as additives in the processing of meat, and are found in water. There is growing evidence that they exhibit a spectrum of health effects, depending on the dietary source. The aim of the study was to examine source-dependent associations between dietary intakes of nitrate/nitrite and both all-cause and cause-specific mortality.

Methods

In 52,247 participants of the Danish Diet, Cancer and Health Study, associations between source-dependent nitrate and nitrite intakes––calculated using comprehensive food composition and national drinking water quality monitoring databases––and all-cause, cardiovascular disease (CVD)-related, and cancer-related mortality over 27 years were examined using restricted cubic splines within Cox proportional hazards models adjusting for demographic, lifestyle, and dietary confounders. Analyses were stratified by factors hypothesised to influence the formation of carcinogenic N-nitroso compounds (namely, smoking and dietary intakes of vitamin C, vitamin E, folate, and polyphenols).

Results

Plant-sourced nitrate intake was inversely associated with all-cause mortality [HR_Q5vsQ1: 0.83 (0.80, 0.87)] while higher risks of all-cause mortality were seen for higher intakes of naturally occurring animal-sourced nitrate [1.09 (1.04, 1.14)], additive permitted meat-sourced nitrate [1.19 (1.14, 1.25)], and tap water-sourced nitrate [1.19 (1.14, 1.25)]. Similar source-dependent associations were seen for nitrite and for CVD-related and cancer-related mortality except that naturally occurring animal-sourced nitrate and tap water-sourced nitrate were not associated with cancer-related mortality and additive permitted meat-sourced nitrate was not associated with CVD-related mortality. No clear patterns emerged in stratified analyses.

Conclusion

Nitrate/nitrite from plant sources are inversely associated while those from naturally occurring animal-sources, additive-permitted meat sources, and tap water-sources are positively associated with mortality.

中文翻译：

丹麦饮食、癌症和健康研究中特定来源的硝酸盐摄入量和全因死亡率

介绍

硝酸盐和亚硝酸盐天然存在于植物性和动物性食品中，在肉类加工中用作添加剂，并且存在于水中。越来越多的证据表明，它们对健康有一系列影响，具体取决于饮食来源。该研究的目的是检查膳食中硝酸盐/亚硝酸盐的摄入量与全因和特定原因死亡率之间的来源依赖性关联。

方法

在丹麦饮食、癌症和健康研究的 52,247 名参与者中，使用综合食物成分和国家饮用水质量监测数据库计算得出的来源依赖性硝酸盐和亚硝酸盐摄入量与全因心血管疾病 (CVD) 相关的关联性，并使用 Cox 比例风险模型中的限制三次样条检查了 27 年来与癌症相关的死亡率，并根据人口、生活方式和饮食混杂因素进行了调整。根据假设影响致癌N-亚硝基化合物形成的因素（即吸烟和膳食中维生素 C、维生素 E、叶酸和多酚的摄入量）对分析进行分层。

结果

植物来源的硝酸盐摄入量与全因死亡率呈负相关[HR _Q5vsQ1 ：0.83 (0.80, 0.87)]，而天然动物来源的硝酸盐摄入量越高，全因死亡的风险越高[1.09 (1.04, 1.14) )]、添加剂允许的肉类来源的硝酸盐 [1.19 (1.14, 1.25)] 和自来水来源的硝酸盐 [1.19 (1.14, 1.25)]。亚硝酸盐以及心血管疾病相关和癌症相关死亡率也存在类似的来源依赖性关联，但天然存在的动物源硝酸盐和自来水源硝酸盐与癌症相关死亡率无关，并且允许添加的肉类来源硝酸盐也没有相关性。与 CVD 相关死亡率有关。分层分析中没有出现明确的模式。