Source-specific nitrate and nitrite intake and associations with gastric cancer in the Danish Diet, Cancer and Health Cohort
Menée à l'aide de données danoises portant sur 54 610 personnes (durée de suivi : 27 ans), cette étude analyse l'association entre les apports en nitrates ou nitrites et le risque de cancer de l'estomac (260 cas) en fonction de la provenance (aliments ou eau potable)
Nitrate and nitrite, present in foods and drinking water, may contribute to gastric cancer (GC) through the formation of carcinogenic N-nitrosamines, but risks likely vary by source and endogenous nitrosating factors. In the Danish Diet, Cancer, and Health Cohort, source-specific nitrate and nitrite intakes (plant sources, naturally-occurring animal sources, additive-permitted meat sources, and drinking water) were estimated from a food frequency questionnaire using food databases and water monitoring data. Associations with GC, identified via the Danish Cancer Registry, were examined using multivariable-adjusted Cox proportional hazards models. Analyses were stratified by GC risk factors and factors hypothesized to influence endogenous N-nitrosamine formation to explore potential effect modification. Among 54,610 participants, 260 incident cases of GC (120 cardia, 59 non-cardia, and 81 overlapping/unclassified) were identified over 27 years. Plant sourced nitrite intake was associated with lower GC rates [HRQ5vQ1 (95%CI): 0.63 (0.41, 0.96)]. Conversely, intakes of nitrite from naturally-occurring animal sources [HRQ4vQ1 1.55 (1.01, 2.38)]; and both nitrate and nitrite from additive-permitted meat sources were associated with higher rates of GC [HRQ5vQ1 3.12 (1.09, 8.88) and 1.94 (1.19, 3.15), respectively], with higher point estimates for non-cardia GC. Nitrate from tap water was associated with higher rates of cardia GC rates [HRQ5vsQ1 1.95 (1.11, 3.43)]. Nitrate and nitrite intakes demonstrated heterogeneous associations with GC incidence according to source and anatomical subsite. These findings warrant the re-evaluation of legislation on nitrate and nitrite additives in processed meats and threshold levels for nitrate in drinking water, as well as further investigation into nitrite from animal-sourced foods.
European Journal of Epidemiology , article en libre accès, 2026