Eating more foods with nitrites or nitrates may increase risk for type 2 diabetes
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Adults who eat more foods that include added nitrites or nitrates have a higher risk for developing type 2 diabetes than those exposed to fewer of these compounds, according to findings published in PLOS Medicine.
“These results provide a new piece of evidence in the context of current discussions regarding the need for a reduction of nitrite additive use in processed meats by the food industry and could support the need for better regulation of soil contamination by fertilizers,” Bernard Srour, PharmD, PhD, scientist, and Mathilde Touvier, PhD, research director of the nutritional epidemiology research team for INSERM, INRAE, at Sorbonne Paris Nord University in France, told Healio. “In the meantime, several public health authorities worldwide already recommend citizens to limit their consumption of foods containing controversial additives, including sodium nitrite.”
Srour, Touvier and colleagues conducted a prospective cohort study of 104,168 adolescents and adults aged 15 years or older in France who responded to a series of questionnaires online beginning in May 2009 (79.1% women; mean age, 42.7 years). Sociodemographic data, lifestyle characteristics, anthropometry, health status and dietary intake were collected at baseline. Participants were asked to complete a series of three nonconsecutive 24-hour dietary records every 6 months. Food-originated nitrites and nitrates were identified using concentration levels from the European Food Safety Authority. Data from three databases were used to determine the presence of food additives. The cohort was divided into tertiles based on their level of nitrate and nitrite exposure. Type 2 diabetes cases were either self-reported or determined through the presence of hyperglycemia in laboratory data along with the use of a type 2 diabetes medication during follow-up.
Natural and additive nitrites increased type 2 diabetes risk
According to dietary intake, most food-originated nitrites and nitrates came from vegetables and vegetable-based meals, and most additive-originated nitrites and nitrates came from processed meats. Of the cohort, 73.9% were exposed to sodium nitrite as a food additive and 31.6% were exposed to potassium nitrate.
During a median follow-up of 7.3 years, there were 969 new cases of type 2 diabetes. After adjusting for covariates, participants in the highest total nitrite exposure tertile (adjusted HR = 1.27; 95% CI, 1.04-1.54) and the highest food- and water-originated nitrite exposure tertile (aHR = 1.26; 95% CI, 1.03-1.54) had a greater risk for developing type 2 diabetes than those in the lowest tertiles. A higher risk for type 2 diabetes was also observed for participants exposed to higher levels of nitrites from food additives (aHR = 1.53; 95% CI, 1.24-1.88) and higher levels of sodium nitrite (aHR = 1.54; 95% CI, 1.26-1.9) compared with those who were not exposed to those types of nitrites.
Higher diabetes risk with nitrites from processed meats
Participants who ate more nitrites from red and processed meats (aHR = 1.3; 95% CI, 1.3-1.58) and nitrates from red and processed meats (aHR = 1.34; 95% CI, 1.1-1.63) had a higher type 2 diabetes risk than those in the lowest tertiles. No increased risk was observed from nitrites and nitrates found in fruits or vegetables.
In sex-specific analysis, women exposed to higher levels of total nitrites (aHR = 1.47; 95% CI, 1.14-1.9), nitrites from food additives (aHR = 1.36; 95% CI, 1.06-1.75) and food- and water-originated nitrites (aHR = 1.5; 95% CI, 1.15-1.94) had a higher type 2 diabetes risk than women exposed to lower levels. Men exposed to more nitrites from food additives had a higher risk for type 2 diabetes than those who were not exposed (aHR = 1.65; 95% CI, 1.15-2.36).
“As this is the first large-scale study finding these associations, these results need to be replicated in other large-scale cohorts,” Srour and Touvier said. “Short-term intervention studies on insulin resistance could also be tested.”
For more information:
Bernard Srour, PharmD, PhD, can be reached at b.srour@eren.smbh.univ-paris13.fr.
Mathilde Touvier, PhD, can be reached at m.touvier@eren.smbh.univ-paris13.fr.
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