Nitrate and nitrite ingestion and risk of ovarian cancer among postmenopausal women in Iowa

Maki Inoue-Choi, Rena R. Jones, Kristin E. Anderson, Kenneth P. Cantor, James R Cerhan, Stuart Krasner, Kim Robien, Peter J. Weyer, Mary H. Ward

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Nitrate and nitrite are precursors in the endogenous formation of N-nitroso compounds (NOC), potential human carcinogens. We evaluated the association of nitrate and nitrite ingestion with postmenopausal ovarian cancer risk in the Iowa Women's Health Study. Among 28,555 postmenopausal women, we identified 315 incident epithelial ovarian cancers from 1986 to 2010. Dietary nitrate and nitrite intakes were assessed at baseline using food frequency questionnaire data. Drinking water source at home was obtained in a 1989 follow-up survey. Nitrate-nitrogen (NO<inf>3</inf>-N) and total trihalomethane (TTHM) levels for Iowa public water utilities were linked to residences and average levels were computed based on each woman's duration at the residence. We computed multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional hazards regression. We tested interactions of nitrate with TTHMs and dietary factors known to influence NOC formation. Ovarian cancer risk was 2.03 times higher (CI = 1.22-3.38, p<inf>trend</inf> = 0.003) in the highest quartile (≥2.98 mg/L) compared with the lowest quartile (≤0.47 mg/L; reference) of NO<inf>3</inf>-N in public water, regardless of TTHM levels. Risk among private well users was also elevated (HR = 1.53, CI = 0.93-2.54) compared with the same reference group. Associations were stronger when vitamin C intake was <median (p<inf>interaction</inf> = 0.01 and 0.33 for private well and public supplies, respectively). Dietary nitrate was inversely associated with ovarian cancer risk (p<inf>trend</inf> = 0.02); whereas, dietary nitrite from processed meats was positively associated with the risk (p<inf>trend</inf> = 0.04). Our findings indicate that high nitrate levels in public drinking water and private well use may increase ovarian cancer risk among postmenopausal women.

Original languageEnglish (US)
Pages (from-to)173-182
Number of pages10
JournalInternational Journal of Cancer
Volume137
Issue number1
DOIs
StatePublished - Jul 1 2015

Fingerprint

Nitrites
Nitrates
Ovarian Neoplasms
Eating
Trihalomethanes
Nitroso Compounds
Confidence Intervals
Drinking Water
Water
Women's Health
Carcinogens
Meat
Ascorbic Acid
Nitrogen
Food

Keywords

  • diet
  • disinfection byproducts
  • drinking water
  • nitrate
  • nitrite
  • ovarian cancer

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Inoue-Choi, M., Jones, R. R., Anderson, K. E., Cantor, K. P., Cerhan, J. R., Krasner, S., ... Ward, M. H. (2015). Nitrate and nitrite ingestion and risk of ovarian cancer among postmenopausal women in Iowa. International Journal of Cancer, 137(1), 173-182. https://doi.org/10.1002/ijc.29365

Nitrate and nitrite ingestion and risk of ovarian cancer among postmenopausal women in Iowa. / Inoue-Choi, Maki; Jones, Rena R.; Anderson, Kristin E.; Cantor, Kenneth P.; Cerhan, James R; Krasner, Stuart; Robien, Kim; Weyer, Peter J.; Ward, Mary H.

In: International Journal of Cancer, Vol. 137, No. 1, 01.07.2015, p. 173-182.

Research output: Contribution to journalArticle

Inoue-Choi, M, Jones, RR, Anderson, KE, Cantor, KP, Cerhan, JR, Krasner, S, Robien, K, Weyer, PJ & Ward, MH 2015, 'Nitrate and nitrite ingestion and risk of ovarian cancer among postmenopausal women in Iowa', International Journal of Cancer, vol. 137, no. 1, pp. 173-182. https://doi.org/10.1002/ijc.29365
Inoue-Choi, Maki ; Jones, Rena R. ; Anderson, Kristin E. ; Cantor, Kenneth P. ; Cerhan, James R ; Krasner, Stuart ; Robien, Kim ; Weyer, Peter J. ; Ward, Mary H. / Nitrate and nitrite ingestion and risk of ovarian cancer among postmenopausal women in Iowa. In: International Journal of Cancer. 2015 ; Vol. 137, No. 1. pp. 173-182.
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abstract = "Nitrate and nitrite are precursors in the endogenous formation of N-nitroso compounds (NOC), potential human carcinogens. We evaluated the association of nitrate and nitrite ingestion with postmenopausal ovarian cancer risk in the Iowa Women's Health Study. Among 28,555 postmenopausal women, we identified 315 incident epithelial ovarian cancers from 1986 to 2010. Dietary nitrate and nitrite intakes were assessed at baseline using food frequency questionnaire data. Drinking water source at home was obtained in a 1989 follow-up survey. Nitrate-nitrogen (NO3-N) and total trihalomethane (TTHM) levels for Iowa public water utilities were linked to residences and average levels were computed based on each woman's duration at the residence. We computed multivariable-adjusted hazard ratios (HR) and 95{\%} confidence intervals (CI) using Cox proportional hazards regression. We tested interactions of nitrate with TTHMs and dietary factors known to influence NOC formation. Ovarian cancer risk was 2.03 times higher (CI = 1.22-3.38, ptrend = 0.003) in the highest quartile (≥2.98 mg/L) compared with the lowest quartile (≤0.47 mg/L; reference) of NO3-N in public water, regardless of TTHM levels. Risk among private well users was also elevated (HR = 1.53, CI = 0.93-2.54) compared with the same reference group. Associations were stronger when vitamin C intake was interaction = 0.01 and 0.33 for private well and public supplies, respectively). Dietary nitrate was inversely associated with ovarian cancer risk (ptrend = 0.02); whereas, dietary nitrite from processed meats was positively associated with the risk (ptrend = 0.04). Our findings indicate that high nitrate levels in public drinking water and private well use may increase ovarian cancer risk among postmenopausal women.",
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