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In 2011 to 2012, the urinary (creatinine corrected) concentration of nitrate among persons aged 6 years and older was 137.4 mg/g of creatinine.
Introduction
Nitrates and nitrites are nitrogen-oxygen chemical units that naturally occur in soil, water, and some foods. When taken into the body by drinking water and through other dietary sources, nitrate and nitrite can react with amines and amides to form N-nitroso compounds (NOC), which are known to cause cancer in animals and may cause cancer in humans. Excessive nitrate or nitrate exposure can also result in acute acquired methemoglobinemia, a blood abnormality that causes blood to lose its ability to carry oxygen to tissues (anoxia). This is especially dangerous in infants younger than 4 months of age.
Most studies assessing connections between nitrate and cancer in humans have focused on excess exposure to nitrate in areas containing nitrogen-based fertilizers. Some of the highest levels of nitrate are found in shallow wells and surface water supplies that contain high levels due to runoff from nitrogen fertilizers, as well as from leaking septic tanks and sewage, erosion of natural deposits, and confined animal feedlot operations and resulting excrement. When drinking water or eating food from areas containing nitrogen fertilizers, people could be exposed to high levels of nitrate. In addition, workers who manufacture these fertilizers can have high exposures to dusts that contain nitrate. Oral tobacco also may contribute to nitrate intake, but is minor compared to diet or contaminated drinking water.
Studies have shown increased risks of colon, kidney, and stomach cancer among people with higher ingestion of water nitrate and higher meat intake compared with low intakes of both, a dietary pattern that results in increased NOC formation. Other studies have shown modest evidence that higher nitrate intake can increase the risk of thyroid cancer and ovarian cancer among women, and elevate the risk of pancreatic cancer among men and women.
Examination of nitrate is new to the Cancer Trends Progress Report this year.
Measure
We present exposure data on the 95th percentile of the population, representing people with the greatest exposure. The 95th percentile level means that 95% of the population has concentrations below that level. Public health officials use such reference values to determine whether groups of people are experiencing an exposure that is unusual compared with an exposure experienced by the rest of the population. [Citation]
To calculate whether the differences between 95th percentiles for two different time points is statistically significant, we used a different statistical methodology than that used by the National Center for Environmental Health, who publishes the National Report on Human Exposure to Environmental Chemicals from where our data are derived. Our estimates may differ slightly from those in the original report due to differences in statistical procedures used. [Methodology]
Healthy People 2020 Target
There are no Healthy People 2020 targets regarding nitrate.
Healthy People 2020 is a set of goals set forth by the Department of Health and Human Services.
Data Source
Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey.
Trends and Most Recent Estimates
By Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2011 to 2012) | |
|---|---|---|---|
| Milligram/gram of creatinine (mg/g) | 95% Confidence Interval | ||
|
Both Sexes
|
137.4 | (122.1 - 150.9) |
Male
|
109.4 | (99.2 - 120.1) | |
Female
|
151.3 | (139.9 - 169.9) | |
By Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2011 to 2012) | |
|---|---|---|---|
| Milligram/gram of creatinine (mg/g) | 95% Confidence Interval | ||
|
All Races
|
137.4 | (122.1 - 150.9) |
Non-Hispanic White
|
142.4 | (122.9 - 153.8) | |
Non-Hispanic Black
|
87.3 | (78.2 - 99.2) | |
Hispanic
|
114.8 | (90.5 - 126.9) | |
By Age
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2011 to 2012) | |
|---|---|---|---|
| Milligram/gram of creatinine (mg/g) | 95% Confidence Interval | ||
|
Ages 6-11
|
143.0 | (126.3 - 161.2) |
Ages 12-19
|
86.8 | (67.6 - 126.9) | |
Ages 20+
|
142.1 | (121.0 - 153.9) | |
By Poverty Income Level
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2011 to 2012) | |
|---|---|---|---|
| Milligram/gram of creatinine (mg/g) | 95% Confidence Interval | ||
|
< 200% of the federal poverty level
|
119.7 | (106.4 - 129.1) |
>= 200% of the federal poverty level
|
143.8 | (127.6 - 156.6) | |
By Education Level
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2011 to 2012) | |
|---|---|---|---|
| Milligram/gram of creatinine (mg/g) | 95% Confidence Interval | ||
|
Less than High School
|
116.2 | (95.3 - 167.2) |
High School
|
136.7 | (101.9 - 298.7) | |
Greater than High School
|
143.4 | (119.8 - 165.2) | |
Additional Information on Nitrate
For the public
- Toxic Substances Portal – Nitrates and Nitrites. Agency for Toxic Substances & Disease Registry.
- What are the risk factors for stomach cancer? American Cancer Society.
- Fourth National Report on Human Exposure to Environmental Chemicals (2009). Centers for Disease Control and Prevention.
- Basic Information about Nitrate in Drinking Water. Environmental Protection Agency.
For health professionals
- ATSDR Case Studies in Environmental Medicine Nitrate/Nitrite Toxicity. Agency for Toxic Substances and Disease Registry.
- Interaction Profile for Cyanide, Fluoride, Nitrate, and Uranium (May 2004). Agency for Toxic Substances and Disease Registry.
Scientific reports
- Pancreatic cancer and exposure to dietary nitrate and nitrite in the NIH-AARP Diet and Health Study. Aschebrook-Kilfoy B, Cross AJ, Stolzenberg-Solomon RZ, et al. Am J Epidemiol. 2011;174(3):305–15.
- Thyroid cancer risk and dietary nitrate and nitrite intake in the Shanghai women’s health study. Aschebrook-Kilfoy B, Shu XO, Gao YT, et al. Int J Cancer 2013:132(4):897–904.
- Epithelial ovarian cancer and exposure to dietary nitrate and nitrite in the NIH-AARP Diet and Health Study. Aschebrook-Kilfoy B, Ward MH, Gierach GL, et al. Eur J Cancer Prev. 2012;21(1):65–72.
- Pancreatic cancer and drinking water and dietary sources of nitrate and nitrite. Coss A, Cantor KP, Reif JS, et al. Am J Epidemiol. 2004;159(7):693–701.
- Nitrate in public water supplies and risk of colon and rectum cancers. De Roos A, Ward MH, Lynch C, and Cantor KP. Epidemiology 2003;14(6):640–9.
- Carcinogenicity of nitrate, nitrite, and cyanobacterial peptide toxins. Grosse Y, Baan R, Straif K, et al. Lancet Oncol. 2006;7(8):628–9.
- Dietary intake of polyphenols, nitrate and nitrite and gastric cancer risk in Mexico City. Hernandez-Ramirez RU, Galvan-Portillo MV, Ward MH, et al. Int J Cancer 2009;125(6):1424–30.
- Nitrate in public water supplies and risk of renal cell carcinoma. Ward MH, Rusiecki J, Lynch CF, Cantor KP. Cancer Causes Control 2007 Dec;18(10):1141–51.
- Ingested Nitrate and Nitrite, and Cyanobacterial Peptide Toxins. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans 2010;94.