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Cited by 98Nutritional Studies and DietCarcinogens and Genotoxicity AssessmentHead and Neck Cancer Studies

Association between Dietary Nitrate, Nitrite Intake, and Site-Specific Cancer Risk: A Systematic Review and Meta-Analysis

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Said Abasse, Kassim, Essien, Eno E., Abbas, Muhammad, Yu, Xiaojin, Xie, Weihua, Sun, Jinfang, Akter, Laboni, Cote, Andre·2022·Nutrients
DOI 10.3390/nu14030666PMC PMC8838348
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Abstract

Background: People consume nitrates, nitrites, nitrosamines, and NOCs compounds primarily through processed food. Many studies have yielded inconclusive results regarding the association between cancer and dietary intakes of nitrates and nitrites. This study aimed to quantify these associations across the reported literature thus far. Methods: We performed a systematic review following PRISMA and MOOSE guidelines. A literature search was performed using Web of Science, Embase, PubMed, the Cochrane library, and google scholar up to January 2020. STATA version 12.0 was used to conduct meta-regression and a two-stage meta-analysis. Results: A total of 41 articles with 13 different cancer sites were used for analysis. Of these 13 cancer types/sites, meta-regression analysis showed that bladder and stomach cancer risk was greater, and that pancreatic cancer risk was lower with increasing nitrite intakes. Kidney and bladder cancer risk were both lower with increasing nitrate intakes. When comparing highest to lowest (reference) categories of intake, meta-analysis of studies showed that high nitrate intake was associated with an increased risk of thyroid cancer (OR = 1.40, 95% CI: 1.02, 1.77). When pooling all intake categories and comparing against the lowest (reference) category, higher nitrite intake was associated with an increased risk of glioma (OR = 1.12, 95% CI: 1.03, 1.22). No other associations between cancer risk and dietary intakes of nitrates or nitrites were observed. Conclusion: This study showed varied associations between site-specific cancer risks and dietary intakes of nitrate and nitrite. Glioma, bladder, and stomach cancer risks were higher and pancreatic cancer risk was lower with higher nitrite intakes, and thyroid cancer risk was higher and kidney cancer risk lower with higher nitrate intakes. These data suggest type- and site-specific effects of cancer risk, including protective effects, from dietary intakes of nitrate and nitrite.

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  • Nitrate and nitrite have historically been associated with potential toxic effects, including the risk of methaemoglobinaemia.

    “Beyond nitrosamine formation, nitrate and nitrite have also historically been associated with potential toxic effects, including the risk of methaemoglobinaemia [278,279,280].”

    From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [279]

    The Introduction says high nitrate and nitrite intake was historically considered harmful, but describes that concern in terms of carcinogenic N-nitroso compounds. Our copy does not mention methaemoglobinaemia or establish it as a toxic effect beyond nitrosamine formation. (LLM, conf=0.82)

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  • Nitrate from vegetables, which represent the main dietary source, has not been associated with an increased cancer risk and may even demonstrate protective properties in meta-analyses.

    “Nitrate from vegetables, which represent the main dietary source, has not been associated with an increased cancer risk and may even demonstrate protective properties in meta-analyses [278,279,280].”

    From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [279]

    The Introduction (page unavailable) identifies fruits and vegetables as the primary dietary sources of nitrate. The Abstract (page unavailable) reports lower kidney and bladder cancer risk with higher dietary nitrate intake, but also higher thyroid cancer risk; the analysis does not establish that nitrate specifically from vegetables is protective or unassociated with increased risk. (LLM, conf=0.88)

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Authors
Said Abasse, K., Essien, E. E., Abbas, M., Yu, X., Xie, W., Sun, J., Akter, L., & Cote, A.
Affiliations
  • Faculté des Sciences de L’Administration FSA, Université Laval, Québec, QC G1V 0A6, Canada
  • Southeast University (CN)
  • Riphah International University (PK)
  • Institute of Epidemiology, Disease Control and Research (BD)
Corresponding author
  • Abbas, Muhammad
  • Yu, Xiaojin
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2022-02-04
Volume
14
Issue
3
Pages
666
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu14030666
PMC
PMC8838348
OpenAlex
W4210669951
Cited by
98
References
81
Citations by year
2026: 14 · 2025: 30 · 2024: 39 · 2023: 10 · 2022: 5
FWCI
4.18
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Riphah International University (ORIC-21-22/FPS-51)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Carcinogens and Genotoxicity Assessment
  • Health Sciences › Medicine › Otorhinolaryngology › Head and Neck Cancer Studies
Keywords
dietary nitrate, dietary nitrite, cancer risk, site-specific cancer, bladder cancer, gastric cancer, pancreatic cancer, kidney cancer, thyroid cancer, glioma, processed foods, nitrosamines
MeSH terms
Diet, Glioma, Humans, Nitrates, Nitrites, Risk

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