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Drinking Water Nitrate and Human Health: An Updated Review

Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr. Room 6E138, Rockville, MD 20850, USA
Department of Epidemiology and Biostatistics, Texas A&M University, School of Public Health, College Station, TX 77843, USA
Department of Toxicogenomics, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, P.O Box 616, 6200 MD Maastricht, The Netherlands
The Center for Health Effects of Environmental Contamination, The University of Iowa, 455 Van Allen Hall, Iowa City, IA 52242, USA
U.S. Geological Survey, Water Mission Area, National Water Quality Program, 12201 Sunrise Valley Drive, Reston, VA 20192, USA
ISGlobal, 08003 Barcelona, Spain
IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(7), 1557;
Received: 17 May 2018 / Revised: 10 July 2018 / Accepted: 14 July 2018 / Published: 23 July 2018
(This article belongs to the Special Issue Drinking Water Quality and Human Health)
Nitrate levels in our water resources have increased in many areas of the world largely due to applications of inorganic fertilizer and animal manure in agricultural areas. The regulatory limit for nitrate in public drinking water supplies was set to protect against infant methemoglobinemia, but other health effects were not considered. Risk of specific cancers and birth defects may be increased when nitrate is ingested under conditions that increase formation of N-nitroso compounds. We previously reviewed epidemiologic studies before 2005 of nitrate intake from drinking water and cancer, adverse reproductive outcomes and other health effects. Since that review, more than 30 epidemiologic studies have evaluated drinking water nitrate and these outcomes. The most common endpoints studied were colorectal cancer, bladder, and breast cancer (three studies each), and thyroid disease (four studies). Considering all studies, the strongest evidence for a relationship between drinking water nitrate ingestion and adverse health outcomes (besides methemoglobinemia) is for colorectal cancer, thyroid disease, and neural tube defects. Many studies observed increased risk with ingestion of water nitrate levels that were below regulatory limits. Future studies of these and other health outcomes should include improved exposure assessment and accurate characterization of individual factors that affect endogenous nitrosation. View Full-Text
Keywords: drinking water; nitrate; cancer; adverse reproductive outcomes; methemoglobinemia; thyroid disease; endogenous nitrosation; N-nitroso compounds drinking water; nitrate; cancer; adverse reproductive outcomes; methemoglobinemia; thyroid disease; endogenous nitrosation; N-nitroso compounds
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MDPI and ACS Style

Ward, M.H.; Jones, R.R.; Brender, J.D.; De Kok, T.M.; Weyer, P.J.; Nolan, B.T.; Villanueva, C.M.; Van Breda, S.G. Drinking Water Nitrate and Human Health: An Updated Review. Int. J. Environ. Res. Public Health 2018, 15, 1557.

AMA Style

Ward MH, Jones RR, Brender JD, De Kok TM, Weyer PJ, Nolan BT, Villanueva CM, Van Breda SG. Drinking Water Nitrate and Human Health: An Updated Review. International Journal of Environmental Research and Public Health. 2018; 15(7):1557.

Chicago/Turabian Style

Ward, Mary H.; Jones, Rena R.; Brender, Jean D.; De Kok, Theo M.; Weyer, Peter J.; Nolan, Bernard T.; Villanueva, Cristina M.; Van Breda, Simone G. 2018. "Drinking Water Nitrate and Human Health: An Updated Review" Int. J. Environ. Res. Public Health 15, no. 7: 1557.

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