Type 2 diabetes: Consuming high levels of nitrites may increase risk

  • Nitrates and nitrites are found in food and water. They are sometimes added to foods like processed meats to improve shelf life.
  • Researchers are still working to discover the risks and benefits associated with the consumption of nitrates and nitrites.
  • A​ recent study found that exposure to nitrites through food and water sources may increase the risk of developing type 2 diabetes.

Diabetes is a chronic condition that can cause severe health problems if people don’t manage it properly. Researchers are still working to identify factors that increase people’s risk of developing type two diabetes.

A​ recent study published in PLOS Medicine studied the intake of nitrates and nitrites and the associated risk for type two diabetes. They found that a higher intake of nitrites was associated with an increased risk for type two diabetes, but there wasn’t an associated risk from consuming nitrates.

Nitrates, nitrites, and their dangers

Nitrates and nitrites are found naturally in certain foods. They can also be in the soil and water. Food processors and manufacturers may sometimes add nitrates and nitrites to foods to help keep foods from spoiling. For example, they can be added to processed meats like salami or ham.

I​t is unclear the full risks associated with the consumption of nitrates and nitrites. For example, higher intakes of nitrites could increase some people’s risk for specific cancer types. However, researchers are still working to understand how nitrates and nitrites relate to other disorders and conditions. For example, could nitrates or nitrites contribute to the risk of chronic diseases like diabetes?

Nitrites and risk of diabetes

Researchers in this particular study looked at exposure to nitrates and nitrites and the associated risk for type two diabetes. They included over 100,000 adults in their analysis. Of this group, almost 80% were female. They utilized 24-dietary recalls to look at participants’ exposure to nitrates and nitrites.

T​hey followed participants for an average of 7.3 years, doing regular follow-ups. Researchers noted 969 cases of type two diabetes during the study. They collected data on several nitrite and nitrate exposures:

  • total nitrates and nitrites
  • food and water-originated nitrates and nitrites
  • additive-originated nitrates and nitrites

The study found that nitrite consumption may carry a risk for type two diabetes. However, researchers found no association between nitrates and disease risk. They found that total nitrites and food and water sources of nitrites may increase the risk for type two diabetes. Similarly, they discovered that nitrite additives, particularly sodium nitrite, may increase the risk for type two diabetes as well.

Study authors, Dr. Mathilde Touvier, head of the Nutrition Epidemiology Research Team EREN-CRESS, Inserm, INRAE, Sorbonne Paris Nord University, and Dr. Bernard Srour, Ph.D., PharmD, MPH, a scientist with EREN-CRESS, Inserm, INRAE, Sorbonne Paris Nord University, noted the highlights of the study to MNT:

“This is the first large-scale cohort study to suggest an association between additives-originated nitrites and a higher type-2 diabetes risk. It also corroborates previously suggested associations between total dietary nitrites and type-2 diabetes risk.”

T​hey further suggested that the results indicate the need to reevaluate adding nitrites to foods:

“These results provide a new piece of evidence in the context of current discussions regarding the need for a reduction of nitrite additives’ use in processed meats by the food industry and could support the need for better regulation of soil contamination by fertilizers.

In the meantime, several public health authorities worldwide already recommend citizens to limit their consumption of foods containing controversial additives, including sodium nitrite.”

Study limitations and continued research

The study did have some limitations. First, researchers relied on participants’ self-reporting, which introduces the possibility of errors in data collection.

Second, the study cannot determine that nitrite consumption causes type two diabetes. Researchers acknowledge that there was also the possibility of selection bias and that they couldn’t validate nitrate and nitrite exposures reported by participants. There is the risk of residual confounding as well.

Researchers admit that they may not have been able to detect every case of diabetes among their participants. Limitations in the diversity of the sample further make it difficult to generalize results or to all people. It also indicates the need for researchers to conduct further studies.

Nancy Mitchell, n​on-study author and registered nurse with years of experience working with geriatric patients who have diabetes, noted the following words of caution to MNT:

“The study hints toward the effect of diet on metabolic health, especially as it relates to Type 2 diabetes. However, the study itself lists selection bias as a limitation to their findings. The most effective investigation should involve participants who best mimic the actual lifestyle patterns and eating habits of the average person.

While diet is a major contributor to Type 2 diabetes, we often can’t single out one particular food item as the cause for a chronic condition. In reality, the risk for diabetes rises by a combination of poor diet choices, underlying stress, sedentary habits, and the like. Chronic diseases are multi-dimensional.”

D​r.Mathilde Touvier and Dr. Bernard Srour explained areas for continued research based on the limitations of the data:

“As this is the first large-scale study finding these associations, these results need to be replicated in other largescale cohorts. Short-term intervention studies on insulin resistance could also be tested, for instance.”

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