Title
Does the risk of childhood diabetes mellitus require revision of the guideline values for nitrate in drinking water?
Author
TNO Preventie en Gezondheid
van Maanen, J.M.S.
Albering, H.J.
de Kok, T.M.C.M.
van Breda, S.G.J.
Curfs, D.M.J.
Vermeer, I.T.M.
Ambergen, A.W.
Wolffenbuttel, B.H.R.
Kleinjans, J.C.S.
Reeser, H.M.
Publication year
2000
Abstract
In recent years, several studies have addressed a possible relationship between nitrate exposure and childhood type 1 insulin-dependent diabetes mellitus. The present ecologic study describes a possible relation between the incidence of type 1 diabetes and nitrate levels in drinking water in The Netherlands, and evaluates whether the World Health Organization and the European Commission standard for nitrate in drinking water (50 mg/L) is adequate to prevent risk of this disease. During 1993-1995 in The Netherlands, 1,104 cases of type 1 diabetes were diagnosed in children 0-14 years of age. We were able to use 1,064 of these cases in a total of 2,829,020 children in this analysis. We classified mean nitrate levels in drinking water in 3,932 postal code areas in The Netherlands in 1991-1995 into two exposure categories. One category was based on equal numbers of children exposed to different nitrate levels (0.25-2.08, 2.10-6.42, and 6.44-41.19 mg/L nitrate); the other was based on cut-off values of 10 and 25 mg/L nitrate. We determined standardized incidence ratios (SIRs) for type 1 diabetes in subgroups of the 2,829,020 children with respect to both nitrate exposure categories, sex, and age and as compared in univariate analysis using the chi-square test for trend. We compared the incidence rate ratios (IRRs) by multivariate analysis in a Poisson regression model. We found an effect of increasing age of the children on incidence of type 1 diabetes, but we did not find an effect of sex or of nitrate concentration in drinking water using the two exposure categories. For nitrate levels > 25 mg/L, an increased SIR and an increased IRR of 1.46 were observed; however, this increase was not statistically significant, probably because of the small number of cases (15 of 1,064). We concluded that there is no convincing evidence that nitrate in drinking water at current exposure levels is a risk factor for childhood type 1 diabetes mellitus in The Netherlands, although a threshold value > 25 mg/L for the occurrence of this disease can not be excluded. Chemicals/CAS: Nitrates; Water Pollutants, Chemical
Subject
Drinking water
Guideline values
Age distribution
Exposure
Incidence
Insulin dependent diabetes mellitus
Major clinical study
Multivariate analysis
Practice guideline
Regression analysis
Adolescent
Child
Child, Preschool
Diabetes Mellitus, Type 1
Environmental Health
European Union
Female
Guidelines
Humans
Infant
Infant, Newborn
Male
Maximum Allowable Concentration
Netherlands
Nitrates
Risk Factors
Water Pollutants, Chemical
Water Supply
World Health Organization
To reference this document use:
http://resolver.tudelft.nl/uuid:ab633555-3e06-4b45-877a-8c1d9b15cf4c
TNO identifier
235618
ISSN
0091-6765
Source
Environmental Health Perspectives, 108 (108), 457-461
Document type
article