Long-term exposure to nitrate and trihalomethanes in drinking water and gastric cancer: A multicase–control study in Spain (MCC-Spain)

Background: Disinfection byproducts and N-nitroso compounds (NOC) formed endogenously after nitrate ingestion have been shown to be carcinogenic in animal studies, but epidemiological evidence is limited, especially in relation to gastric cancer. Objective: We evaluated the association between drink...

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Autores: Donat Vargas, Carolina, Kogevinas, Manolis, Castaño-Vinyals, Gemma, Pérez Gómez, Beatriz, Aragonès Sanz, Núria, Guevara, Marcela, Gómez Acebo, Inés, Molina, Antonio, Fernandez-Tardon, Guillermo, Vanaclocha Espi, Mercedes, Molina Barceló, Ana, Moreno Aguado, Víctor, Pollán, Marina, Villanueva, Cristina M.
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/223788
Acceso en línea:https://hdl.handle.net/2445/223788
Access Level:acceso abierto
Palabra clave:Consum d'aigua
Nitrats
Càncer gastrointestinal
Water consumption
Nitrates
Gastrointestinal cancer
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spelling Long-term exposure to nitrate and trihalomethanes in drinking water and gastric cancer: A multicase–control study in Spain (MCC-Spain)Donat Vargas, CarolinaKogevinas, ManolisCastaño-Vinyals, GemmaPérez Gómez, BeatrizAragonès Sanz, NúriaGuevara, MarcelaGómez Acebo, InésMolina, AntonioFernandez-Tardon, GuillermoVanaclocha Espi, MercedesMolina Barceló, AnaMoreno Aguado, VíctorPollán, MarinaVillanueva, Cristina M.Consum d'aiguaNitratsCàncer gastrointestinalWater consumptionNitratesGastrointestinal cancerBackground: Disinfection byproducts and N-nitroso compounds (NOC) formed endogenously after nitrate ingestion have been shown to be carcinogenic in animal studies, but epidemiological evidence is limited, especially in relation to gastric cancer. Objective: We evaluated the association between drinking water exposure to nitrate and trihalomethanes (THMs) and gastric cancer in a multicase–control study conducted in Spain (MCC-Spain). Methods: In 2008–2013, 254 hospital-based incident gastric cancer cases and 2,365 population-based controls were recruited, providing information on residential histories and type of water consumed. Adult lifetime average nitrate and THM levels in residences from age 18 until 2 years before the interview were estimated and linked with water consumption information to calculate waterborne ingested nitrate, brominated (Br)-THMs, and chloroform. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression, with adjustment for potential confounders. We assessed the effect modification by factors influencing endogenous NOC formation. Results: Median [percentile 25th (P25)–percentile 75 (P75)] (P25–P75) lifetime waterborne ingested nitrate (mg/day), Br-THMs (μ⁢g/day), and chloroform (μ⁢g/day) were 2.7 (1.4–5.6), 3.8 (1.5–8.1), and 12.2 (4.0–23.7), respectively, in cases and 3.8 (1.8–8.5), 5.7 (2.6–19.2), and 12.9 (4.6–24.5) in controls, respectively. Adjusted OR (95% CI) for gastric cancer comparing nitrate intake >9.7 vs. ≤9.7mg/day (percentile 80th, P80) was 1.42 (0.88, 2.29). This association was more pronounced among participants with low consumption of vegetables [2.24 (1.02, 4.91)], vitamin C [2.10 (0.94, 4.71)], and vitamin E [2.81 (1.16, 6.78)] and among those with high consumption of alcohol [2.78 (0.98, 7.93)] or processed meat [1.91 (0.97, 3.75)]. When stratified by age, the association only remained in the >65 years of age group (median 73 years of age). OR for gastric cancer comparing Br-THM ingestion ≥vs.80th<80th percentile was 0.65 (0.33, 1.28) and for chloroform was 1.36 (0.87, 2.14). Comparable ORs were found for residential concentrations. Conclusions: Long-term waterborne nitrate exposure below regulatory limits may increase gastric cancer risk among older adults and in those with poor dietary patterns. These findings need to be confirmed by cohort studies with larger sample sizes.National Institute of Environmental Health Science2025202520252025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion11 p.application/pdfhttps://hdl.handle.net/2445/223788Articles publicats en revistes (Ciències Clíniques)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.1289/EHP15039Environmental Health Perspectives, 2025, vol. 133, num.5https://doi.org/10.1289/EHP15039Domini públic / Public domainhttps://creativecommons.org/publicdomain/zero/1.0/info:eu-repo/semantics/openAccessoai:recercat.cat:2445/2237882026-05-29T05:05:01Z
dc.title.none.fl_str_mv Long-term exposure to nitrate and trihalomethanes in drinking water and gastric cancer: A multicase–control study in Spain (MCC-Spain)
title Long-term exposure to nitrate and trihalomethanes in drinking water and gastric cancer: A multicase–control study in Spain (MCC-Spain)
spellingShingle Long-term exposure to nitrate and trihalomethanes in drinking water and gastric cancer: A multicase–control study in Spain (MCC-Spain)
Donat Vargas, Carolina
Consum d'aigua
Nitrats
Càncer gastrointestinal
Water consumption
Nitrates
Gastrointestinal cancer
title_short Long-term exposure to nitrate and trihalomethanes in drinking water and gastric cancer: A multicase–control study in Spain (MCC-Spain)
title_full Long-term exposure to nitrate and trihalomethanes in drinking water and gastric cancer: A multicase–control study in Spain (MCC-Spain)
title_fullStr Long-term exposure to nitrate and trihalomethanes in drinking water and gastric cancer: A multicase–control study in Spain (MCC-Spain)
title_full_unstemmed Long-term exposure to nitrate and trihalomethanes in drinking water and gastric cancer: A multicase–control study in Spain (MCC-Spain)
title_sort Long-term exposure to nitrate and trihalomethanes in drinking water and gastric cancer: A multicase–control study in Spain (MCC-Spain)
dc.creator.none.fl_str_mv Donat Vargas, Carolina
Kogevinas, Manolis
Castaño-Vinyals, Gemma
Pérez Gómez, Beatriz
Aragonès Sanz, Núria
Guevara, Marcela
Gómez Acebo, Inés
Molina, Antonio
Fernandez-Tardon, Guillermo
Vanaclocha Espi, Mercedes
Molina Barceló, Ana
Moreno Aguado, Víctor
Pollán, Marina
Villanueva, Cristina M.
author Donat Vargas, Carolina
author_facet Donat Vargas, Carolina
Kogevinas, Manolis
Castaño-Vinyals, Gemma
Pérez Gómez, Beatriz
Aragonès Sanz, Núria
Guevara, Marcela
Gómez Acebo, Inés
Molina, Antonio
Fernandez-Tardon, Guillermo
Vanaclocha Espi, Mercedes
Molina Barceló, Ana
Moreno Aguado, Víctor
Pollán, Marina
Villanueva, Cristina M.
author_role author
author2 Kogevinas, Manolis
Castaño-Vinyals, Gemma
Pérez Gómez, Beatriz
Aragonès Sanz, Núria
Guevara, Marcela
Gómez Acebo, Inés
Molina, Antonio
Fernandez-Tardon, Guillermo
Vanaclocha Espi, Mercedes
Molina Barceló, Ana
Moreno Aguado, Víctor
Pollán, Marina
Villanueva, Cristina M.
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Consum d'aigua
Nitrats
Càncer gastrointestinal
Water consumption
Nitrates
Gastrointestinal cancer
topic Consum d'aigua
Nitrats
Càncer gastrointestinal
Water consumption
Nitrates
Gastrointestinal cancer
description Background: Disinfection byproducts and N-nitroso compounds (NOC) formed endogenously after nitrate ingestion have been shown to be carcinogenic in animal studies, but epidemiological evidence is limited, especially in relation to gastric cancer. Objective: We evaluated the association between drinking water exposure to nitrate and trihalomethanes (THMs) and gastric cancer in a multicase–control study conducted in Spain (MCC-Spain). Methods: In 2008–2013, 254 hospital-based incident gastric cancer cases and 2,365 population-based controls were recruited, providing information on residential histories and type of water consumed. Adult lifetime average nitrate and THM levels in residences from age 18 until 2 years before the interview were estimated and linked with water consumption information to calculate waterborne ingested nitrate, brominated (Br)-THMs, and chloroform. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression, with adjustment for potential confounders. We assessed the effect modification by factors influencing endogenous NOC formation. Results: Median [percentile 25th (P25)–percentile 75 (P75)] (P25–P75) lifetime waterborne ingested nitrate (mg/day), Br-THMs (μ⁢g/day), and chloroform (μ⁢g/day) were 2.7 (1.4–5.6), 3.8 (1.5–8.1), and 12.2 (4.0–23.7), respectively, in cases and 3.8 (1.8–8.5), 5.7 (2.6–19.2), and 12.9 (4.6–24.5) in controls, respectively. Adjusted OR (95% CI) for gastric cancer comparing nitrate intake >9.7 vs. ≤9.7mg/day (percentile 80th, P80) was 1.42 (0.88, 2.29). This association was more pronounced among participants with low consumption of vegetables [2.24 (1.02, 4.91)], vitamin C [2.10 (0.94, 4.71)], and vitamin E [2.81 (1.16, 6.78)] and among those with high consumption of alcohol [2.78 (0.98, 7.93)] or processed meat [1.91 (0.97, 3.75)]. When stratified by age, the association only remained in the >65 years of age group (median 73 years of age). OR for gastric cancer comparing Br-THM ingestion ≥vs.80th<80th percentile was 0.65 (0.33, 1.28) and for chloroform was 1.36 (0.87, 2.14). Comparable ORs were found for residential concentrations. Conclusions: Long-term waterborne nitrate exposure below regulatory limits may increase gastric cancer risk among older adults and in those with poor dietary patterns. These findings need to be confirmed by cohort studies with larger sample sizes.
publishDate 2025
dc.date.none.fl_str_mv 2025
2025
2025
2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/223788
url https://hdl.handle.net/2445/223788
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1289/EHP15039
Environmental Health Perspectives, 2025, vol. 133, num.5
https://doi.org/10.1289/EHP15039
dc.rights.none.fl_str_mv Domini públic / Public domain
https://creativecommons.org/publicdomain/zero/1.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Domini públic / Public domain
https://creativecommons.org/publicdomain/zero/1.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 11 p.
application/pdf
dc.publisher.none.fl_str_mv National Institute of Environmental Health Science
publisher.none.fl_str_mv National Institute of Environmental Health Science
dc.source.none.fl_str_mv Articles publicats en revistes (Ciències Clíniques)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,81155

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