Health Scope

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A Review of Adverse Effects and Benefits of Nitrate and Nitrite in Drinking Water and Food on Human Health

Mina Parvizishad 1 , Arash Dalvand 2 , Amir Hossein Mahvi 1 , 3 , * and Fatemeh Goodarzi 1
Authors Information
1 Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2 Environmental Science and Technology Research Center, Department of Environmental Health Engineering, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3 Center for Solid Waste Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
Article information
  • Health Scope: August 2017, 6 (3); e14164
  • Published Online: June 18, 2017
  • Article Type: Review Article
  • Received: July 9, 2016
  • Revised: September 27, 2016
  • Accepted: November 20, 2016
  • DOI: 10.5812/jhealthscope.14164

To Cite: Parvizishad M, Dalvand A, Mahvi A H, Goodarzi F. A Review of Adverse Effects and Benefits of Nitrate and Nitrite in Drinking Water and Food on Human Health, Health Scope. 2017 ; 6(3):e14164. doi: 10.5812/jhealthscope.14164.

Copyright © 2017, Journal of Health Scope. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Introduction
2. Methods
3. Sources of Human Exposure to Nitrates and Nitrites
4. The endogenous Formation of N-Nitroso Compounds
5. Adverse Effects of Nitrates and Nitrites on Human Health
6. Benefits of Nitrate
7. Conclusion
  • 1. Mesdaghi nia AR, Mahvi AH, Naseri S, Mohamadi AA, Shekarriz M, Alimohamadi M. Study of nitrate reduction from water using nanosized iron [In Persian]. Iran J Health Environ. 2011; 4(3): 313-20
  • 2. Gelberg KH, Church L, Casey G, London M, Roerig DS, Boyd J, et al. Nitrate levels in drinking water in rural New York State. Environ Res. 1999; 80(1): 34-40[DOI][PubMed]
  • 3. Sankararamakrishnan N, Sharma AK, Iyengar L. Contamination of nitrate and fluoride in ground water along the Ganges Alluvial Plain of Kanpur district, Uttar Pradesh, India. Environ Monit Assess. 2008; 146(1-3): 375-82[DOI][PubMed]
  • 4. Suthar S, Bishnoi P, Singh S, Mutiyar PK, Nema AK, Patil NS. Nitrate contamination in groundwater of some rural areas of Rajasthan, India. J Hazard Mater. 2009; 171(1-3): 189-99[DOI][PubMed]
  • 5. Costa JL, Massone H, Martı́nez D, Suero EE, Vidal CM, Bedmar F. Nitrate contamination of a rural aquifer and accumulation in the unsaturated zone. Agric Water Manag. 2002; 57(1): 33-47[DOI]
  • 6. Kross BC, Hallberg GR, Bruner DR, Cherryholmes K, Johnson JK. The nitrate contamination of private well water in Iowa. Am J Public Health. 1993; 83(2): 270-2[DOI][PubMed]
  • 7. Hu K, Huang Y, Li H, Li B, Chen D, White RE. Spatial variability of shallow groundwater level, electrical conductivity and nitrate concentration, and risk assessment of nitrate contamination in North China Plain. Environ Int. 2005; 31(6): 896-903[DOI][PubMed]
  • 8. Mahvi AH, Nouri J, Babaei AA, Nabizadeh R. Agricultural activities impact on groundwater nitrate pollution. Int J Environ Sci Technol . 2013; 2(1): 41-7[DOI]
  • 9. Atafar Z, Mesdaghinia A, Nouri J, Homaee M, Yunesian M, Ahmadimoghaddam M, et al. Effect of fertilizer application on soil heavy metal concentration. Environ Monit Assess. 2010; 160(1-4): 83-9[DOI][PubMed]
  • 10. Rotaru A, Răileanu P. Groundwater contamination from waste storage works. Environ Eng Manag J. 2008; 7(6): 731-5
  • 11. Mahvi AH, Ebrahimi SJ, Mesdaghinia A, Gharibi H, Sowlat MH. Performance evaluation of a continuous bipolar electrocoagulation/electrooxidation-electroflotation (ECEO-EF) reactor designed for simultaneous removal of ammonia and phosphate from wastewater effluent. J Hazard Mater. 2011; 192(3): 1267-74[DOI][PubMed]
  • 12. Wakida FT, Lerner DN. Non-agricultural sources of groundwater nitrate: a review and case study. Water Res. 2005; 39(1): 3-16[DOI][PubMed]
  • 13. Gharibi H, Mahvi AH, Nabizadeh R, Arabalibeik H, Yunesian M, Sowlat MH. A novel approach in water quality assessment based on fuzzy logic. J Environ Manage. 2012; 112: 87-95[DOI][PubMed]
  • 14. Yousefi N, Fatehizedeh A, Ghadiri K, Mirzaei N, Ashrafi SD, Mahvi AH. Application of nanofilter in removal of phosphate, fluoride and nitrite from groundwater. Desalination Water Treat. 2016; 57(25): 11782-8[DOI]
  • 15. Shahbazi P, Vaezi F, Mahvi AH, Naddaffi K, Rahmani AR. Nitrate removal from drinking water by point of use ion exchange. J Res Health Sci. 2010; 10(2): 91-7[PubMed]
  • 16. Khazaei M, Nabizadeh R, Mahvi AH, Izanloo H, Ansari Tadi R, Gharagazloo F. Nitrogen and phosphorous removal from aerated lagoon effluent using horizontal roughing filter (HRF). Desalination Water Treat. 2016; 57(12): 5425-34[DOI]
  • 17. Walker R. The metabolism of dietary nitrites and nitrates. Biochem Soc Trans. 1996; 24(3): 780-5[DOI][PubMed]
  • 18. Mensinga TT, Speijers GJ, Meulenbelt J. Health implications of exposure to environmental nitrogenous compounds. Toxicol Rev. 2003; 22(1): 41-51[DOI][PubMed]
  • 19. Liebscher H, Hii B, McNaughton D. Nitrates and pesticides in the Abbotsford aquifer, southwestern British Columbia. 1992;
  • 20. Egboka BCE. Nitrate contamination of shallow groundwaters in Ontario, Canada. Sci Total Environ. 1984; 35(1): 53-70[DOI]
  • 21. Duijvenbooden WV, Matthijsen AJCM, Speijers GJA, Went CFV, Apeldoorn MEV. Integrated Criteria Document Nitrate. National Institute of Public Health and Environmental Protection Report. 1989; (758473012)
  • 22. Gangolli SD, van den Brandt PA, Feron VJ, Janzowsky C, Koeman JH, Speijers GJ, et al. Nitrate, nitrite and N-nitroso compounds. Environ Toxicol Pharmacol. 1994; 292(1): 1-38[DOI]
  • 23. Pennington JAT. Dietary exposure models for nitrates and nitrites. Food Control. 1998; 9(6): 385-95[DOI]
  • 24. Iarc Working Group on the Evaluation of Carcinogenic Risks to Humans . IARC monographs on the evaluation of carcinogenic risks to humans. Ingested nitrate and nitrite, and cyanobacterial peptide toxins. IARC Monogr Eval Carcinog Risks Hum. 2010; 94[PubMed]
  • 25. Walker R. Nitrates, nitrites and N-nitrosocompounds: a review of the occurrence in food and diet and the toxicological implications. Food Addit Contam. 1990; 7(6): 717-68[DOI][PubMed]
  • 26. Prospero JM, Savoie DL. Effect of continental sources on nitrate concentrations over the Pacific Ocean. Nature. 1989; 339(6227): 687-9[DOI]
  • 27. Janssen LHJM, Visser H, Römer FG. Analysis of large scale sulphate, nitrate, chloride and ammonium concentrations in The Netherlands using an aerosol measuring network. Atmos Environ. 1989; 23(12): 2783-96[DOI]
  • 28. Lefebvre A, Eilers W, Chunn B. Environmental sustainability of canadian agriculture: Agri-environmental indicator report series–report# 2. 2010;
  • 29. Spiegelhalder B, Eisenbrand G, Preussmann R. Influence of dietary nitrate on nitrite content of human saliva: possible relevance to in vivo formation of N-nitroso compounds. Food Cosmet Toxicol. 1976; 14(6): 545-8[DOI][PubMed]
  • 30. Leaf CD, Wishnok JS, Tannenbaum SR. L-arginine is a precursor for nitrate biosynthesis in humans. Biochem Biophys Res Commun. 1989; 163(2): 1032-7[DOI][PubMed]
  • 31. Ohshima H, Bartsch H. Chronic infections and inflammatory processes as cancer risk factors: possible role of nitric oxide in carcinogenesis. Mutat Res. 1994; 305(2): 253-64[DOI][PubMed]
  • 32. Tricker AR. N-nitroso compounds and man: sources of exposure, endogenous formation and occurrence in body fluids. Eur J Cancer Prev. 1997; 6(3): 226-68[DOI][PubMed]
  • 33. Yang CY, Wu DC, Chang CC. Nitrate in drinking water and risk of death from colon cancer in Taiwan. Environ Int. 2007; 33(5): 649-53[DOI][PubMed]
  • 34. van Loon AJ, Botterweck AA, Goldbohm RA, Brants HA, van Klaveren JD, van den Brandt PA. Intake of nitrate and nitrite and the risk of gastric cancer: a prospective cohort study. Br J Cancer. 1998; 78(1): 129-35[DOI][PubMed]
  • 35. Knekt P, Jarvinen R, Dich J, Hakulinen T. Risk of colorectal and other gastro-intestinal cancers after exposure to nitrate, nitrite and N-nitroso compounds: a follow-up study. Int J Cancer. 1999; 80(6): 852-6[DOI][PubMed]
  • 36. Palli D, Saieva C, Coppi C, Del Giudice G, Magagnotti C, Nesi G, et al. O6-alkylguanines, dietary N-nitroso compounds, and their precursors in gastric cancer. Nutr Cancer. 2001; 39(1): 42-9[DOI][PubMed]
  • 37. Jensen OM. Nitrate in drinking water and cancer in northern Jutland, Denmark, with special reference to stomach cancer. Ecotoxicol Environ Saf. 1982; 6(3): 258-67[DOI][PubMed]
  • 38. Morales-Suarez-Varela MM, Llopis-Gonzalez A, Tejerizo-Perez ML. Impact of nitrates in drinking water on cancer mortality in Valencia, Spain. Eur J Epidemiol. 1995; 11(1): 15-21[DOI][PubMed]
  • 39. Gulis G, Czompolyova M, Cerhan JR. An ecologic study of nitrate in municipal drinking water and cancer incidence in Trnava District, Slovakia. Environ Res. 2002; 88(3): 182-7[DOI][PubMed]
  • 40. Law G, Parslow R, McKinney P, Cartwright R. Non-Hodgkin's lymphoma and nitrate in drinking water: a study in Yorkshire, United Kingdom. J Epidemiol Community Health. 1999; 53(6): 383-4[DOI][PubMed]
  • 41. Cocco P, Broccia G, Aru G, Casula P, Muntoni S, Cantor KP, et al. Nitrate in community water supplies and incidence of non-Hodgkin's lymphoma in Sardinia, Italy. J Epidemiol Community Health. 2003; 57(7): 510-1[DOI][PubMed]
  • 42. Weyer PJ, Cerhan JR, Kross BC, Hallberg GR, Kantamneni J, Breuer G, et al. Municipal drinking water nitrate level and cancer risk in older women: the Iowa Women's Health Study. Epidemiology. 2001; 12(3): 327-38[PubMed]
  • 43. Ward MH, Mark SD, Cantor KP, Weisenburger DD, Correa-Villasenor A, Zahm SH. Drinking water nitrate and the risk of non-Hodgkin's lymphoma. Epidemiology. 1996; 7(5): 465-71[DOI][PubMed]
  • 44. Chiu HF, Tsai SS, Yang CY. Nitrate in drinking water and risk of death from bladder cancer: an ecological case-control study in Taiwan. J Toxicol Environ Health A. 2007; 70(12): 1000-4[DOI][PubMed]
  • 45. Ward MH, Cantor KP, Riley D, Merkle S, Lynch CF. Nitrate in public water supplies and risk of bladder cancer. Epidemiology. 2003; 14(2): 183-90[DOI][PubMed]
  • 46. Zeegers MP, Selen RF, Kleinjans JC, Goldbohm RA, van den Brandt PA. Nitrate intake does not influence bladder cancer risk: the Netherlands cohort study. Environ Health Perspect. 2006; 114(10): 1527-31[DOI][PubMed]
  • 47. Volkmer BG, Ernst B, Simon J, Kuefer R, Bartsch GJ, Bach D, et al. Influence of nitrate levels in drinking water on urological malignancies: a community-based cohort study. BJU Int. 2005; 95(7): 972-6[DOI][PubMed]
  • 48. Ward MH, Rusiecki JA, Lynch CF, Cantor KP. Nitrate in public water supplies and the risk of renal cell carcinoma. Cancer Causes Control. 2007; 18(10): 1141-51[DOI][PubMed]
  • 49. Michaud DS, Holick CN, Batchelor TT, Giovannucci E, Hunter DJ. Prospective study of meat intake and dietary nitrates, nitrites, and nitrosamines and risk of adult glioma. Am J Clin Nutr. 2009; 90(3): 570-7[DOI][PubMed]
  • 50. Aschebrook-Kilfoy B, Cross AJ, Stolzenberg-Solomon RZ, Schatzkin A, Hollenbeck AR, Sinha R, et al. Pancreatic cancer and exposure to dietary nitrate and nitrite in the NIH-AARP Diet and Health Study. Am J Epidemiol. 2011; 174(3): 305-15[DOI][PubMed]
  • 51. Mirvish SS. Nitrate Contamination. 1991; : 253-66
  • 52. Boink ABTJ, Vleeming W, Dormans JAMA, Speijers GJA. Managing Risks of Nitrates to Humans and the Environment. 1999; : 317-26[DOI]
  • 53. Gowans WJ. Fatal methaemoglobinaemia in a dental nurse. A case of sodium nitrite poisoning. Br J Gen Pract. 1990; 40(340): 470-1[PubMed]
  • 54. Fan AM, Steinberg VE. Health implications of nitrate and nitrite in drinking water: an update on methemoglobinemia occurrence and reproductive and developmental toxicity. Regul Toxicol Pharmacol. 1996; 23(1 Pt 1): 35-43[DOI][PubMed]
  • 55. Walton G. Survey of literature relating to infant methemoglobinemia due to nitrate-contaminated water. Am J Public Health Nations Health. 1951; 41(8 Pt 1): 986-96[PubMed]
  • 56. Craun GF, Greathouse DG, Gunderson DH. Methaemoglobin levels in young children consuming high nitrate well water in the United States. Int J Epidemiol. 1981; 10(4): 309-17[DOI][PubMed]
  • 57. Fewtrell L. Drinking-water nitrate, methemoglobinemia, and global burden of disease: a discussion. Environ Health Perspect. 2004; 112(14): 1371-4[DOI][PubMed]
  • 58. Bruning-Fann CS, Kaneene JB. The effects of nitrate, nitrite and N-nitroso compounds on human health: a review. Vet Hum Toxicol. 1993; 35(6): 521-38[PubMed]
  • 59. Sanchez-Echaniz J, Benito-Fernandez J, Mintegui-Raso S. Methemoglobinemia and consumption of vegetables in infants. Pediatrics. 2001; 107(5): 1024-8[DOI][PubMed]
  • 60. van Maanen JM, van Dijk A, Mulder K, de Baets MH, Menheere PC, van der Heide D, et al. Consumption of drinking water with high nitrate levels causes hypertrophy of the thyroid. Toxicol Lett. 1994; 72(1-3): 365-74[DOI][PubMed]
  • 61. Gatseva PD, Argirova MD. High-nitrate levels in drinking water may be a risk factor for thyroid dysfunction in children and pregnant women living in rural Bulgarian areas. Int J Hyg Environ Health. 2008; 211(5-6): 555-9[DOI][PubMed]
  • 62. Kostraba JN, Gay EC, Rewers M, Hamman RF. Nitrate levels in community drinking waters and risk of IDDM. An ecological analysis. Diabetes Care. 1992; 15(11): 1505-8[DOI][PubMed]
  • 63. Dahlquist GG, Blom LG, Persson LA, Sandstrom AI, Wall SG. Dietary factors and the risk of developing insulin dependent diabetes in childhood. BMJ. 1990; 300(6735): 1302-6[DOI][PubMed]
  • 64. Virtanen SM, Jaakkola L, Rasanen L, Ylonen K, Aro A, Lounamaa R, et al. Nitrate and nitrite intake and the risk for type 1 diabetes in Finnish children. Childhood Diabetes in Finland Study Group. Diabet Med. 1994; 11(7): 656-62[DOI][PubMed]
  • 65. Group PE. Nitrate in drinking water and childhood-onset insulin-dependent diabetes mellitus in Scotland and Central England. 1999;
  • 66. van Maanen JM, Albering HJ, de Kok TM, van Breda SG, Curfs DM, Vermeer IT, et al. Does the risk of childhood diabetes mellitus require revision of the guideline values for nitrate in drinking water? Environ Health Perspect. 2000; 108(5): 457-61[DOI][PubMed]
  • 67. Casu A, Carlini M, Contu A, Bottazzo GF, Songini M. Type 1 diabetes in sardinia is not linked to nitrate levels in drinking water. Diabetes Care. 2000; 23(7): 1043-4[DOI][PubMed]
  • 68. Lundberg JO, Feelisch M, Bjorne H, Jansson EA, Weitzberg E. Cardioprotective effects of vegetables: is nitrate the answer? Nitric Oxide. 2006; 15(4): 359-62[DOI][PubMed]
  • 69. Yoshida K, Kasama K. Biotransformation of nitric oxide. Environ Health Perspect. 1987; 73: 201-5[DOI][PubMed]
  • 70. Benjamin N, O'Driscoll F, Dougall H, Duncan C, Smith L, Golden M, et al. Stomach NO synthesis. Nature. 1994; 368(6471): 502[DOI][PubMed]
  • 71. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, et al. Breastfeeding and the use of human milk. Pediatrics. 2005; 115(2): 496-506[DOI][PubMed]
  • 72. James DC, Lessen R, American Dietetic A. Position of the American Dietetic Association: promoting and supporting breastfeeding. J Am Diet Assoc. 2009; 109(11): 1926-42[DOI][PubMed]
  • 73. Ohta N, Tsukahara H, Ohshima Y, Nishii M, Ogawa Y, Sekine K, et al. Nitric oxide metabolites and adrenomedullin in human breast milk. Early Hum Dev. 2004; 78(1): 61-5[DOI][PubMed]
  • 74. Hord NG, Ghannam JS, Garg HK, Berens PD, Bryan NS. Nitrate and nitrite content of human, formula, bovine, and soy milks: implications for dietary nitrite and nitrate recommendations. Breastfeed Med. 2011; 6(6): 393-9[DOI][PubMed]
  • 75. Sindelar JJ, Milkowski AL. Human safety controversies surrounding nitrate and nitrite in the diet. Nitric Oxide. 2012; 26(4): 259-66[DOI][PubMed]
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