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http://www.medpagetoday.com/PublicHealthPolicy/EnvironmentalHealth/14961#ayk
Study Links Nitrosamines to Mortality in Diabetes, Other Diseases
By Todd Neale, Staff Writer, MedPage Today
Published: July 06, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
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LITTLE FALLS, N.J., July 6 -- Rising mortality rates for diabetes, Alzheimer's disease, and Parkinson's disease in recent decades parallel increased exposure to nitrosamines in the food supply and environment, researchers found.
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■Explain to interested patients that this study compared epidemiological trends to identify a possible link between nitrosamine exposure and diseases characterized by insulin resistance, but did not actually measure exposures in patients.
Nitrosamines, nitrates, and nitrites can induce DNA damage, oxidative stress, cell death, and cancer, and they have been associated with insulin resistance, according to Suzanne de la Monte, MD, MPH, of Brown University and Rhode Island Hospital in Providence, and colleagues.
Insulin resistance is a characteristic of normal aging, as well as of diabetes, Alzheimer's disease, and Parkinson's disease. Rates of these diseases have increased so rapidly in recent decades that genetics likely can't explain what is happening, the researchers said in the July issue of the Journal of Alzheimer's Disease.
"Epidemiological trends support exposure rather than genetic causes of these diseases," they said.
They proposed that exposure to nitrates, nitrites, and nitrosamines -- through the food supply, smoking, and use of products such as fertilizers -- might be to blame.
"If this hypothesis is correct," they said, "potential solutions would include eliminating the use of nitrites and nitrates in food processing, food preservation, and agriculture; taking steps to prevent formation of nitrosamines; and employing safe and effective measures to detoxify food and water prior to human consumption."
Some nitrosamines are deliberately added to foods for various reasons. Sodium nitrite, for instance is added to meat and fish to prevent toxin production by Clostridium botulinum. It's also used to preserve, color, and flavor meats.
Additional exposures occur through manufacturing, processing, and using rubber and latex products, fertilizers, pesticides, and cosmetics, according to the researchers.
Previous studies have shown that the cellular changes induced by nitrosamines are similar to those that occur during normal aging and with diseases characterized by insulin resistance.
To explore a possible connection between nitrosamine exposure and the rates of diabetes, Alzheimer's disease, and Parkinson's disease, Dr. de la Monte and her colleagues tracked mortality trends from 1968 to 2005.
Over that time period, death rates for Alzheimer's disease jumped 150-fold in individuals ages 75 to 84 and 800-fold in those 85 and older.
Data on Parkinson's disease were available only after 1980. From 1980 through 2005, death rates tripled in 75- to 84-year-olds and increased six-fold in those 85 and older.
Death rates for diabetes reached a low in 1980 and increased through the end of the study period, with some evidence of a plateau in the three of the last four years.
These patterns were compared with trends in the consumption of fast food, use of nitrite-containing fertilizers, sales from a major meat processing company, and consumption of grain -- all indirect measures of exposure to nitrosamines -- from 1955 to 2005.
The researchers found strong parallels between increases in exposure and disease mortality rates.
Nitrogen-containing fertilizer consumption increased by 230% between 1955 and 2005, and its use doubled from 1960 to 1980, "just preceding the insulin-resistance epidemics," the researchers said.
In addition, sales from fast food chains and the meat processing company increased more than eight-fold from 1970 to 2005 and grain consumption increased five-fold.
"Exposures to nitrites and nitrosamines through food, water, and agriculture have increased just prior to and within the same interval [as increasing mortality rates] due to proliferation of food processing, increased requirement for food preservation to enable 'safe' storage and long distance shipping, and the use of fertilizers to enhance crop growth and meet growing demand for produce," the researchers said.
They concluded, "Sincere efforts should be made to significantly curtail or eliminate human exposure to nitrates and nitrites and refine extant biotechnology to monitor exposure, metabolite formation, and associated cellular and tissue injury linked to nitrosamine-mediated insulin resistance-related diseases."
The study was supported by grants from the NIH.
The authors did not make any other financial disclosures.
Primary source: Journal of Alzheimer's Disease
Source reference:
De la Monte S, et al "Epidemiological trends strongly suggest exposures as etiologic agents in the pathogenesis of sporadic Alzheimer's disease, diabetes mellitus, and non-alcoholic steatohepatitis" J Alzheimers Dis 2009; 17: 519-29.
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