Nitrites and nitrates dietary exposure from natural sources and additives and type-2 diabetes risk

Abstract   Nitrates and nitrites occur naturally in water and soil and are commonly ingested from drinking water and dietary sources. They are also used as food additives. The epidemiological evidence linking exposure to nitrites/nitrates with type-2 diabetes (T2D) risk is scarce. We aimed to study these associations in a large population based prospective cohort study. Overall, 104,168 adults from the French NutriNet-Santé cohort study (median follow-up time 6.7 years) were included. Associations between intakes of nitrites and nitrates (evaluated using repeated 24h dietary records, linked to a comprehensive food composition database and accounting for details of commercial names/brands of industrial products) and risk of T2D were assessed using cause-specific multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors). During follow-up, 969 incident T2D cases were ascertained. Total nitrites and nitrites from natural sources were both positively associated with higher T2D risk (HRtertile 3 vs.1=1.29 (95% CI 1.06-1.56), Ptrend=0.004, and 1.27 (95% CI 1.05-1.54), Ptrend=0.01, respectively). Participants with higher exposure to nitrites from food additives (i.e. above the sex-specific median), and specifically those having higher exposure to sodium nitrite (e250) had a higher T2D risk compared with those who were not exposed to food additive nitrites (HRtertile 3 vs.1=1.58 (95% CI 1.28-1.94), Ptrend<0.001, and 1.59 (95% CI 1.30-1.96), Ptrend<0.001), respectively). There was no evidence for an association between nitrates of any source and T2D risk (all Ptrend>0.4). In this large prospective cohort, a higher dietary exposure to nitrites (from both natural sources and food additives) was associated with higher T2D risk. These results provide additional evidence in the context of current discussions about updating regulations on the use of nitrites as food additives. Key messages • A high exposure to dietary nitrites (from both natural and food additive sources) is associated with an increased risk of type-2 diabetes. • These findings support further regulations concerning the use of nitrites as food additives in processed meats.

AEBR is one of the oldest regional associations in Europe (founded in 1971), with a hundred members (border and cross-border regions) in more than thirty European countries. AEBR works for the interest of border regions towards EU and national authorities, developing capacities, increasing awareness, organizing events and implementing projects. AEBR currently implements IVY (Interreg Volunteer Youth) on behalf of the European Commission's DG Regio, within the framework of the European Solidarity Corps, which has deployed more than 700 young Europeans in Interreg programmes and projects during the last four years. It also manages b-solutions to tackle cross-border legal and administrative obstacles and test possible solutions, and takes part in other projects in Europe and other continents. It has recently finished a study for DG SANTE on cross-border patients' flows in various EU cross-border areas. The association will be presented by it's Secretary General, Martin Guillermo-Ramírez.
Abstract citation ID: ckac129.489 European Regional and Local Health Authorities (EUREGHA)

Michele Calabro
M Calabro 1 1 European Regional and Local Health Authorities, Brussels, Belgium Contact: michele.calabro@euregha.net EUREGHA's vision is to ensure that the local and regional perspective is represented in EU health policy because local and regional authorities are the natural interface between citizens and European institutions, being the bridging bodies between policies and practices and the closest organizations to the concept of communities. We are the only European network prioritizing the representation of local and regional health authorities at EU level, as they fulfil a key role in improving efficiency, quality, and accessibility of healthcare systems and services. EUREGHA understands their specific needs and works tirelessly to represent regional and local health authorities in EU health policy, to amplify their voices as a means to improve European public health and healthcare. Through advocacy, policy monitoring, profile promotion, partnerships, and project development, EUREGHA facilitates and promotes collaboration between its members, EU institutions, pan-European health networks and other healthcare stakeholders. Network activities and projects are implemented upon a strategic background of ''ways to make things happen'' such as value based healthcare, smart specialization strategies and skills for innovation and digital transformation -on one side -and along thematic and field objectives such as crossborder healthcare, cancer, obesity, mental health and ageingon the other side. Lower Austria is a long-standing member and Vice-Chair of EUREGHA.

8.D. Oral presentations: Diabetes and nutrition
Abstract citation ID: ckac129.490 Nitrites and nitrates dietary exposure from natural sources and additives and type-2 diabetes risk Bernard Srour B Srour 1 , E Chazelas 1 , C Debras 1 , N Druesne-Pecollo 1 , C Agaesse 1 , F Szabo de Edelenyi 1 , L Sellem 1 , E Kesse-Guyot 1 , M Deschasaux-Tanguy 1 , M Touvier 1 1 EREN, Inserm, Inrae, Cnam, USPN, INSERM, Bobigny, France Contact: b.srour@eren.smbh.univ-paris13.fr Nitrates and nitrites occur naturally in water and soil and are commonly ingested from drinking water and dietary sources. They are also used as food additives. The epidemiological evidence linking exposure to nitrites/nitrates with type-2 diabetes (T2D) risk is scarce. We aimed to study these associations in a large population based prospective cohort study. Overall, 104,168 adults from the French NutriNet-Santé cohort study (median follow-up time 6.7 years) were included. Associations between intakes of nitrites and nitrates (evaluated using repeated 24h dietary records, linked to a comprehensive food composition database and accounting for details of commercial names/brands of industrial products) and risk of T2D were assessed using cause-specific multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors). During follow-up, 969 incident T2D cases were ascertained. Total nitrites and nitrites from natural sources were both positively associated with higher T2D risk (HRtertile 3 vs.1 = 1.29 (95% CI 1.06-1.56), Ptrend = 0.004, and 1.27 (95% CI 1.05-1.54), Ptrend = 0.01, respectively). Participants with higher exposure to nitrites from food additives (i.e. above the sex-specific median), and specifically those having higher exposure to sodium nitrite (e250) had a higher T2D risk compared with those who were not exposed to food additive nitrites (HRtertile 3 vs.1 = 1.58 (95% CI 1.28-1.94), Ptrend<0.001, and 1.59 (95% CI 1.30-1.96), Ptrend<0.001), respectively). There was no evidence for an association between nitrates of any source and T2D risk (all Ptrend>0.4). In this large prospective cohort, a higher dietary exposure to nitrites (from both natural sources and food additives) was associated with higher T2D risk. These results provide additional evidence in the context of current discussions about updating regulations on the use of nitrites as food additives.

Key messages:
A high exposure to dietary nitrites (from both natural and food additive sources) is associated with an increased risk of type-2 diabetes. These findings support further regulations concerning the use of nitrites as food additives in processed meats.
iii198 European Journal of Public Health, Volume 32 Supplement 3, 2022