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Jan M.S. van Maanen,¹ Harma J. Albering,¹ Theo M.C.M. de Kok,¹ Simone G.J. van Breda,¹ Danielle M.J. Curfs,¹ Ingrid T.M. Vermeer,¹ Anton W. Ambergen,² Bruce H.R. Wolffenbuttel,³ Jos C.S. Kleinjans,¹ and H. Maarten Reeser^4,5

¹Department of Health Risk Analysis and Toxicology, ²Department of Methodology and Statistics, Faculty of Health Sciences, University of Maastricht, Maastricht, The Netherlands
³Department of Endocrinology, University Hospital, Maastricht, The Netherlands
⁴Juliana Children's Hospital, The Hague, The Netherlands
⁵TNO Prevention and Health, Leiden, The Netherlands

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. Key words: drinking water, guideline values, nitrate, type 1 diabetes. Environ Health Perspect 108:457-461 (2000) . [Online 30 March 2000]

http://ehpnet1.niehs.nih.gov/docs/2000/108p457-461vanmaanen/ abstract.html

Address correspondence to J.M.S. van Maanen, Department of Health Risk Analysis and Toxicology, University of Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands. Telephone: 31 43 3881094/3881097. Fax: 31 43 3884146. E-mail: j.vanmaanen@grat.unimaas.nl

Received 15 July 1999 ; accepted 1 October 1999.