Drinking-water nitrate and cancer risk: A systematic review and meta-analysis

Drinking water source and exposure to regulated water contaminants in the California Teachers Study cohort

BACKGROUND

Pollutants including metals/metalloids, nitrate, disinfection byproducts, and volatile organic compounds contaminate federally regulated community water systems (CWS) and unregulated domestic wells across the United States. Exposures and associated health effects, particularly at levels below regulatory limits, are understudied.

OBJECTIVE

We described drinking water sources and exposures for the California Teachers Study (CTS), a prospective cohort of female California teachers and administrators.

METHODS

Participants' geocoded addresses at enrollment (1995-1996) were linked to CWS service area boundaries and monitoring data (N = 115,206, 92%); we computed average (1990-2015) concentrations of arsenic, uranium, nitrate, gross alpha (GA), five haloacetic acids (HAA5), total trihalomethanes (TTHM), trichloroethylene (TCE), and tetrachloroethylene (PCE). We used generalized linear regression to estimate geometric mean ratios of CWS exposures across demographic subgroups and neighborhood characteristics. Self-reported drinking water source and consumption at follow-up (2017-2019) were also described.

RESULTS

Medians (interquartile ranges) of average concentrations of all contaminants were below regulatory limits: arsenic: 1.03 (0.54,1.71) µg/L, uranium: 3.48 (1.01,6.18) µg/L, GA: 2.21 (1.32,3.67) pCi/L, nitrate: 0.54 (0.20,1.97) mg/L, HAA5: 8.67 (2.98,14.70) µg/L, and TTHM: 12.86 (4.58,21.95) µg/L. Among those who lived within a CWS boundary and self-reported drinking water information (2017-2019), approximately 74% self-reported their water source as municipal, 15% bottled, 2% private well, 4% other, and 5% did not know/missing. Spatially linked water source was largely consistent with self-reported source at follow-up (2017-2019). Relative to non-Hispanic white participants, average arsenic, uranium, GA, and nitrate concentrations were higher for Black, Hispanic and Native American participants. Relative to participants living in census block groups in the lowest socioeconomic status (SES) quartile, participants in higher SES quartiles had lower arsenic/uranium/GA/nitrate, and higher HAA5/TTHM. Non-metropolitan participants had higher arsenic/uranium/nitrate, and metropolitan participants had higher HAA5/TTHM.

IMPACT

Though average water contaminant levels were mostly below regulatory limits in this large cohort of California women, we observed heterogeneity in exposures across sociodemographic subgroups and neighborhood characteristics. These data will be used to support future assessments of drinking water exposures and disease risk.

Reconsider the burn: The transient effect of a chlorine burn on controlling opportunistic pathogens in a full-scale chloraminated engineered water system

Nitrification is a serious water-quality issue in chloraminated engineered water systems (EWSs). Nitrification is often remediated by a chlorine burn (i.e., a free‑chlorine conversion), a short-term switch from chloramination to chlorination in EWSs. Opportunistic pathogens (OPs) are the dominant infectious agents in EWSs. However, the responses of OPs to a chlorine burn are unknown. This study for the first time assessed how a chlorine burn affected OPs in a full-scale EWS. We determined the impact of a 1.5-month chlorine burn on four dominant OPs (Legionella, Mycobacterium, Pseudomonas, and Vermamoeba vermiformis) in a representative full-scale chloraminated EWS in the United States. Legionella and Mycobacterium were the most abundant OPs. In the water main, the summed concentration of the four OPs during the chlorine burn [3.27 ± 1.58 log10(GCN·L-1); GCN: genome or gene copy number] was lower (p ≤ 0.001) than before the burn [4.83 ± 0.50 log10(GCN·L-1)]. After the burn, the summed concentration increased to 4.27 ± 0.68 log10(GCN·L-1), comparable to before the burn (p > 0.05), indicating a transient effect of the chlorine burn in the water main. At the residential sites, the summed concentrations of the four OPs were comparable (p > 0.05) at 5.50 ± 0.84, 5.27 ± 1.44, and 5.08 ± 0.71 log10(GCN·L-1) before, during, and after the chlorine burn, respectively. Therefore, the chlorine burn was less effective in suppressing OP (re)growth in the premise plumbing. The low effectiveness might be due to more significant water stagnation and disinfectant residual decay in the premise plumbing. Indeed, for the entire sampling period, the total chlorine residual concentration in the premise plumbing (1.8 mg Cl2·L-1) was lower than in the water main (2.4 mg Cl2·L-1). Consequently, for the entire sampling period, the summed concentration of the four OPs in the premise plumbing [5.26 ± 1.08 log10(GCN·L-1)] was significantly higher (p < 0.001) than in the water main [4.04 ± 1.25 log10(GCN·L-1)]. In addition, the chlorine burn substantially increased the levels of disinfection by-products (DBPs) in the water main. Altogether, a chlorine burn is transient or even ineffective in suppressing OP (re)growth but raises DBP concentrations in chloraminated EWSs. Therefore, the practice of chlorine burns to control nitrification should be optimized, reconsidered, or even replaced.

Modulatory effects of Moringa oleifera leaf extract on sodium nitrate-induced experimental colitis via regulation of P53, Ki-67 and PCNA biomarkers

BACKGROUND

Ulcerative colitis is a risk factor for colorectal carcinoma. Different mechanisms are related to colitis like apoptosis and hyperproliferation. Moringa oleifera leaves extract (MO) provides a promising option to overcome the risk.

PURPOSE

To examine the colonic changes in a rat model of colitis induced by sodium nitrate (SN) and study the effects of MO.

STUDY DESIGN

Eight adult male rats were allocated in each of the three group; control (distilled water), SN (100 mg/kg/day, orally via gastric gavage), and SN + MO (100 mg/kg/day, orally via gastric gavage).

METHODS

Body weight was measured after the end of the experiment. Colonic homogenates were tested for levels of oxidative stress indicators. Immunohistochemistry for P53, PCNA and Ki-67 was performed. Fresh colon specimens were used for quantitative real-time PCR for assessment of P53, PCNA and Ki-67 gene expression.

RESULTS

SN group revealed a significant decreased weight (p = 0.002). MDA and NO levels were higher with SN administration than with MO co-administration (p= 0.04, 0.01 respectively). GSH level was reduced in SN group (p = 0.02) and significantly increased with MO intake (p = 0.04). SN-induced colonic destructive changes were reversed with MO. P53, PCNA and Ki-67 levels of gene expression were reduced in SN + MO group than SN group (P = 0.007, 0.02, 0.001 respectively).

CONCLUSION

MO protected the colonic mucosa against SN-induced changes regulating apoptosis, and cell proliferation.

Long-term cancer and overall mortality associated with drinking water nitrate in the United States

OBJECTIVES

Nitrate is a probable carcinogen regulated in drinking water by the US Environmental Protection Agency (EPA) to a maximum contaminant level (MCL) of 10 mg/L nitrate-nitrogen (NO3-N; equivalent to 44.3 mg/L NO3). We aimed to determine the association of US drinking water nitrate levels with overall as well as cardiovascular, cancer, and other cause mortality.

STUDY DESIGN

This study used a population-based retrospective cohort design.

METHODS

We analyzed data from 2029 participants of the 2005-2006 National Health and Nutrition Examination Survey followed for mortality until 2019 for a median of 13.9 years. We used Cox proportional hazards regression to estimate the hazard ratio (HR) and 95% confidence interval (CI) for mortality associated with drinking water nitrate, adjusting for covariates that included socio-economic factors and pack-years of cigarette smoking.

RESULTS

Drinking water nitrate was detected in 50.8 % of the samples, had a median concentration of 0.77 mg/L NO3, and was above US EPA MCL in 0.4 % of participants. In adjusted analysis, drinking water nitrate detection was associated with 73 % higher cancer mortality (HR: 1.73, 95% CI: 1.19-2.51), whereas a 10-fold increase in drinking water nitrate levels was associated with 69 % higher cancer mortality (HR: 1.69, 95% CI: 1.24-2.31) and 21 % higher overall mortality (HR: 1.21, 95% CI: 1.00-1.46). Drinking water nitrate below EPA MCL was still associated with higher cancer mortality (HR: 1.61, 95% CI: 1.07-2.43 per 10-fold increase and HR: 1.61, 95% CI: 1.08-2.42 for detection).

CONCLUSIONS

Levels of drinking water nitrate may be an overlooked contributor to cancer mortality in the United States.

Public health risks associated with drinking water consumption in the upper Awash River sub-basin, Ethiopia, sub-Saharan Africa

The Upper Awash sub-basin characterized by urban, industrial, agricultural and population growth, has impacted the quality of its water sources. This study focuses on the assessment of public health risks associated with drinking water sources in the sub-basin. In accordance with WHO guidelines, 120 water samples were collected from 60 water supply schemes in dry and wet seasons located in areas with low and high water pollution risk (WPR). Multi-meter, Photometer, Digital Arsenator, and Microbiological test kit measured the concentration of parameters. The assessment uses methods of hazard identification, exposure and dose-response analysis, and risk characterization, including Hazard Quotient (HQ), Cancer Risk (CR), Hazard Index (HI), and probability of infection. Monte Carlo simulation analyzes non-cancer risks from Nitrite, Nitrate, Chromium, Iron, Fluoride, and Arsenic, and CRs from Chromium and Arsenic, and infection risks from Escherichia coli (E.coli). As a result, the Hazard Quotient (HQ) of Nitrate was beyond unity (HQ > 1) in the dry season for all groups. HQ of Chromium was HQ > 1 for Women (1.1E+00) and Children (1.4E+00) in the wet season in the high WPR area. Chromium HQ > 1 for children (1.4E+00) in the wet season and Fluoride (HQ > 1) for Children (3.2E+00) in the dry season in the low WPR area. Arsenic CR was above 1 in 10,000 persons for children in the dry season, for all groups, and for women and children in the wet season in the high WPR areas. The CR of chromium ranged from 1 in 1000 persons, which is beyond the limit. Moreover, the Hazard Index (HI) was higher than the unity (HI > 1) for most cases. All E coli infection risks daily and annually exceeded the acceptable risks. Therefore, Public health concerns in the Sub-basin were quantified, and evidences were generated for risk management to undertake source protection through integrated watershed management and appropriate water treatment technologies.

Nitrate prediction in groundwater of data scarce regions: The futuristic fresh-water management outlook

Nitrate contamination in groundwater poses a significant threat to water quality and public health, especially in regions with limited data availability. This study addresses this challenge by employing machine learning (ML) techniques to predict nitrate (NO3--N) concentrations in Mexico's groundwater. Four ML algorithms-Extreme Gradient Boosting (XGB), Boosted Regression Trees (BRT), Random Forest (RF), and Support Vector Machines (SVM)-were executed to model NO3--N concentrations across the country. Despite data limitations, the ML models achieved robust predictive performances. XGB and BRT algorithms demonstrated superior accuracy (0.80 and 0.78, respectively). Notably, this was achieved using ∼10 times less information than previous large-scale assessments. The novelty lies in the first-ever implementation of the 'Support Points-based Split Approach' during data pre-processing. The models considered initially 68 covariates and identified 13-19 significant predictors of NO3--N concentration spanning from climate, geomorphology, soil, hydrogeology, and human factors. Rainfall, elevation, and slope emerged as key predictors. A validation incorporated nationwide waste disposal sites, yielding an encouraging correlation. Spatial risk mapping unveiled significant pollution hotspots across Mexico. Regions with elevated NO3--N concentrations (>10 mg/L) were identified, particularly in the north-central and northeast parts of the country, associated with agricultural and industrial activities. Approximately 21 million people, accounting for 10 % of Mexico's population, are potentially exposed to elevated NO3--N levels in groundwater. Moreover, the NO3--N hotspots align with reported NO3--N health implications such as gastric and colorectal cancer. This study not only demonstrates the potential of ML in data-scarce regions but also offers actionable insights for policy and management strategies. Our research underscores the urgency of implementing sustainable agricultural practices and comprehensive domestic waste management measures to mitigate NO3--N contamination. Moreover, it advocates for the establishment of effective policies based on real-time monitoring and collaboration among stakeholders.

Evidence-based identification of breast cancer and associated ovarian and uterus cancer risk components in source waters from high incidence area in the Pearl River Basin, China

Breast cancer, ovarian cancer, and uterus cancer are among the most common female cancers. They are suspected to associate with exposures to specific environmental pollutants, which remain unidentified in source waters. In this work, we focused on the Pearl River Basin region in China, which experienced a high incidence of breast, ovarian, and uterus cancers. Combining cancer patient data, mammalian cell cytotoxicity analyses, and exhaustive historical and current chemical assessments, we for the first time identified source water components that promoted proliferation of mammalian cells, and confirmed their association with these female cancers via the estrogen receptor mediated pathway. Therefore, the components that have previously been found to enhance the proliferation of estrogen receptor-containing cells through endocrine disruption could be the crucial factor. Based on this, components that matched with this toxicological characteristic (i.e., estrogen-like effect) were further identified in source waters, including (1) organic components: phthalates, bisphenol A, nonylphenols, and per-/polyfluoroalkyls; (2) inorganic components: Sb, Co, As, and nitrate. Moreover, these identified water components were present at levels comparable to other regions with high female cancer prevalence, suggesting that the potential risk of these components may not be exclusive to the study region. Together, multiple levels of evidence suggested that long-term co-exposures to source water estrogenic components may be important to the development of breast, ovarian, and uterus cancers.

Floodplain lakes as an indicator of increasing industrial pollution - Case study from a fertilizer factory in Poland

Despite the development of organic farming, the demand for mineral fertilizers is still high. Processes of fertilizer production are water-consuming, which is why factories are often located near large rivers. Such facilities should be monitored in detail because they might pose a threat to water quality. The aim of this study was to analyse the impact of a nitrogen fertilizer factory chemical wastewater treatment plant (CWTP) on the water quality of nearby river-lake systems. Potential contamination could indicate installation defects. Six floodplain lakes were selected for analysis: three located within the embanked area and three outside the embanked area, all close to the CWTP. Two similar lakes 30 km upstream were chosen as controls. Water samples were taken monthly from March to November 2022. We analysed pH, electrical conductivity (EC), the content of Cl-, total nitrogen (TN), NH4+, NO3-, total phosphorus (TP), PO43-, dissolved organic carbon (DOC), Ca2+, K+, Mg2+ and Na+. Statistical analysis indicated that the canal that drains, among others, the cooling towers wastewater, might have an impact on the nearby lakes, significantly increasing their content of Cl- and Na+. On the other hand, the concentration of NH4+ was significantly higher in the lakes located downstream of the CWTP, although they did not have any surface connection with the CWTP reservoir. This fact and NH4+-polluted water seeping under the dike indicate that the CWTP reservoir might be leaking. Further research on underground water is required to establish whether the CWTP reservoir is properly secured. It is extremely important because the CWTP is located in the Vistula River valley, which supplies drinking water to almost 2 mln people. Any damage to the reservoir, e.g., during a flood, would lead to an ecological disaster involving not only the Vistula but also the Baltic Sea, affecting millions of people.

Long-Term Continuous Test of H2-Induced Denitrification Catalyzed by Palladium Nanoparticles in a Biofilm Matrix

Pd0 catalysis and microbially catalyzed reduction of nitrate (NO3--N) were combined as a strategy to increase the kinetics of NO3- reduction and control selectivity to N2 gas versus ammonium (NH4+). Two H2-based membrane biofilm reactors (MBfRs) were tested in continuous mode: one with a biofilm alone (H2-MBfR) and the other with biogenic Pd0 nanoparticles (Pd0NPs) deposited in the biofilm (Pd-H2-MBfR). Solid-state characterizations of Pd0NPs in Pd-H2-MBfR documented that the Pd0NPs were uniformly located along the outer surfaces of the bacteria in the biofilm. Pd-H2-MBfR had a higher rate of NO3- reduction compared to H2-MBfR, especially when the influent NO3- concentration was high (28 mg-N/L versus 14 mg-N/L). Pd-H2-MBfR enriched denitrifiers of Dechloromonas, Azospira, Pseudomonas, and Stenotrophomonas in the microbial community and also increased abundances of genes affiliated with NO3--N reductases, which reflected that the denitrifying bacteria could channel their respiratory electron flow to NO3- reduction to NO2-. N2 selectivity in Pd-H2-MBfR was regulated by the H2/NO3- flux ratio: 100% selectivity to N2 was achieved when the ratio was less than 1.3 e- equiv of H2/e- equiv N, while the selectivity toward NH4+ occurred with larger H2/NO3- flux ratios. Thus, the results with Pd-H2-MBfR revealed two advantages of it over the H2-MBfR: faster kinetics for NO3- removal and controllable selectivity toward N2 versus NH4+. By being able to regulate the H2/NO3- flux ratio, Pd-H2-MBfR has significant implications for improving the efficiency and effectiveness of the NO3- reduction processes, ultimately leading to more environmentally benign wastewater treatment.

Positive feedback loop between dietary nitrate intake and oral health

Nitrate was once thought to be an inert end-product of endothelial-derived nitric oxide (NO) heme oxidation; however, this view has been radically revised over the past few decades. Following the clarification of the nitrate-nitrite-NO pathway, accumulated evidence has shown that nitrate derived from the diet is a supplementary source of endogenous NO generation, playing important roles in a variety of pathological and physiological conditions. However, the beneficial effects of nitrate are closely related with oral health, and oral dysfunction has an adverse effect on nitrate metabolism and further impacts overall systemic health. Moreover, an interesting positive feedback loop has been identified between dietary nitrate intake and oral health. Dietary nitrate's beneficial effect on oral health may further improve its bioavailability and promote overall systemic well-being. This review aims to provide a detailed description of the functions of dietary nitrate, with an emphasis on the key role oral health plays in nitrate bioavailability. This review also provides recommendations for a new paradigm that includes nitrate therapy in the treatment of oral diseases.

Highly Sensitive Graphene-Based Electrochemical Sensor for Nitrite Assay in Waters

The importance of nitrite ions has long been recognized due to their extensive use in environmental chemistry and public health. The growing use of nitrogen fertilizers and additives containing nitrite in processed food items has increased exposure and, as a result, generated concerns about potential harmful health consequences. This work presents the development of an electrochemical sensor based on graphene/glassy carbon electrode (EGr/GC) with applicability in trace level detection of nitrite in water samples. According to the structural characterization of the exfoliated material, it appears as a mixture of graphene oxide (GO; 21.53%), few-layers graphene (FLG; 73.25%) and multi-layers graphene (MLG; 5.22%) and exhibits remarkable enhanced sensing response towards nitrite compared to the bare electrode (three orders of magnitude higher). The EGr/GC sensor demonstrated a linear range between 3 × 10^-7 and 10^-3 M for square wave voltammetry (SWV) and between 3 × 10^-7 and 4 × 10^-4 M for amperometry (AMP), with a low limit of detection LOD (9.9 × 10^-8 M). Excellent operational stability, repeatability and interference-capability were displayed by the modified electrode. Furthermore, the practical applicability of the sensor was tested in commercially available waters with excellent results.

Exposure to nitrosatable drugs during pregnancy and childhood cancer: A matched case-control study in Denmark, 1996-2016

BACKGROUND

Nitrosatable drugs can be synthesized to N-nitroso compounds in human stomach. In a pregnant woman, N-nitroso compounds can be translocated to the fetus through the placenta. Maternal exposure of nitrosatable compounds during pregnancy has been associated with childhood brain tumors and leukemia. However, few studies have investigated an association between nitrosatable drug exposure during pregnancy and childhood cancer. We examined if maternal prescriptions of nitrosatable drugs received during pregnancy are associated with childhood cancer.

METHODS

A matched case-control study was conducted using Danish nationwide registry data from 1995 to 2016. Each childhood cancer case was matched with twenty-five controls. Maternal exposure of nitrosatable drugs during pregnancy was identified from the Danish National Prescription Register. A multivariable conditional logistic regression model was used to estimate adjusted odds ratios (adj.OR) with 95% confidence intervals (CI) for each childhood cancer type.

RESULTS

Maternal prescriptions of nitrosatable drugs positively associate with central nervous system tumors (adj.OR = 1.25; 95% CI = 1.04-1.51) and neuroblastoma (adj.OR = 1.96; 95% CI = 1.34-2.85) in offspring. We also observed a positive association between perinatal exposure of nitrosatable drugs and acute lymphoblastic leukemia (adj.OR = 1.31; 95% CI = 1.07-1.59), however, it appeared to be due to confounding by indication, i.e., maternal infections.

CONCLUSION

Nitrosatable drug use during pregnancy potentially increased risk of central nervous system tumors and neuroblastoma. While a positive association between maternal prescriptions of nitrosatable drugs and acute lymphoblastic leukemia should be interpreted cautiously because of confounding by indication.

Genetic engineering for enhanced biological nitrogen fixation in cereal crops

Enhancing biological nitrogen (N) fixation in cereal crops has been a long-sought objective. Recently, Yan et al. identified plant compounds that induce biofilm production of diazotrophic bacteria and then performed genetic engineering in order to improve nitrogen fixation in rice plants. These findings hold promise for sustainable agriculture.

Association of Dietary Nitrate, Nitrite, and N-Nitroso Compounds Intake and Gastrointestinal Cancers: A Systematic Review and Meta-Analysis

N-nitroso compounds (NOCs) are a class of chemical carcinogens found in various environmental sources such as food, drinking water, cigarette smoke, the work environment, and the indoor air population. We conducted a systematic review and meta-analysis to investigate the links between nitrate, nitrite, and NOCs in food and water and the risk of gastrointestinal (GI) cancers, including esophageal cancer (EC), gastric cancer (GC), colorectal cancer (CRC), and pancreatic cancer (PC). A systematic search of the literature in Scopus, PubMed, Google Scholar, Web of Science, ScienceDirect, and Embase was performed for studies on the association between NOCs in drinking water and food sources and GI cancers. Forest plots of relative risk (RR) were constructed for all the cancer sites and the intake sources. The random-effects model was used to assess the heterogeneity between studies. Forty articles were included after removing duplicate and irrelevant articles. The meta-analysis indicated that the intake of high dose vs. low dose of these compounds was significantly associated with the overall GI cancer risk and nitrite (RR = 1.18, 95% CI = 1.07-1.29), and N-nitrosodimethylamine (NDMA) (RR = 1.32, 95% CI = 1.06-1.65). We found that dietary nitrite intake increased GC (RR = 1.33, 95% CI = 1.02-1.73), and EC (RR = 1.38, 95% CI = 1.01-1.89). Additionally, dietary NDMA intake increased the risk of CRC (RR = 1.36, 95% CI = 1.18-1.58). This meta-analysis provides some evidence that the intake of dietary and water nitrate, nitrite, and NOCs may be associated with GI cancers. In particular, dietary nitrite is linked to GC and EC risks and dietary NDMA intake is associated with CRC.

Nitrate contamination in drinking water and adverse reproductive and birth outcomes: a systematic review and meta-analysis

Exposure to low levels of nitrate in drinking water may have adverse reproductive effects. We reviewed evidence about the association between nitrate in drinking water and adverse reproductive outcomes published to November 2022. Randomized trials, cohort or case-control studies published in English that reported the relationship between nitrate intake from drinking water and the risk of perinatal outcomes were included. Random-effect models were used to pool data. Three cohort studies showed nitrate in drinking water is associated with an increased risk of preterm birth (odds ratio for 1 mg/L NO₃-N increased (OR₁) = 1.01, 95% CI 1.00, 1.01, I² = 23.9%, 5,014,487 participants; comparing the highest versus the lowest nitrate exposure groups pooled OR (OR_p) = 1.05, 95% CI 1.01, 1.10, I² = 0%, 4,152,348 participants). Case-control studies showed nitrate in drinking water may be associated with the increased risk of neural tube defects OR₁ = 1.06, 95% CI 1.02, 1.10; 2 studies, 2196 participants; I² = 0%; and OR_p = 1.51, 95% CI 1.12, 2.05; 3 studies, 1501 participants; I² = 0%). The evidence for an association between nitrate in drinking water and risk of small for gestational age infants, any birth defects, or any congenital heart defects was inconsistent. Increased nitrate in drinking water may be associated with an increased risk of preterm birth and some specific congenital anomalies. These findings warrant regular review as new evidence becomes available.

Appraisal of groundwater quality and health risk in the Yalamlam basin, Saudi Arabia

Groundwater quality in Yalamlam basin, Saudi Arabia, was appraised for drinking, irrigation, livestock and poultry applications by international standards, drinking water quality index (DWQI), irrigation water quality (IWQ) parameters, and irrigation water quality index (IWQI) calculations. Potential non-carcinogenic health risks due to high NO₃^- and F^- water were assessed for various age groups using the United States Environmental Protection Agency (USEPA) models. Groundwater samples (n = 40) were analyzed for pH, electrical conductivity (EC), and major and minor constituents. The average total dissolved solids (TDS), EC, and total hardness (TH) in the groundwater are 3478 µS/cm, 1739 mg/l, and 1240 mg/l, respectively. High salinity, TH, NO₃^-, and F^- in this aquifer restrict the usage of groundwater for drinking. DWQI values suggest that only 47.5% of samples are potable. According to USEPA recommendation, 72.5%, 80%, and 100% of samples for NO₃^- and 22.5%, 32.5%, and 40% of samples for F^- surpassed the limit (HQ_oral > 1) for adults, children, and infants, respectively, which creates non-carcinogenic health hazards to the respective age groups. The total hazard index is greater than one in 75%, 87.5%, and 100% of samples computed for adults, children, and infants, respectively. Due to high salinity, 53% of samples are not pertinent for irrigation. USSL classification reveals that groundwater samples in the study site are recommended only for salt-tolerant crops and coarse-textured high permeability soil. In this study, IWQI is reclassified using salinity, which suggests that 68% of samples are moderately suitable for irrigation. Based on EC alone, 83% are desirable for livestock and poultry uses whereas integration of multiple parameters with EC indicates that only 53% are acceptable for all kinds of livestock and poultry uses in the study site. Spatial distribution of major and minor ions, DWQI, HQ_oral, and IWQI imply that groundwater quality is degraded from upstream to downstream. High salinity groundwater in the downstream wells is unsuitable for any application, which needs a proper treatment before use. Spatial maps created for various parameters are useful for identifying the good quality groundwater zone for groundwater development potential for various stakeholders.

Association between vitamins and risk of brain tumors: A systematic review and dose-response meta-analysis of observational studies

Background

Brain tumor is one of the important causes of cancer mortality, and the prognosis is poor. Therefore, early prevention of brain tumors is the key to reducing mortality due to brain tumors.

Objective

This review aims to quantitatively evaluate the association between vitamins and brain tumors by meta-analysis.

Methods

We searched articles on PubMed, Cochrane Library, Web of Science, and Embase databases from inception to 19 December 2021. According to heterogeneity, the fixed-effects model or random-effects model was selected to obtain the relative risk of the merger. Based on the methods described by Greenland and Longnecker, we explored the dose-response relationship between vitamins and the risk of brain tumors. Subgroup analysis, sensitivity analysis, and publication bias were also used for the analysis.

Results

The study reviewed 23 articles, including 1,347,426 controls and 6,449 brain tumor patients. This study included vitamin intake and circulating concentration. For intake, it mainly included vitamin A, vitamin B, vitamin C, vitamin E, β-carotene, and folate. For circulating concentrations, it mainly included vitamin E and vitamin D in the serum (25-hydroxyvitamin D and α-tocopherol). For vitamin intake, compared with the lowest intakes, the highest intakes of vitamin C (RR = 0.81, 95%CI:0.66–0.99, I² = 54.7%, P_{for heterogeneity} = 0.007), β-carotene (RR = 0.78, 95%CI:0.66–0.93, I² = 0, P_{for heterogeneity} = 0.460), and folate (RR = 0.66, 95%CI:0.55–0.80, I² = 0, P_{for heterogeneity} = 0.661) significantly reduced the risk of brain tumors. For serum vitamins, compared with the lowest concentrations, the highest concentrations of serum α-tocopherol (RR = 0.61, 95%CI:0.44–0.86, I² = 0, P_{for heterogeneity} = 0.656) significantly reduced the risk of brain tumors. The results of the dose-response relationship showed that increasing the intake of 100 μg folate per day reduced the risk of brain tumors by 7% (P_{−nonlinearity} = 0.534, RR = 0.93, 95%CI:0.90–0.96).

Conclusion

Our analysis suggests that the intake of vitamin C, β-carotene, and folate can reduce the risk of brain tumors, while high serum α-tocopherol concentration also has a protective effect on brain tumors. Therefore, vitamins may provide new ideas for the prevention of brain tumors.

Systematic Review Registration

PROSPERO, identifier CRD42022300683.

Restoring groundwater quality at the drinking water catchment scale: A multidisciplinary and participatory approach

Preserving or restoring the quality of groundwater resources with regard to nitrate is a major challenge. To date, useful and easily applicable tools to identify the best measures to implement at local scale are lacking. An innovative methodology is proposed to identify cost-effective restoration measures at the drinking water catchment scale. The methodology is based on the articulation of two tools: a model simulating nitrate groundwater contamination time series and an economic evaluation, within a participatory approach. It was applied to a representative drinking water catchment in Northwest France that has been affected by nitrate contamination for decades. Five scenarios of measures (changes in fertilization and intercropping practices, or in cropping patterns) were co-constructed with stakeholders, evaluated in terms of cost and impact on groundwater nitrate concentration, and discussed with stakeholders. Overall, two scenarios stand out. Introducing hemp in crop rotations is the only scenario generating an economic benefit, but for a very low impact on nitrate concentration (decrease of 4 mg/l by 2050 for 10% of hemp in crop rotations). Introducing alfalfa in crop rotations is the most effective measure to decrease nitrate concentration (decrease of 23 mg/l by 2050 for 20% of alfalfa in crop rotations), and for a moderate cost compared to the other scenarios (25-51 €/ha/year). Results show that substantial changes in cropping patterns - more important than those imagined initially by stakeholders (e.g. converting 40% of cropland to alfalfa) are needed to restore groundwater quality targets in the medium-long term. Measures deemed promising and achievable by the stakeholders proved to be insufficiently effective. The approach developed has been shown to provide valued and trusted information to stakeholders and to objectify debates. Stakeholders have shown interest in the evaluation of costs and further socio-economic information, in addition to the evaluation of the effectiveness of measures on groundwater quality, validating the multidisciplinary dimension of the approach. The approach has the advantage of being easy to implement, and is therefore applicable to other study sites where needed.

Association Between Dietary Nitrite intake and Glioma Risk: A Systematic Review and Dose-Response Meta-Analysis of Observational Studies

Background

Nitrite and nitrate intake through food and water may be an important risk factor for many cancers, including glioma. However, the association of nitrite and nitrate with glioma is unclear.

Objective

This review aimed to quantitatively assess the effects of nitrite and nitrate on glioma by meta-analysis.

Methods

A literature search was conducted for available articles published in English using the databases of Embase, Web of Science, PubMed, Medline, and the Cochrane Library up to 24 March 2022. According to heterogeneity, the fixed-effects or random-effects model was selected to obtain the merger’s relative risk (RR). Based on the methods described by Greenland and Longnecker, we explored the dose-response relationship between nitrite/nitrate and the risk of glioma. Subgroup analysis, sensitivity analysis, and publication bias tests were also used.

Results

This study reviewed 17 articles, including 812,107 participants and 4,574 cases. For glioma in adults, compared with the lowest intakes, the highest intakes of nitrite significantly increased the risk of glioma (RR=1.26, 95% confidence interval (95%CI):1.09-1.47). For brain tumors in children, compared with the lowest intakes, the highest intakes of nitrate significantly increased the risk of brain tumors (RR=1.27, 95%CI:1.06-1.52). The results of subgroup and sensitivity analyses remained unchanged. In the dose-response relationship, per 1 mg/day increase in nitrite intake increased the risk of glioma by 14% (RR=1.14, 95%CI:1.01-1.27).

Conclusions

Our analysis suggests that nitrite increases the risk of glioma in adults, while nitrate increases the risk of brain tumors in children. Therefore, the effects of nitrite and nitrate on glioma cannot be ignored.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022320295.

Association between Dietary Nitrate, Nitrite Intake, and Site-Specific Cancer Risk: A Systematic Review and Meta-Analysis

Background: People consume nitrates, nitrites, nitrosamines, and NOCs compounds primarily through processed food. Many studies have yielded inconclusive results regarding the association between cancer and dietary intakes of nitrates and nitrites. This study aimed to quantify these associations across the reported literature thus far. Methods: We performed a systematic review following PRISMA and MOOSE guidelines. A literature search was performed using Web of Science, Embase, PubMed, the Cochrane library, and google scholar up to January 2020. STATA version 12.0 was used to conduct meta-regression and a two-stage meta-analysis. Results: A total of 41 articles with 13 different cancer sites were used for analysis. Of these 13 cancer types/sites, meta-regression analysis showed that bladder and stomach cancer risk was greater, and that pancreatic cancer risk was lower with increasing nitrite intakes. Kidney and bladder cancer risk were both lower with increasing nitrate intakes. When comparing highest to lowest (reference) categories of intake, meta-analysis of studies showed that high nitrate intake was associated with an increased risk of thyroid cancer (OR = 1.40, 95% CI: 1.02, 1.77). When pooling all intake categories and comparing against the lowest (reference) category, higher nitrite intake was associated with an increased risk of glioma (OR = 1.12, 95% CI: 1.03, 1.22). No other associations between cancer risk and dietary intakes of nitrates or nitrites were observed. Conclusion: This study showed varied associations between site-specific cancer risks and dietary intakes of nitrate and nitrite. Glioma, bladder, and stomach cancer risks were higher and pancreatic cancer risk was lower with higher nitrite intakes, and thyroid cancer risk was higher and kidney cancer risk lower with higher nitrate intakes. These data suggest type- and site-specific effects of cancer risk, including protective effects, from dietary intakes of nitrate and nitrite.