Vitamin C intake modify the impact of dietary nitrite on the incidence of type 2 diabetes: A 6-year follow-up in Tehran Lipid and Glucose Study

Nitric Oxide. 2017 Jan 30;62:24-31. doi: 10.1016/j.niox.2016.11.005. Epub 2016 Dec 2.


Background: There is no epidemiological study on the association between dietary nitrate (NO3) and nitrite (NO2) and intakes and the risk of type 2 diabetes (T2D).

Objective: The aim of this study was therefore to examine the potential effect of dietary NO3 and NO2 on the occurrence of T2D.

Design: This longitudinal study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) on 2139 T2D-free adults, aged 20-70 years, followed for a median of 5.8 y. Dietary intakes of NO3 and NO2 were estimated using a 168-food items validate semi-quantitative food frequency questionnaire, at baseline. Multivariate Hazard Ratios (HR) and 95% confidence intervals (CI), adjusted for diabetes risk score (DRS), and dietary intakes of fat, fiber and vitamin C, were calculated for residual energy-adjusted NO3 and NO2 intakes. Since significant interaction (P = 0.024) was found between NO2 and vitamin C intakes in the multivariable model, stratified analyses were done for < and ≥ median vitamin C intakes.

Results: Median (inter quartile range; IQR) daily intake of NO3 and NO2 were 410 mg/d (343-499) and 8.77 mg/d (7.53-10.2). An increased risk of T2D was observed among participants who had higher intake of total and animal-based NO2 in participants who had low vitamin C intake (HR = 2.43, 95% CI = 1.45-4.05, HR = 1.88, 95% CI = 1.12-3.15, respectively). We found no significant association between NO3 in overall, and plant- and animal sources as well, with the risk of T2D. Plant-derived NO2 was also unrelated to incidence of T2D.

Conclusion: Our findings indicated that higher intakes of total and animal-based NO2 may be an independent dietary risk factor for development of T2D in subjects with lower vitamin C intakes.

Keywords: Nitrate; Nitrite; Type 2 diabetes; Vitamin C.

MeSH terms

  • Adult
  • Aged
  • Ascorbic Acid / administration & dosage*
  • Blood Glucose / analysis
  • Diabetes Mellitus, Type 2 / chemically induced
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Dietary Supplements*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Iran / epidemiology
  • Longitudinal Studies
  • Middle Aged
  • Nitrates / administration & dosage
  • Nitrites / adverse effects*
  • Young Adult


  • Blood Glucose
  • Nitrates
  • Nitrites
  • Ascorbic Acid