Exposure to Perchlorate, Nitrate and Thiocyanate, and Prevalence of Diabetes Mellitus

Int J Epidemiol. 2017 Dec 1;46(6):1913-1923. doi: 10.1093/ije/dyx188.


Background: It is known that perchlorate, nitrate and thiocyanate have the property of inhibiting sodium iodide symporter. Animal studies have suggested that these compounds, especially perchlorate, might also interfere with insulin secretion. However, the association between their exposure and diabetes risk is largely unknown in humans.

Methods: Among 11 443 participants (mean age 42.3 years) from the National Health and Nutritional Examination Survey 2001-14, urinary perchlorate, nitrate and thiocyanate were measured by using ion chromatography coupled with electrospray tandem mass spectrometry. Diabetes was defined as self-reported doctor diagnosis, use of oral hypoglycaemic medication or insulin, fasting plasma glucose ≥ 126 mg/dl or glycated haemoglobin A1c (HbA1c) ≥ 6.5%.

Results: The median (interquartile range) levels of urinary perchlorate, nitrate and thiocyanate were 3.32 (1.84, 5.70) μg/l, 46.4 (27.9, 72.0) mg/l and 1.23 (0.59, 2.78) mg/l, respectively. Higher levels of urinary perchlorate were associated with elevated levels of fasting glucose, HbA1c, insulin and homeostatic model assessment of insulin resistance (all Ptrend < 0.001). After multivariate adjustment including urinary creatinine, smoking status and body mass index (BMI), higher urinary perchlorate, but not nitrate or thiocyanate, was associated with an increased prevalence of diabetes mellitus. Comparing extreme quintiles, the odds ratio (95% confidence interval) of diabetes was 1.53 (1.21, 1.93; Ptrend < 0.001) for perchlorate, 1.01 (0.77, 1.32; Ptrend = 0.44) for nitrate and 0.98 (0.73, 1.31; Ptrend = 0.64) for thiocyanate. When urinary perchlorate, nitrate and thiocyanate were further mutually adjusted, the results did not materially change. Similar results were observed when analyses were stratified by smoking status, as well as by age, gender, kidney function and BMI.

Conclusions: Higher urinary perchlorate levels are associated with an increased prevalence of diabetes mellitus, independent of traditional risk factors. Future prospective studies are needed to confirm these findings.

Keywords: Perchlorate; diabetes; epidemiology; insulin resistance; nitrate; thiocyanate.

MeSH terms

  • Adult
  • Diabetes Mellitus / epidemiology*
  • Environmental Exposure*
  • Female
  • Humans
  • Insulin Resistance
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Nitrates / urine*
  • Nutrition Surveys
  • Perchlorates / urine*
  • Symporters / antagonists & inhibitors
  • Thiocyanates / urine*
  • United States / epidemiology


  • Nitrates
  • Perchlorates
  • Symporters
  • Thiocyanates
  • sodium-iodide symporter