The hypothesis that endogenous synthesis of nitrosamines from dietary precursors is a risk factor for nasopharyngeal carcinoma (NPC) in China was tested by applying the nitrosoproline (NPRO) test to subjects living in high- and low-risk districts for NPC in Zangwu county, Guangxi region, in southern China. Samples of 12-h urine were collected from 77 subjects: (a) before any treatment; (b) after ingestion of proline; and (c) after ingestion of proline together with vitamin C. NPRO, other nitrosamino acids, and nitrate were measured as indices of exposure to preformed and endogenously formed nitrosamines or their precursors. The NPRO level after proline intake was significantly increased in subjects from the high-risk area (P = 0.012) and markedly reduced after ingestion of ascorbic acid (P = 0.007), but such an effect was not seen in subjects from the low-risk area. Levels of N-nitrosothiazolidine-4-carboxylic acid and the sum of nitrosamino acids in subjects in the high-risk area were significantly reduced by ascorbic acid (P < 0.01) but were not reduced in subjects from the low-risk area. The urinary nitrate level was about twice as high in subjects from the high-risk area. In subjects from high- and low-risk areas combined, NPRO levels in any of the three dose groups were highly correlated with nitrate levels (P = 0.0001). These results demonstrate a higher potential for endogenous nitrosation in subjects living in the high-risk area of NPC and suggest the occurrence of nitrosation inhibitors in the diet consumed in the low-risk area.(ABSTRACT TRUNCATED AT 250 WORDS)

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