Infant Methemoglobinemia: The Role of Dietary Nitrate in Food and Water

Abstract

ABSTRACT. Infants for whom formula may be prepared with well water remain a high-risk group for nitrate poisoning. This clinical report reinforces the need for testing of well water for nitrate content. There seems to be little or no risk of nitrate poisoning from commercially prepared infant foods in the United States. However, reports of nitrate poisoning from home-prepared vegetable foods for infants continue to occur. Breastfeeding infants are not at risk of methemoglobinemia even when mothers ingest water with very high concentrations of nitrate nitrogen (100 ppm). Pediatrics 2005;116: 784-786; methemoglobinemia.

Nitrate and Nitrite Content of Human, Formula, Bovine, and Soy Milks: Implications for Dietary Nitrite and Nitrate Recommendations

“…Maternal nitrate and nitrite intakes are not reflected in nitrate and nitrite composition of human milk. 1 The data supporting this conclusion are sparse. One study published on this topic demonstrated that women who consumed water with a nitrate concentration <100 mg/L did not produce milk with elevated nitrate levels.…”

“…Historically, health risks due to nitrates in groundwater have been associated with risk of methemoglobinemia (blue-baby syndrome) in children; 1 consumption of nitrites and nitrates in processed meats, used to enhance flavor and prevent microbial growth, is associated with a modest increased risk of gastrointestinal cancer and chronic obstructive pulmonary disease. [2][3][4] The health risks due to excessive nitrite and nitrate consumption in these specific population subgroups led to regulatory limits on the permissible concentration of nitrate in drinking water (50 mg of nitrate/L in the European Union, 44 mg/L in the United States) in accordance with World Health Organization(WHO) recommendations first established in 1970 and reaffirmed in 2004.…”

Acquired methemoglobinemia in infants

“…Repeated doses were not necessary. Mean recovery time was 10.2±3.5 [4][5][6][7][8][9][10][11][12][13][14][15][16] hours. The plasma G6PD levels were normal in all neonates.…”

“…NADPH-MetHb reductase has a more important role in MetHb regulation in infants with cytochrome b5 reductase deficiency. MetHb has an increased affinity for oxygen, and causes a leftward shift in the oxygen dissociation curve, and hypoxemia and lactic acidosis develop [1,2,6]. If MetHb level is higher than 10%, cyanosis occurs, and a MetHb level of 70% is lethal.…”

The Surgeon General's Call to Action To Promote Healthy Homes 2009

“…The presence of contaminants in water can lead to other adverse health effects; for example, pesticides can cause reproductive problems (Casarett and Doull 1991), polychlorinated biphenyls and lead can cause neurological disorders (Chevrier et al 2007), and nitrates can cause methemoglobinemia or "blue baby syndrome" (Greer et al 2005). Water contamination has many sources, including naturally occurring chemicals and minerals (e.g., arsenic, radon, uranium), local land-use practices (e.g., fertilizers, nitrates, pesticides, concentrated animal feeding operations), manufacturing processes, sewer overflow, and malfunctioning wastewater treatment systems (e.g., septic systems).…”