Nitrate in Baby Foods

Case Report: Clinical presentations of cyanosis associated with acquired methemoglobinemia in infants—a clinical challenge

“…Notably, the clinical presentations of younger infants with acquired methemoglobinemia might be more severe. They had low stomach acid production, large numbers of nitrite-reducing bacteria, the relatively easy oxidation of fetal hemoglobin, and immaturity of the methemoglobin reductase system ( 18 – 20 ). In this study, we described a rare case of a 49-day-old infant who developed acquired methemoglobinemia, presenting with central cyanosis, due to the inappropriate preparation of her milk formula with spinach juice.…”

“…It was speculated that these infants produced low levels of stomach acid and had amounts of nitrite-reducing bacteria. In addition, infants have higher levels of fetal hemoglobin, presenting with relatively easy oxidation than adult hemoglobin, and their methemoglobin reductase system remains immature with lower levels of erythrocyte CYB5R activity ( 18 – 20 ). Considering our case, she was previously healthy without infectious disease, diarrhea, or drug administration and did not have G6PD deficiency.…”

The Dose Makes the Poison: A Case Report of Acquired Methemoglobinemia

“…Risk of MET development occurs when the diet is mainly based on vegetables containing very large amounts of nitrates, and/or when the storage of previously prepared vegetable-based foods is suboptimal. Infants under 6 months of age are the subjects with the greatest risk, as they have low stomach acid production, more nitrate-reducing bacteria in the gut microbiota, incomplete development of the methemoglobin reductase system, and a certain amount of fetal hemoglobin that is more easily oxidized [9][10][11]. However, as weaning is not recommended before the 6th month of life [12], vegetable-induced MET may occur in older children in whom it is likely that some of the factors that favor nitrite formation tend to persist [13].…”

Statement on possible public health risks for infants and young children from the presence of nitrates in leafy vegetables

“…These factors combine to place very young infants at greater risk for MetHb formation (Johnson and Kross, 1990;Zeman et al, 2002). However, as a consequence of milk feeding, and in the absence of any nutritional indication to add complementary foods to the diet of healthy term infants before 4 to 6 months of age (Philipps, 1971;Dusdieker et al, 1994), very young infants (up to 3 months) are not considered to be at significant risk of nitrate intoxication from vegetables. Consequently, this age group is not discussed further in this Statement.…”