Epidemiological and toxicological aspects of nitrates and nitrites in the environment

Neutrality and impartiality in Midwestern U.S. newspapers: community-oriented newspaper journalists reporting of environmental water problems in agricultural and ranching states

BACKGROUND

U.S. journalists embedded in rural and agricultural communities could adversely affect the health of residents if they avoid alerting and engaging their readers - farmers, ranchers, and community members - on environmental and health issues. We expected reporters would maintain community status quo and inaction by framing local water pollution and quality issues neutrally deemphasizing threats and solutions to maintain their own credibility as unbiased informational sources.

METHOD

In a content analysis of local water quality newspaper articles from five farming and cattle ranching states in the west central U.S. Midwest, we employed seven variables to investigate whether journalists practiced neutral, detached forms of journalism (i.e. dissemination versus interpretative role enactment, government-frame) as well as whether they deemphasized water pollution as a concerning issue (i.e. problem, threat), water pollution solutions, and readers' efficaciousness.

RESULTS

The results showed these journalists relied heavily on government-driven narratives presenting water quality issues from an impartial, straight reporting lens in which they primarily followed the journalistic dissemination role enactment, while neglecting to provide readers with interpretative, threat, efficacy, or solution's information.

CONCLUSIONS

The study seeks to help communicators understand the information diet people living in this part of the country likely receive on environmental and health risks in the context of water pollution. Communicators seeking to reach and affect audiences in this region should understand local information practices to navigate how to craft culturally specific public health messages.

The Role of Nutrition in the Development and Management of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a prevalent lung condition associated with significant morbidity and mortality. The management of COPD classically involves pulmonary rehabilitation, bronchodilators, and corticosteroids. An aspect of COPD management that is currently lacking in the literature is nutritional management, despite the prevalence of inadequate nutritional status in patients with COPD. In addition, certain nutritional imbalances have been reported to increase the risk of COPD development. This review summarizes the current literature on the role diet and nutrients may play in the risk and management of COPD development.

Does prenatal exposure to multiple airborne and tap-water pollutants increase neonatal thyroid-stimulating hormone concentrations? Data from the Picardy region, France

OBJECTIVE

Systematic screening for congenital hypothyroidism by heel-stick sampling has revealed unexpected heterogeneity in the geographic distribution of newborn thyroid-stimulating hormone concentrations in Picardy, France. We explored a possible relationship with environmental pollutants.

METHODS

Zip code geolocation data from mothers of newborns without congenital hypothyroidism born in 2021 were linked to ecological data for a set of airborne (particulate matter with a diameter of 2.5 μm or less [PM2.5] or 10 μm or less [PM10]) and tap-water (nitrate and perchlorate ions and atrazine) pollutants. Statistical associations between mean exposure levels during the third trimester of pregnancy and Thyroid-stimulating hormone (TSH) concentrations in 6249 newborns (51 % male) were investigated using linear regression models.

RESULTS

Median neonatal TSH concentration (interquartile range, IQR) was 1.7 (1-2.8) mIU/L. An increase of one IQR in prenatal exposure to perchlorate ions (3.6 μg/L), nitrate ions (19.2 mg/L), PM2.5 (3.7 μg/m3) and PM10 (3.4 μg/m3), were associated with increases in TSH concentrations of 2.30 % (95 % CI: 0.95-3.66), 5.84 % (95 % CI: 2.81-8.87), 13.44 % (95 % CI: 9.65-17.28) and 6.26 % (95 % CI: 3.01-9.56), respectively.

CONCLUSIONS

Prenatal exposure to perchlorate and nitrate ions in tap water and to airborne PM over the third trimester of pregnancy was significantly associated with increased neonatal TSH concentrations.

The Possible Role of Food and Diet in the Quality of Life in Patients with COPD-A State-of-the-Art Review

Diet has been described as a modifiable risk factor for the development and progression of chronic diseases, and emerging evidence increasingly points to its preventive and therapeutic role in chronic obstructive pulmonary disease (COPD). While the relationship between the underlying disease and diet is natural in conditions such as metabolic disorders, obesity, diabetes, etc., the direct effect is not so evident in chronic obstructive pulmonary disease. Poor diet quality and the development of nutrient deficiencies in respiratory diseases, including COPD, can be associated with disease-specific factors such as the exacerbation of respiratory symptoms. These symptoms can be improved by dietary interventions, leading to positive changes in the pathogenesis of the disease and the quality of life of patients. Therefore, our aim was to review the latest randomized controlled trials (RCTs) of dietary interventions in chronic respiratory patients and describe their effects on respiratory function, physical activity, systemic inflammatory parameters, and quality of life. We conducted a literature search on dietary interventions for COPD patients in the PubMed, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL) databases, focusing on publications from 1 July 2018 to 1 July 2023. We used specific keywords and MESH terms, focusing on RCTs. A total of 26 articles and 1811 COPD patients were included in this review. On the basis of our findings, dietary interventions, in particular components of the Mediterranean diet such as protein, omega-3 polyunsaturated fatty acids, and vegetables, appear to have beneficial effects in patients with chronic respiratory diseases, and their application is beneficial. However, long-term follow-up studies are still needed to examine the effects of dietary interventions in this patient population.

Nutritional State and COPD: Effects on Dyspnoea and Exercise Tolerance

Chronic Obstructive Pulmonary Disease (COPD) is a disease that is spreading worldwide and is responsible for a huge number of deaths annually. It is characterized by progressive and often irreversible airflow obstruction, with a heterogeneous clinical manifestation based on disease severity. Along with pulmonary impairment, COPD patients display different grades of malnutrition that can be linked to a worsening of respiratory function and to a negative prognosis. Nutritional impairment seems to be related to a reduced exercise tolerance and to dyspnoea becoming a major determinant in patient-perceived quality of life. Many strategies have been proposed to limit the effects of malnutrition on disease progression, but there are still limited data available to determine which of them is the best option to manage COPD patients. The purpose of this review is to highlight the main aspects of COPD-related malnutrition and to underline the importance of poor nutritional state on muscle energetics, exercise tolerance and dyspnoea.

Probabilistic risk and benefit assessment of nitrates and nitrites by integrating total diet study-based exogenous dietary exposure with endogenous nitrite formation using toxicokinetic modeling

The impacts of dietary nitrates and nitrites on human health have been a controversial topic for many years. However, the risk and benefit assessment of nitrates and nitrites is complicated by the large variation in nitrate and nitrite intake among people and the endogenous nitrite formation in the body. This study conducted a probabilistic risk-benefit assessment of dietary nitrates and nitrites based on internal dose by integrating exogenous and endogenous exposures with human trial data on cardiovascular benefits. A total diet study was carried out to quantify the age-specific dietary intakes of nitrates and nitrites. A previously well-validated human toxicokinetic model was used to predict internal doses for different age groups. In addition, the integrated approach was applied to different populations from different countries/regions based on reported exposure estimates to conduct a comprehensive risk-benefit assessment of dietary nitrates and nitrites. The results demonstrated that vegetable consumption was the main contributor to the internal nitrate and nitrite levels in all age groups. Exposure to nitrates and nitrites exceeding acceptable daily intakes in a variety of foods showed cardiovascular benefits. The probabilistic risk assessment showed that the exposure to nitrates and nitrites did not pose an appreciable health and safety risk. Therefore, the present results suggest that dietary nitrates and nitrites have clear cardiovascular benefits that may outweigh potential risks. Our analysis contributes significantly to addressing the controversy regarding risks and benefits from dietary nitrates and nitrites, and our approach could be applied to other dietary constituents with the potential for both risks and benefits.

Frontiers in assessing septic systems vulnerability in coastal Georgia, USA: Modeling approach and management implications

Threats to public health and environmental quality from septic systems are more prevalent in areas with poorly draining soils, high water tables, or frequent flooding. Significant research gaps exist in assessing these systems’ vulnerability and evaluating factors associated with higher rates of septic systems replacement and repair. We developed a novel GIS-based framework for assessing septic system vulnerability using a database of known septic system specifications and a modified Soil Topographic Index (STI) that incorporates seasonal high groundwater elevation to assess risks posed to septic systems in coastal Georgia. We tested the hypothesis that both the modified STI and septic system specifications such as tank capacity per bedroom and drainfield type would explain most of the variance in septic system repair and replacement using classification inference tree and generalized logistic regression models. Our modeling results indicate that drainfield type (level vs. mounded) is the most significant variable (p-value < 0.001) in predicting septic systems functionality followed by septic tank capacity per bedroom (p-value < 0.01). These show the importance of septic system design regulations such as a minimum requirement for horizontal separation distance between the bottom of trenches and seasonal water table, and adequate tank capacity design. However, for septic systems with a mounded drainfield and a larger tank capacity per bedroom, the modified STI representing hydrological characteristics of septic system location is a significant predictor of a high septic system repair and replacement rate. The methodology developed in this study can have important implications for managing existing septic systems and planning for future development in coastal areas, especially in an environment of rapid climatic change.

Role of Diet in Chronic Obstructive Pulmonary Disease Prevention and Treatment

Chronic obstructive pulmonary disease is one of the leading causes of morbidity and mortality worldwide and a growing healthcare problem. Identification of modifiable risk factors for prevention and treatment of COPD is urgent, and the scientific community has begun to pay close attention to diet as an integral part of COPD management, from prevention to treatment. This review summarizes the evidence from observational and clinical studies regarding the impact of nutrients and dietary patterns on lung function and COPD development, progression, and outcomes, with highlights on potential mechanisms of action. Several dietary options can be considered in terms of COPD prevention and/or progression. Although definitive data are lacking, the available scientific evidence indicates that some foods and nutrients, especially those nutraceuticals endowed with antioxidant and anti-inflammatory properties and when consumed in combinations in the form of balanced dietary patterns, are associated with better pulmonary function, less lung function decline, and reduced risk of COPD. Knowledge of dietary influences on COPD may provide health professionals with an evidence-based lifestyle approach to better counsel patients toward improved pulmonary health.

Safety assessment of antioxidants and color fixatives for the Korean population using dietary intake monitoring

Food additives such as antioxidants and color fixatives are substances used in food intentionally for technical effect, such as decolorizing or intensifying the color of food. Based on the necessity of re-evaluating food additives for safety and to improve consumer perception, we conducted safety assessments for food additives according to the Risk Assessment Guidelines of the Korean Ministry of Food and Drug Safety. These safety assessments evaluated new risk information based on toxicology data and estimates of dietary intake exposures to food additives in comparison with the acceptable daily intake (ADI). Estimated daily intakes (EDI) of food additives were calculated using food consumption data for the Korean population derived from the Korea National Health and Nutrition Examination Survey and monitoring data based on the analysis of food additives in food products. Unlike contaminants, antioxidants and color fixatives are purposely added as food additives, and they are largely consumed in processed foods. Therefore, EDI was compared with ADI to investigate the likelihood of potentially hazardous effects in humans. The risk likelihoods of food additives, evaluated by comparing the EDI with the ADI, were less than 2% in the total population. Thus, exposure levels to antioxidants and color fixatives do not exceed the ADI. Based on the safety assessments conducted in this study, we estimate exposure to food additives to be within safe limits for all population groups.

The role of inorganic nitrate and nitrite in CVD

CVD is the leading cause of death worldwide, a consequence of mostly poor lifestyle and dietary behaviours. Although whole fruit and vegetable consumption has been consistently shown to reduce CVD risk, the exact protective constituents of these foods are yet to be clearly identified. A recent and biologically plausible hypothesis supporting the cardioprotective effects of vegetables has been linked to their inorganic nitrate content. Approximately 60–80 % inorganic nitrate exposure in the human diet is contributed by vegetable consumption. Although inorganic nitrate is a relatively stable molecule, under specific conditions it can be metabolised in the body to produce NO via the newly discovered nitrate–nitrite–NO pathway. NO is a major signalling molecule in the human body, and has a key role in maintaining vascular tone, smooth muscle cell proliferation, platelet activity and inflammation. Currently, there is accumulating evidence demonstrating that inorganic nitrate can lead to lower blood pressure and improved vascular compliance in humans. The aim of this review is to present an informative, balanced and critical review of the current evidence investigating the role of inorganic nitrate and nitrite in the development, prevention and/or treatment of CVD. Although there is evidence supporting short-term inorganic nitrate intakes for reduced blood pressure, there is a severe lack of research examining the role of long-term nitrate intakes in the treatment and/or prevention of hard CVD outcomes, such as myocardial infarction and cardiovascular mortality. Epidemiological evidence is needed in this field to justify continued research efforts.

Re-evaluation of potassium nitrite (E 249) and sodium nitrite (E 250) as food additives

The Panel on Food Additives and Nutrient Sources added to Food (ANS) provided a scientific opinion re-evaluating the safety of potassium nitrite (E 249) and sodium nitrite (E 250) when used as food additives. The ADIs established by the SCF (1997) and by JECFA (2002) for nitrite were 0-0.06 and 0-0.07 mg/kg bw per day, respectively. The available information did not indicate in vivo genotoxic potential for sodium and potassium nitrite. Overall, an ADI for nitrite per se could be derived from the available repeated dose toxicity studies in animals, also considering the negative carcinogenicity results. The Panel concluded that an increased methaemoglobin level, observed in human and animals, was a relevant effect for the derivation of the ADI. The Panel, using a BMD approach, derived an ADI of 0.07 mg nitrite ion/kg bw per day. The exposure to nitrite resulting from its use as food additive did not exceed this ADI for the general population, except for a slight exceedance in children at the highest percentile. The Panel assessed the endogenous formation of nitrosamines from nitrites based on the theoretical calculation of the NDMA produced upon ingestion of nitrites at the ADI and estimated a MoE > 10,000. The Panel estimated the MoE to exogenous nitrosamines in meat products to be < 10,000 in all age groups at high level exposure. Based on the results of a systematic review, it was not possible to clearly discern nitrosamines produced from the nitrite added at the authorised levels, from those found in the food matrix without addition of external nitrite. In epidemiological studies there was some evidence to link (i) dietary nitrite and gastric cancers and (ii) the combination of nitrite plus nitrate from processed meat and colorectal cancers. There was evidence to link preformed NDMA and colorectal cancers.

Hell and High Water: Diminished Septic System Performance in Coastal Regions Due to Climate Change

Climate change may affect the ability of soil-based onsite wastewater treatment systems (OWTS) to treat wastewater in coastal regions of the Northeastern United States. Higher temperatures and water tables can affect treatment by reducing the volume of unsaturated soil and oxygen available for treatment, which may result in greater transport of pathogens, nutrients, and biochemical oxygen demand (BOD₅) to groundwater, jeopardizing public and aquatic ecosystem health. The soil treatment area (STA) of an OWTS removes contaminants as wastewater percolates through the soil. Conventional STAs receive wastewater from the septic tank, with infiltration occurring deeper in the soil profile. In contrast, shallow narrow STAs receive pre-treated wastewater that infiltrates higher in the soil profile, which may make them more resilient to climate change. We used intact soil mesocosms to quantify the water quality functions of a conventional and two types of shallow narrow STAs under present climate (PC; 20°C) and climate change (CC; 25°C, 30 cm elevation in water table). Significantly greater removal of BOD₅ was observed under CC for all STA types. Phosphorus removal decreased significantly from 75% (PC) to 66% (CC) in the conventional STA, and from 100% to 71–72% in shallow narrow STAs. No fecal coliform bacteria (FCB) were released under PC, whereas up to 17 and 20 CFU 100 mL^-1 were released in conventional and shallow narrow STAs, respectively, under CC. Total N removal increased from 14% (PC) to 19% (CC) in the conventional STA, but decreased in shallow narrow STAs, from 6–7% to less than 3.0%. Differences in removal of FCB and total N were not significant. Leaching of N in excess of inputs was also observed in shallow narrow STAs under CC. Our results indicate that climate change can affect contaminant removal from wastewater, with effects dependent on the contaminant and STA type.

NO-Rich Diet for Lifestyle-Related Diseases

Decreased nitric oxide (NO) availability due to obesity and endothelial dysfunction might be causally related to the development of lifestyle-related diseases such as insulin resistance, ischemic heart disease, and hypertension. In such situations, instead of impaired NO synthase (NOS)-dependent NO generation, the entero-salivary nitrate-nitrite-NO pathway might serve as a backup system for NO generation by transmitting NO activities in the various molecular forms including NO and protein S-nitrosothiols. Recently accumulated evidence has demonstrated that dietary intake of fruits and vegetables rich in nitrate/nitrite is an inexpensive and easily-practicable way to prevent insulin resistance and vascular endothelial dysfunction by increasing the NO availability; a NO-rich diet may also prevent other lifestyle-related diseases, including osteoporosis, chronic obstructive pulmonary disease (COPD), and cancer. This review provides an overview of our current knowledge of NO generation through the entero-salivary pathway and discusses its safety and preventive effects on lifestyle-related diseases.

Proposed toxic and hypoxic impairment of a brainstem locus in autism

Electrophysiological findings implicate site-specific impairment of the nucleus tractus solitarius (NTS) in autism. This invites hypothetical consideration of a large role for this small brainstem structure as the basis for seemingly disjointed behavioral and somatic features of autism. The NTS is the brain's point of entry for visceral afference, its relay for vagal reflexes, and its integration center for autonomic control of circulatory, immunological, gastrointestinal, and laryngeal function. The NTS facilitates normal cerebrovascular perfusion, and is the seminal point for an ascending noradrenergic system that modulates many complex behaviors. Microvascular configuration predisposes the NTS to focal hypoxia. A subregion--the "pNTS"--permits exposure to all blood-borne neurotoxins, including those that do not readily transit the blood-brain barrier. Impairment of acetylcholinesterase (mercury and cadmium cations, nitrates/nitrites, organophosphates, monosodium glutamate), competition for hemoglobin (carbon monoxide, nitrates/nitrites), and higher blood viscosity (net systemic oxidative stress) are suggested to potentiate microcirculatory insufficiency of the NTS, and thus autism.

Hepatoprotective effects of cod liver oil against sodium nitrite toxicity in rats

CONTEXT

Exposure to high levels of nitrites for a prolonged time have adverse health effects on several organs especially the liver due to oxidative properties. Meanwhile, cod liver oil has been reported to ameliorate organ dysfunction in animal models that involve oxidative stress.

OBJECTIVE

Examine the impact of dietary cod liver oil on sodium nitrite-induced liver damage.

MATERIALS AND METHODS

Thirty-two adult male Sprague-Dawely rats were daily treated with sodium nitrite (80 mg/kg) in presence or absence of cod liver oil (5 ml/kg). Morphological changes were assessed in liver sections. Oxidative stress and antioxidant markers were measured in serum and liver homogenates. Liver samples were used for measurements of MCP-1, DNA fragmentation and mitochondrial function.

RESULTS

The hepatoprotective effect of cod liver oil was proved by significant reduction of elevated liver enzymes and normal appearance of hepatocytes. Cod liver oil significantly reduced hepatic malondialdehyde, hydrogen peroxide and superoxide anion (224.3 ± 18.9 nmol/g, 59.3 ± 5.1 and 62.5 ± 5.1 µmol/g, respectively) compared with sodium nitrite (332.5 ± 25.5 nmol/g, 83.1 ± 8.1 and 93.9 ± 6.5 µmol/g, respectively). Cod liver oil restored hepatic cytochrome c oxidase activity after 38% reduction by sodium nitrite. Furthermore, cod liver oil significantly reduced hepatic MCP-1 (79.8 pg/mg) and DNA fragmentation (13.8%) compared with sodium nitrite (168.7 pg/mg and 41.3%, respectively).

DISCUSSION AND CONCLUSION

Cod liver oil ameliorates sodium nitrite induced hepatic impairment through several mechanisms including attenuation of oxidative stress, blocking MCP-1, reactivation of mitochondrial function and reduction of DNA fragmentation.

Role of ceruloplasmin in nitric oxide metabolism in plasma of humans and sheep: a comparison of adults and fetuses

Nitric oxide (NO) is metabolized in plasma, in part by the ferroxidase ceruloplasmin (Cp), to form nitrite and nitrosothiols (SNOs), which are proposed to mediate protective responses to hypoxia and ischemia. We hypothesized that NO metabolism would be attenuated in fetal plasma due to low Cp activity. We measured Cp concentrations and activity in plasma samples collected from adults and fetuses of humans and sheep. We then added NO ([NO]: 1.5 or 100 μM) to plasma and aqueous buffer and measured rates of NO disappearance and the production of nitrite and SNO. Cp concentrations in fetal plasma were <15% of adult levels. In aqueous buffer, 1.5 μM NO disappeared with a half-life of 347 ± 64 s (means ± SE) but in plasma of humans the half-life was 19 ± 2 s (adult) and 11 ± 1 s (fetus, P = 0.004) and in sheep it was 31 ± 3 s (adult) and 43 ± 5 s (fetus, P = 0.04). Cp activity was not correlated with the overall elimination half-life of NO or with the amount of SNO ([NO]: 100 μM) or nitrite ([NO]: 1.5 or 100 μM) produced but correlated with SNO yields at 1.5 μM [NO] (r = 0.92, P = 0.04). Our data demonstrate that Cp is not essential to the increased rate of metabolism of NO in plasma relative to aqueous buffers and that it is not essential to the production of nitrite from NO. Cp may be involved in the conversion of NO to SNO in plasma under near-physiological concentrations of NO.

Histopathological changes in the liver of rabbits exposed to high nitrate ingestion in drinking water

OBJECTIVES

In India, especially in Rajasthan, people drink water which contains high level of nitrates and the possibility of finding concentrations of up to 500 mg of nitrate ions per litre of water is not unusual. Excessive use of nitrate fertilisers and herbicides results in accumulation of nitrate in plants and methemoglobinaemia in cattle as consequences of nitrate poisoning. The ingested nitrate is converted to nitrite in the digestive system and it is absorbed in blood, thus causing methemoglobinaemia. Methaemoglobinaemia is not restricted to infants alone, but it is prevalent in higher age groups also.

METHODS

Therefore, an experimental study was conducted on 10 rabbits which were between three and a half months to four months of age, which had weights which ranged from 1.310 kg to 1.720 kg. Five groups A, B, C,D and E were formed, with two rabbits in each group. The control Group A was given water orally, which had 45 mg/litres of nitrate. Groups B to E (experimental groups) were administered water orally, which had concentrations of 100mg/litre, 200mg/litre, 400mg/litre and 500mg/litre of nitrate respectively, for 120 days. During experimental period, the differences in general behaviour of rabbits were noted. After this, rabbits were anaesthetised and sacrificed according to guidelines of ICMR and their livers were removed and processed for making paraffin sections,.Hematoxyllin and eosin staining was done for microscopic observations.

RESULTS

During experimental period, the animals were found to be lethargic on 75(th) day. Quantity of intake of food and water was not altered in the rabbits which were undergoing experiments in different groups. Rabbits of all groups i.e. A to E showed a continuous increase in heart rate (up to 218/minute in Group E) and respiration rate (up to 84/minute in Group E) respectively. The microscopic study showed mild necrosis of hepatocytes, with infiltration of inflammatory cells in between hepatocytes. In higher groups, the liver showed bridging necrosis and portal triditis. Dilatations of central vein with eosinophilic degeneration were observed in Group E only.

Genomic basis of ecological niche divergence among cryptic sister species of non-biting midges

BACKGROUND

There is a lack of understanding the evolutionary forces driving niche segregation of closely related organisms. In addition, pinpointing the genes driving ecological divergence is a key goal in molecular ecology. Here, larval transcriptome sequences obtained by next-generation-sequencing are used to address these issues in a morphologically cryptic sister species pair of non-biting midges (Chironomus riparius and C. piger).

RESULTS

More than eight thousand orthologous open reading frames were screened for interspecific divergence and intraspecific polymorphisms. Despite a small mean sequence divergence of 1.53% between the sister species, 25.1% of 18,115 observed amino acid substitutions were inferred by α statistics to be driven by positive selection. Applying McDonald-Kreitman tests to 715 alignments of gene orthologues identified eleven (1.5%) genes driven by positive selection.

CONCLUSIONS

Three candidate genes were identified as potentially responsible for the observed niche segregation concerning nitrite concentration, habitat temperature and water conductivity. Additionally, signs of positive selection in the hydrogen sulfide detoxification pathway were detected, providing a new plausible hypothesis for the species' ecological differentiation. Finally, a divergently selected, nuclear encoded mitochondrial ribosomal protein may contribute to reproductive isolation due to cytonuclear coevolution.

Application of multivariate statistical methods for groundwater physicochemical and biological quality assessment in the context of public health

Three representative areas (lowland, semi-mountainous, and coastal) have been selected for the collection of drinking water samples, and a total number of 28 physical, chemical, and biological parameters per water sample have been determined and analyzed. The mean values of the physical and chemical parameters were found to be within the limits mentioned in the 98/83/EEC directive. The analysis of biological parameters shows that many of the water samples are inadequate for human consumption because of the presence of bacteria. Cluster analysis (CA) first was used to classify sample sites with similar properties and results in three groups of sites; discriminant analysis (DA) was used to construct the best discriminant functions to confirm the clusters determined by CA and evaluate the spatial variations in water quality. The standard mode discriminant functions, using 17 parameters, yielded classification matrix correctly assigning 96.97% of the cases. In the stepwise mode, the DA produced a classification matrix with 96.36% correct assignments using only ten parameters (EC, Cl-, NO3-, HCO3-, CO3(-2), Ca+2, Na+, Zn, Mn, and Pb). CA and factor analysis (FA) are used to characterize water quality and assist in water quality monitoring planning. CA proved that two major groups of similarity (six subclusters) between 17 physicochemical parameters are formed, and FA extracts six factors that account for 66.478% of the total water quality variation, when all samples' physicochemical data set is considered. It is noteworthy that the classification scheme obtained by CA is completely confirmed by principal component analysis.

Sodium nitrite-mediated killing of the major cystic fibrosis pathogens Pseudomonas aeruginosa, Staphylococcus aureus, and Burkholderia cepacia under anaerobic planktonic and biofilm conditions

A hallmark of airways in patients with cystic fibrosis (CF) is highly refractory, chronic infections by several opportunistic bacterial pathogens. A recent study demonstrated that acidified sodium nitrite (A-NO(2)(-)) killed the highly refractory mucoid form of Pseudomonas aeruginosa, a pathogen that significantly compromises lung function in CF patients (S. S. Yoon et al., J. Clin. Invest. 116:436-446, 2006). Therefore, the microbicidal activity of A-NO(2)(-) (pH 6.5) against the following three major CF pathogens was assessed: P. aeruginosa (a mucoid, mucA22 mutant and a sequenced nonmucoid strain, PAO1), Staphylococcus aureus USA300 (methicillin resistant), and Burkholderia cepacia, a notoriously antibiotic-resistant organism. Under planktonic, anaerobic conditions, growth of all strains except for P. aeruginosa PAO1 was inhibited by 7.24 mM (512 μg ml(-1) NO(2)(-)). B. cepacia was particularly sensitive to low concentrations of A-NO(2)(-) (1.81 mM) under planktonic conditions. In antibiotic-resistant communities known as biofilms, which are reminiscent of end-stage CF airway disease, A-NO(2)(-) killed mucoid P. aeruginosa, S. aureus, and B. cepacia; 1 to 2 logs of cells were killed after a 2-day incubation with a single dose of ∼15 mM A-NO(2)(-). Animal toxicology and phase I human trials indicate that these bactericidal levels of A-NO(2)(-) can be easily attained by aerosolization. Thus, in summary, we demonstrate that A-NO(2)(-) is very effective at killing these important CF pathogens and could be effective in other infectious settings, particularly under anaerobic conditions where bacterial defenses against the reduction product of A-NO(2)(-), nitric oxide (NO), are dramatically reduced.

The protective potential of Yucca schidigera (Sarsaponin 30) against nitrite-induced oxidative stress in rats

The present study was designed to determine the protective effects of Yucca schidigera (Ys) against oxidative damage induced by acute nitrite intoxication as well as the histopathological evaluation of Ys in rats. The rats were divided into three groups each containing 12 rats: control (C); nitrite intoxication (N); Ys + nitrite intoxication (NY). C and N groups were fed standard rat feed (SRF). The NY group was fed SRF + 100 ppm Ys powder for 4 weeks. Acute nitrite intoxication was induced by subcutaneous (s.c.) administration of sodium nitrite (60 mg/kg) 1 day after the feeding period. Fifty minutes after sodium nitrite administration, blood samples and tissues including lung, liver, and kidney were collected for clinical biochemistry and histopathological investigations. Ys treatment was found to decrease methemoglobin, blood and tissue malondialdehyde, and tissue nitric oxide concentrations, and to increase the glutathione in blood and various tissues. However, plasma nitric oxide, total antioxidant activity, beta-carotene, and vitamin A did not differ between N and NY groups. While the N group rats showed distinct pathology in various tissues (compared with controls), the NY group had similar lung and liver pathology to the control. Only moderate or mild hemorrhage and hyperemia were seen in kidneys of NY group rats. Consequently, the natural compounds found in Ys, such as polyphenols, steroidal saponins, and other phytonutrients, could be used to substantially protect the organism from nitrite-induced oxidative damage and its complications.

Consumption of cured meats and prospective risk of chronic obstructive pulmonary disease in women

BACKGROUND

Most cured meats contain nitrites. Nitrites generate oxidative-nitrative stress and were shown in animal models to cause emphysema. Prospective epidemiologic data on cured meats and chronic obstructive pulmonary disease (COPD), however, are sparse.

OBJECTIVE

We examined the relation between cured meat consumption and the prospective risk of newly diagnosed COPD in women.

DESIGN

This was a prospective cohort study of 71 531 women from the Nurses' Health Study who completed a validated dietary questionnaire at baseline in 1984 and had no baseline COPD or a report of asthma. Participants were aged 38-63 y in 1984 and were followed for 16 y.

RESULTS

A total of 750 new cases of COPD were documented during the follow-up. Cured meat consumption was positively associated with COPD risk after adjustment for age, smoking, and multiple other potential confounders. The adjusted relative risks of COPD across categories of cured meat consumption (never or almost never, 1-3 servings/mo, 1 serving/wk, 2-3 servings/wk, and > or = 4 servings/wk) were 1.0, 1.14 (95% CI: 0.78, 1.66), 1.15 (95% CI: 0.79, 1.69), 1.40 (95% CI: 0.96, 2.05), and 1.51 (95% CI: 1.00, 2.27), respectively, (P for trend = 0.005). This positive association was present among both past (P for trend = 0.02) and current (P for trend = 0.03) smokers. No association was observed among never smokers, probably because of the small number of COPD cases in these women.

CONCLUSION

Frequent cured meat consumption was associated with an increased risk of newly diagnosed COPD among women who smoke.

Prospective study of cured meats consumption and risk of chronic obstructive pulmonary disease in men

Cured meats are high in nitrites. Nitrites generate reactive nitrogen species that may cause damage to the lung. The objective is to assess the relation between frequent consumption of cured meats and the risk of newly diagnosed chronic obstructive pulmonary disease (COPD). Between 1986 and 1998, the authors identified 111 self-reported cases of newly diagnosed COPD among 42,915 men from the Health Professionals Follow-up Study. The cumulative average intake of cured meats consumption (processed meats, bacon, hot dogs) was calculated from food frequency questionnaires administrated in 1986, 1990, and 1994 and divided according to servings per week (never/almost never, <1 serving/week, 1-3 servings/week, 4-6 servings/week, at least once/day). After adjustment for age, smoking status, pack-years, pack-years squared, energy intake, race/ethnicity, US region, body mass index, and physical activity, the consumption of cured meats was positively associated with the risk of newly diagnosed COPD (for highest vs. lowest intake: relative risk = 2.64, 95% confidence interval: 1.39, 5.00; p(trend) = 0.002). In contrast to these findings, the consumption of cured meats was not associated with the risk of adult-onset asthma. These data suggest that cured meat may worsen the adverse effects of smoking on risk of COPD.

Cured meat consumption, lung function, and chronic obstructive pulmonary disease among United States adults

RATIONALE

Cured meats are high in nitrites. Nitrites generate reactive nitrogen species that may cause nitrative and nitrosative damage to the lung resulting in emphysema.

OBJECTIVE

To test the hypothesis that frequent consumption of cured meats is associated with lower lung function and increased odds of chronic obstructive pulmonary disease (COPD).

METHODS

Cross-sectional study of 7,352 participants in the Third National Health and Nutrition Examination Survey, 45 years of age or more, who had adequate measures of cured meat, fish, fruit, and vegetable intake, and spirometry.

RESULTS

After adjustment for age, smoking, and multiple other potential confounders, frequency of cured meat consumption was inversely associated with FEV(1) and FEV(1)/FVC but not FVC. The adjusted differences in FEV(1) between individuals who did not consume cured meats and those who consumed cured meats 1 to 2, 3 to 4, 5 to 13, and 14 or more times per month were -37.6, -11.5, -42.0, and -110 ml, respectively (p for trend < 0.001). Corresponding differences for FEV(1)/FVC were -0.91, -0.54, -1.13, and -2.13% (p for trend = 0.001). These associations were not modified by smoking status. The multivariate odds ratio for COPD (FEV(1)/FVC <or= 0.7 and FEV(1) < 80% predicted) was 1.78 (95% confidence interval, 1.29-2.47) comparing the highest with the lowest category of cured meat consumption. The corresponding odds ratios for mild, moderate, and severe COPD were 1.11, 1.46, and 2.41, respectively.

CONCLUSIONS

Frequent cured meat consumption was associated independently with an obstructive pattern of lung function and increased odds of COPD. Additional studies are required to determine if cured meat consumption is a causal risk factor for COPD.

Workgroup report: Drinking-water nitrate and health--recent findings and research needs

Human alteration of the nitrogen cycle has resulted in steadily accumulating nitrate in our water resources. The U.S. maximum contaminant level and World Health Organization guidelines for nitrate in drinking water were promulgated to protect infants from developing methemoglobinemia, an acute condition. Some scientists have recently suggested that the regulatory limit for nitrate is overly conservative; however, they have not thoroughly considered chronic health outcomes. In August 2004, a symposium on drinking-water nitrate and health was held at the International Society for Environmental Epidemiology meeting to evaluate nitrate exposures and associated health effects in relation to the current regulatory limit. The contribution of drinking-water nitrate toward endogenous formation of N-nitroso compounds was evaluated with a focus toward identifying subpopulations with increased rates of nitrosation. Adverse health effects may be the result of a complex interaction of the amount of nitrate ingested, the concomitant ingestion of nitrosation cofactors and precursors, and specific medical conditions that increase nitrosation. Workshop participants concluded that more experimental studies are needed and that a particularly fruitful approach may be to conduct epidemiologic studies among susceptible subgroups with increased endogenous nitrosation. The few epidemiologic studies that have evaluated intake of nitrosation precursors and/or nitrosation inhibitors have observed elevated risks for colon cancer and neural tube defects associated with drinking-water nitrate concentrations below the regulatory limit. The role of drinking-water nitrate exposure as a risk factor for specific cancers, reproductive outcomes, and other chronic health effects must be studied more thoroughly before changes to the regulatory level for nitrate in drinking water can be considered.

Health Implications of Exposure to Environmental Nitrogenous Compounds

All living systems need nitrogen for the production of complex organic molecules, such as proteins, nucleic acids, vitamins, hormones and enzymes. Due to the intense use of synthetic nitrogen fertilisers and livestock manure in modern day agriculture, food (particularly vegetables) and drinking water may contain higher concentrations of nitrate than in the past. The mean intake of nitrate per person in Europe is about 50-140 mg/day and in the US about 40-100 mg/day. In the proximal small intestine, nitrate is rapidly and almost completely absorbed (bioavailability at least 92%). In humans, approximately, 25% of the nitrate ingested is secreted in saliva, where some 20% (about 5-8% of the nitrate intake) is converted to nitrite by commensal bacteria. The nitrite so formed is then absorbed primarily in the small intestine. Nitrate may also be synthesised endogenously from nitric oxide (especially in case of inflammation), which reacts to form nitrite. Normal healthy adults excrete in the urine approximately 62 mg nitrate ion/day from endogenous synthesis. Thus, when nitrate intake is low and there are no additional exogenous sources (e.g. gastrointestinal infections), the endogenous production of nitrate is more important than exogenous sources. Nitrate itself is generally regarded nontoxic. Toxicity is usually the result of the conversion of nitrate into the more toxic nitrite. There are two major toxicological concerns regarding nitrite. First, nitrite may induce methaemoglobinaemia, which can result in tissue hypoxia, and possibly death. Secondly, nitrite may interact with secondary or N-alkyl-amides to form N-nitroso carcinogens. However, epidemiological investigations and human toxicological studies have not shown an unequivocal relationship between nitrate intake and the risk of cancer. The Joint Expert Committee of the Food and Agriculture Organization of the United Nations/World Health Organization (JECFA) and the European Commission's Scientific Committee on Food have set an acceptable daily intake (ADI) for nitrate of 0-3.7 mg nitrate ion/kg bodyweight; this appears to be safe for healthy neonates, children and adults. The same is also true of the US Environmental Protection Agency (EPA) Reference Dose (RfD) for nitrate of 1.6 mg nitrate nitrogen/kg bodyweight per day (equivalent to about 7.0 mg nitrate ion/kg bodyweight per day). This opinion is supported by a recent human volunteer study in which a single dose of nitrite, equivalent to 15-20 times the ADI for nitrate, led to only mild methaemoglobinaemia (up to 12.2%), without other serious adverse effects. The JECFA has proposed an ADI for nitrite of 0-0.07 mg nitrite ion/kg bodyweight and the EPA has set an RfD of 0.1 mg nitrite nitrogen/kg bodyweight per day (equivalent to 0.33 mg nitrite ion/kg bodyweight per day). These values are again supported by human volunteer studies.

A nested case-control study of methemoglobinemia risk factors in children of Transylvania, Romania

In this nested case-control study, we investigated the risk factors for methemoglobinemia (MHG) in 71 children in the Transylvania region of Romania. This study was unique in that the exposures for cases and controls were calculated as continuous values and were reported in milligrams per kilogram per day of nitrate/nitrite based on careful dietary reconstruction and environmental sampling. This procedure allowed us to compare point estimates of nitrate/nitrite exposure with other continuous, categoric, and ranked risk factors such as the presence or absence of diarrheal disease, reported severity of diarrheal disease, the use of vitamin supplements, the presence, absence, and/or duration of breast-feeding, and whether or not first-generation relatives experienced MHG. Analysis of these factors and exposure levels using both univariate and multivariate whole-model tests was performed to understand the relative significance of risk factors at varying levels of exposure to the development of MHG. Univariate and multifactorial analysis of risk factors for MHG underscored that, for this population, MHG is most strongly associated with nitrate/nitrite exposure through the dietary route (p = 0.0318), via feeding of formula and tea made with water containing high levels of nitrates, and that breast-feeding protects infants younger than 6 months of age (p = 0.0244). Our findings also raise questions about the role of diarrheal disease in the development of MHG, as likelihood ratios (likelihood 4.323, p = 0.0376) and multifactorial analysis indicated a significant role for diarrheal disease for some individuals.

The nitrite/collagen reaction: non-enzymatic nitration as a model system for age-related damage

The effects of age seen in long-lived connective tissue proteins are thought to be the result of post-translational modifications by reactive molecules. One such molecule is the nitrite ion. Human nitrite exposure results predominately from endogenous production of nitric oxide as well as inhalation of cigarette smoke and ingestion of cured meats. Although nitrite reactions with various proteins have been studied previously with regard to carcinogenesis, the specific reaction with collagen and its role in age-related damage has never been examined. We describe the reaction of nitrite with type I collagen at neutral pH and body temperature. The incubation of collagen with nitrite results in an increase in cross-linking, the accumulation of a yellow chromophore, and a depletion of tyrosine residues. Similar changes also are found in aged human collagen. In addition, 3-nitro-tyrosine, which has recently been used as a marker for peroxynitrite mediated damage, is produced from this reaction. Thus, we propose non-enzymatic nitration as an in vitro model system for human collagen age-related damage.

The mechanisms for nitration and nitrotyrosine formation in vitro and in vivo: impact of diet

The detection of 3-nitro-L-tyrosine residues associated with many disease states, including gastric cancer, has implicated a role for peroxynitrite in vivo, and thus endogenously produced nitric oxide and superoxide. Additionally, dietary nitrate has been suggested to be involved in the pathogenesis of gastric cancer through a mechanism involving reduction to nitrite and subsequent formation of potentially mutagenic nitroso-compounds. Studies have now demonstrated that a multitude of reactive nitrogen species other than peroxynitrite are capable of producing nitrotyrosine. Thus, we have reviewed the evidence that dietary nitrate, amongst other reactive nitrogen species, may contribute to the body burden of nitrotyrosine.

Recurrent acute respiratory tract infections in areas with high nitrate concentrations in drinking water

A review of the literature indicated an association among high nitrate ingestion, methemoglobinemia, and pathologic changes in bronchi and lung parenchyma. The present study examined a possible correlation among drinking water nitrate concentration, methemoglobin levels, cytochrome b(5) reductase activity, and acute respiratory tract infection with a history of recurrence (RRTI). Our study was conducted in five village units in the state of Rajasthan, India, with nitrate concentrations of 26, 45, 95, 222, and 459 mg NO(3) ion/L. We randomly selected 88 children. The children were up to 8 years of age, age matched, and represented 10% of the total population of these areas. We obtained detailed RRTI histories and conducted medical examinations. Methemoglobin levels and cytochrome b(5) reductase activity were estimated biochemically. The data collected were statistically analyzed using spreadsheet software on a personal computer. We observed strong interdependence between methemoglobin levels and RRTI in children up to 8 years of age. Methemoglobin levels alone explained 80% of the variation in the RRTI cases. This study indicates that methemoglobinemia, secondary to high nitrate ingestion in drinking water, causes RRTI. Increased production of methemoglobin and free radicals of nitric oxide and oxygen due to nitrate metabolism in the body lead to alveolar damage and mismatching of ventilation and perfusion, which may be the reason for high mortality in children due to RRTI.

Recurrent acute respiratory tract infections in areas with high nitrate concentrations in drinking water

A review of the literature indicated an association among high nitrate ingestion, methemoglobinemia, and pathologic changes in bronchi and lung parenchyma. The present study examined a possible correlation among drinking water nitrate concentration, methemoglobin levels, cytochrome b(5) reductase activity, and acute respiratory tract infection with a history of recurrence (RRTI). Our study was conducted in five village units in the state of Rajasthan, India, with nitrate concentrations of 26, 45, 95, 222, and 459 mg NO(3) ion/L. We randomly selected 88 children. The children were up to 8 years of age, age matched, and represented 10% of the total population of these areas. We obtained detailed RRTI histories and conducted medical examinations. Methemoglobin levels and cytochrome b(5) reductase activity were estimated biochemically. The data collected were statistically analyzed using spreadsheet software on a personal computer. We observed strong interdependence between methemoglobin levels and RRTI in children up to 8 years of age. Methemoglobin levels alone explained 80% of the variation in the RRTI cases. This study indicates that methemoglobinemia, secondary to high nitrate ingestion in drinking water, causes RRTI. Increased production of methemoglobin and free radicals of nitric oxide and oxygen due to nitrate metabolism in the body lead to alveolar damage and mismatching of ventilation and perfusion, which may be the reason for high mortality in children due to RRTI.

Diarrhoea and nitrogen oxides

It is hypothesized that higher indoor nitrogen dioxide levels cause diarrhoea in infants and that this is the result of a direct action of oxides of nitrogen on the gut. This hypothesis is tested by reviewing the reported association between methaemoglobin and diarrhoea in children and two recent reports on indoor air and diarrhoea in infants. The collection of further empirical data is now needed. Studies which measure indoor levels of nitrogen dioxide could usefully collect data on infants symptoms that are not exclusively respiratory. Similarly, studies which are collecting diary information on children's health symptoms should consider collecting data on indoor air quality with respect to the oxides of nitrogen.

Epidemiological evaluation of recurrent stomatitis, nitrates in drinking water, and cytochrome b5 reductase activity

OBJECTIVE

Our aim was to examine a possible correlation between drinking water nitrate concentration, recurrent stomatitis, and cytochrome b5 reductase activity. Dietary nitrate can form nitrite in vivo. This can cause methemoglobinemia in the red blood cells. Cytochrome b5 reductase is an enzyme in the red blood cells that reduces methemoglobin back to hemoglobin.

METHODS

Five areas were selected in the State of Rajasthan, India, having drinking water nitrate concentration (as nitrate) of 26, 45, 95, 222, and 459 mg of NO3/L. House schedules were prepared in these areas in accordance with a statistically designed protocol. We selected 193 age- and weight-matched persons, representing 10% of the total population in each of these areas. Detailed history was taken for recurrent stomatitis, medical examination was conducted, and blood samples were taken to ascertain cytochrome b5 reductase activity in the selected population. Collected data were statistically analyzed to ascertain a relationship between nitrate concentration, cytochrome b5 reductase activity, and percent stomatitis, using Microsoft Excel software.

RESULTS

This study suggests that there is a significant interdependence between drinking water nitrate concentration, cytochrome b5 reductase activity, and recurrent stomatitis.

CONCLUSION

Increased cytochrome b5 reductase activity primarily induced by the presence of high nitrate concentration in drinking water could be the cause for recurrent stomatitis.

The nitrite/elastin reaction: implications for in vivo degenerative effects

Nitrite ion is a by-product of nitrogen oxides (nitric oxide and nitrogen dioxide) from cigarette smoke and is used as a preservative for curing meats. Therefore, study of the reaction of nitrite with elastin in vitro was undertaken. By colorimetric assay, reactivity of nitrite with insoluble elastin at neutral pH, 37 degrees C, and physiologic concentration was confirmed. In histochemical studies on in situ human aortic elastin, nitrite-treated sections displayed marked structural disruptions. Determinations of fluorescence and absorbance on nitrite-treated soluble bovine elastin revealed marked alterations of fluorescence, and increased UV and visible absorbance. Amino acid analysis confirmed that it reacted with tyrosine. The findings indicate that non-enzymatic nitration by nitrite may have deleterious effects on elastin in vivo and may provide insights into the pathogenesis of chronic elastin degenerative processes, including aortic aneurysms, pulmonary emphysema, and premature skin wrinkling, all of which have been well known to have associations with cigarette smoking.

Nitrite-induced adrenal effects in rats and the consequences for the no-observed-effect level

In a previous subchronic oral toxicity study with potassium nitrite, hypertrophy of the adrenal zona glomerulosa was observed for all nitrite levels examined including the lowest level of 100 mg/litre. This present study was carried out, therefore, to establish a no-observed-effect level (NOEL) for nitrite. Groups of 10 male and 10 female 6-wk-old Wistar rats received KNO2 at levels of 12.5, 25, 50, 100 or 3000 mg/litre or NaNO2 at levels of 81 or 2432 mg/litre in the drinking water for 13 wk. The nitrite content of the drinking water in the latter two groups was equal to that of the 100 and 3000 mg KNO2/litre groups, respectively. Potassium and sodium concentrations were equalized in the corresponding test groups with KCl and NaCl, respectively. General health, behaviour and survival were not affected by the ingestion of nitrite. Body weight and food and liquid intake were slightly decreased in the 3000 mg KNO2/litre and 2432 mg NaNo2/litre groups for both sexes. Methaemoglobin concentration was significantly elevated in rats of both high-dose nitrite groups in wk 4 and 12, while slight increases in a number of red blood cell variables occurred with 3000 mg KNO2/litre in females in wk 12. Relative kidney weights were increased in both high-dose nitrite groups. In wk 4, plasma aldosterone and corticosterone levels were slightly decreased in males with 2432 mg NaNO2/litre and plasma corticosterone in females with 3000 mg KNO2/litre but not in wk 13. Systolic blood pressure was not affected by nitrite. Microscopic examination revealed slight hypertrophy of the adrenal zona glomerulosa in animals of the 100 and 3000 mg KNO2/litre and of the 81 and 2432 mg NaNO2/litre groups, the incidence and degree being dose related. The results obtained with 100 and 3000 mg KNO2/litre in the drinking water were comparable with those found at the same levels in the previous 90-day study. The effects with sodium nitrite were similar to those observed with potassium nitrite. The biological significance of the adrenal zona glomerulosa hypertrophy is discussed. It is concluded that the NOEL of KNO2 is 50 mg/litre in the drinking water, equivalent to about 5 mg/kg body weight/day.

Infant Methemoglobinemia in the Transylvania Region of Romania

The incidence of infant methemoglobinemia reported in three counties of Transylvania, Romania, was evaluated from medical records, field visits, and interviews. Well water was the main source of nitrate for induction of acquired infant methemoglobinemia, which occurred post-breast-feeding when the infants consumed nitrate-contaminated water used in mixing formula. The average age of reported infants with methemoglobinemia was 39 days, supporting earlier observations that infants less than 4 months old are the most susceptible segment of the population. Vitamin C, rather than methylene blue, was the main medical intervention in the Transylvania region. The mean incidence rates of methemoglobinemia in the three counties (Saut-Mare, Mures, and Bistrita-Nasaud) ranged from 24 to 363 per 100,000 live births over a five-year period (1990-1994). These rates are below earlier reported incidence rates of up to 13% (13,000 per 100,000 live births). Three selected case reports are presented to describe hospital/clinic data, well-water data, and infant feeding practices. Recommendations for appropriate intervention programs are described. The significances of possible physical and neuropsychological effects on the development of children following methemoglobinemia are discussed and the need for further investigations is outlined.

Endogenous methemoglobinemia associated with diarrheal disease in infancy

Infantile diarrhea is sometimes associated with methemoglobinemia. To determine the significance of intestinal bacterial infection or overgrowth and other predisposing factors in this entity, we evaluated prospectively 45 consecutive patients who were admitted for gastroenteritis and methemoglobinemia between March 1980 and September 1992. All the patients were younger than 3 months of age. In 95% of them, methemoglobinemia occurred between the ages of 15 days to 2 months. The peak mean methemoglobin concentration was 9.4% (range, 2.4-57%). Although stool cultures were positive in only 22% of the infants, the epidemiologic data strongly suggested a bacterial or viral etiology in our study population: for 12 years, there was a significant decrease in the annual incidence of methemoglobinemia associated with diarrhea in parallel to the decrease in infantile diarrhea due to known pathogens throughout the country in the same period. There was also a marked seasonal variation in the incidence of the disease, with two peaks in January and the summer months when viral and bacterial infections, respectively, are prevalent. Failure to thrive and low admission-weight percentiles were associated with methemoglobinemia in most of the patients and diarrhea lasting > or = 7 days in 22 (49%) patients. The blood pH and the degree of acidosis did not correlate with the severity of methemoglobinemia. All the patients were formula fed. In the etiology of methemoglobinemia in infants with enteritis, viral and bacterial pathogens appear to play an important role by altering intestinal flora. Breast feeding appears to protect against this entity.