50 mg/L as )-other extraneous factors (Breslow-Day-Test for interaction), bivariate and multivariate analyses were performed. Abnormal MetHb levels (up to 7.9%) were associated (p-value = 0.020) with exposure to drinking water nitrate. Only water chlorination was an effect modifier. Among those who do not disinfect water, the prevalence of ab- normal MetHb for those with nitrate level >50 mg/L was 4.95 (p-value = 0.001, 95% CI = [1.92 - 12.79]) times the prevalence for those with nitrate level <50 mg/L. Whereas, among those who do disinfect water, the prevalence for those with high nitrate levels was only 1.38 (p-value = 0.435, 95% CI = [0.62 - 3.07]) times the prevalence of those with low nitrate levels. The biological plausibility of a relationship between waterborne microorganisms, drinking water nitrate, drinking water chlorination, and development of an abnormal MetHb level needs to be further explored." /> 50 mg/L as )-other extraneous factors (Breslow-Day-Test for interaction), bivariate and multivariate analyses were performed. Abnormal MetHb levels (up to 7.9%) were associated (p-value = 0.020) with exposure to drinking water nitrate. Only water chlorination was an effect modifier. Among those who do not disinfect water, the prevalence of ab- normal MetHb for those with nitrate level >50 mg/L was 4.95 (p-value = 0.001, 95% CI = [1.92 - 12.79]) times the prevalence for those with nitrate level <50 mg/L. Whereas, among those who do disinfect water, the prevalence for those with high nitrate levels was only 1.38 (p-value = 0.435, 95% CI = [0.62 - 3.07]) times the prevalence of those with low nitrate levels. The biological plausibility of a relationship between waterborne microorganisms, drinking water nitrate, drinking water chlorination, and development of an abnormal MetHb level needs to be further explored." /> Does Exposure to Nitrate in Drinking Water Contribute Anything the Effect of Water Chlorination on Children Methemoglobin Levels?
 JEP  Vol.3 No.2 , February 2012
Does Exposure to Nitrate in Drinking Water Contribute Anything the Effect of Water Chlorination on Children Methemoglobin Levels?
ABSTRACT
Previous studies showed contradictory findings regarding the relationship between nitrate in drinking well-water and abnormal methemoglobin (MetHb) level (>2%) among children. We studied the effect of water chlorination in this relationship in children aged up to 7. 240 subclinical children participated in this cross-sectional study. Water nitrate was analyzed for each participant, and so was blood MetHb. Analysis of two water nitrate exposure levels (<50 and="">50 mg/L as )-other extraneous factors (Breslow-Day-Test for interaction), bivariate and multivariate analyses were performed. Abnormal MetHb levels (up to 7.9%) were associated (p-value = 0.020) with exposure to drinking water nitrate. Only water chlorination was an effect modifier. Among those who do not disinfect water, the prevalence of ab- normal MetHb for those with nitrate level >50 mg/L was 4.95 (p-value = 0.001, 95% CI = [1.92 - 12.79]) times the prevalence for those with nitrate level <50 mg/L. Whereas, among those who do disinfect water, the prevalence for those with high nitrate levels was only 1.38 (p-value = 0.435, 95% CI = [0.62 - 3.07]) times the prevalence of those with low nitrate levels. The biological plausibility of a relationship between waterborne microorganisms, drinking water nitrate, drinking water chlorination, and development of an abnormal MetHb level needs to be further explored.

Cite this paper
M. Sadeq, R. Abouqal, B. Attarassi, M. Lakranbi, R. ElAouad and L. Idrissi, "Does Exposure to Nitrate in Drinking Water Contribute Anything the Effect of Water Chlorination on Children Methemoglobin Levels?," Journal of Environmental Protection, Vol. 3 No. 2, 2012, pp. 169-176. doi: 10.4236/jep.2012.32021.
References
[1]   A. Mansouri and A. A. Lurie, “Concise Review: Methe- moglobinemia,” American Journal of Hematology, Vol. 42, No. 1, 1993, pp. 7-12. doi:10.1002/ajh.2830420104

[2]   J. P. Fréjaville, B. Christoforov, C. Bismuth, et al., “To- xicologie Clinique et Analytique,” in French, 2nd Edition, Flammarion Médecine Sciences, Paris, 1971, pp. 63-64.

[3]   WHO, “Nitrate and Nitrite in Drinking Water,” Back- ground Documents for Development of WHO Guidelines for Drinking-Water Quality, WHO/SDE/WSH/07.01/16, Geneva, 2007.

[4]   G. L. Askew, L. Finelli, C. A. Genese, F. E. Sorhage, D. M. Sosin and K. C. Spitalny, “Boilerbaisse: An Outbreak of Methemoglobinemia in New Jersey in 1992,” Pediat- rics, Vol. 94, No. 3, 1994, pp. 381-384.

[5]   L. M. Haddad and J. F. Winchester, “Clinical Manage- ment of Poisoning and Drug Overdose,” 2nd Edition, WB Sunders, Philadelphia, 1990, pp. 1419-1431.

[6]   R. O. Wright, W. J. Lewander and A. D. Woolf, “Methe- moglobinemia: Ethiology, Pharmacology, and Clinical Management,” Annals of Emergency Medicine, Vol. 34, No. 3, 1999, pp. 646-656. doi:10.1016/S0196-0644(99)70167-8

[7]   A. Finan, P. Keenan, F. O’Donovan, P. Mayne and J. Murphy, “Methemoglobinemia Associated with Sodium Nitrite in Three Siblings,” BMJ, Vol. 317, 1998, pp. 1138- 1139. doi:10.1136/bmj.317.7166.1138

[8]   R. Ash-Bernal, R. Wise and S. M. Wright, “Acquired Me- themoglobinemia: A Retrospective Series of 138 Cases at Two Teaching Hospitals,” Medicine (Baltimore), Vol. 83, No. 5, 2004, pp. 265-273. doi:10.1097/01.md.0000141096.00377.3f

[9]   E. Jaffe, “Methemoglobin Phathophysiology,” Progress in Clinical Biological Research, Vol. 51, 1981, pp. 133-151.

[10]   G. F. Craun, D. G. Greathouse and D. H. Gunderson, “Methaemoglobin Levels in Young Children Consuming High Nitrate Well Water in the United States,” Interna- tional Journal of Epidemiology, Vol. 10, No. 4, 1981, pp. 309-317. doi:10.1093/ije/10.4.309

[11]   S. K. Gupta, R. C. Gupta, A. K. Seth, A. B. Gupta, J. K. Bassin and A. Gupta, “Adaptation of Cytochrome-b5 Re- ductase Activity and Methaemoglobinaemia in Areas with a High Nitrate Concentration in Drinking Water,” Bulletin of the World Health Organization, Vol. 77, No. 9, 1999, pp. 749-753.

[12]   Maroc. HCP. CLAD. Haut Commissariat du Plan, Centre de la Lecture Automatique des Documents, “RGPH2004 en ligne,” in French, 2006. http://clad.hcp.ma

[13]   A. Dean, K. Sullivan and M. M. Soe, “OpenEpi. Open Source Epidemiologic Statistics for Public Health,” 2004. http://openepi.com

[14]   A. A. Avery, “Infantile Methemoglobinemia: Reexamining the Role of Drinking Water Nitrates,” Environmental Health Perspectives, Vol. 107, 1999, pp. 583-586. doi:10.1289/ehp.99107583

[15]   A. A. Avery, “Cause of Methemoglobinemia: Illness ver- sus Nitrate Exposure,” Environmental Health Perspec- tives, Vol. 109, 2001, pp. 12-14. doi:10.1289/ehp.109-a12

[16]   M. H. Ward, T. M. deKok, P. Levallois, J. Brender, G. Gulis, B. T. Nolan and J. van Derslice “Workgroup Re- port: Drinking-Water Nitrate and Health—Recent Find- ings and Research Needs,” Environmental Health Pers- pectives, Vol. 113, 2005, pp.1607-1614. doi:10.1289/ehp.8043

[17]   C. L. Zeman, B. Kross, M. Vlad, “A Nested Case-Control Study of Methemoglobinemia. Risk Factors in Children of Transylvania, Romania,” Environmental Health Pers- pectives, Vol. 110, 2002, pp. 817-822. doi:10.1289/ehp.02110817

[18]   J. Rodier, “L’analyse de l’eau, Eaux Naturelles, Eaux Ré- siduelles, eau de mer: Chimie, Physico-Chimie, bacté Rio- logie, Biologie,” in French, Vol. 1, 5th Edition, Dunod, Paris, 1975, pp.166-167; 170-172; 566-567.

[19]   A. Aminot and M. Chaussepied, “Manuel des Analyses Chimiques en Milieu Marin,” in French, CNEXO, Brest, 1983, pp. 119-124.

[20]   J. Rodier, “L’Analyse Chimique et Physico-Chimique de l’eau. Eaux naturelles-Eaux Usées,” in French, 2nd Edi- tion, Dunod, Paris, 1960, pp. 78-79.

[21]   D. Pradeau, “Analyse Pratique du méDicament,” in French, Lavoisier, Editions Médicales Internationales (EMI), Paris, 1992, pp. 362-364.

[22]   I. Sunshine, “Methodology for Analytical Toxicology,”. Vol. 1, CRC Press, Cleveland, 1975, pp. 245-246.

[23]   Maroc. SNIMA, “Norme Marocaine Homologuée: Qua- lité des Eaux d’Alimentation Humaine, NM 03.7.001,” in French, Service de Normalisation Industrielle Marocaine, Rabat, 2006.

[24]   I. G. O’Brien and F. Gibson, “The Structure of Entero- chelin and Related 2,3-Dihydroxy-N-Benzoylserine Conjugates from Escherichia coli,” Biochimica & Biophysica Acta, Vol. 215, 1970, pp. 393-402.

[25]   J. R. Pollack and J. B. Neilands, “Enterobactin, an Iron Transport Compound from Salmonella Typhimurium,” Biochemical and Biophysical Research Communications, Vol. 38, No. 6, 1970, pp. 989-992. doi:10.1016/0006-291X(70)90819-3

[26]   H. J. Rogers, “Iron-Bonding Catechols and Virulence in Escherichia coli,” Infection and Immunity, Vol. 7, No. 3, 1973, pp. 445-456.

[27]   H. J. Rogers, C. Synge, B. Kimber and P. M. Bayley, “Production of Enterochelin by Escherichia coli O111,” Biochimica et Biophysica Acta, Vol. 497, No. 2, 1977, pp. 548-557.

[28]   H. J. Rogers, “Role of Iron Chelators, Antibodies and Iron-Bonding Proteins in Infection,” In: D. Slessinger, Ed. microbiology, American Society of Microbiology, Washington DC, 1983, pp. 334-337.

[29]   C. J. Carrano and K. N. Raymond, “Ferric Ion Sequestering Agents: 2.Kenetics and Mechanisms of Iron Removal from Transferring by Enterochelin and Synthetic Tricatechols,” Journal of the American Chemical Society, Vol. 101, 1979, pp. 5401-5404. doi:10.1021/ja00512a047

 
 
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