| Drinking-Water Nitrate, Methemoglobinemia, and Global Burden of Disease: A Discussion Lorna Fewtrell Centre for Research into Environment and Health, Crewe, Cheshire, United Kingdom Abstract
On behalf of the World Health Organization (WHO) , I have undertaken a series of literature-based investigations examining the global burden of disease related to a number of environmental risk factors associated with drinking water. In this article I outline the investigation of drinking-water nitrate concentration and methemoglobinemia. The exposure assessment was based on levels of nitrate in drinking water greater than the WHO guideline value of 50 mg/L. No exposure-response relationship, however, could be identified that related drinking-water nitrate level to methemoglobinemia. Indeed, although it has previously been accepted that consumption of drinking water high in nitrates causes methemoglobinemia in infants, it appears now that nitrate may be one of a number of co-factors that play a sometimes complex role in causing the disease. I conclude that, given the apparently low incidence of possible water-related methemoglobinemia, the complex nature of the role of nitrates, and that of individual behavior, it is currently inappropriate to attempt to link illness rates with drinking-water nitrate levels. Key words: burden of disease, drinking water, methemoglobinemia, nitrates. Environ Health Perspect 112: 1371-1374 (2004) . doi:10.1289/ehp.7216 available via http://dx.doi.org/ [Online 22 July 2004]
Address correspondence to L. Fewtrell, Centre for Research into Environment and Health, 5 Quakers Coppice, Crewe Gates Farm, Crewe, Cheshire, CW1 6FA UK. Telephone: 44-0-1270-250583. Fax: 44-0-1270-589761. E-mail: Lorna@creh.demon.co.uk This work was funded by the World Health Organization ; however, the views are those of the author. The author declares she has no competing financial interests. Received 29 April 2004 ; accepted 22 July 2004.
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