EFSA’s Panel on Contaminants (CONTAM) has published a statement on the possible acute health effects of nitrate in infants and young children consuming spinach and lettuce. The Panel concludes that levels of nitrate in these vegetables are not of health concern for most children. It notes however, that infants and young children aged 1-3 years who consume high amounts of spinach with high nitrate levels could at times reach an intake level for which a risk of methaemoglobinaemia - a condition that reduces oxygen supply to the body - cannot be excluded. The Panel also provides advice to the European Commission on maximum levels of nitrate in leafy vegetables.
This statement complements EFSA’s scientific opinion of 2008 in which the CONTAM Panel compared risks and benefits of exposure to nitrates in vegetables. Following this opinion, the European Commission asked EFSA to provide more information on potential acute health effects of nitrate in infants and children.
Nitrate occurs naturally in vegetables and particularly high levels are found in leafy vegetables such as lettuce and spinach. In the human body nitrate is converted into nitrite, which at high levels can lead to methaemoglobinaemia.
Based on the analysis of new and more detailed food consumption data now available for children, the Panel concludes that levels of nitrate in lettuce are not of health concern for children; however, infants and young children aged 1-3 years who eat large amounts of spinach (over 200g) on a given day could be exposed to high levels of nitrates. In these cases, the Panel considers that for some young children the possibility of a risk of methaemoglobinaemia cannot be excluded. Furthermore, it recommends that children suffering from bacterial gastrointestinal infections should not be given spinach because these infections result in a higher conversion of nitrate to nitrite, thereby increasing the risk of methaemaglobinaemia. The Panel indicates that inappropriate storage of cooked leafy vegetables (for instance, vegetables stored at room temperature over long periods) can also result in the conversion of nitrate to nitrite. Furthermore, the conversion of nitrate to nitrite is accelerated when vegetables are pureed.
Spinach and lettuce are subject to EU legislation, which establishes maximum levels of nitrate in foods. The Panel found that only 1% of lettuce samples and 5% of spinach samples tested exceeded the current maximum levels. In answer to the Commission’s request, the Panel advises that replacing derogations in place in certain Member States with slightly higher maximum levels for nitrate in leafy vegetables would have a minor impact on the exposure of young children.
 Methaemaglobinaemia is also called “Blue baby syndrome”
 The CONTAM Panel considered 45,000 analytical results for nitrate in vegetables, including 3,733 results submitted to EFSA since the 2008 opinion. The food consumption data used in the statement were provided by EFSA’s DATEX unit, which in cooperation with the EU Member States has recently developed a database of food consumption data for children in the EU.
 Commission Regulation (EC) No 1881/2006 fixes maximum nitrate levels in spinach and lettuce. Vegetables grown in Northern European countries tend to have higher nitrate content as a result of reduced exposure to sunlight. In order to take into account unfavourable light conditions during parts of the year in some countries (Belgium, France, Ireland, the Netherlands and the United Kingdom), these Member States were given a temporary derogation from these levels for spinach and lettuce. The Panel found that replacing national derogations with the suggested maximum level of 3500 mg/kg in spinach would have a minor impact on children’s exposure to nitrate.