Nitrate-rich vegetables (e.g. courgette soup) given to young infants can cause severe methaemoglobinaemia.
Original statement
No Arabic original wording available.
Translation
Nitrate-rich vegetables (e.g. courgette soup) given to young infants can cause severe methaemoglobinaemia.
Origin
- Source status
- Archive editors
- Attribution
- Archive editors
- Origin
- https://eltayebat.com/rule/leafy-greens-cucurbits/
- Attribution uncertainty
- Archive editorial text and study selection written by the archive operators, not necessarily by Elawady.
- Claimed mechanism
Nitrate converted to nitrite oxidises haemoglobin; infants have low methaemoglobin reductase.
- Claimed health effect
Methaemoglobinaemia (cyanosis).
- Population concerned
Infants under about 3 months
- Geographic restriction by Elawady
none found
Scientific assessment
True – The statement is supported by robust evidence.
Certainty of evidence: moderate – Further research may still affect the assessment.
1. What was claimed?
High-nitrate vegetables can poison young infants.
2. What is demonstrably correct?
Correct: two infants (1 and 2 months) developed methaemoglobinaemia of 30.4% and 27% after formula reconstituted with concentrated courgette soup; AAP notes continued reports from home-prepared vegetable foods. A Spanish series of 78 infant cases found that purees prepared more than 24 hours in advance (OR 17.4-24.9) and very high-nitrate leaves (borage, chard) were the main risk factors (Martinez 2013, I-VEG-113); an Italian series found badly preserved vegetable broth as the main cause in weaning infants (median age 8 months; Raucci 2022, I-VEG-114). EFSA (2010, I-VEG-115) could not exclude a risk for some infants eating more than one spinach meal a day and warned about storage of cooked vegetables.
3. What is wrong or exaggerated?
The archive uses an infant-specific risk as an argument against greens for everyone. Paediatric guidance recommends offering vegetables, including bitter green vegetables, from 4-6 months (ESPGHAN 2017, I-VEG-111).
4. What remains unclear?
Not applicable.
5. Which studies support it?
Savino 2006; Greer 2005; EU Reg. 2023/915 (200 mg/kg limit for baby foods).
6. Which studies contradict it?
None for infants.
7. What applies to Germany and Europe?
EU Regulation 2023/915 sets 200 mg NO3/kg for baby food and processed cereal-based food.
8. What is known about Egypt?
Home-prepared vegetable broths for very young infants are a relevant practice to warn about.
9. What practical conclusion is appropriate?
Do not give home-made high-nitrate vegetable broths (spinach, chard, beet, borage, courgette) to infants in the first months, and do not keep home-made vegetable purees or broths for a day or more (prepare fresh or freeze); vegetables remain recommended in complementary feeding from about 4-6 months.
Assessment details
- Rationale for certainty of evidence
Case reports and AAP clinical report; mechanism well understood; EU sets low nitrate limits for baby foods.
- Source quality
Case report (2 infants) and paediatric guidance.
- Regional transferability
Applies in Germany and Egypt; well-water nitrate is an additional risk.
- Individual exceptions
Breastfed infants are not at risk even with high maternal nitrate intake (Greer 2005).
- Regional scope of the claim
- not specified
- Last reviewed
- 26 October 2026 provisional
Scientific evidence in detail
Scientifically well supported – The claim agrees with consistent, high-quality evidence.
Research question: In infants, does ingestion of home-prepared nitrate-rich vegetable broths or purees cause methaemoglobinaemia, and under which conditions (age, vegetable, storage)?
Research question in detail (PECO)
- Population
- Infants and young children
- Intervention or exposure
- Home-prepared broths/purees of high-nitrate vegetables (spinach, chard, borage, beet, courgette)
- Comparison
- No such exposure; fresh or frozen preparations
- Geographic scope
- universal biology; vegetable nitrate levels vary with production
- Outcomes
- methaemoglobinaemia
- cyanosis
- hospitalisation
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
Stored vegetable purees caused infant methaemoglobinaemia
Martinez A et al.. J Pediatr Gastroenterol Nutr 2013 · PMID 23287806 · DOI 10.1097/MPG.0b013e3182849d2b Case-control studyabstract checkednewly addedSpanish series of 78 cases with matched controls.
- Actual result
- Purees prepared 24-48 h before: OR 17.4 (3.5-86.3); >48 h: OR 24.9 (3.3-187.6); borage OR 5.2 (1.1-24.6).
- Methodological quality
- low (retrospective, bivariate) but largest series
- Relevance
- direct
- Limitations
- Wide CIs.
Courgette soup poisoning in two babies
Savino F et al.. Ann Nutr Metab 2006 · PMID 16809905 · DOI 10.1159/000094301 Case series / case reportabstract checkedArchive-cited case report (Savino 2006).
- Actual result
- Two infants (1 and 2 months) with MetHb 30.4% and 27% after courgette soup.
- Methodological quality
- very low (case report)
- Relevance
- direct
- Limitations
- Two cases.
EFSA on nitrate in spinach for babies
EFSA Panel on Contaminants in the Food Chain (CONTAM). EFSA Journal 2010 · DOI 10.2903/j.efsa.2010.1935 Risk assessmentabstract checkednewly addedEFSA 2010 statement.
- Actual result
- Risk for some infants eating more than one spinach meal a day cannot be excluded; storage of cooked vegetables increases nitrite.
- Methodological quality
- authoritative risk assessment
- Relevance
- direct
- Limitations
- Modelling-based.
What speaks against the claim?
European paediatricians: offer green vegetables to infants
Fewtrell M et al.. J Pediatr Gastroenterol Nutr 2017 · PMID 28027215 · DOI 10.1097/MPG.0000000000001454 Guideline / position statementabstract checkednewly addedESPGHAN complementary-feeding position paper.
- Actual result
- Recommends offering bitter green vegetables from 4-6 months.
- Methodological quality
- authoritative guidance
- Relevance
- limits generalisation beyond early infancy and poor storage
- Limitations
- Not a contradiction of the infant risk.
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
True for infants: nitrate-rich vegetable broths or purees, especially when stored for a day or more, can cause methaemoglobinaemia, mostly in the first year of life. Freshly prepared or frozen vegetables remain recommended in complementary feeding from about 4-6 months.
Why some studies weigh more
Consistent case series from several countries, a case-control analysis, an EFSA statement and an AAP clinical report agree; no evidence contradicts the infant risk.
Is a causal relationship established? Yes, established Mechanism (nitrate to nitrite, oxidation of haemoglobin, low infant MetHb reductase) and repeated temporal cases with nitrite measurement.
Remaining uncertainty
Incidence per exposed infant.
Justified conclusion
True for infants under the stated conditions; not an argument against vegetables for older children or adults.
Why do studies seem to disagree?
Not a conflict: ESPGHAN recommends green vegetables from 4-6 months, while case series show harm mainly from stored or concentrated broths and very high-nitrate leaves; the conditions differ (age, preparation, storage).
Does this depend on the country?
- General biological effects
- Infant physiology is universal.
- Eating habits
- Home-made vegetable broths for infant constipation or weaning are common in Egypt and Mediterranean countries.
- Origin of the food
- Nitrate content depends on fertilisation, season and light; EU sets limits for baby foods.
- Contaminants
- Not a contaminant issue; natural nitrate accumulation.
- National production conditions
- Egyptian nitrate data in leafy vegetables were not reviewed.
- Legal rules
- EU Reg. 2023/915 (I-VEG-14) limits nitrate in baby foods to 200 mg/kg.
- Actual monitoring data
- not reviewed
A regional difference that changes the conclusion is not supported by robust data.
Statistical re-check
- Log-symmetry and width of odds-ratio CIs – Symmetric (consistent reporting), very wide (imprecise); storage time strongest association. recalculated
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- Methaemoglobinaemia in infants after high-nitrate vegetable preparations
- Starting level
- low (observational studies)
- Reasons for downgrading
- imprecision
- Reasons for upgrading
- large effect (OR >10 for stored purees)
- consistent mechanism and repeated cases
- Result
- moderate
Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.
Clinical guidelines and official statements checked
- EFSA CONTAM Panel: Statement on possible public health risks for infants and young children from nitrates in leafy vegetables (I-VEG-115) (2010) · Original publication
Risk for some infants eating more than one spinach meal a day cannot be excluded; inappropriate storage of cooked vegetables increases nitrite; do not feed spinach to children with bacterial GI infections (abstract via Crossref; EFSA page HTTP 403). - ESPGHAN Committee on Nutrition: Complementary Feeding: A Position Paper (Fewtrell 2017; I-VEG-111) (2017) · Original publication
Complementary foods not before 4 months and not later than 6 months; offer varied flavours and textures including bitter-tasting green vegetables (PubMed abstract). - American Academy of Pediatrics: Infant methemoglobinemia: the role of dietary nitrate in food and water (Greer 2005; I-VEG-08) (2005) · Original publication
Existing linked clinical report; home-prepared foods from high-nitrate vegetables should be avoided in young infants (per existing register entry).
Search strategy
Documented literature searches for this review (search strings in the original database syntax).
| Database | Date | Search | Looking for | Hits | Included |
|---|---|---|---|---|---|
| PubMed | 26 October 2026 | (methemoglobinemia OR methaemoglobinaemia) AND (infant*) AND (vegetable* OR spinach OR "carrot juice" OR zucchini OR courgette OR beet*) | supporting evidence | 57 | |
| Europe PMC | 26 October 2026 | (methemoglobinemia OR methaemoglobinaemia) AND infant AND nitrate AND (diarrhea OR gastroenteritis OR "endogenous nitric oxide" OR reexamin*) | contradicting evidence | 122 | |
| Europe PMC | 26 October 2026 | (methemoglobinemia OR methaemoglobinemia OR methaemoglobinaemia) AND (infant* OR children) AND (vegetable* OR "vegetable broth" OR puree OR spinach OR chard) | supporting evidence | 525 | |
| PubMed | 26 October 2026 | (nitrate OR nitrite) AND (vegetable*) AND (infant* OR "young children") AND (safe OR "no risk" OR "risk assessment" OR exposure) | contradicting evidence | 23 | |
| EFSA website | 26 October 2026 | https://www.efsa.europa.eu/en/efsajournal/pub/1935 (HTTP 403; abstract obtained via Crossref API) | guidelines | 1 |
Open questions
Incidence in Egypt; nitrate levels in Egyptian leafy vegetables.
How deeply was this checked?
7 linked studies: 1 checked in full text (0 of them with a structured risk-of-bias assessment), 6 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.
Last scientific review: 26 October 2026
History of the verdict
- 25 October 2026 · Phase 1 · Initial assessment: True (moderate)
- 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: True (moderate)
New series confirm the infant risk and add storage time and older infants (up to ~13 months) as relevant; verdict unchanged; safety note sharpened to mention storage and to keep the recommendation of fresh vegetables in complementary feeding.
New sources: I-VEG-113 I-VEG-114 I-VEG-115 I-VEG-111
In plain language
Very young babies can develop a dangerous blood disorder (methaemoglobinaemia) if they are given home-made soups of nitrate-rich vegetables such as courgette or spinach. This is well documented. It applies to infants in their first months, not to older children or adults.
Studies on this claim
Studies supporting the claim (6)
-
Courgette soup poisoning in two babies
Savino F et al.. Ann Nutr Metab 2006 · PMID 16809905 · DOI 10.1159/000094301Case series / case reportcited by the Tayebat archiveabstract checkedTwo infants under 3 months developed methaemoglobinaemia from concentrated courgette soup.
Does the study support the specific claim? Partly · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Report cases
- How was the study done?
Case report
- How many people, animals or samples were studied?
2 infants
- What was actually found?
Methaemoglobinaemia
- How large was the observed effect?
30.4% and 27%
- What do the results mean in everyday life?
Don't give vegetable broths to young infants.
- What are the study's limitations?
Two cases
- What does it say about Elawady's specific claim?
Infant-specific
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Cannot show harm in adults.
-
Nitrate and infant blood disorder
Greer FR, Shannon M. Pediatrics 2005 · PMID 16140723 · DOI 10.1542/peds.2005-1497Guideline / position statementindependent cross-checkabstract checkedBabies can be poisoned by nitrate mainly from well water or home-made vegetable foods; breastfed babies are not at risk.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Advise on infant nitrate
- How was the study done?
Clinical report
- How many people, animals or samples were studied?
Not applicable
- What was actually found?
Infant risk specific
- How large was the observed effect?
Not applicable
- What do the results mean in everyday life?
Avoid home-made high-nitrate broths for infants.
- What are the study's limitations?
Not systematic
- What does it say about Elawady's specific claim?
Infant-specific
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Cannot show adult harm.
-
EU nitrate limits for leafy vegetables
European Commission. Official document 2023Guideline / position statementindependent cross-checkfull text checked★ key studyThe EU caps nitrate in spinach, lettuce and rocket and sets a much lower limit for baby food.
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Set limits
- How was the study done?
Regulation
- How many people, animals or samples were studied?
Not applicable
- What was actually found?
Limits per product
- How large was the observed effect?
Not applicable
- What do the results mean in everyday life?
Nitrate in EU greens is controlled.
- What are the study's limitations?
Limits are not health thresholds per se
- What does it say about Elawady's specific claim?
Regulatory context
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Cannot show harm or safety at individual level.
-
Stored vegetable purees caused infant methaemoglobinaemia
Martinez A et al.. J Pediatr Gastroenterol Nutr 2013 · PMID 23287806 · DOI 10.1097/MPG.0b013e3182849d2bCase-control studyindependent cross-checkabstract checked★ key studyIn 78 Spanish infants, purees made more than a day in advance and nitrate-rich leaves such as borage and chard were linked to methaemoglobinaemia.
78 infant cases; stored purees and high-nitrate leaves (borage, chard) implicated.
Does the study support the specific claim? Yes · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Identify risk factors for vegetable-related methaemoglobinaemia.
- How was the study done?
Case series with case-control comparison.
- How many people, animals or samples were studied?
78 cases, 78 controls.
- What was actually found?
Storage >24 h and borage/chard strongly associated.
- How large was the observed effect?
OR 17.4 to 24.9 for stored purees.
- What do the results mean in everyday life?
Prepare infant vegetable purees fresh or freeze them; avoid very high-nitrate leaves for young infants.
- What are the study's limitations?
Small, bivariate.
- What does it say about Elawady's specific claim?
Supports the infant-specific claim.
- Do the results apply to Germany and Europe?
European; applicable.
- What can explicitly not be concluded from this study?
Cannot show risk for adults or for fresh, properly stored purees.
-
Badly stored vegetable broth caused blue-baby poisoning in Italian infants
Raucci U et al.. Clin Toxicol (Phila) 2022 · PMID 35416740 · DOI 10.1080/15563650.2022.2061986Case series / case reportindependent cross-checkabstract checked19 children (median age 8 months) developed methaemoglobinaemia, mostly after home-made vegetable broth that had been badly preserved; all survived with treatment.
Recent Italian series: badly preserved vegetable broth in weaning infants.
Does the study support the specific claim? Yes · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Describe acquired methaemoglobinaemia in children.
- How was the study done?
Retrospective multicentre series.
- How many people, animals or samples were studied?
19 children.
- What was actually found?
Mostly from badly preserved vegetable broth.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Store home-made vegetable broths for babies properly or prepare them fresh.
- What are the study's limitations?
Small; no denominator.
- What does it say about Elawady's specific claim?
Supports infant risk.
- Do the results apply to Germany and Europe?
European.
- What can explicitly not be concluded from this study?
Cannot estimate how often it happens.
-
EFSA on nitrate in spinach for babies
EFSA Panel on Contaminants in the Food Chain (CONTAM). EFSA Journal 2010 · DOI 10.2903/j.efsa.2010.1935Risk assessmentindependent cross-checkabstract checkedEFSA judged spinach nitrate unlikely to be a concern for most infants, but could not exclude risk for some, and warned that badly stored cooked vegetables form nitrite.
EFSA: risk for some infants cannot be excluded; storage increases nitrite.
Does the study support the specific claim? Yes · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Assess infant nitrate risk from leafy vegetables.
- How was the study done?
Risk assessment.
- How many people, animals or samples were studied?
Not applicable.
- What was actually found?
Some infant risk; storage key; avoid spinach during GI infections.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Use fresh or frozen vegetable purees; be careful with spinach for small children.
- What are the study's limitations?
Modelling-based.
- What does it say about Elawady's specific claim?
Supports infant-specific claim.
- Do the results apply to Germany and Europe?
EU.
- What can explicitly not be concluded from this study?
No outcome data.
No study in this group is marked as key.
Studies contradicting or limiting the claim (0)
No studies in this group.
Studies with mixed or unclear results (1)
-
European paediatricians: offer green vegetables to infants
Fewtrell M et al.. J Pediatr Gastroenterol Nutr 2017 · PMID 28027215 · DOI 10.1097/MPG.0000000000001454Guideline / position statementindependent cross-checkabstract checked★ key studyESPGHAN advises starting solids between 4 and 6 months and offering varied foods including bitter green vegetables.
Vegetables are recommended for infants from 4-6 months; the nitrate warning applies to younger infants and to storage/preparation.
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Give complementary-feeding recommendations.
- How was the study done?
Position paper.
- How many people, animals or samples were studied?
Not applicable.
- What was actually found?
Green vegetables recommended from 4-6 months.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Vegetables are part of normal infant feeding after the first months.
- What are the study's limitations?
Consensus document.
- What does it say about Elawady's specific claim?
Contradicts removing vegetables for children; context for infant nitrate warning.
- Do the results apply to Germany and Europe?
European.
- What can explicitly not be concluded from this study?
Does not quantify nitrate risk.
No study in this group is marked as key.
Regional context
Germany / EU
EU Regulation 2023/915 sets 200 mg NO3/kg for baby food and processed cereal-based food.
Egypt
Home-prepared vegetable broths for very young infants are a relevant practice to warn about.
What applies in my country?
General scientific assessment
True True for young infants; not an argument against vegetables for adults.
The following areas of food safety are relevant to this statement:
- Pesticides and pesticide residues
- Contaminants (heavy metals, PFAS, PCBs, dioxins, nitrate)
- Pathogens (Salmonella, Campylobacter, etc.)
Fruit and vegetables
Choose a country to see the checked information for it.
Limits: legal rules describe what is allowed, not what every single food contains. Measurement data come from samples and are meaningful only together with their method details.
Country of residence or purchase Compare with another country
References
- Methemoglobinemia caused by the ingestion of courgette soup given in order to resolve constipation in two formula-fed infants.. Savino F et al.. Ann Nutr Metab 2006 · PMID 16809905 · DOI 10.1159/000094301
- Infant methemoglobinemia: the role of dietary nitrate in food and water.. Greer FR, Shannon M. Pediatrics 2005 · PMID 16140723 · DOI 10.1542/peds.2005-1497
- Commission Regulation (EU) 2023/915 on maximum levels for certain contaminants in food (Annex I, section 6.1 Nitrates). European Commission. Official document 2023
- Methemoglobinemia induced by vegetable intake in infants in northern Spain.. Martinez A et al.. J Pediatr Gastroenterol Nutr 2013 · PMID 23287806 · DOI 10.1097/MPG.0b013e3182849d2b
- Acquired methemoglobinemia in children presenting to Italian pediatric emergency departments: a multicenter report.. Raucci U et al.. Clin Toxicol (Phila) 2022 · PMID 35416740 · DOI 10.1080/15563650.2022.2061986
- Statement on possible public health risks for infants and young children from the presence of nitrates in leafy vegetables. EFSA Panel on Contaminants in the Food Chain (CONTAM). EFSA Journal 2010 · DOI 10.2903/j.efsa.2010.1935
- Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition.. Fewtrell M et al.. J Pediatr Gastroenterol Nutr 2017 · PMID 28027215 · DOI 10.1097/MPG.0000000000001454