Epidemiological Evaluation of Recurrent Stomatitis, Nitrates in Drinking Water, and Cytochrome B₅ Reductase Activity

Abstract

OBJECTIVES: 

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.