Relationship of dietary nitrate intake from vegetables with cardiovascular disease mortality: a prospective study in a cohort of older Australians

Liu, Alex H.; Bondonno, Catherine P.; Russell, Joanna; Flood, Victoria M; Lewis, Joshua R.; Croft, Kevin D.; Woodman, Richard; Lim, Wai H.; Kifley, Annette; Wong, Germaine; Mitchell, Paul; Hodgson, Jonathan M.; Blekkenhorst, Lauren C.

doi:10.1007/s00394-018-1823-x

Cited by 35 publications

(50 citation statements)

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“…On average, women within our sample were consuming approximately 61 mg/day total nitrate and 48 mg/day vegetable nitrate at baseline. This level of nitrate intake was markedly lower than mean nitrate intakes estimated in previous Australian based cohort studies, including the Calcium Intake Fracture Outcome Study (CAIFOS) (total nitrate ~79 mg/day; vegetable nitrate ~67mg/day) [41] and the Blue Mountains Eye Study cohort (BMES) (total nitrate ~129 mg/day; vegetable nitrate ~110 mg/day) [42]. These large differences in estimated nitrate intakes have occurred despite using the same nitrate databases to estimate intakes [19,28,29,30].…”

Section: Discussionmentioning

confidence: 74%

“…On the other hand, we expect there are two major reasons why our cohort has lower estimated nitrate intakes than those reported by the BMES, including differences in the FFQ tool and cohort population. Unlike the ALSWH and CAIFOS cohorts which use the 74 item DQES and include only female participants, the BMES includes female and male participants aged >45 years old, and assessed diet using a 145 item FFQ [42]. This is an important factor to consider in this context, given men and women differ in their preferences for food items and consumption amounts, thus it is reasonable to expect that gender differences could be driving these inconsistencies [43].…”

Section: Discussionmentioning

confidence: 99%

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Vegetable Nitrate Intakes Are Associated with Reduced Self-Reported Cardiovascular-Related Complications within a Representative Sample of Middle-Aged Australian Women, Prospectively Followed up for 15 Years

et al. 2019

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Nitric oxide (NO) facilitates anti-atherosclerotic effects. Vegetables are a major source of dietary nitrate. Experimental data indicates that dietary nitrate can significantly reduce major risk factors for atherosclerosis and subsequent cardiovascular disease (CVD), as nitrate can be metabolized to produce NO via the nitrate-nitrite-NO pathway. The purpose of this study was to prospectively investigate the association between habitual dietary nitrate intakes and the incidence of self-reported CVD-related complications within a representative sample of middle-aged Australian women (1946–1951 cohort of the Australian Longitudinal Study on Women’s Health). Women free from disease at baseline who had completed the food frequency questionnaire data were included. Generalized estimating equations were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) across quartiles for nitrate intakes. Of the 5324 women included for analysis, there were 1951 new cases of CVD-related complications over 15-years of follow-up. Women reporting higher total dietary nitrate intakes (Q4 > 78.2 mg/day) and vegetable nitrate intakes (Q4 > 64.4 mg/day) were 25% and 27% reduced risk of developing CVD-related complications respectively, compared with women reporting low total (Q1 < 45.5 mg/day) and vegetable nitrate intakes (Q1 < 34.8 mg/day). Our findings were consistent with other observational data indicating that dietary nitrate may explain some of the cardiovascular benefits of vegetable consumption.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Vegetable Nitrate Intakes Are Associated with Reduced Self-Reported Cardiovascular-Related Complications within a Representative Sample of Middle-Aged Australian Women, Prospectively Followed up for 15 Years

et al. 2019

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“…This study on the other hand calculated nitrate intake using the updated US Department of Agriculture food composition tables, which is most appropriate given that this study has been conducted in an American population. In light of these differences, it is not surprising that the nitrate intake in the NHS have been estimated at levels markedly higher (mean nitrate intake: 152 mg/d) than those reported in the Australian-based cohorts (Blekkenhorst et al (21) mean nitrate: 80 mg/d; Liu et al (22) mean nitrate: 130 mg/d). However, our mean nitrate intake estimations are similar to those previously reported in the NHS by Kang et al (42) (mean nitrate intake: 142 mg/d), in which higher dietary nitrate intake were associated with a lower primary open-angle glaucoma risk.…”

Section: Discussionmentioning

confidence: 94%

“…More recently, Liu et al (22) prospectively investigated the association of nitrate intake with CVD mortality in a sample of 2229 Australian men and women aged ≥49 years, followed up for 14 years. Participants consuming the highest (>137•8 mg/d) compared with the lowest (<69•5 mg/d) quartile for vegetable nitrate intake were observed to be at a 37 % lower hazards of CVD mortality (HR: 0•63, 95 % CI 0•41, 0•95) (22) . In light of these previously published findings, it is perplexing to note that despite observing a similar trend to Blekkenhorst et al (21) in the age-adjusted model, the fully adjusted model was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Dietary nitrate consumption and risk of CHD in women from the Nurses’ Health Study

et al. 2019

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The consumption of nitrate-rich vegetables can acutely lower blood pressure and improve mediators shown to optimise vascular health. However, we do not yet understand the impact of long-term habitual dietary nitrate intake and its association with CVD. Therefore, the aim of this investigation was to examine the relationship between habitual dietary nitrate intakes and risk of CHD in women from the Nurses’ Health Study. We prospectively followed 62 535 women who were free from diabetes, CVD and cancer at baseline in 1986. Information on diet was updated every 4 years with validated FFQ. The main outcome was CHD defined by the occurrence of non-fatal myocardial infarction or fatal CHD. Cox proportional hazard regression models were used to estimate the relative risks (RR) and 95 % CI. During 26 years of follow-up, 2257 cases of CHD were identified. When comparing the highest quintile of nitrate intake with the lowest quintile, in aged-adjusted analysis there was a protective association for CHD (RR=0·77, 95 % CI 0·68, 0·97; P=0·0002) which dissipated after further adjustment for smoking, physical activity, BMI and race (RR=0·91; 95 % CI 0·80, 1·04; P=0·27). This magnitude of association was further attenuated once we adjusted for the Alternative Healthy Eating Index excluding vegetable and fruit consumption (RR=1·04, 95 % CI 0·91, 1·20; P=0·34). Dietary nitrate intake was not related to the risk of CHD after adjustment for other lifestyle and non-vegetable dietary factors in a large group of US women.

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“…For example, several investigations have demonstrated that dietary supplementation with inorganic nitrate, typically in doses between 4 and 12 mmol/day (~250–750 mg/day), can reduce blood pressure (BP),13–17 improve endothelial function14 17 18 and, at least in recreationally active and moderately trained individuals, enhance exercise performance 19–24. In addition, several recent observational studies have linked increased nitrate intake with reduced risk of cardiovascular disease mortality,25 atherosclerotic vascular disease26 and ischaemic cerebrovascular disease 27…”

Section: Introductionmentioning

confidence: 99%

Knowledge and beliefs about dietary inorganic nitrate among UK-based nutrition professionals: development and application of the KINDS online questionnaire

et al. 2019

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ObjectivesTo examine knowledge and beliefs about the biological roles of dietary inorganic nitrate in UK-based nutrition professionals, and to explore potential differences by participants’ education level.SettingAn online questionnaire was administered to UK-based nutrition professionals, exploring knowledge and/or beliefs across five areas: (1) health and performance effects of nitrate; (2) current and recommended intake values for nitrate; (3) dietary sources of nitrate; (4) methods of evaluating nitrate intake and (5) nitrate metabolism.ParticipantsOne hundred and twenty-five nutrition professionals.Primary outcomeKnowledge and beliefs about inorganic nitrate.ResultsMost nutrition professionals taking part in the survey had previously heard of inorganic nitrate (71%) and perceived it to be primarily beneficial (51%). The majority believed that nitrate consumption can improve sports performance (59%) and reduce blood pressure (54%), but were unsure about effects on cognitive function (71%), kidney function (80%) and cancer risk (70%). Knowledge of dietary sources of nitrate and factors affecting its content in food were generally good (41%–79% of participants providing correct answers). However, most participants were unsure of the average population intake (65%) and the acceptable daily intake (64%) of nitrate. Most participants (65%) recognised at least one compound (ie, nitric oxide or nitrosamines) that is derived from dietary nitrate in the body. Knowledge of nitrate, quantified by a 23-point index created by summing correct responses, was greater in individuals with a PhD (p=0.01; median (IQR)=13 (9–17)) and tended to be better in respondents with a masters degree (p=0.054; 13 (8–15)) compared with undergraduate-level qualifications (10 (2–14)).ConclusionsUK-based nutrition professionals demonstrated mixed knowledge about the physiology of dietary nitrate, which was better in participants with higher education. More efficient dissemination of current knowledge about inorganic nitrate and its effects on health to nutrition professionals will support them to make more informed recommendations about consumption of this compound.

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Relationship of dietary nitrate intake from vegetables with cardiovascular disease mortality: a prospective study in a cohort of older Australians

Cited by 35 publications

References 73 publications

Vegetable Nitrate Intakes Are Associated with Reduced Self-Reported Cardiovascular-Related Complications within a Representative Sample of Middle-Aged Australian Women, Prospectively Followed up for 15 Years

Vegetable Nitrate Intakes Are Associated with Reduced Self-Reported Cardiovascular-Related Complications within a Representative Sample of Middle-Aged Australian Women, Prospectively Followed up for 15 Years

Dietary nitrate consumption and risk of CHD in women from the Nurses’ Health Study

Knowledge and beliefs about dietary inorganic nitrate among UK-based nutrition professionals: development and application of the KINDS online questionnaire

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