Body mass-normalized moderate dose of dietary nitrate intake improves endothelial function and walking capacity in patients with peripheral artery disease

Abstract

Peripheral artery disease (PAD) is characterized by the accumulation of atherosclerotic plaques in the lower extremity conduit arteries, which impairs blood flow and walking capacity. Dietary nitrate has been used to reduce blood pressure (BP) and improve walking capacity in PAD. However, a standardized dose for PAD has not been determined. Therefore, we sought to determine the effects of a body mass-normalized moderate dose of nitrate (0.11 mmol nitrate/kg) as beetroot juice on serum nitrate/nitrite, vascular function, walking capacity, and tissue oxygen utilization capacity in patients with PAD. 11 patients with PAD received either nitrate supplement or placebo in a randomized crossover design. Total serum nitrate/nitrite, resting BP, brachial and popliteal artery endothelial function (flow-mediated dilation, FMD), arterial stiffness (pulse-wave velocity, PWV), augmentation index (AIx), maximal walking distance and time, claudication onset time, and skeletal muscle oxygen utilization were measured pre-and-post-nitrate and placebo intake. There were significant group x time interactions (p<0.05) for serum nitrate/nitrite, FMD, BP, walking distance and time, and skeletal muscle oxygen utilization. The nitrate group showed significantly increased serum nitrate/nitrite (Δ1.32μM), increased brachial and popliteal FMD (Δ1.3% and Δ1.7%, respectively), reduced peripheral and central systolic BP (Δ-4.7mmHg and Δ-8.2mmHg, respectively), increased maximal walking distance (Δ92.7m) and time (Δ56.3s), and reduced deoxygenated hemoglobin during walking. There were no changes in PWV, AIx, or claudication (p>0.05). These results indicate that a body-mass normalized moderate dose of nitrate may be effective and safe for reducing BP, improving endothelial function, and improving walking capacity in patients with PAD.

Nutraceuticals and Dietary Supplements for Older Adults with Long COVID-19

“… 172 In this context, beetroot juice may improve both endurance and power exercise performance through increasing NO bioavailability, which in turn modulates mitochondrial respiration, reduces oxygen cost of exercise, and improves muscular and cerebral perfusion. 173 , 174 Recent evidence has shown that the stimulation of the nitrate-nitrite-NO pathway by beetroot juice consumption may improve endothelial function, as measured by flow-mediated dilation, in persons with or at risk of endothelial dysfunction, including older adults, 175 people with peripheral artery disease, 176 pregnant women, 177 and persons with hypercholesterolemia 178 and hypertension. 179 Moreover, beetroot juice ingestion was associated with a reduction in blood pressure in normotensive 180 and hypertensive people, 181 and in older adults.…”

Plant-Based Foods and Vascular Function: A Systematic Review of Dietary Intervention Trials in Older Subjects and Hypothesized Mechanisms of Action

“…The main characteristic of the 15 studies included in the review are summarized in Table 1 [56][57][58][59][60][61] and Table 2 [62][63][64][65][66][67][68][69][70]. Specifically, Table 1 reports the results of acute interventions (n = 6), and Table 2 reports the results related to the chronic dietary interventions (n = 9).…”

“…Specifically, Table 1 reports the results of acute interventions (n = 6), and Table 2 reports the results related to the chronic dietary interventions (n = 9). The majority of the studies (n = 7) were performed in the USA [57][58][59][60]62,67,68]. Of the remaining studies, four were conducted in the UK [61,65,66,69], two studies were performed in Australia [63,64], and two in Brazil [56,70].…”

“…The characteristics of the study population studied are heterogenous between the studies included in the review. Seven studies involved healthy subjects [57][58][59]61,62,66,69], four studies involved older subjects with cardiovascular risk factors [56,65,67,70], two studies involved subjects with overt peripheral artery disease [60,68], and one study involved subjects with mild cognitive impairment [63]. None of these studies involved only normoweight subjects.…”

“…None of these studies involved only normoweight subjects. Eight studies included overweight subjects [57][58][59]62,63,66,68,69], while six studies included obese or both overweight and obese subjects [56,60,64,65,67,70]. One study included normoweight, overweight, and obese subjects [61].…”