Nitrate, the oral microbiome, and cardiovascular health: a systematic literature review of human and animal studies

Blekkenhorst, Lauren C.; Bondonno, Nicola P.; Liu, Alex H.; Ward, Natalie C.; Prince, Richard; Lewis, Joshua R.; Devine, Amanda; Hodgson, Jonathan M.; Bondonno, Catherine P.

doi:10.1093/ajcn/nqx046

Cited by 62 publications

(76 citation statements)

References 145 publications

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“…The physiological effects of inorganic nitrate consumption have received considerable research interest in recent years. Strong evidence now exists showing the potential for supplemental nitrate to reduce BP13–17 and to enhance exercise performance19–24 in healthy individuals, although evidence in clinical populations is less clear 32. This growing evidence was reflected in participant responses, with over half of participants stating that these were physiological effects of inorganic nitrate.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…The oral microbiome has been implicated in several oral cavity (dental caries, periodontitis, endodontic, alveolar osteitis, and tonsillitis) and systemic diseases (cardiovascular disease, stroke, pneumonia, and diabetes) [14][15][16][17]. Long et al [18] reported that several bacterial taxa in the phylum Actinobacteria are negatively associated with obesity and diabetes.…”

Section: Introductionmentioning

confidence: 99%

Profiling the Oral Microbiome and Plasma Biochemistry of Obese Hyperglycemic Subjects in Qatar

et al. 2019

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The present study is designed to compare demographic characteristics, plasma biochemistry, and the oral microbiome in obese (N = 37) and lean control (N = 36) subjects enrolled at Qatar Biobank, Qatar. Plasma hormones, enzymes, and lipid profiles were analyzed at Hamad Medical Cooperation Diagnostic Laboratory. Saliva microbiome characterization was carried out by 16S rRNA amplicon sequencing using Illumina MiSeq platform. Obese subjects had higher testosterone and sex hormone-binding globulin (SHBG) concentrations compared to the control group. A negative association between BMI and testosterone (p < 0.001, r = −0.64) and SHBG (p < 0.001, r = −0.34) was observed. Irrespective of the study groups, the oral microbiome was predominantly occupied by Streptococcus, Prevotella, and Veillonella species. A generalized linear model revealed that the Firmicutes/Bacteroidetes ratio (2.25 ± 1.83 vs. 1.76 ± 0.58; corrected p-value = 0.04) was higher, and phylum Fusobacteria concentration (4.5 ± 3.0 vs. 6.2 ± 4.3; corrected p-value = 0.05) was low in the obese group compared with the control group. However, no differences in microbiome diversity were observed between the two groups as evaluated by alpha (Kruskal–Wallis p ≥ 0.78) and beta (PERMANOVA p = 0.37) diversity indexes. Certain bacterial phyla (Acidobacteria, Bacteroidetes, Fusobacteria, Proteobacteria, Spirochaetes, and Firmicutes/Bacteroidetes) were positively associated (p = 0.05, r ≤ +0.5) with estradiol, fast food consumption, creatinine, breastfed during infancy, triglycerides, and thyroid-stimulating hormone concentrations. In conclusion, no differences in oral microbiome diversity were observed between the studied groups. However, the Firmicutes/Bacteroidetes ratio, a recognized obesogenic microbiome trait, was higher in the obese subjects. Further studies are warranted to confirm these findings in a larger cohort.

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“…Dietary NO 3 − is well absorbed in the upper gastrointestinal tract. About 25% of dietary NO 3 − is captured by the salivary glands, where it is reduced to NO 2 − by commensal bacteria that express and secret NO 3 − -reductase enzyme in saliva [ 6 , 191 ]. The metabolic activity of the hundreds of commensal bacteria species belonging to the Granulicatella , Actinomyces , Veillonella , Prevotella , Neisseria , Haemophilus , and Rothia genera that live on the tongue can directly influence the NO 3 − to NO metabolism.…”

Section: Beetroot Product Interventions Increase Nitric Oxide Prodmentioning

confidence: 99%

“…These compounds, termed functional nutrients, provide benefits for the promotion and maintenance of human health [ 1 , 2 ]. Epidemiological studies have demonstrated that dietary nitrate (NO 3 − ) from certain vegetables can provide a physiological substrate for the production of nitric oxide (NO) which, in turn, supports cardiovascular function, causes vasodilation, and decreases blood pressure [ 3 , 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, secondary metabolites found in vegetables are involved in protective responses to different abiotic plant stresses [ 6 ]. In the last decade, systematic reviews and meta-analyses have demonstrated the potential health benefits of the dietary intake of plant polyphenols, mainly antioxidants, to decrease the risk of chronic and degenerative diseases [ 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Beetroot, A Remarkable Vegetable: Its Nitrate and Phytochemical Contents Can be Adjusted in Novel Formulations to Benefit Health and Support Cardiovascular Disease Therapies

2020

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The cardioprotective effects of dietary nitrate from beetroot in healthy and hypertensive individuals are undeniable and irrefutable. Nitrate and nitrate-derived nitrite are precursors for nitric oxide synthesis exhibiting an effect on cardiomyocytes and myocardial ischemia/reperfusion, improving endothelial function, reducing arterial stiffness and stimulating smooth muscle relaxation, decreasing systolic and diastolic blood pressures. Beetroot phytochemicals like betanin, saponins, polyphenols, and organic acids can resist simulated gastrointestinal digestion, raising the hypothesis that the cardioprotective effects of beetroots result from the combination of nitrate/nitrite and bioactive compounds that limit the generation of reactive oxygen species and modulate gene expression. Nitrate and phytochemical concentrations can be adjusted in beet formulations to fulfill requirements for acute or long-term supplementations, enhancing patient adherence to beet intervention. Based on in vitro, in vivo, and clinical trials, beet nitrate and its bioactive phytochemicals are promising as a novel supportive therapy to ameliorate cardiovascular diseases.

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Nitrate, the oral microbiome, and cardiovascular health: a systematic literature review of human and animal studies

Cited by 62 publications

References 145 publications

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

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

Profiling the Oral Microbiome and Plasma Biochemistry of Obese Hyperglycemic Subjects in Qatar

Beetroot, A Remarkable Vegetable: Its Nitrate and Phytochemical Contents Can be Adjusted in Novel Formulations to Benefit Health and Support Cardiovascular Disease Therapies

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