Abstract
Background
Emerging evidence suggests that increasing dietary nitrate intake may be an effective
approach to reduce blood pressure. Beetroot juice is often used to supplement dietary
nitrate, whereas nitrate intake levels from habitual diet are low. An increase in
the habitual intake of nitrate-rich vegetables may represent an alternative to nitrate
supplementation. However, the effectiveness and acceptability of a nitrate–rich-vegetables
diet remain to be established.
Objective
The aim was to investigate the effect and feasibility of two different intervention
strategies to increase dietary nitrate intake, on plasma nitrate/nitrite concentrations
and blood pressure.
Design
A randomized, crossover trial was used.
Participants
Participants were healthy men and women (both n=15; age: 24±6 years) from the Netherlands.
Intervention
Participants were instructed to consume ∼400 mg nitrate at lunch, provided through
nitrate-rich vegetables and dietary counseling, or beetroot juice supplementation.
Both interventions lasted 1 week, with 1-week washout (January to April 2017).
Main outcome
Plasma nitrate and nitrite concentrations and resting systolic and diastolic blood
pressure were measured in an overnight fasted state (before and after intervention)
and ∼2.5 hours after lunch (before and throughout intervention on day 1, 4, and 7).
Statistical analysis
Two-factor (time × treatment) repeated-measures analyses of variance were performed.
Results
Mean plasma nitrate concentrations increased with both interventions, with a larger
increase in beetroot juice vs nitrate-rich vegetables, both in a fasted state and
∼2.5 hours after lunch (day 1, beetroot juice: 2.31±0.56 mg/dL [373±90 μmol/L] vs
nitrate-rich vegetables: 1.71±0.83 mg/dL [277±134 μmol/L]; P<0.001). Likewise, mean plasma nitrite concentrations increased with both interventions,
but were higher after lunch in beetroot juice than in nitrate-rich vegetables (day
1: 2.58±1.52 μg/dL [560±331 nmol/L] vs 2.15±1.21 μg/dL [468±263 nmol/L]; P=0.020). Fasting mean systolic and diastolic blood pressure did not change, but mean
systolic and diastolic blood pressure assessed ∼2.5 hours after lunch were significantly
reduced throughout both intervention periods (P<0.05), with no differences between beetroot juice and nitrate-rich vegetables (day
1, systolic blood pressure: –5.1±9.5 mm Hg and diastolic blood pressure: –5.3±8.9
mm Hg).
Conclusion
Short-term consumption of dietary nitrate in the form of nitrate-rich vegetables represents
an effective means to increase plasma nitrate and nitrite concentrations, and reduces
blood pressure to the same extent as beetroot juice supplementation.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Academy of Nutrition and DieteticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality—a systematic review and dose-response meta-analysis of prospective studies.Int J Epidemiol. 2017; 46: 1029-1056
- Association of dietary nitrate with atherosclerotic vascular disease mortality: A prospective cohort study of older adult women.Am J Clin Nutr. 2017; 106: 207-216
- The effect of fruit and vegetable intake on risk for coronary heart disease.Ann Intern Med. 2001; 134: 1106-1114
- Habitual dietary nitrate intake in highly trained athletes.Int J Sport Nutr Exerc Metab. 2016; : 1-25
- Food sources of nitrates and nitrites: The physiologic context for potential health benefits.Am J Clin Nutr. 2009; 90: 1-10
- The nitrate-independent blood pressure–lowering effect of beetroot juice: A systematic review and meta-analysis.Adv Nutr. 2017; 8: 830-838
- Medium-term effects of dietary nitrate supplementation on systolic and diastolic blood pressure in adults: A systematic review and meta-analysis.J Hypertens. 2017; 35: 1353-1359
- Dietary nitrate supplementation improves revascularization in chronic ischemia: Clinical perspective.Circulation. 2012; 126: 1983-1992
- Dietary nitrate and physical performance.Annu Rev Nutr. 2018; 38: 303-328
- Effect of beetroot juice on lowering blood pressure in free-living, disease-free adults: A randomized, placebo-controlled trial.Nutr J. 2012; 11: 106
- Nitrate in vegetables and their impact on human health. A review.Acta Alimentaria. 2013; 42: 158-172
- Effects of acute dietary nitrate supplementation on aortic blood pressure and aortic augmentation index in young and older adults.Nitric Oxide. 2016; 59: 21-27
- Dietary nitrate supplementation enhances muscle contractile efficiency during knee-extensor exercise in humans.J Appl Physiol. 2010; 109: 135-148
- Dietary nitrate supplementation reduces the O2 cost of low-intensity exercise and enhances tolerance to high-intensity exercise in humans.J. Appl Physiol. 2009; 107: 1144-1155
- Dietary nitrate supplementation improves exercise performance and decreases blood pressure in COPD patients.Nitric Oxide. 2015; 48: 22-30
- Nitrate supplementation's improvement of 10-km time-trial performance in trained cyclists.Int J Sport Nutr Exerc Metab. 2012; 22: 64
- Acute dietary nitrate intake improves muscle contractile function in patients with heart failure: A double-blind, placebo-controlled, randomized trial.Circ Heart Fail. 2015; 8: 914-920
- Dietary nitrate reduces maximal oxygen consumption while maintaining work performance in maximal exercise.Free Radic Biol Med. 2010; 48: 342-347
- Dietary nitrate supplementation enhances exercise performance in peripheral arterial disease.J Appl Physiol. 2011; 110: 1582-1591
- Nitrate-rich vegetables increase plasma nitrate and nitrite concentrations and lower blood pressure in healthy adults.J Nutr. 2016; 146: 986-993
- Effects of a nitrate-rich meal on arterial stiffness and blood pressure in healthy volunteers.Nitric Oxide. 2013; 35: 123-130
- Flavonoid-rich apples and nitrate-rich spinach augment nitric oxide status and improve endothelial function in healthy men and women: A randomized controlled trial.Free Radic Biol Med. 2012; 52: 95-102
- Acute ingestion of beetroot bread increases endothelium-independent vasodilation and lowers diastolic blood pressure in healthy men: A randomized controlled trial.J. Nutr. 2013; 143: 1399-1405
- High-nitrate vegetable diet increases plasma nitrate and nitrite concentrations and reduces blood pressure in healthy women.Public Health Nutr. 2015; 18: 2669-2678
- Effects of a short-term high-nitrate diet on exercise performance.Nutrients. 2016; 8: 534
- Short-term effects of nitrate-rich green leafy vegetables on blood pressure and arterial stiffness in individuals with high-normal blood pressure.Free Radic Biol Med. 2014; 77: 353-362
- Nitrate-rich fruit and vegetable supplement reduces blood pressure in normotensive healthy young males without significantly altering flow-mediated vasodilation: A randomized, double-blinded, controlled trial.J Nutr Metab. 2018; 2018: 1729653
- Dietary nitrate in Japanese traditional foods lowers diastolic blood pressure in healthy volunteers.Nitric Oxide. 2010; 22: 136-140
- Plasma nitrate and nitrite are increased by a high-nitrate supplement but not by high-nitrate foods in older adults.Nutr Res. 2012; 32: 160-168
- The 2015 Dutch food-based dietary guidelines.Eur J Clin Nutr. 2016; 70: 869-878
- Comparative Analysis of Nutrition Policies in the WHO European Region: A Comparative Analysis of Nutrition Policies and Plans of Action in WHO European Region, May 2006.WHO Regional Office for Europe, Copenhagen, Denmark2006 (Publication No. EUR/06/5062700/BD/2)
- Nitrate and nitrite in vegetables on the Danish market: Content and intake.Food Addit Contam. 1999; 16: 291-299
- Dietary exposures to nitrate in the UK.Food Addit Contam. 1999; 16: 521-532
- Effects of dietary nitrate on blood pressure in healthy volunteers.N Engl J Med. 2006; 355: 2792-2793
- Beetroot juice and exercise: Pharmacodynamic and dose-response relationships.J Appl Physiol. 2013; 115: 325-336
- The effect of nitrate supplementation on exercise performance in healthy individuals: A systematic review and meta-analysis.Int J Sport Nutr Exerc Metab. 2013; 23: 522-532
- Inorganic nitrite and nitrate: Evidence to support consideration as dietary nutrients.Nutr Res. 2015; 35: 643-654
- Dietary nitrates, nitrites, and nitrosamines intake and the risk of gastric cancer: A meta-analysis.Nutrients. 2015; 7: 9872-9895
- Accumulation of nitrate in vegetables and its possible implications to human health.Agr Sci China. 2007; 6: 1246-1255
- Effects of exercise, diet and weight loss on high blood pressure.Sports Med. 2004; 34: 307-316
- Acute dietary nitrate supplementation improves cycling time trial performance.Med Sci Sports Exerc. 2011; 43: 1125-1131
- Influence of acute dietary nitrate supplementation on 50 mile time trial performance in well-trained cyclists.Eur J Appl Physiol. 2012; 112: 4127-4134
- Beetroot juice supplementation speeds O2 uptake kinetics and improves exercise tolerance during severe-intensity exercise initiated from an elevated metabolic rate.Am J Physiol Regul Integr Comp Physiol. 2013; 305: R1441-R1450
- The increase in plasma nitrite after a dietary nitrate load is markedly attenuated by an antibacterial mouthwash.Nitric Oxide. 2008; 19: 333-337
- Evaluation of dietary intake assessed by the Dutch self-administered web-based dietary 24-h recall tool (Compl-eat™) against interviewer-administered telephone-based 24-h recalls.J Nutr Sci. 2017; 6: e49
- Effectiveness of the US Department of Agriculture 5-step multiple-pass method in assessing food intake in obese and nonobese women.Am J Clin Nutr. 2003; 77: 1171-1178
- The diet of the Dutch: Results of the first two years of the Dutch National Food Consumption Survey 2012-2016.RIVM Lett Rep. 2016; 2016-0082
- Acute and chronic effects of dietary nitrate supplementation on blood pressure and the physiological responses to moderate-intensity and incremental exercise.Am J Physiol Regul Integr Comp Physiol. 2010; 299: R1121-R1131
- PubChem Database: Nitrate, CID=943.https://pubchem.ncbi.nlm.nih.gov/compound/NitrateDate accessed: February 20, 2020
- Concomitant S-, N-, and heme-nitros (yl) ation in biological tissues and fluids: Implications for the fate of NO in vivo.FASEB J. 2002; 16: 1775-1785
- Aerobic fitness affects the exercise performance responses to nitrate supplementation.Med Sci Sports Exerc. 2015; 47: 1643-1651
- IBM SPSS Statistics for Windows [computer program]. Version 23.0. IBM Corp, Armonk, NY2015
- Nitrate, nitrite and N-nitroso compounds.Eur J Pharmacol. 1994; 292: 1-38
- Health implications of exposure to environmental nitrogenous compounds.J Toxicol Toxin Rev. 2003; 22: 41-51
- Soup and satiety.Physiol Behav. 2005; 83: 739-747
- Dietary fiber and energy regulation.J Nutr. 2000; 130: 272S-275S
- Dietary compensation by humans for supplemental energy provided as ethanol or carbohydrate in fluids.Physiol Behav. 1996; 59: 179-187
- Depletion and disruption of dietary fibre: Effects on satiety, plasma-glucose, and serum-insulin.Lancet. 1977; 310: 679-682
- Inorganic nitrate supplementation lowers blood pressure in humans role for nitrite-derived NO.Hypertension. 2010; 56: 274-281
- Inorganic nitrate ingestion improves vascular compliance but does not alter flow-mediated dilatation in healthy volunteers.Nitric Oxide. 2012; 26: 197-202
- Blood pressure-lowering effects of beetroot juice and novel beetroot-enriched bread products in normotensive male subjects.Br J Nutr. 2012; 108: 2066-2074
- Influence of dietary nitrate food forms on nitrate metabolism and blood pressure in healthy normotensive adults.Nitric Oxide. 2018; 72: 66-74
- Gastrointestinal physiology and functions.Br J Nutr. 2002; 88: S159-S163
- Acute blood pressure lowering, vasoprotective, and antiplatelet properties of dietary nitrate via bioconversion to nitrite.Hypertension. 2008; 51: 784-790
- Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: A randomized, phase 2, double-blind, placebo-controlled study.Hypertension. 2015 Feb; 65: 320-327
- Vegetable-derived bioactive nitrate and cardiovascular health.Mol Aspects Med. 2018; 61: 83-91
- Inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults: A systematic review and meta-analysis.Nutr J. 2013; 143: 818-826
- cGMP-dependent protein kinases and cGMP phosphodiesterases in nitric oxide and cGMP action.Pharmacol Rev. 2010; 62: 525-563
- Nitric oxide boosting effects of the Mediterranean diet: A potential mechanism of action.J Gerontol A Biol Sci Med Sci. 2018; 73: 902-904
- The efficacy of administering fruit-derived polyphenols to improve health biomarkers, exercise performance and related physiological responses.Nutrients. 2019; 11: 2389
- Interactions between cocoa flavanols and inorganic nitrate: Additive effects on endothelial function at achievable dietary amounts.Free Radic Biol Med. 2015; 80: 121-128
- Dietary approaches to prevent and treat hypertension: A scientific statement from the American Heart Association.Hypertension. 2006; 47: 296-308
- Fruit and vegetable intake in relation to risk of ischemic stroke.JAMA. 1999; 282: 1233-1239
- Hidden vegetables: An effective strategy to reduce energy intake and increase vegetable intake in adults.Am J Clin Nutr. 2011; 93: 756-763
- Energy density but not fat content of foods affected energy intake in lean and obese women.Am J Clin Nutr. 1999; 69: 863-871
- Portion size can be used strategically to increase vegetable consumption in adults.Am J Clin Nutr. 2010; 91: 913-922
- Compliance with the Dietary Approaches to Stop Hypertension (DASH) diet: A systematic review.PLoS One. 2013; 8e78412
- Diagnostic status of hypertension on the adherence to the Dietary Approaches to Stop Hypertension (DASH) diet.Prev Med Rep. 2016; 4: 525-531
- Participation in a farmers' market fruit and vegetable prescription program at a federally qualified health center improves hemoglobin A1C in low income uncontrolled diabetics.Prev Med Rep. 2017; 7: 176-179
- Processed meat consumption and stomach cancer risk: A meta-analysis.J Natl Cancer Inst. 2006; 98: 1078-1087
- Nitrite and potential endogenous formation of N-nitroso compounds; safety evaluation of certain food additives.JECFA. WHO Food Additives Series. 2003; 50: 49-74
- Dietary nitrate and blood pressure: Evolution of a new nutrient?.Nutr Res Rev. 2017; 30: 208-219
- Dietary nitrate improves vascular function in patients with hypercholesterolemia: A randomized, double-blind, placebo-controlled study.Am J Clin Nutr. 2015; 103: 25-38
- Urinary levels of N-nitroso compounds in relation to risk of gastric cancer: Findings from the Shanghai Cohort Study.PloS one. 2015; 10e0117326
- Urinary excretion of nitrate, nitrite and N-nitroso compounds in Schistosomiasis and bilharzia bladder cancer patients.Carcinogenesis. 1989; 10: 547-552
- Influence of ascorbic acid dose on N-nitrosoproline formation in humans.Carcinogenesis. 1987; 8: 791-795
- Consumption of nitrate-rich beetroot juice with or without vitamin C supplementation increases the excretion of urinary nitrate, nitrite, and n-nitroso compounds in humans.Int J Mol Sci. 2019; 20: 2277
- Diurnal blood pressure variation and related behavioral factors.Hypertens Res. 2011; 34: 281
- Postprandial hypotension: Epidemiology, pathophysiology, and clinical management.Ann Intern Med. 1995; 122: 286-295
- Postprandial hypotension in older adults: Can it be prevented by drinking water before the meal?.Clin Nutr. 2015; 34: 885-891
- Dietary nitrate from beetroot juice for hypertension: A systematic review.Biomolecules. 2018; 8: 134
- Misreporting of energy and micronutrient intake estimated by food records and 24 hour recalls, control and adjustment methods in practice.Br J Nutr. 2009; 101: S73-S85
Biography
C. M. T. van der Avoort is a doctoral degree candidate, Institute of Sport and Exercise Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
Biography
K. L. Jonvik is an associate professor, Institute of Sport and Exercise Studies HAN University of Applied Sciences, Nijmegen, The Netherlands.
Biography
L. J. C. van Loon is a professor, Department of Human Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Biography
J. Nyakayiru is a researcher, Department of Human Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Biography
L. B. Verdijk is an associate professor, Department of Human Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Biography
M. T. E. Hopman is professor, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands.
Article info
Publication history
Published online: May 05, 2020
Accepted:
February 22,
2020
Received:
September 23,
2019
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict was reported by the authors.
FUNDING/SUPPORT This study was part of the EAT2MOVE project and supported by a grant from the Province of Gelderland, the Netherlands.
This trial was registered at www.trialregister.nl, NTR6276.
ACKNOWLEDGEMENTS The authors thank the volunteers for their participation in this study.
AUTHOR CONTRIBUTIONS This study was designed by C. van der Avoort, L. van Loon M. Hopman, and L. B. Verdijk; data were collected by C. van der Avoort and analyzed by C. van der Avoort L. van Loon, M. Hopman, and L. B. Verdijk; data interpretation and manuscript preparation were undertaken by C. van der Avoort, L. van Loon, M. Hopman, and L. B. Verdijk. All authors approved the final version of the manuscript.
Identification
Copyright
© 2020 by the Academy of Nutrition and Dietetics.
