Effects of inorganic nitrate and beetroot supplementation on endothelial function: a systematic review and meta-analysis

Lara, Jose; Ashor, Ammar W.; Oggioni, C.; Ahluwalia, A.; Mathers, John C.; Siervo, Mario

doi:10.1007/s00394-015-0872-7

Cited by 163Cardiovascular Health and Disease PreventionNitric Oxide and Endothelin EffectsCardiovascular and exercise physiology

Effects of inorganic nitrate and beetroot supplementation on endothelial function: a systematic review and meta-analysis

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Lara, Jose, Ashor, Ammar W., Oggioni, C., Ahluwalia, A., Mathers, John C., Siervo, Mario·2016·European Journal of Nutrition

DOI 10.1007/s00394-015-0872-7

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Abstract

Background Diets rich in inorganic nitrate are associated with lower blood pressure, an effect that may be mediated by an improvement of endothelial function (EF). Therefore, a systematic review and meta-analysis of randomised controlled trials (RCTs) were conducted to examine the effects of inorganic nitrate and beetroot supplementation on measures of EF.Methods MEDLINE, EMBASE and Scopus databases were searched from inception until November 2014. Specific inclusion criteria were as follows: (1) RCTs; (2) trials comparing inorganic nitrate or beetroot supplementation with placebo control groups; and (3) trials reporting effects of these interventions on outcomes of vascular function. Random-effect models were used to assess the pooled effect sizes showed as standardised mean differences (SMD).Results Nine crossover trials and three parallel trials met our inclusion criteria. The trials were conducted between 2008 and 2014 and included a total of 246 participants with 10-64 participants per study. The duration of each intervention ranged from 1.5 h to 28 days. Inorganic nitrate and beetroot consumption was associated with an improvement in vascular function (SMD 0.36; 95 % CI 0.16, 0.56; P < 0.001). The effect on EF was significantly associated with the dose of inorganic nitrate (β = 0.04, SE = 0.01, P < 0.001), age (β = -0.01, SE = 0.004, P = 0.02), baseline BMI (β = -0.04, SE = 0.02, P = 0.05) and systolic BP (β = -0.01, SE = 0.005, P = 0.02).Conclusions Inorganic nitrate and beetroot supplementation was associated with beneficial effects on EF. These effects appear to be reduced in older subjects and in subjects with greater cardiometabolic risk.

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Oral supplementation with either nitrite or nitrate increases circulating nitrite levels and prevents and reverses endothelial dysfunction in a dose-dependent manner in mice and in healthy, hypertensive, and obese individuals, or in those with hypercholesterolemia and peripheral arterial disease.
“Oral supplementation with either nitrite or nitrate increases circulating nitrite levels and prevents and reverses endothelial dysfunction in a dose-dependent manner both in mice[68,69] and in healthy[70,71,97,111,112], hypertensive[113], and obese individuals[114], or in those with hypercholesterolemia[115] and peripheral arterial disease[116].”
From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [71]
Oral administration of nitrate and nitrite provides dose-dependent improvement in endothelial dysfunction, inflammation and vascular function.
“oral administration of nitrate and nitrite provides dose-dependent improvement in endothelial dysfunction, inflammation and vascular function[71]”
From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [71]

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“Beet” the cold: beetroot juice supplementation improves peripheral blood flow, endothelial function, and anti-inflammatory status in individuals with Raynaud’s phenomenon
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Beetroot Increases Muscle Performance and Oxygenation During Sustained Isometric Exercise, but Does Not Alter Muscle Oxidative Efficiency and Microvascular Reactivity at Rest
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Skeletal Muscle Nitrate as a Regulator of Systemic Nitric Oxide Homeostasis
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Cerebrovascular Dysfunction in Atrial Fibrillation
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Nitrate: “the source makes the poison”
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Beetroot juice versus chard gel: A pharmacokinetic and pharmacodynamic comparison of nitrate bioavailability
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Dietary nitrate does not modify blood pressure and cardiac output at rest and during exercise in older adults: a randomised cross-over study
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Beetroot and Sodium Nitrate Ameliorate Cardiometabolic Changes in Diet‐Induced Obese Hypertensive Rats
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Dietary Nitrate from Plant Foods: A Conditionally Essential Nutrient for Cardiovascular Health
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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
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Nitrate and Nitrite in the Diet: Protective and Harmful Effects in Health and Disease
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Acute and short-term beetroot juice nitrate-rich ingestion enhances cardiovascular responses following aerobic exercise in postmenopausal women with arterial hypertension: A triple-blinded randomized controlled trial
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The Cardioprotective Role of Nitrate-Rich Vegetables
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Associations between Vegetable Nitrate Intake and Cardiovascular Disease Risk and Mortality: A Systematic Review
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A Narrative Review on Dietary Strategies to Provide Nitric Oxide as a Non-Drug Cardiovascular Disease Therapy: Beetroot Formulations—A Smart Nutritional Intervention
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Nitrate-Containing Beetroot Juice Reduces Oxygen Consumption During Submaximal Exercise in Low but Not High Aerobically Fit Male Runners
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Whole beetroot consumption reduces systolic blood pressure and modulates diversity and composition of the gut microbiota in older participants
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Pharmacokinetic Profile of Incremental Oral Doses of Dietary Nitrate in Young and Older Adults: A Crossover Randomized Clinical Trial
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Potential roles of nitrate and nitrite in nitric oxide metabolism in the eye
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Vitamin C, Antioxidant Status, and Cardiovascular Aging
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Dietary nitrate improves muscle microvascular reactivity and lowers blood pressure at rest and during isometric exercise in untreated hypertensives
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Impact of Red Beetroot Juice on Vascular Endothelial Function and Cardiometabolic Responses to a High-Fat Meal in Middle-Aged/Older Adults with Overweight and Obesity: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial
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Short‑term impact of aged garlic extract on endothelial function in diabetes: A randomized, double‑blind, placebo‑controlled trial
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Pink pressure: beetroot (Beta vulgaris rubra) as a possible novel medical therapy for chronic kidney disease
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Benefit-risk analysis for foods (BRAFO): Evaluation of exposure to dietary nitrates
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Inorganic Nitrate Supplementation for Cardiovascular Health
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Effects of chronic dietary nitrate supplementation on longevity, vascular function and cancer incidence in rats
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Higher urinary nitrate was associated with lower prevalence of congestive heart failure: results from NHANES
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Organ uptake and release of inorganic nitrate and nitrite in the pig
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The Generation of Nitric Oxide from Aldehyde Dehydrogenase-2: The Role of Dietary Nitrates and Their Implication in Cardiovascular Disease Management
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Dietary nitrate supplementation enhances cerebrovascular CO2 reactivity in a sex-specific manner
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Arterial stiffness in chronic kidney disease
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Is vitamin C a booster of the effects of dietary nitrate on endothelial function? Physiologic rationale and implications for research
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Potential role for age as a modulator of oral nitrate reductase activity
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Ageing modifies the oral microbiome, nitric oxide bioavailability and vascular responses to dietary nitrate supplementation
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The effect of dietary nitrate on macro- and microvascular function: A systematic review
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Beetroot juice supplementation and exercise performance: is there more to the story than just nitrate?
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Increased nitrate intake from beetroot juice over 4 weeks affects nitrate metabolism, but not vascular function or blood pressure in older adults with hypertension
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High-nitrate salad increased plasma nitrates/nitrites and brachial artery flow-mediated dilation in postmenopausal women: A pilot study
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Caloric Restriction (CR) Plus High-Nitrate Beetroot Juice Does Not Amplify CR-Induced Metabolic Adaptation and Improves Vascular and Cognitive Functions in Overweight Adults: A 14-Day Pilot Randomised Trial
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A Critical Review on Vasoactive Nutrients for the Management of Endothelial Dysfunction and Arterial Stiffness in Individuals under Cardiovascular Risk
da Silva, D. V. T., Baião, D. D. S., de Almeida, C. C., & Paschoalin, V. M. F. (2023) · Nutrients · doi:10.3390/nu15112618 · Cited by 15 · see citing works
The Effects of Ischemic Preconditioning Supplementation on Endothelial Function: A Systematic Review and Meta-Analysis
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Feasibility and acceptability of a nutritional intervention testing the effects of nitrate-rich beetroot juice and folic acid on blood pressure in Tanzanian adults with elevated blood pressure
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Thirty minutes of handgrip exercise potentiates flow‐mediated dilatation in response to sustained and transient shear stress stimuli to a similar extent
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Effects of inorganic nitrate on ischaemia-reperfusion injury after coronary artery bypass surgery: a randomised controlled trial
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Effect of a plant-based bioequivalent inorganic nitrate ( NO3− ) complex with vitamins, antioxidants and phytophenol rich food extracts in hypertensive individuals - A randomized, double-blind, placebo-controlled study
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Acute inorganic nitrate intake increases regional insulin action in the brain: Results of a double-blind, randomized, controlled cross-over trial with abdominally obese men
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Dietary Inorganic Nitrate/Nitrite Supplementation Reduces Central and Peripheral Blood Pressure in Patients With Type 2 Diabetes Mellitus
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Dietary nitrate as modulator of physical performance and cardiovascular health
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Almond ingestion contributes to improved cardiovascular health in sedentary older adults participating in a walking intervention: A pilot study
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Inorganic nitrate supplementation attenuates conduit artery retrograde and oscillatory shear in older adults
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Ageing modifies acute resting blood pressure responses to incremental consumption of dietary nitrate: a randomised, cross-over clinical trial
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Effect of acute nitrate ingestion on central hemodynamic load in hypoxia
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Nutraceuticals and functional foods in the prevention of hypertension induced by excessive intake of dietary salt
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Effects of Acute Beetroot Juice and Sodium Nitrate on Selected Blood Metabolites and Response to Transient Ischemia: A Crossover Randomized Clinical Trial
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Dietary Beetroot Juice – Effects in Patients with COPD: A Review
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The Impact of Inorganic Nitrate on Endothelial Function: A Systematic Review of Randomized Controlled Trials and Meta-analysis
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Effects of almond, dried grape and dried cranberry consumption on endurance exercise performance, recovery and psychomotor speed: protocol of a randomised controlled trial
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The impact of inorganic nitrate consumption on endothelial function measured by flow-mediated dilatation: a systematic review of randomised controlled trials
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PS-P07-7: IMPACT OF INORGANIC NITRATE ON ENDOTHELIAL FUNCTION IN ADULTS A SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS AND META ANALYSIS
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The effect of beetroot inorganic nitrate supplementation on cardiovascular risk factors: A systematic review and meta-regression of randomized controlled trials
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The dose–response effects of nitrate-rich beetroot ingestion on cardiovascular and endothelial function: a randomised controlled trial
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Inorganic Nitrate and Beetroot Juice Supplementation Reduces Blood Pressure in Adults: A Systematic Review and Meta-Analysis
Siervo, M., Lara, J., Ogbonmwan, I., & Mathers, J. C. (2013) · The Journal of Nutrition · doi:10.3945/jn.112.170233 · Cited by 375 · see citing works
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Authors: Lara, J., Ashor, A. W., Oggioni, C., Ahluwalia, A., Mathers, J. C., & Siervo, M.
Affiliations: Mustansiriyah University (IQ)
Newcastle University (GB)
Queen Mary University of London (GB)
ORCID: Ashor, Ammar W.
Ahluwalia, A.
Mathers, John C.
Siervo, Mario
Venue: European Journal of Nutrition
Publisher: Springer Science and Business Media LLC
Published: 2015-03-13
Volume: 55
Issue: 2
Pages: 451-459
ISSN: 1436-6207 (ISSN-L)
1436-6215
DOI: 10.1007/s00394-015-0872-7
OpenAlex: W1996941873
Semantic Scholar: b395b7a8059c33596526d1da56b264a3564c0ede
Cited by: 163
References: 49
Citations by year: 2026: 16 · 2025: 11 · 2024: 13 · 2023: 13 · 2022: 16 · 2021: 14 · 2020: 17 · 2019: 17 · 2018: 17 · 2017: 14 · 2016: 9 · 2015: 6
FWCI: 2.63
Type: journal article
Language: en
Open access: green
doi.org
Licence: www.springer.com/tdm (tdm)
Locations: European Journal of Nutrition (publishedVersion)
PubMed (publishedVersion)
Newcastle University ePrints (Newcastle Univesity)
Funders: Medical Research Council (MR/N007921/1, MR/K006312/1)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords: inorganic nitrate, endothelial function, vascular function, dietary nitrate, blood pressure, dose-response relationship, age effects, body mass index, cardiometabolic risk
MeSH terms: Blood Pressure, Cardiovascular Diseases, Endothelium, Humans, Nitrates, Risk Factors, Body Mass Index, Randomized Controlled Trials as Topic, Treatment Outcome, Plant Roots, Dietary Supplements, Metabolic Syndrome, Beta vulgaris

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Effects of inorganic nitrate and beetroot supplementation on endothelial function: a systematic review and meta-analysis

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