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 L; Lewis, Joshua R; Devine, Amanda; Croft, Kevin D; Hodgson, Jonathan M; Bondonno, Catherine P

doi:10.1093/ajcn/nqx046

Cited by 89Nitric Oxide and Endothelin EffectsCardiovascular Health and Disease PreventionOral microbiology and periodontitis research

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

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Blekkenhorst, Lauren C, Bondonno, Nicola P, Liu, Alex H, Ward, Natalie C, Prince, Richard L, Lewis, Joshua R, Devine, Amanda, Croft, Kevin D +2 more·2018·The American Journal of Clinical Nutrition

DOI 10.1093/ajcn/nqx046

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Abstract

Background Dietary nitrate is an important source of nitric oxide (NO), a molecule critical for cardiovascular health. Nitrate is sequentially reduced to NO through an enterosalivary nitrate-nitrite-NO pathway that involves the oral microbiome. This pathway is considered an important adjunct pathway to the classical l-arginine-NO synthase pathway. Objective The objective of this study was to systematically assess the evidence for dietary nitrate intake and improved cardiovascular health from both human and animal studies. Design A systematic literature search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by using key search terms in Medline and EMBASE databases and defined inclusion and exclusion criteria. Results Thirty-seven articles on humans and 14 articles on animals were included from 12,541 screened references. Data on the effects of dietary nitrate on blood pressure, endothelial function, ischemic reperfusion injury, arterial stiffness, platelet function, and cerebral blood flow in both human and animal models were identified. Beneficial effects of nitrate on vascular health have predominantly been observed in healthy human populations, whereas effects in populations at risk of cardiovascular disease are less clear. Few studies have investigated the long-term effects of dietary nitrate on cardiovascular disease clinical endpoints. In animal studies, there is evidence that nitrate improves blood pressure and endothelial function, particularly in animal models with reduced NO bioavailability. Nitrate dose seems to be a critical factor because there is evidence of cross-talk between the 2 pathways of NO production. Conclusions Evidence for a beneficial effect in humans at risk of cardiovascular disease is limited. Furthermore, there is a need to investigate the long-term effects of dietary nitrate on cardiovascular disease clinical endpoints. Further animal studies are required to elucidate the mechanisms behind the observed effects.

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Under physiological conditions, approximately 5-7% of ingested nitrate is converted to nitrite; this process is strongly influenced by the composition of the oral microbiome.
“Under physiological conditions, approximately 5–7% of ingested nitrate is converted to nitrite; however, this process is strongly influenced by the composition of the oral microbiome [23,30].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [30]

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Vitamin C intake modify the impact of dietary nitrite on the incidence of type 2 diabetes: A 6-year follow-up in Tehran Lipid and Glucose Study
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Nitrate causes a dose-dependent augmentation of nitric oxide status in healthy women
Bondonno, C. P., Croft, K. D., Puddey, I. B., Considine, M. J., Yang, X., Ward, N. C., & Hodgson, J. M. (2012) · Food & Function · doi:10.1039/c2fo10206d · Cited by 31 · see citing works
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The effect of prolonged dietary nitrate supplementation on atherosclerosis development
Marsch, E., Theelen, T. L., Janssen, B. J., Briedé, J. J., Haenen, G. R. M. M., Senden, J. M., van Loon, L. J. C., Poeze, M., Bierau, J., Gijbels, M. J., et al. (2015) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2015.11.031 · Cited by 27 · see citing works
Consumption of nitrate containing vegetables and the risk of chronic kidney disease: Tehran Lipid and Glucose Study
Mirmiran, P., Bahadoran, Z., Golzarand, M., Asghari, G., & Azizi, F. (2016) · Renal Failure · doi:10.3109/0886022x.2016.1165118 · Cited by 27 · see citing works
Low dose dietary nitrate improves endothelial dysfunction and plaque stability in the ApoE−/− mouse fed a high fat diet
Bakker, J. R., Bondonno, N. P., Gaspari, T. A., Kemp‐Harper, B. K., McCashney, A. J., Hodgson, J. M., Croft, K. D., & Ward, N. C. (2016) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2016.08.009 · Cited by 25 · see citing works
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Sulfate, nitrate and blood pressure – An EPIC interaction between sulfur and nitrogen
Kuhnle, G., Luben, R., Khaw, K., & Feelisch, M. (2017) · Pharmacological Research · doi:10.1016/j.phrs.2017.06.006 · Cited by 20 · see citing works
Differential effect of beetroot bread on postprandial DBP according to Glu298Asp polymorphism in the eNOS gene: a pilot study
Hobbs, D. A., George, T. W., & Lovegrove, J. A. (2014) · Journal of Human Hypertension · doi:10.1038/jhh.2014.16 · Cited by 15 · see citing works
Dietary nitrate facilitates an acetazolamide-induced increase in cerebral blood flow during visual stimulation
Aamand, R., Ho, Y.-C. L., Dalsgaard, T., Roepstorff, A., & Lund, T. E. (2013) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00797.2013 · Cited by 14 · see citing works
Effects of Dietary Approaches to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis
Siervo, M., Lara, J., Chowdhury, S., Oggioni, C., Ashor, D. A., & Mathers, J. C. (2015) · Proceedings of The Nutrition Society · doi:10.1017/s0029665115001536 · Cited by 9 · see citing works
Magnesium nitrate attenuates blood pressure rise in SHR rats
Vilšķe̅rsts, R., Kuka, J., Liepinsh, E., Cirule, H., Gulbe, A., Kalvinsh, I., & Dambrova, M. (2014) · Magnesium Research · doi:10.1684/mrh.2014.0358 · Cited by 9 · see citing works
Effect of acute nitrate ingestion on central hemodynamic load in hypoxia
Lefferts, W. K., Hughes, W. E., & Heffernan, K. S. (2015) · Nitric Oxide · doi:10.1016/j.niox.2015.12.001 · Cited by 9 · see citing works
Pathophysiology of ischaemia-reperfusion injury
Carden, D. L., & Granger, D. N. (2000) · The Journal of Pathology · doi:10.1002/(sici)1096-9896(200002)190:3 · Cited by 5 · see citing works

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Lifestyle interventions for the prevention and treatment of hypertension
Valenzuela, P. L., Carrera‐Bastos, P., Gálvez, B. G., Ruiz‐Hurtado, G., Ordovás, J. M., Ruilope, L. M., & Lucía, A. (2020) · Nature Reviews Cardiology · doi:10.1038/s41569-020-00437-9 · Cited by 379 · see citing works
Oral microbial biofilms: an update
Mosaddad, S. A., Tahmasebi, E., Yazdanian, A., Rezvani, M. B., Seifalian, A. M., Yazdanıan, M., & Tebyanian, H. (2019) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-019-03641-9 · Cited by 306 · see citing works
A systematic framework for understanding the microbiome in human health and disease: from basic principles to clinical translation
Ma, Z., Zuo, T., Frey, N., & Rangrez, A. Y. (2024) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-024-01946-6 · Cited by 297 · see citing works
Let thy food be thy medicine….when possible
Witkamp, R. F., & van Norren, K. (2018) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2018.06.026 · Cited by 130 · see citing works
Beetroot, A Remarkable Vegetable: Its Nitrate and Phytochemical Contents Can be Adjusted in Novel Formulations to Benefit Health and Support Cardiovascular Disease Therapies
dos S. Baião, D., da Silva, D. V. T., & Paschoalin, V. M. F. (2020) · Antioxidants · doi:10.3390/antiox9100960 · Cited by 102 · see citing works
Vegetable nitrate intake, blood pressure and incident cardiovascular disease: Danish Diet, Cancer, and Health Study
Bondonno, C. P., Dalgaard, F., Blekkenhorst, L. C., Murray, K., Lewis, J. R., Croft, K. D., Kyrø, C., Torp-Pedersen, C. T., Gislason, G., Tjønneland, A. M., et al. (2021) · European Journal of Epidemiology · doi:10.1007/s10654-021-00747-3 · Cited by 72 · see citing works
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Interplay Among the Oral Microbiome, Oral Cavity Conditions, the Host Immune Response, Diabetes Mellitus, and Its Associated-Risk Factors—An Overview
Negrini, T. D. C., Carlos, I. Z., Duque, C., Caiaffa, K. S., & Arthur, R. A. (2021) · Frontiers in Oral Health · doi:10.3389/froh.2021.697428 · Cited by 76 · see citing works
A Holistic Approach for Ethics and Sustainability in the Food Chain: The Gateway to Oral and Systemic Health
Varzakas, T. H., & Αντωνιάδου, Μ. (2024) · Foods · doi:10.3390/foods13081224 · Cited by 78 · see citing works
Effects of dietary nitrate on inflammation and immune function, and implications for cardiovascular health
Raubenheimer, K., Bondonno, C. P., Blekkenhorst, L. C., Wagner, K., Peake, J. M., & Neubauer, O. (2019) · Nutrition Reviews · doi:10.1093/nutrit/nuz025 · Cited by 63 · see citing works
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L-Arginine and Nitric Oxide in Vascular Regulation—Experimental Findings in the Context of Blood Donation
Kurhaluk, N., & Tkaczenko, H. (2025) · Nutrients · doi:10.3390/nu17040665 · Cited by 62 · see citing works
From nitrate to NO: potential effects of nitrate-reducing bacteria on systemic health and disease
Liu, H., Huang, Y., Huang, M., Wang, M., Ming, Y., Chen, W., Chen, Y., Tang, Z., & Jia, B. (2023) · European Journal of Medical Research · doi:10.1186/s40001-023-01413-y · Cited by 58 · see citing works
Nitrate: The Dr. Jekyll and Mr. Hyde of human health?
Bondonno, C. P., Zhong, L., Bondonno, N. P., Sim, M., Blekkenhorst, L. C., Liu, A. H., Rajendra, A., Pokharel, P., Erichsen, D. W., Neubauer, O., et al. (2023) · Trends in Food Science & Technology · doi:10.1016/j.tifs.2023.03.014 · Cited by 56 · see citing works
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Promotion of nitric oxide production: mechanisms, strategies, and possibilities
Gonzalez, M., Clayton, S., Wauson, E., Christian, D., & Tran, Q. (2025) · Frontiers in Physiology · doi:10.3389/fphys.2025.1545044 · Cited by 56 · see citing works
The oral microbiome, nitric oxide and exercise performance
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Development of a Food Composition Database for Assessing Nitrate and Nitrite Intake from Animal‐based Foods
Zhong, L., Liu, A. H., Blekkenhorst, L. C., Bondonno, N. P., Sim, M., Woodman, R. J., Croft, K. D., Lewis, J. R., Hodgson, J. M., & Bondonno, C. P. (2021) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.202100272 · Cited by 45 · see citing works
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Gasotransmitters in pregnancy: from conception to uterine involution†
Guerra, D. D., & Hurt, K. J. (2019) · Biology of Reproduction · doi:10.1093/biolre/ioz038 · Cited by 44 · see citing works
Relationship of dietary nitrate intake from vegetables with cardiovascular disease mortality: a prospective study in a cohort of older Australians
Liu, A. H., Bondonno, C. P., Russell, J. C., Flood, V. M., Lewis, J. R., Croft, K. D., Woodman, R. J., Lim, W. H., Kifley, A., Wong, G., et al. (2018) · European Journal of Nutrition · doi:10.1007/s00394-018-1823-x · Cited by 40 · see citing works
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The role of dietary nitrate and the oral microbiome on blood pressure and vascular tone
Alzahrani, H., Jackson, K. G., Hobbs, D. A., & Lovegrove, J. A. (2020) · Nutrition Research Reviews · doi:10.1017/s0954422420000281 · Cited by 37 · see citing works
Profiling the Oral Microbiome and Plasma Biochemistry of Obese Hyperglycemic Subjects in Qatar
Sohail, M. U., Elrayess, M. A., Thani, A. A. A., Al‐Asmakh, M., & Yassine, H. M. (2019) · Microorganisms · doi:10.3390/microorganisms7120645 · Cited by 38 · see citing works
A Single Dose of Beetroot Juice Does Not Change Blood Pressure Response Mediated by Acute Aerobic Exercise in Hypertensive Postmenopausal Women
Amaral, A. L., Mariano, I. M., Carrijo, V. H. V., de Souza, T. C. F., Batista, J. P., Mendonça, A. M., de Souza, A. V., Caixeta, D. C., Teixeira, R. R., Espíndola, F. S., et al. (2019) · Nutrients · doi:10.3390/nu11061327 · Cited by 32 · see citing works
A Longitudinal Study of the Human Oropharynx Microbiota Over Time Reveals a Common Core and Significant Variations With Self-Reported Disease
Bach, L., Ram, A., Ijaz, U. Z., Evans, T. J., & Lindström, J. (2021) · Frontiers in Microbiology · doi:10.3389/fmicb.2020.573969 · Cited by 27 · see citing works
Effects of increased nitrate intake from beetroot juice on blood markers of oxidative stress and inflammation in older adults with hypertension
Fejes, R., Pilat, N., Lutnik, M., Weisshaar, S., Weijler, A. M., Krüger, K., Draxler, A., Bragagna, L., Peake, J. M., Woodman, R. J., et al. (2024) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2024.07.004 · Cited by 27 · see citing works
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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
Baião, D. D. S., da Silva, D. V. T., & Paschoalin, V. M. F. (2021) · Foods · doi:10.3390/foods10040859 · Cited by 27 · see citing works
Unlocking Modifiable Risk Factors for Alzheimer’s Disease: Does the Oral Microbiome Hold Some of the Keys?
Loughman, A., Adler, C. J., & Macpherson, H. (2023) · Journal of Alzheimer s Disease · doi:10.3233/jad-220760 · Cited by 26 · see citing works
Dysbiosis of the Salivary Microbiome is Associated with Hypertension and Correlated with Metabolic Syndrome Biomarkers
Sohail, M. U., Hedin, L., & Al‐Asmakh, M. (2021) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s325073 · Cited by 25 · see citing works
Altered Oral Nitrate Reduction and Bacterial Profiles in Hypertensive Women Predict Blood Pressure Lowering Following Acute Dietary Nitrate Supplementation
Willmott, T., Ormesher, L., McBain, A. J., Humphreys, G. J., Myers, J., Singh, G., Lundberg, J. O., Weitzberg, E., Nihlén, C., & Cottrell, E. C. (2023) · Hypertension · doi:10.1161/hypertensionaha.123.21263 · Cited by 23 · see citing works
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
Litwin, N. S., Ark, H. V., Hartley, S. C., Michell, K. A., Vazquez, A. R., Fischer, E., Melby, C. L., Weir, T. L., Wei, Y., Rao, S., et al. (2019) · Current Developments in Nutrition · doi:10.1093/cdn/nzz113 · Cited by 22 · see citing works
Nitrates and Nitrites in Vegetables and the Health Risk
Dodocioiu, A. M., Buzatu, G.-D., & Botu, M. (2025) · Foods · doi:10.3390/foods14173037 · Cited by 24 · see citing works
Mouthwash use and risk of diabetes
Preshaw, P. M. (2018) · BDJ · doi:10.1038/sj.bdj.2018.1020 · Cited by 20 · see citing works
Current clinical framework on nitric oxide role in periodontal disease and blood pressure
Lima, L. L. L., Gaspar, S. R., Rocha, B. S., Alves, R. C., & Almeida, M. G. (2024) · Clinical Oral Investigations · doi:10.1007/s00784-024-05913-x · Cited by 21 · see citing works
Association of Dietary Nitrate Intake with the 15-Year Incidence of Age-Related Macular Degeneration
Gopinath, B., Liew, G., Kifley, A., Lewis, J. R., Bondonno, C. P., Joachim, N., Hodgson, J. M., & Mitchell, P. (2018) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2018.07.012 · Cited by 19 · see citing works
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Dietary Nitrate Intake Is Positively Associated with Muscle Function in Men and Women Independent of Physical Activity Levels
Sim, M., Blekkenhorst, L. C., Bondonno, N. P., Radavelli‐Bagatini, S., Peeling, P., Bondonno, C. P., Magliano, D. J., Shaw, J. E., Woodman, R. J., Murray, K., et al. (2020) · Journal of Nutrition · doi:10.1093/jn/nxaa415 · Cited by 18 · see citing works
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Circulating markers of nitric oxide homeostasis and cardiometabolic diseases: insights from population-based studies
Bahadoran, Z., Mirmiran, P., Jeddi, S., Carlström, M., Azizi, F., & Ghasemi, A. (2019) · Free Radical Research · doi:10.1080/10715762.2019.1587168 · Cited by 17 · see citing works
Increased nitrate intake from beetroot juice over 4 weeks affects nitrate metabolism, but not vascular function or blood pressure in older adults with hypertension
Fejes, R., Lutnik, M., Weisshaar, S., Pilat, N., Wagner, K., Stüger, H., Peake, J. M., Woodman, R. J., Croft, K. D., Bondonno, C. P., et al. (2024) · Food & Function · doi:10.1039/d3fo03749e · Cited by 17 · see citing works
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Oral Cavity is the Gateway to the Body: Role of Oral Health Professionals: A Narrative Review
Iyer, P. (2023) · Journal of the California Dental Association · doi:10.1080/19424396.2023.2193372 · Cited by 19 · see citing works
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 acute effects of exercise intensity and inorganic nitrate supplementation on vascular health in females after menopause
Hogwood, A. C., de Zevallos, J. O., Weeldreyer, N. R., Clark, J. R., Mazzella, V., Cain, L., Myaing, D., Love, K. M., WELTMAN, A. L., & Allen, J. D. (2023) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00559.2023 · Cited by 14 · see citing works
Alterations in the Salivary Microbiome and Metabolism in Patients With Carotid Atherosclerosis from Rural Northeast China
Wu, Y., Xing, L., Lu, L., Liu, S., Zhao, D., Lin, L., Wang, S., Li, C., & Pan, Y. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.034014 · Cited by 14 · see citing works
Potential role of dietary nitrate in relation to cardiovascular and cerebrovascular health, cognition, cognitive decline and dementia: a review
Rajendra, A., Bondonno, N. P., Rainey‐Smith, S. R., Gardener, S. L., Hodgson, J. M., & Bondonno, C. P. (2022) · Food & Function · doi:10.1039/d2fo02427f · Cited by 14 · see citing works
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Oral nitrate-reducing bacteria as potential probiotics for blood pressure homeostasis
Chai, X., Liu, L., & Chen, F. (2024) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2024.1337281 · Cited by 15 · see citing works
Effects of dietary nitrate supplementation on oral health and associated markers of systemic health: a systematic review
Alhulaefi, S., Watson, A., Ramsay, S., Jakubovics, N., Matu, J., Griffiths, A., Kimble, R., Siervo, M., Brandt, K., & Shannon, O. (2024) · Critical reviews in food science and nutrition · doi:10.1080/10408398.2024.2351168 · Cited by 15 · see citing works
The Effects of Antimicrobial Mouthwashes on Systemic Disease: What Is the Evidence?
Alrashdan, M. S., Leão, J. C., Doble, A., McCullough, M. J., & Porter, S. R. (2023) · International Dental Journal · doi:10.1016/j.identj.2023.08.012 · Cited by 12 · see citing works
A randomised controlled crossover trial investigating the short-term effects of different types of vegetables on vascular and metabolic function in middle-aged and older adults with mildly elevated blood pressure: the VEgetableS for vaScular hEaLth (VESSEL) study protocol
Connolly, E. L., Bondonno, C. P., Sim, M., Radavelli‐Bagatini, S., Croft, K. D., Boyce, M. C., James, A. P., Clark, K., Anokye, R., Bondonno, N. P., et al. (2020) · Nutrition Journal · doi:10.1186/s12937-020-00559-3 · Cited by 12 · see citing works
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Plant but not animal sourced nitrate intake is associated with lower dementia-related mortality in the Australian Diabetes, Obesity, and Lifestyle Study
Rajendra, A., Bondonno, N. P., Zhong, L., Radavelli‐Bagatini, S., Murray, K., Rainey‐Smith, S. R., Gardener, S. L., Blekkenhorst, L. C., Magliano, D. J., Shaw, J. E., et al. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1327042 · Cited by 13 · see citing works
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Impact of Mouthwash-Induced Oral Microbiome Disruption on Alzheimer's Disease Risk: A Perspective Review
Boulares, A., Jdidi, H., & Bragazzi, N. L. (2025) · International Dental Journal · doi:10.1016/j.identj.2024.07.005 · Cited by 11 · see citing works
Association of dietary nitrate intake with retinal microvascular structure in older adults
Gopinath, B., Liew, G., Lewis, J. R., Blekkenhorst, L. C., Bondonno, C. P., Burlutsky, G., Hodgson, J. M., & Mitchell, P. (2019) · European Journal of Nutrition · doi:10.1007/s00394-019-02055-9 · Cited by 11 · see citing works
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Knowledge and beliefs about dietary inorganic nitrate among UK-based nutrition professionals: development and application of the KINDS online questionnaire
Shannon, O. M., Grisotto, G., Babateen, A. M., McGrattan, A., Brandt, K., Mathers, J. C., & Siervo, M. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-030719 · Cited by 11 · see citing works
Dietary Nitrates, Nitrites, and Food Safety: Risks Versus Benefits
Martin, K. R. (2021) · Acta Scientifci Nutritional Health · doi:10.31080/asnh.2020.05.0884 · Cited by 10 · see citing works
Investigating the association between nitrate dosing and nitrite generation by the human oral microbiota in continuous culture
Willmott, T., Serrage, H. J., Cottrell, E. C., Humphreys, G. J., Myers, J., Campbell, P. M., & McBain, A. J. (2024) · Applied and Environmental Microbiology · doi:10.1128/aem.02035-23 · Cited by 9 · see citing works
Increased Nitrate Intake From Beetroot Juice Over 4 Weeks Changes the Composition of the Oral, But Not the Intestinal Microbiome
Fejes, R., Séneca, J., Pjevac, P., Lutnik, M., Weisshaar, S., Pilat, N., Steiner, R., Wagner, K., Woodman, R. J., Bondonno, C. P., et al. (2025) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.70156 · Cited by 11 · see citing works
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The association between the oral microbiome and hypertension: a systematic review
Al‐Maweri, S. A., Almashraqi, A. A., Al‐Qadhi, G., Al-Hebshi, N. N., & Ba‐Hattab, R. (2025) · Journal of Oral Microbiology · doi:10.1080/20002297.2025.2459919 · Cited by 7 · see citing works
Baseline habitual dietary nitrate intake and Alzheimer's Disease related neuroimaging biomarkers in the Australian Imaging, Biomarkers and Lifestyle study of ageing
Rajendra, A., Bondonno, N. P., Murray, K., Zhong, L., Rainey‐Smith, S. R., Gardener, S. L., Blekkenhorst, L. C., Doré, V., Villemagne, V. L., Laws, S. M., et al. (2025) · The Journal of Prevention of Alzheimer s Disease · doi:10.1016/j.tjpad.2025.100161 · Cited by 7 · see citing works
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Association between Circulating Osteocalcin and Cardiometabolic Risk Factors following a 4-Week Leafy Green Vitamin K-Rich Diet
Tacey, A., Sim, M., Smith, C., Woessner, M. N., Byrnes, E., Lewis, J. R., Brennan‐Speranza, T. C., Hodgson, J. M., Blekkenhorst, L. C., & Levinger, I. (2020) · Annals of Nutrition and Metabolism · doi:10.1159/000511660 · Cited by 7 · see citing works
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Impact of Cold Storage on Bioactive Compounds and Their Stability of 36 Organically Grown Beetroot Genotypes
Yasaminshirazi, K., Hartung, J., Fleck, M., & Graeff‐Hönninger, S. (2021) · Foods · doi:10.3390/foods10061281 · Cited by 7 · see citing works
Microencapsulated and Ready-to-Eat Beetroot Soup: A Stable and Attractive Formulation Enriched in Nitrate, Betalains and Minerals
da Trindade, L. R., Baião, D. D. S., da Silva, D. V. T., de Almeida, C. C., Pauli, F. P., Ferreira, V. F., Conte‐Júnior, C. A., & Paschoalin, V. M. F. (2023) · Foods · doi:10.3390/foods12071497 · Cited by 7 · see citing works
The association between dietary nitrate, nitrite and total antioxidant capacity with cardiometabolic risk factors: a cross-sectional study among patients with type 2 diabetes
Karimzadeh, L., Behrouz, V., Sohrab, G., Razavion, T., & Haji‐Maghsoudi, S. (2024) · International Journal of Food Sciences and Nutrition · doi:10.1080/09637486.2024.2395817 · Cited by 6 · see citing works
Metabolite Profiles in Response to Dietary Interventions for Management of Blood Pressure: A Systematic Review
Gómez‐Martín, M., Rikken, F., Clarke, E. D., Stanford, J., Ferguson, J. J. A., & Collins, C. E. (2025) · Current Nutrition Reports · doi:10.1007/s13668-025-00676-7 · Cited by 4 · see citing works
NO: a key player in microbiome dynamics and cancer pathogenesis
Jasemi, S. K., Faridafshar, H., Amin, M. N., Babamohamadi, M., Falahati, M., Amirian, R., & Izadi, Z. (2025) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2025.1532255 · Cited by 5 · see citing works
Source‐specific nitrate intake and incident dementia in the Danish Diet, Cancer and Health Study
Bondonno, C. P., Pokharel, P., Erichsen, D. W., Zhong, L., Schullehner, J., Kyrø, C., Frederiksen, K., Hendriksen, P. F., Dalgaard, F., Blekkenhorst, L. C., et al. (2025) · Alzheimer s & Dementia · doi:10.1002/alz.70995 · Cited by 4 · see citing works
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Chronic nitrite treatment activates adenosine monophosphate-activated protein kinase-endothelial nitric oxide synthase pathway in human aortic endothelial cells
Liu, Y., Croft, K. D., Hodgson, J. M., Mori, T. A., & Ward, N. C. (2021) · Journal of Functional Foods · doi:10.1016/j.jff.2021.104447 · Cited by 4 · see citing works
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Host Traits Impact the Outcome of Metagenomic Library Preparation From Dental Calculus Samples Across Diverse Mammals
Moraitou, M., Richards, J., Bolyos, C., Saliari, K., Gilissen, E., Timmons, Z., Kitchener, A. C., Pauwels, O. S. G., Sabin, R., Kokkini, P., et al. (2025) · Molecular Ecology Resources · doi:10.1111/1755-0998.70039 · Cited by 5 · see citing works
Effects of Chewing Gum on Nitric Oxide Metabolism, Markers of Cardiovascular Health and Neurocognitive Performance after a Nitrate-Rich Meal
Ong, S. L. H., Bondonno, N. P., Downey, L. A., Scholey, A. B., Smith, M., Stough, C. K. K., Blekkenhorst, L. C., Woodman, R. J., Croft, K. D., Hodgson, J. M., et al. (2021) · Journal of the American Nutrition Association · doi:10.1080/07315724.2020.1869119 · Cited by 3 · see citing works
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Oral and fecal microbiome of confiscated Bengal slow lorises in response to confinement duration
Ni, Q., Dong, S., Xing, B., Zeng, B., Kong, F., Xu, H., Yao, Y., Li, D., Zhang, M., Fan, X., et al. (2022) · Frontiers in Microbiology · doi:10.3389/fmicb.2022.941261 · Cited by 3 · see citing works
Les fruits et légumes « Biologiques » sont-ils de qualité supérieure et meilleurs pour notre santé ?
Amiot, M. J. (2023) · Cahiers de Nutrition et de Diététique · doi:10.1016/j.cnd.2022.12.001 · Cited by 3 · see citing works
Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations
Kurhaluk, N., Kołodziejska, R., Buyun, L., Kamiński, P., & Tkaczenko, H. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27083461 · Cited by 3 · see citing works
“Under physiological conditions, approximately 5–7% of ingested nitrate is converted to nitrite; however, this process is strongly influenced by the composition of the oral microbiome [23,30].”
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Dietary Nitrate, Nitric Oxide, and Cardiovascular Health
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Self-citation

Authors: Blekkenhorst, L. C., Bondonno, N. P., Liu, A. H., Ward, N. C., Prince, R. L., Lewis, J. R., Devine, A., Croft, K. D., Hodgson, J. M., & Bondonno, C. P.
Affiliations: Edith Cowan University (AU)
The University of Western Australia (AU)
The University of Sydney (AU)
Corresponding author: Blekkenhorst, Lauren C
ORCID: Blekkenhorst, Lauren C
Bondonno, Nicola P
Liu, Alex H
Ward, Natalie C
Prince, Richard L
Lewis, Joshua R
Devine, Amanda
Croft, Kevin D
Hodgson, Jonathan M
Bondonno, Catherine P
Venue: The American Journal of Clinical Nutrition
Publisher: Elsevier BV
Published: 2018-04
Volume: 107
Issue: 4
Pages: 504-522
ISSN: 0002-9165 (ISSN-L)
DOI: 10.1093/ajcn/nqx046
OpenAlex: W2795400775
Cited by: 89
References: 159
Citations by year: 2026: 10 · 2025: 14 · 2024: 15 · 2023: 10 · 2022: 5 · 2021: 10 · 2020: 10 · 2019: 9 · 2018: 6
FWCI: 1.15
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 1769 d)
Locations: American Journal of Clinical Nutrition (publishedVersion)
PubMed (publishedVersion)
UWA Profiles and Research Repository (UWA) (submittedVersion)
Australasian Journal of Paramedicine (submittedVersion)
eSpace (Curtin University) (submittedVersion)
Topics: Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
Keywords: dietary nitrate, nitric oxide, oral microbiota, cardiovascular health, blood pressure, endothelial function, ischemia-reperfusion injury, arterial stiffness, platelet function, cerebral blood flow, cardiovascular risk
MeSH terms: Animals, Cardiovascular Diseases, Humans, Mouth, Nitrates, Microbiota

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

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