Prospective association between dietary source-determined nitrate/nitrite and the risk of metabolic syndrome among children and adolescents: Tehran lipid and glucose study
Open accessAbstract
Concerning rare evidence on the relationship of dietary nitrate (NO 3 )/nitrite (NO 2 ) from plant or animal food groups with metabolic syndrome (MetS) in children and adolescents, this study investigates the longitudinal association of total, plant- or animal-sourced dietary NO 2 /NO 3 intake in children and adolescents with the incidence of MetS and its risk factors. In this secondary analysis, 1144 children and adolescents (46.2% male) aged 6–19 years were selected from the Tehran Lipid and Glucose Study participants. Dietary data were gathered by a valid and reliable semi-quantitative food frequency questionnaire. A validated national database was used to estimate dietary NO 2 /NO 3 intakes. MetS was defined according to Cook’s criteria and the Iranian-modified National Cholesterol Education Program. The mean ± SD ages of males and females at baseline were 13.1 ± 3.76 and 14.0 ± 3.77, respectively. The risk of MetS increased with consuming total nitrite and total nitrate exceeding acceptable dietary intake (ADI); however, this association disappears after adjusting for dietary variables. There were positive significant associations between total NO 2 intake and the incidence of high fasting blood glucose (FBG) in follow-ups [HR (CI) Q4: 1.42(1.13–1.77), P-trend = 0.001]. Also, the HR of high FBG increased across quartiles of animal-based dietary NO 3 and plant-sourced dietary NO 2 . The risk of high blood pressure (BP) increased about 5% with consuming every 100 mg of total nitrate exceeding ADI. Exposure to nitrate from animal and plant food groups were positively associated with high BP incidence, while higher intake of plant originated nitrite increased the risk of high BP incidence. Participants with the highest animal-sourced nitrate intake had a 19% higher risk of high triglyceride (TG), compared to the lowest intake. Our findings provide evidence that dietary NO 2 /NO 3 intake in children and adolescents whether from the plant or animal food sources were not associated with MetS incidence. High dietary intake of total NO 2 increased the incidence of some MetS risk factors; while high intake of NO 3 in spite of their sources increased the incidence of high BP. Exposure to animal-sourced nitrate intake had increased the risk of high TG.
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In paediatric populations, higher nitrite intake is linked to adverse glycaemic outcomes.
“higher nitrite intake has been linked to adverse glycaemic outcomes.”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [217]
In certain paediatric groups, both plant- and animal-derived nitrate intake are associated with elevated blood pressure or triglycerides.
“both plant- and animal-derived nitrate intake have been associated with elevated blood pressure or triglycerides in certain groups [217].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [217]
In paediatric populations, total nitrate intake is not consistently associated with metabolic syndrome risk.
“While total nitrate intake is not consistently associated with metabolic syndrome risk”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [217]
Evidence from paediatric populations suggests a complex, potentially dose- and source-dependent relationship between nitrate intake and metabolic outcomes.
“Evidence from paediatric populations suggests a more complex, potentially dose- and source-dependent, relationship.”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [217]
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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
- Authors
- Hosseini-Esfahani, F., Rafiei, M., Bahadoran, Z., Hasheminia, M., Mirmiran, P., & Azizi, F.
- Affiliations
- Research Institute for Endocrine Sciences (IR)
- Corresponding author
- Mirmiran, Parvin
- Venue
- Nutrition Journal
- Published
- 2025-11-24
- Volume
- 24
- Issue
- 1
- Pages
- 193-193
- ISSN
- 1475-2891 (ISSN-L)
- PMC
- PMC12751790
- OpenAlex
- W4416602755
- Cited by
- 1
- References
- 39
- Citations by year
- 2026: 1
- FWCI
- 0.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Nutrition Journal (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences (43012295)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Keywords
- nitrate, nitrite, dietary intake, metabolic syndrome, children and adolescents, fasting blood glucose, blood pressure, triglycerides, Tehran Lipid and Glucose Study, dietary exposure assessment, acceptable daily intake, food frequency questionnaire, Tehran, risk factors, hypertension, dyslipidemia, insulin resistance
- MeSH terms
- Adolescent, Animals, Blood Glucose, Child, Diet, Female, Humans, Iran, Male, Nitrates, Nitrites, Prospective Studies, Risk Factors, Incidence, Metabolic Syndrome, Young Adult
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