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Cited by 1Nutritional Studies and DietDiet, Metabolism, and DiseaseNitric Oxide and Endothelin Effects

The association between dietary intakes of nitrate with nitrite from animal and plant food sources and the incidence of metabolic syndrome: a prospective study

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Davarpanah, Milad, Bahadoran, Zahra, Hasheminia, Mitra, Rostami, Fatemeh Norouzi, Javadi, Maryam, Mirmiran, Parvin, Azizi, Fereidoun·2025·Nutrition Journal
DOI 10.1186/s12937-025-01263-wPMC PMC12764135
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Abstract

AIM: In the current study the potential effect of dietary nitrate (NO3)/nitrite (NO2) on the incidence of metabolic syndrome (MetS) was investigated. METHODS: Total of 1911 men and women (mean age of 37.5 ± 12.8 and 58.9% women), participated in the third (2006–2008) examinations of the Tehran Lipid and Glucose Study (TLGS), were included and followed up to 2018–2022. A semi-quantitative food frequency questionnaire was used at baseline to estimate dietary intakes of NO3 and NO2. Multivariable-adjusted Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incidence of MetS across quartile categories of NO3 and NO2 dietary intakes. RESULTS: Mean (SD) daily intake of NO3 and NO2 were 436 (246) mg/d and 9.5 (4.7) mg/d, which were mostly derived from plant sources (95.2% and 56.1% respectively). The highest compared to the lowest quartile of total and plant-based dietary NO3 was accompanied with a significant decreased risk of MetS (HR = 0.73, 95% CI = 0.54–0.98, HR = 0.75, 95% CI = 0.56-1.00); however, no significant association was observed between animal-based NO3 intakes and incidence of MetS. Morover, no significant association between total, plant-based and animal-based dietary intakes of NO2 and the incidence of MetS was found. CONCLUSION: Higher total and plant-based NO3 intakes may reduce risk of MetS in adults.

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  • Nitrite intake, particularly from animal sources, may have no effect or an adverse effect on metabolic syndrome risk, depending on antioxidant status such as vitamin C intake.

    “nitrite intake, particularly from animal sources, may have no effect or even have an adverse effect, depending on antioxidant status such as vitamin C intake [212,213].”

    From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [213]

    The Results report no significant association between total, plant-based, or animal-based nitrite intake and metabolic syndrome incidence. The Discussion suggests that antioxidants in plant foods may neutralize harmful effects of high nitrate and nitrite intake, but it does not report an adverse association for animal-derived nitrite or test whether metabolic syndrome risk depends on vitamin C intake. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Plant-derived nitrate intake is associated with a reduced risk of metabolic syndrome.

    “Longitudinal data further indicate that plant-derived nitrate intake is associated with a reduced risk of metabolic syndrome.”

    From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [213]

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Research works printed but not linked: 51

  1. [1]Kelishadi R, Ardalan G, Gheiratmand R, Majdzadeh R, Hosseini M, Gouya M, et al. Thinness, overweight and obesity in a National sample of Iranian children and adolescents: CASPIAN study. Child Care Health Dev. 2008;34(1):44–54. 18171443
  2. [2]Lutsey PL, Steffen LM, Stevens J. Dietary intake and the development of the metabolic syndrome: the atherosclerosis risk in communities study. Circulation. 2008;117(6):754–61. 18212291
  3. [3]Detection, NCEPEPo. Adults ToHBCi. Third report of the National cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult treatment panel III). The Program; 2002. 12485966
  4. [4]Azizi F, Salehi P, Etemadi A, Zahedi-Asl S. Prevalence of metabolic syndrome in an urban population: Tehran lipid and glucose study. Diabetes Res Clin Pract. 2003;61(1):29–37. 12849921
  5. [5]Bahadoran Z, Mirmiran P, Ghasemi A, Kabir A, Azizi F, Hadaegh F. Is dietary nitrate/nitrite exposure a risk factor for development of thyroid abnormality? A systematic review and meta-analysis. Nitric Oxide. 2015;47:65–76. 25889269
  6. [6]Bahadoran Z, Ghasemi A, Mirmiran P, Azizi F, Hadaegh F. Nitrate-nitrite-nitrosamines exposure and the risk of type 1 diabetes: a review of current data. World J Diabetes. 2016;7(18):433. 27795817 PMC5065663
  7. [8]Bahadoran Z, Mirmiran P, Carlström M, Ghasemi A. Inorganic nitrate: A potential prebiotic for oral microbiota dysbiosis associated with type 2 diabetes. Nitric Oxide. 2021;116:38–46. 34506950
  8. [11]Bahadoran Z, Mirmiran P, Azizi F, Ghasemi A. Systemic nitric oxide metabolites and the chance of pre-diabetes regression to normoglycemia: A 9-year cohort study. BioImpacts: BI. 2024;14(5):29917. 39296799 PMC11406430
  9. [12]Knott AB, Bossy-Wetzel E. Impact of nitric oxide on metabolism in health and age‐related disease. Diabetes Obes Metabolism. 2010;12:126–33. PMC3988980 21029309
  10. [13]Tong M, Neusner A, Longato L, Lawton M, Wands JR, De la Monte SM. Nitrosamine exposure causes insulin resistance diseases: relevance to type 2 diabetes mellitus, non-alcoholic steatohepatitis, and alzheimer’s disease. J Alzheimers Dis. 2009;17(4):827–44. 20387270 PMC2952429
  11. [15]Srour B, Chazelas E, Druesne-Pecollo N, Esseddik Y, de Edelenyi FS, Agaësse C, et al. Dietary exposure to nitrites and nitrates in association with type 2 diabetes risk: results from the NutriNet-Santé population-based cohort study. PLoS Med. 2023;20(1):e1004149. 36649248 PMC9844911
  12. [16]Nguyen NN, Tran LT, Ho ND, Huynh LB, Nguyen HS, Chen Y-C. Dietary nitrate, nitrite, and Nitrosamine in association with diabetes: a systematic review and meta-analysis. Nutr Rev. 2024;82(11):1473–81. 38007611
  13. [17]Ueyama J, Kondo T, Imai R, Kimata A, Yamamoto K, Suzuki K, et al. Association of serum NO x level with clustering of metabolic syndrome components in middle-aged and elderly general populations in Japan. Environ Health Prev Med. 2008;13:36–42. 19568878 PMC2698239
  14. [18]Asl SZ, Ghasemi A, Azizi F. Serum nitric oxide metabolites in subjects with metabolic syndrome. Clin Biochem. 2008;41(16–17):1342–7. 18793628
  15. [19]Azizi F, Ghanbarian A, Momenan AA, Hadaegh F, Mirmiran P, Hedayati M, et al. Prevention of non-communicable disease in a population in nutrition transition: Tehran lipid and glucose study phase II. Trials. 2009;10:1–15. 19166627 PMC2656492
  16. [20]Hosseini-Esfahani F, Jessri M, Mirmiran P, Bastan S, Azizi F. Adherence to dietary recommendations and risk of metabolic syndrome: Tehran lipid and glucose study. Metabolism. 2010;59(12):1833–42. 20667561
  17. [21]Derakhshan A, Sardarinia M, Khalili D, Momenan AA, Azizi F, Hadaegh F. Sex specific incidence rates of type 2 diabetes and its risk factors over 9 years of follow-up: Tehran lipid and glucose study. PLoS ONE. 2014;9(7):e102563. 25029368 PMC4100911
  18. [22]Askari S, Asghari G, Ghanbarian A, Khazan M, Alamdari S, Azizi F. Seasonal variations of blood pressure in adults: Tehran lipid and glucose study. Arch Iran Med. 2014;17(6):0. 24916531
  19. [23]Momenan AA, Delshad M, Sarbazi N, REZAEI GN, Ghanbarian A, AZIZI F. Reliability and validity of the modifiable activity questionnaire (MAQ) in an Iranian urban adult population. 2012. 22519376
  20. [25]Tohidi M, Ghasemi A, Hadaegh F, Derakhshan A, Chary A, Azizi F. Age-and sex-specific reference values for fasting serum insulin levels and insulin resistance/sensitivity indices in healthy Iranian adults: Tehran lipid and glucose study. Clin Biochem. 2014;47(6):432–8. 24530467
  21. [26]Mirmiran P, Esfahani FH, Mehrabi Y, Hedayati M, Azizi F. Reliability and relative validity of an FFQ for nutrients in the Tehran lipid and glucose study. Public Health Nutr. 2010;13(5):654–62. 19807937
  22. [27]Esfahani FH, Asghari G, Mirmiran P, Azizi F. Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran lipid and glucose study. J Epidemiol. 2010;20(2):150–8. 20154450 PMC3900814
  23. [28]Bahadoran Z, Mirmiran P, Jeddi S, Azizi F, Ghasemi A, Hadaegh F. Nitrate and nitrite content of vegetables, fruits, grains, legumes, dairy products, meats and processed meats. J Food Compos Anal. 2016;51:93–105.
  24. [29]Bahadoran Z, Ghasemi A, Mirmiran P, Mehrabi Y, Azizi F, Hadaegh F. Estimation and validation of dietary nitrate and nitrite intake in Iranian population. Iran J Public Health. 2019;48(1):162. 30847325 PMC6401587
  25. [30]Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; National heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation. 2009;120(16):1640–5. 19805654
  26. [31]Care D. Classification and diagnosis of diabetes. Diabetes Care. 2017;40(Suppl 1):S11–24. 27979889
  27. [33]Hmelak Gorenjak A, Cencič A. Nitrate in vegetables and their impact on human health. A review. Acta Aliment. 2013;42(2):158–72.
  28. [34]Bahadoran Z, Mirmiran P, Ghasemi A, Carlström M, Azizi F, Hadaegh F. Association between dietary intakes of nitrate and nitrite and the risk of hypertension and chronic kidney disease: Tehran lipid and glucose study. Nutrients. 2016;8(12):811. 28009811 PMC5188466
  29. [35]Fewtrell L. Drinking-water nitrate, methemoglobinemia, and global burden of disease: a discussion. Environ Health Perspect. 2004;112(14):1371–4. 15471727 PMC1247562
  30. [36]Ghasemi A, Zahediasl S, Azizi F. Nitric oxide and clustering of metabolic syndrome components in pediatrics. Eur J Epidemiol. 2010;25:45–53. 19701686
  31. [37]Kina-Tanada M, Sakanashi M, Tanimoto A, Kaname T, Matsuzaki T, Noguchi K, et al. Long-term dietary nitrite and nitrate deficiency causes the metabolic syndrome, endothelial dysfunction and cardiovascular death in mice. Diabetologia. 2017;60:1138–51. 28352942
  32. [38]Khalifi S, Rahimipour A, Jeddi S, Ghanbari M, Kazerouni F, Ghasemi A. Dietary nitrate improves glucose tolerance and lipid profile in an animal model of hyperglycemia. Nitric Oxide. 2015;44:24–30. 25461274
  33. [39]Gheibi S, Jeddi S, Carlström M, Gholami H, Ghasemi A. Effects of long-term nitrate supplementation on carbohydrate metabolism, lipid profiles, oxidative stress, and inflammation in male obese type 2 diabetic rats. Nitric Oxide: Biology Chem. 2018;75:27–41. 29432804
  34. [40]Li T, Lu X, Sun Y, Yang X. Effects of spinach nitrate on insulin resistance, endothelial dysfunction markers and inflammation in mice with high-fat and high-fructose consumption. Food Nutr Res. 2016;60(1):32010. 27616738 PMC5018658
  35. [41]Bahadoran Z, Norouzirad R, Mirmiran P, Gaeini Z, Jeddi S, Shokri M, et al. Effect of inorganic nitrate on metabolic parameters in patients with type 2 diabetes: A 24-week randomized double-blind placebo-controlled clinical trial. Nitric Oxide. 2021;107:58–65. 33340674
  36. [42]Jonvik KL, Nyakayiru J, Pinckaers PJ, Senden JM, van Loon LJ, Verdijk LB. Nitrate-rich vegetables increase plasma nitrate and nitrite concentrations and lower blood pressure in healthy adults. J Nutr. 2016;146(5):986–93. 27075914
  37. [43]Bahadoran Z, Ghasemi A, Mirmiran P, Azizi F, Hadaegh F. Beneficial effects of inorganic nitrate/nitrite in type 2 diabetes and its complications. Nutr Metabolism. 2015;12:1–9. PMC4436104 25991919
  38. [44]Ignarro LJ. Biosynthesis and metabolism of endothelium-derived nitric oxide. Annu Rev Pharmacol Toxicol. 1990;30(1):535–60. 2188578
  39. [45]Tsutsui M, Tanimoto A, Tamura M, Mukae H, Yanagihara N, Shimokawa H, et al. Significance of nitric oxide synthases: lessons from triple nitric oxide synthases null mice. J Pharmacol Sci. 2015;127(1):42–52. 25704017
  40. [46]Bahadoran Z, Mirmiran P, Ghasemi A. Role of nitric oxide in insulin secretion and glucose metabolism. Trends Endocrinol Metabolism. 2020;31(2):118–30. 31690508
  41. [47]Henstridge DC, Drew BG, Formosa MF, Natoli AK, Cameron-Smith D, Duffy SJ, et al. The effect of the nitric oxide donor sodium Nitroprusside on glucose uptake in human primary skeletal muscle cells. Nitric Oxide. 2009;21(2):126–31. 19567271
  42. [49]Bjornstad P, Eckel RH. Pathogenesis of lipid disorders in insulin resistance: a brief review. Curr Diab Rep. 2018;18:1–8. 30328521 PMC6428207
  43. [50]McConell GK, Rattigan S, Lee-Young RS, Wadley GD, Merry TL. Skeletal muscle nitric oxide signaling and exercise: a focus on glucose metabolism. Am J Physiology-Endocrinology Metabolism. 2012;303(3):E301–7. 22550064
  44. [51]Ohtake K, Nakano G, Ehara N, Sonoda K, Ito J, Uchida H, et al. Dietary nitrite supplementation improves insulin resistance in type 2 diabetic KKAy mice. Nitric Oxide. 2015;44:31–8. 25461271
  45. [52]Gheibi S, Bakhtiarzadeh F, Jeddi S, Farrokhfall K, Zardooz H, Ghasemi A. Nitrite increases glucose-stimulated insulin secretion and islet insulin content in obese type 2 diabetic male rats. Nitric Oxide. 2017;64:39–51. 28089828
  46. [55]Webb AJ, Patel N, Loukogeorgakis S, Okorie M, Aboud Z, Misra S, et al. Acute blood pressure lowering, vasoprotective, and antiplatelet properties of dietary nitrate via bioconversion to nitrite. Hypertension. 2008;51(3):784–90. 18250365 PMC2839282
  47. [56]Matthews V, Hollingshead R, Koch H, Croft K, Ward N. Long-Term dietary nitrate supplementation does not prevent development of the metabolic syndrome in mice fed a High‐Fat diet. Int J Endocrinol. 2018;2018(1):7969750. 30174691 PMC6098922
  48. [57]Mitschke MM, Hoffmann LS, Gnad T, Scholz D, Kruithoff K, Mayer P, et al. Increased cGMP promotes healthy expansion and Browning of white adipose tissue. FASEB J. 2013;27(4):1621–30. 23303211
  49. [59]Dallaire P, Marette A. Obesity-linked insulin resistance: is nitric oxide the missing link. Can J Diabetes. 2004;28(1):59–66.
  50. [60]Gago B, Lundberg JO, Barbosa RM, Laranjinha J. Red wine-dependent reduction of nitrite to nitric oxide in the stomach. Free Radic Biol Med. 2007;43(9):1233–42. 17893036
  51. [62]Lundberg JO, Carlström M, Weitzberg E. Metabolic effects of dietary nitrate in health and disease. Cell Metabol. 2018;28(1):9–22. 29972800

Cited by

Sorted by citations

Authors
Davarpanah, M., Bahadoran, Z., Hasheminia, M., Rostami, F. N., Javadi, M., Mirmiran, P., & Azizi, F.
Affiliations
  • Research Institute for Endocrine Sciences (IR)
  • Iran University of Medical Sciences (IR)
  • Qazvin University of Medical Sciences (IR)
Corresponding author
  • Bahadoran, Zahra
  • Javadi, Maryam
ORCID
Venue
Nutrition Journal
Publisher
Springer Science and Business Media LLC
Published
2025-11-24
Volume
25
Issue
1
Pages
1-1
ISSN
1475-2891 (ISSN-L)
DOI
10.1186/s12937-025-01263-w
PMC
PMC12764135
OpenAlex
W4416608516
Cited by
1
References
8
Citations by year
2026: 1
FWCI
0.91
Type
journal article
Language
en
Open access
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
  • Shahid Beheshti University of Medical Sciences
  • Qazvin University of Medical Sciences
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
dietary nitrate, dietary nitrite, metabolic syndrome, nitrate consumption, metabolic syndrome incidence, Tehran Lipid and Glucose Study
MeSH terms
Adult, Animals, Diet, Female, Humans, Iran, Male, Middle Aged, Nitrates, Nitrites, Prospective Studies, Risk Factors, Incidence, Proportional Hazards Models, Metabolic Syndrome

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