Performance and Health Benefits of Dietary Nitrate Supplementation in Older Adults: A Systematic Review
Open accessAbstract
Supplementation with nitrate (NO3−)-rich beetroot juice has been shown to improve exercise performance and cardiovascular (CV) responses, due to an increased nitric oxide (NO) availability. However, it is unclear whether these benefits are greater in older adults who have an age-related decrease in NO and higher risk of disease. This systematic review examines 12 randomised, crossover, control trials, investigating food-based NO3− supplementation in older adults and its potential benefits on physiological and cognitive performances, and CV, cerebrovascular and metabolic health. Four studies found improvements in physiological performance (time to exhaustion) following dietary NO3− supplementation in older adults. Benefits on cognitive performance were unclear. Six studies reported improvements in CV health (blood pressure and blood flow), while six found no improvement. One study showed improvements in cerebrovascular health and two found no improvement in metabolic health. The current literature indicates positive effects of dietary NO3− supplementation in older adults on physiological performance, with some evidence indicating benefits on cardiovascular and cerebrovascular health. Effects on cognitive performance were mixed and studies on metabolic health indicated no benefit. However, there has been limited research conducted on the effects of dietary NO3− supplementation in older adults, thus, further study, utilising a randomised, double-blind, control trial design, is warranted.
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These effects may translate into improved walking economy, muscle power, and tolerance to high-intensity activity, which are critical for maintaining independence in older adults.
“These effects may translate into improved walking economy, muscle power, and tolerance to high-intensity activity–all of which are critical for maintaining independence in older adults [174,182].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [174]
The Results (§3.7.2) report longer walking time and improved time to exhaustion during submaximal cycling after dietary nitrate supplementation in some older adults. They do not establish improved walking economy, muscle power, or tolerance to high-intensity activity; the same section reports no improvement in grip strength or several walking and functional tests in healthy older adults. The Introduction (§1) discusses age-related declines in function, but does not establish that the claimed effects maintain independence. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn older adults, nitrate supplementation is associated with improvements in functional outcomes such as time to exhaustion, peak power, and mobility test results.
“In older adults, nitrate supplementation has been associated with improvements in functional outcomes, such as time to exhaustion, peak power, and the results of mobility tests (e.g., the timed up-and-go and sit-to-stand tests).”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [174]
The Results (Section 3.7.2) report improved time to exhaustion in some studies of older adults. They do not report improved peak power, and the up-and-go and repeated chair-raising tests showed no significant improvement; the Discussion (Section 4.1) notes only a nonsignificant trend across those tests. Page numbers are not available in our copy. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe effects of nitrate on cognition are inconsistent and dependent on dosage.
“the effects on cognition are inconsistent and dependent on dosage [174].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [174]
The Conclusions (§5; page not provided) say results for cognitive performance are mixed, supporting the 'inconsistent' portion. They say the effects *may* be influenced by nitrate dosage, but do not establish that cognitive effects depend on dosage; the Discussion (§4.2) also identifies supplementation duration, cognitive tests, and participant health as possible explanations for the differing results. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOlder adults typically exhibit reduced baseline cerebral perfusion and greater vascular dysfunction.
“who typically exhibit reduced baseline cerebral perfusion and greater vascular dysfunction [169,174].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [174]
The effects of nitrate on cerebral haemodynamics may be more pronounced in older adults.
“These effects may be more pronounced in older adults”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [174]
Findings on nitrate supplementation and functional outcomes in older adults are not uniform.
“However, findings are not uniform [174].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [174]
Systematic reviews suggest improvements in cardiovascular and physical performance with nitrate.
“Systematic reviews suggest improvements in cardiovascular and physical performance”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [174]
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Dietary Nitrate from Beetroot Juice for Hypertension: A Systematic Review
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“However, findings are not uniform [174].”
Influential
- Authors
- Stanaway, L., Rutherfurd-Markwick, K., Page, R., & Ali, A.
- Affiliations
- Massey University (NZ)
- Corresponding author
- Ali, Ajmol
- Venue
- Nutrients
- Publisher
- MDPI AG
- Published
- 2017-10-27
- Volume
- 9
- Issue
- 11
- Pages
- 1171
- ISSN
- 2072-6643 (ISSN-L)
- PMC
- PMC5707643
- OpenAlex
- W2765275903
- Cited by
- 60
- References
- 13
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 9 · 2023: 5 · 2022: 5 · 2021: 8 · 2020: 10 · 2019: 10 · 2018: 1
- FWCI
- 1.23
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Nutrients (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- dietary nitrate, beetroot juice, older adults, exercise performance, time to exhaustion, nitric oxide, cardiovascular health, blood pressure, blood flow, cerebrovascular health, cognitive performance, metabolic health, aging
- MeSH terms
- Aged, Aging, Blood Pressure, Cardiovascular Diseases, Cerebrovascular Circulation, Cognition, Female, Humans, Male, Metabolic Diseases, Nitrates, Nitric Oxide, Dietary Supplements, Beta vulgaris
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