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Consumption of nitrate-containing vegetables is inversely associated with hypertension in adults: a prospective investigation from the Tehran Lipid and Glucose Study

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Abstract

Background

There is growing evidence of the potential properties of nitrate-rich foods against development of hypertension (HTN) and vascular disease. In this study, we investigated the association of nitrate-containing vegetables (NCVs) with risk of HTN after 3 years of follow-up.

Methods

This prospective study was conducted on 1546 non-hypertensive subjects, aged 20–70 years. Blood pressure was measured at baseline and after 3 years and HTN was defined by the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure criteria. Dietary intake was collected using a validated semi-quantitative food frequency questionnaire (FFQ). NCVs and high-, medium- and low-NCV subcategories were defined, and the odds of HTN after 3 years according to tertiles of NCV and NCV-category intake were estimated by logistic regression and adjusted for potential variables.

Results

Mean age of participants was 38.0 ± 12.0 years at baseline and 57.0 % were women. Mean dietary intake of energy-adjusted NCV was 298.0 ± 177.3 g/day. After adjustment for total energy intake, fiber, sodium, potassium and processed meat, a significant inverse association was observed between NCV and the risk of HTN in the highest tertile category (odds ratio 0.63, 95 % confidence interval: 0.41–0.98, p for trend = 0.05). There was no significant association of 3 year risk of HTN across tertiles of low nitrate-, medium nitrate- and high-nitrate vegetables.

Conclusion

Higher dietary nitrate intake from vegetables sources may have a protective effect against development of HTN.

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References

  1. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ (2002) Selected major risk factors and global and regional burden of disease. Lancet 360:1347–1360

    Article  PubMed  Google Scholar 

  2. Kearney PM, Whelton M, Reynolds K, Whelton PK, He J (2004) Worldwide prevalence of hypertension: a systematic review. J Hypertens 22:11–19

    Article  CAS  PubMed  Google Scholar 

  3. Esteghamati A, Meysamie A, Khalilzadeh O, Rashidi A, Haghazali M, Asgari F et al (2009) Third national surveillance of risk factors of non-communicable diseases (surfncd-2007) in Iran: methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and dyslipidemia. BMC Public Health 9:167

    Article  PubMed  PubMed Central  Google Scholar 

  4. Siervo M, Lara J, Ogbonmwan I, Mathers JC (2013) Inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults: a systematic review and meta-analysis. J Nutr 143:818–826

    Article  CAS  PubMed  Google Scholar 

  5. Yuzbashian E, Asghari G, Mirmiran P, Hosseini FS, Azizi F (2015) Associations of dietary macronutrients with glomerular filtration rate and kidney dysfunction: Tehran lipid and glucose study. J Nephrol 28:173–180

    Article  CAS  PubMed  Google Scholar 

  6. Golzarand M, Bahadoran Z, Mirmiran P, Sadeghian-Sharif S, Azizi F (2015) Dietary phytochemical index is inversely associated with the occurrence of hypertension in adults: a 3-year follow-up (the Tehran Lipid and Glucose Study). Eur J Clin Nutr 69:392–398

    Article  CAS  PubMed  Google Scholar 

  7. de Paula TP, Steemburgo T, de Almeida JC, Dall’Alba V, Gross JL, de Azevedo MJ (2012) The role of Dietary Approaches to Stop Hypertension (DASH) diet food groups in blood pressure in type 2 diabetes. Br J Nutr 108:155–162

    Article  PubMed  Google Scholar 

  8. Hord NG, Tang Y, Bryan NS (2009) Food sources of nitrates and nitrites: the physiologic context for potential health benefits. Am J Clin Nutr 90:1–10

    Article  CAS  PubMed  Google Scholar 

  9. Gilchrist M, Winyard PG, Aizawa K, Anning C, Shore A, Benjamin N (2013) Effect of dietary nitrate on blood pressure, endothelial function, and insulin sensitivity in type 2 diabetes. Free Radic Biol Med 60:89–97

    Article  CAS  PubMed  Google Scholar 

  10. Larsen FJ, Schiffer TA, Ekblom B, Mattsson MP, Checa A, Wheelock CE et al (2014) Dietary nitrate reduces resting metabolic rate: a randomized, crossover study in humans. Am J Clin Nutr 99:843–850

    Article  CAS  PubMed  Google Scholar 

  11. Bondonno CP, Liu AH, Croft KD, Ward NC, Yang X, Considine MJ et al (2014) Short-term effects of nitrate-rich green leafy vegetables on blood pressure and arterial stiffness in individuals with high-normal blood pressure. Free Radic Biol Med 77:353–362

    Article  CAS  PubMed  Google Scholar 

  12. Habermeyer M, Roth A, Guth S, Diel P, Engel KH, Epe B et al (2015) Nitrate and nitrite in the diet: how to assess their benefit and risk for human health. Mol Nutr Food Res 59:106–128

    Article  CAS  PubMed  Google Scholar 

  13. Pannala AS, Mani AR, Spencer JP, Skinner V, Bruckdorfer KR, Moore KP et al (2003) The effect of dietary nitrate on salivary, plasma, and urinary nitrate metabolism in humans. Free Radic Biol Med 34:576–584

    Article  CAS  PubMed  Google Scholar 

  14. Kelly J, Fulford J, Vanhatalo A, Blackwell JR, French O, Bailey SJ et al (2013) Effects of short-term dietary nitrate supplementation on blood pressure, O2 uptake kinetics, and muscle and cognitive function in older adults. Am J Physiol Regul Integr Comp Physiol 304:R73–R83

    Article  CAS  PubMed  Google Scholar 

  15. Liu AH, Bondonno CP, Croft KD, Puddey IB, Woodman RJ, Rich L et al (2013) Effects of a nitrate-rich meal on arterial stiffness and blood pressure in healthy volunteers. Nitric Oxide 35:123–130

    Article  CAS  PubMed  Google Scholar 

  16. Webb AJ, Patel N, Loukogeorgakis S, Okorie M, Aboud Z, Misra S et al (2008) Acute blood pressure lowering, vasoprotective, and antiplatelet properties of dietary nitrate via bioconversion to nitrite. Hypertension 51:784–790

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Azizi F, Rahmani M, Emami H, Mirmiran P, Hajipour R, Madjid M et al (2002) Cardiovascular risk factors in an Iranian urban population: tehran lipid and glucose study (phase 1). Soz Praventivmed 47:408–426

    Article  PubMed  Google Scholar 

  18. Esfahani FH, Asghari G, Mirmiran P, Azizi F (2010) Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study. J Epidemiol 20:150–158

    Article  PubMed  Google Scholar 

  19. Santamaria P (2006) Nitrate in vegetables: toxicity, content, intake and EC regulation. J Sci Food Agric 86:10–17

    Article  CAS  Google Scholar 

  20. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al (2003) The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 289:2560–2572

    Article  CAS  PubMed  Google Scholar 

  21. Kriska AM, Knowler WC, LaPorte RE, Drash AL, Wing RR, Blair SN et al (1990) Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians. Diabetes Care 13:401–411

    Article  CAS  PubMed  Google Scholar 

  22. Willett WC, Howe GR, Kushi LH (1997) Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 65:1220S–1228S (discussion 29S-31S)

    CAS  PubMed  Google Scholar 

  23. Alonso A, de la Fuente C, Martin-Arnau AM, de Irala J, Martinez JA, Martinez-Gonzalez MA (2004) Fruit and vegetable consumption is inversely associated with blood pressure in a Mediterranean population with a high vegetable-fat intake: the Seguimiento Universidad de Navarra (SUN) Study. Br J Nutr 92:311–319

    Article  CAS  PubMed  Google Scholar 

  24. Berry SE, Mulla UZ, Chowienczyk PJ, Sanders TA (2010) Increased potassium intake from fruit and vegetables or supplements does not lower blood pressure or improve vascular function in UK men and women with early hypertension: a randomised controlled trial. Br J Nutr 104:1839–1847

    Article  CAS  PubMed  Google Scholar 

  25. John JH, Ziebland S, Yudkin P, Roe LS, Neil HA (2002) Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: a randomised controlled trial. Lancet 359:1969–1974

    Article  CAS  PubMed  Google Scholar 

  26. Dauchet L, Kesse-Guyot E, Czernichow S, Bertrais S, Estaquio C, Peneau S et al (2007) Dietary patterns and blood pressure change over 5 year follow-up in the SU.VI.MAX cohort. Am J Clin Nutr 85:1650–1656

    CAS  PubMed  Google Scholar 

  27. Miller GD, Marsh AP, Dove RW, Beavers D, Presley T, Helms C et al (2012) Plasma nitrate and nitrite are increased by a high-nitrate supplement but not by high-nitrate foods in older adults. Nutr Res 32:160–168

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Lidder S, Webb AJ (2013) Vascular effects of dietary nitrate (as found in green leafy vegetables and beetroot) via the nitrate-nitrite-nitric oxide pathway. Br J Clin Pharmacol 75:677–696

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Bahadoran Z, Mirmiran P, Ghasemi A, Kabir A, Azizi F, Hadaegh F (2015) Is dietary nitrate/nitrite exposure a risk factor for development of thyroid abnormality? A systematic review and meta-analysis. Nitric Oxide 47:65–76

    Article  CAS  PubMed  Google Scholar 

  30. Bahadoran Z, Ghasemi A, Mirmiran P, Azizi F, Hadaegh F (2015) Beneficial effects of inorganic nitrate/nitrite in type 2 diabetes and its complications. Nutr Metab (Lond) 12:16

    Article  Google Scholar 

  31. Gilchrist M, Winyard PG, Benjamin N (2010) Dietary nitrate–good or bad? Nitric Oxide 22:104–109

    Article  CAS  PubMed  Google Scholar 

  32. van Grinsven HJ, Ward MH, Benjamin N, de Kok TM (2006) Does the evidence about health risks associated with nitrate ingestion warrant an increase of the nitrate standard for drinking water? Environ Health 5:26

    Article  PubMed  PubMed Central  Google Scholar 

  33. Greenway FLPB, Flanagan DR, Giordano T, Qiu Y, Brandon A (2012) Single-dose pharmacokinetics of different oral sodium nitrite formulations in diabetes patients. Diabetes Technol Ther 14:552–560

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Mohler ER 3rd, Hiatt WR, Gornik HL, Kevil CG, Quyyumi A, Haynes WG et al (2014) Sodium nitrite in patients with peripheral artery disease and diabetes mellitus: safety, walking distance and endothelial function. Vasc Med. 19:9–17

    Article  CAS  PubMed  Google Scholar 

  35. Sobko T, Marcus C, Govoni M, Kamiya S (2010) Dietary nitrate in Japanese traditional foods lowers diastolic blood pressure in healthy volunteers. Nitric Oxide 22:136–140

    Article  CAS  PubMed  Google Scholar 

  36. Velmurugan S, Kapil V, Ghosh SM, Davies S, McKnight A, Aboud Z et al (2013) Antiplatelet effects of dietary nitrate in healthy volunteers: involvement of cGMP and influence of sex. Free Radic Biol Med 65:1521–1532

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Hobbs DA, George TW, Lovegrove JA (2013) The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies. Nutr Res Rev 26:210–222

    Article  CAS  PubMed  Google Scholar 

  38. Milkowski A, Garg HK, Coughlin JR, Bryan NS (2010) Nutritional epidemiology in the context of nitric oxide biology: a risk-benefit evaluation for dietary nitrite and nitrate. Nitric Oxide 22:110–119

    Article  CAS  PubMed  Google Scholar 

  39. Bondonno CP, Yang X, Croft KD, Considine MJ, Ward NC, Rich L et al (2012) Flavonoid-rich apples and nitrate-rich spinach augment nitric oxide status and improve endothelial function in healthy men and women: a randomized controlled trial. Free Radic Biol Med 52:95–102

    Article  CAS  PubMed  Google Scholar 

  40. Kapil V, Khambata RS, Robertson A, Caulfield MJ, Ahluwalia A (2015) Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study. Hypertension 65:320–327

    Article  CAS  PubMed  Google Scholar 

  41. Kapil V, Milsom AB, Okorie M, Maleki-Toyserkani S, Akram F, Rehman F et al (2010) Inorganic nitrate supplementation lowers blood pressure in humans: role for nitrite-derived NO. Hypertension 56:274–281

    Article  CAS  PubMed  Google Scholar 

  42. Ashworth A, Mitchell K, Blackwell JR, Vanhatalo A, Jones AM (2015) High-nitrate vegetable diet increases plasma nitrate and nitrite concentrations and reduces blood pressure in healthy women. Public Health Nutr 16:1–10

    Google Scholar 

  43. Lara J, Ashor AW, Oggioni C, Ahluwalia A, Mathers JC, Siervo M (2015) Effects of inorganic nitrate and beetroot supplementation on endothelial function: a systematic review and meta-analysis. Eur J Nutr [Epub ahead of print]

  44. Carlstrom M, Larsen FJ, Nystrom T, Hezel M, Borniquel S, Weitzberg E et al (2010) Dietary inorganic nitrate reverses features of metabolic syndrome in endothelial nitric oxide synthase-deficient mice. Proc Natl Acad Sci USA 107:17716–17720

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Kemmner S, Burkhardt K, Heemann U, Baumann M (2014) Dietary nitrate by beetroot juice can lower renal resistive index in patients with chronic kidney disease. Artery Res 8:147–148

    Article  Google Scholar 

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Acknowledgments

We thank the TLGS participants and the field investigators of the TLGS for their cooperation and assistance in physical examinations, biochemical and nutritional evaluation and database management. This study was supported by grant no. 121 from the National Research Council of the Islamic Republic of Iran and the Research Institute for Endocrine Sciences of Shahid Beheshti University of Medical Sciences. We would like to thank Ms N.Shiva for critical editing of English grammar and syntax of the manuscript.

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Authors and Affiliations

  1. Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran

    Mahdieh Golzarand & Zahra Bahadoran

  2. Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran

    Mahdieh Golzarand, Zahra Bahadoran & Azita Zadeh-Vakili

  3. Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran

    Parvin Mirmiran

  4. Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran

    Azita Zadeh-Vakili

  5. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran

    Fereidoun Azizi

  6. No. 24, Parvaneh St, Yemen St, Chamran Exp, PO Box 19395-4763, Tehran, Islamic Republic of Iran

    Parvin Mirmiran

Authors
  1. Mahdieh Golzarand
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Corresponding author

Correspondence to Parvin Mirmiran.

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The authors declare no conflict of interest.

Ethical approval

This study was approved by the ethics committee of Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences (Ethics code: IR.SBMU.RIES.REC.1394.36).

Informed consent

Written informed consents were obtained from all participants.

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Golzarand, M., Bahadoran, Z., Mirmiran, P. et al. Consumption of nitrate-containing vegetables is inversely associated with hypertension in adults: a prospective investigation from the Tehran Lipid and Glucose Study. J Nephrol 29, 377–384 (2016). https://doi.org/10.1007/s40620-015-0229-6

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  • DOI: https://doi.org/10.1007/s40620-015-0229-6

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