Abstract
BackgroundConsidering the lack of data on the association between habitual dietary intakes of nitrate (NO3−) and nitrite (NO2−) and cardiovascular events, we assessed possible effects of dietary NO3− and NO2−, in the context of total antioxidant capacity (TAC) of the diet, with the risk of cardiovascular (CVD) outcomes.MethodsAdult men and women without CVD (n = 2369) were recruited from the Tehran Lipid and Glucose Study and were followed for a mean of 6.7 years. Dietary NO3− and NO2− intakes, as well as dietary TAC and nitric oxide (NO) index were assessed at baseline (2006–2008). Multivariable-adjusted Cox proportional hazards regression models were used to estimate risk of CVD above and below median of dietary intakes of NO3−/NO2− and dietary TAC and NO index. Due to a significant interaction between NO3−/NO2− intake and TAC, stratified analyses were done for < and ≥ median dietary TAC.ResultsDaily mean (SD) dietary NO3− and NO2− intakes were 460 (195) and 9.5 (3.9) mg; mean (SD) dietary TAC and NO index was 1406 (740) and 338 (197) μmol trolox equivalent (TE)/100 g. In subjects with lower dietary TAC, higher intake of NO3− (≥ 430 mg/d) was accompanied with an increased risk of CVD (HR = 3.28, 95% CI = 1.54–6.99). There were no significant associations between dietary intakes of NO2−, TAC of the diet and NO index with the occurrence of CVD events during the study follow-up.ConclusionHigh habitual intake of NO3−, in the context of low TAC of the food, may be associated with the risk of CVD outcomes.
Highlights
Considering the lack of data on the association between habitual dietary intakes of nitrate (NO3−) and nitrite (NO2−) and cardiovascular events, we assessed possible effects of dietary NO3− and NO2−, in the context of total antioxidant capacity (TAC) of the diet, with the risk of cardiovascular (CVD) outcomes
There are several issues that need to be clarified in the case of NO3− and NO2− intake in the general population; e.g. the total amount and the sources of NO3− and NO2− intakes from the diet, and potential interaction with other dietary components such as antioxidants that may impact on the endogenous metabolic fates of these anions
Despite the beneficial properties of NO3−/NO2− on glucose and insulin homeostasis documented by several pre-clinical and experimental investigations [13], in a recent population-based cohort study we showed that higher NO2− intakes from animal-based sources, along with low intake of vitamin C, may increase the risk of type 2 diabetes [14]
Summary
Considering the lack of data on the association between habitual dietary intakes of nitrate (NO3−) and nitrite (NO2−) and cardiovascular events, we assessed possible effects of dietary NO3− and NO2−, in the context of total antioxidant capacity (TAC) of the diet, with the risk of cardiovascular (CVD) outcomes. There are several issues that need to be clarified in the case of NO3− and NO2− intake in the general population; e.g. the total amount and the sources of NO3− and NO2− intakes from the diet, and potential interaction with other dietary components such as antioxidants that may impact on the endogenous metabolic fates of these anions. We considered dietary NO index, a novel scoring system combining the inherent NO3−/NO2− content and oxygen radical absorbance capacity (ORAC) score of the food [17]
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