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Ottaviani JI, Sagi-Kiss V, Schroeter H, Kuhnle GGC. Reliance on self-reports and estimated food composition data in nutrition research introduces significant bias that can only be addressed with biomarkers. eLife 2024; 13:RP92941. [PMID: 38896457 PMCID: PMC11186626 DOI: 10.7554/elife.92941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
The chemical composition of foods is complex, variable, and dependent on many factors. This has a major impact on nutrition research as it foundationally affects our ability to adequately assess the actual intake of nutrients and other compounds. In spite of this, accurate data on nutrient intake are key for investigating the associations and causal relationships between intake, health, and disease risk at the service of developing evidence-based dietary guidance that enables improvements in population health. Here, we exemplify the importance of this challenge by investigating the impact of food content variability on nutrition research using three bioactives as model: flavan-3-ols, (-)-epicatechin, and nitrate. Our results show that common approaches aimed at addressing the high compositional variability of even the same foods impede the accurate assessment of nutrient intake generally. This suggests that the results of many nutrition studies using food composition data are potentially unreliable and carry greater limitations than commonly appreciated, consequently resulting in dietary recommendations with significant limitations and unreliable impact on public health. Thus, current challenges related to nutrient intake assessments need to be addressed and mitigated by the development of improved dietary assessment methods involving the use of nutritional biomarkers.
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Lee SS, McGrattan A, Soh YC, Alawad M, Su TT, Palanisamy UD, Hussin AM, Kassim ZB, Mohd Ghazali ANB, Christa Maree Stephan B, Allotey P, Reidpath DD, Robinson L, Mohan D, Siervo M. Feasibility and Acceptability of a Dietary Intervention to Reduce Salt Intake and Increase High-Nitrate Vegetable Consumption in Malaysian Middle-Aged and Older Adults with Elevated Blood Pressure: Findings from the DePEC-Nutrition Trial. Nutrients 2022; 14:nu14030430. [PMID: 35276789 PMCID: PMC8839221 DOI: 10.3390/nu14030430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
The DePEC-Nutrition trial is a complex dietary and behavioural intervention of salt intake reduction combined with increased high-nitrate vegetable consumption among Malaysian middle-aged and older adults with elevated blood pressure. This study aimed to assess the feasibility and acceptability of the trial. Participants were recruited from the South East Asia Community Observatory (SEACO) database and randomised into one of four groups: (1) low salt; (2) high-nitrate vegetable; (3) combined high-nitrate vegetable and low salt; and (4) control. The intervention included a combination of group counselling sessions, information booklets, reinforcement videos and text messages to modify dietary behaviour. The primary outcomes evaluated were the measures of feasibility and acceptability of (1) recruitment, follow-up attendance and retention; (2) data collection procedures and clinical outcome measures; and (3) individual and combined multi-modal dietary interventions. A total of 74 participants were recruited, and the 10-month retention rate was 73%. Data collection procedures were acceptable with minimal missing data. All intervention strategies were feasible and acceptable, with group counselling being the most acceptable strategy. This study provides important insights into improving the screening process of participants, facilitating their access to the research facilities and refining the measurement protocols and dietary recommendations, which are instrumental in formulating the design of a full-scale definitive DePEC-Nutrition trial.
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Affiliation(s)
- Siew Siew Lee
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (S.S.L.); (Y.C.S.); (M.A.); (T.T.S.)
| | - Andrea McGrattan
- School of Biomedical, Nutritional and Sports Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;
| | - Yee Chang Soh
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (S.S.L.); (Y.C.S.); (M.A.); (T.T.S.)
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 45700, Malaysia;
| | - Mawada Alawad
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (S.S.L.); (Y.C.S.); (M.A.); (T.T.S.)
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 45700, Malaysia;
| | - Tin Tin Su
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (S.S.L.); (Y.C.S.); (M.A.); (T.T.S.)
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 45700, Malaysia;
| | - Uma Devi Palanisamy
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia;
| | - Azizah Mat Hussin
- Institute of Medical Science Technology, Universiti Kuala Lumpur, Kajang 43000, Malaysia;
| | - Zaid bin Kassim
- District Health Office, Pejabat Kesihatan Daerah (PKD) Segamat, Segamat 85000, Malaysia; (Z.b.K.); (A.N.b.M.G.)
| | | | | | - Pascale Allotey
- International Institute for Global Health, United Nations University, Kuala Lumpur 56000, Malaysia;
| | - Daniel D. Reidpath
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 45700, Malaysia;
- International Centre for Diarrhoeal Disease Research, ICDDR, B, Dhaka 1212, Bangladesh
| | - Louise Robinson
- Population Health Science Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK;
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (S.S.L.); (Y.C.S.); (M.A.); (T.T.S.)
- Correspondence: ; Tel.: +60-3-5515-9658
| | - Mario Siervo
- School of Life Sciences, University of Nottingham Medical School, Nottingham NG7 2UH, UK;
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McGrattan AM, Stephan BCM, Shannon OM, Mazidi M, Gilchrist M, Smallwood M, Winyard P, McMahon N, Blekkenhorst LC, Mohan D, Bandinelli S, Robinson L, Ferrucci L, Siervo M. Independent and interactive associations of dietary nitrate and salt intake with blood pressure and cognitive function: a cross-sectional analysis in the InCHIANTI study. Int J Food Sci Nutr 2021; 73:491-502. [PMID: 34783276 DOI: 10.1080/09637486.2021.1993157] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Blood pressure (BP) control is a key target for interventions to reduce cognitive decline. This cross-sectional study explored associations between objective (24-hour urine excretion) and subjective (food frequency questionnaire [FFQ]) measures of dietary sodium and nitrate intakes with cognitive function and resting BP in the InCHIANTI cohort. Baseline data from 989 participants aged >50 years were included. In fully adjusted models, participants with concurrent high nitrate and low sodium (Odds Ratio (OR)=0.49, 95%CI 0.32-0.76, p = 0.001) and high nitrate and high sodium (OR = 0.49, 95%CI 0.32-0.77, p = 0.002) 24-hour urinary concentrations had lower odds of high BP than participants with low nitrate and high sodium concentrations. We found no significant associations between sodium and nitrate intakes (24-hour urinary concentrations and FFQ) and poor cognitive performance. Urinary nitrate excretion was associated with lower BP and results appeared to be independent of sodium intake. Further analyses in longitudinal studies are required to substantiate these findings.
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Affiliation(s)
- Andrea M McGrattan
- School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Oliver M Shannon
- Faculty of Medical Sciences, Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mohsen Mazidi
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK.,Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
| | - Mark Gilchrist
- Institute of Biomedical and Clinical Sciences, University of Exeter and NIHR Exeter Clinical Research Facility, Exeter, Devon, UK
| | | | - Paul Winyard
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Nicholas McMahon
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD, Australia
| | - Lauren C Blekkenhorst
- School of Medical and Health Sciences, Institute for Nutrition Research, Edith Cowan University, Perth, WA, Australia.,Medical School, The University of Western Australia, Perth, WA, Australia
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Stefania Bandinelli
- Laboratory of Clinical Epidemiology, InCHIANTI Study Group, LHTC Local Health Tuscany Center, Florence, Italy
| | - Louise Robinson
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle up-on Tyne, UK
| | - Luigi Ferrucci
- Biomedical Research Centre, National Institute on Aging, NIH, Baltimore, MD, USA
| | - Mario Siervo
- School of Life Sciences, University of Nottingham, Nottingham, UK
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4
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Shannon OM, Easton C, Shepherd AI, Siervo M, Bailey SJ, Clifford T. Dietary nitrate and population health: a narrative review of the translational potential of existing laboratory studies. BMC Sports Sci Med Rehabil 2021; 13:65. [PMID: 34099037 PMCID: PMC8186051 DOI: 10.1186/s13102-021-00292-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dietary inorganic nitrate (NO3-) is a polyatomic ion, which is present in large quantities in green leafy vegetables and beetroot, and has attracted considerable attention in recent years as a potential health-promoting dietary compound. Numerous small, well-controlled laboratory studies have reported beneficial health effects of inorganic NO3- consumption on blood pressure, endothelial function, cerebrovascular blood flow, cognitive function, and exercise performance. Translating the findings from small laboratory studies into 'real-world' applications requires careful consideration. MAIN BODY This article provides a brief overview of the existing empirical evidence basis for the purported health-promoting effects of dietary NO3- consumption. Key areas for future research are then proposed to evaluate whether promising findings observed in small animal and human laboratory studies can effectively translate into clinically relevant improvements in population health. These proposals include: 1) conducting large-scale, longer duration trials with hard clinical endpoints (e.g. cardiovascular disease incidence); 2) exploring the feasibility and acceptability of different strategies to facilitate a prolonged increase in dietary NO3- intake; 3) exploitation of existing cohort studies to explore associations between NO3- intake and health outcomes, a research approach allowing larger samples sizes and longer duration follow up than is feasible in randomised controlled trials; 4) identifying factors which might account for individual differences in the response to inorganic NO3- (e.g. sex, genetics, habitual diet) and could assist with targeted/personalised nutritional interventions; 5) exploring the influence of oral health and medication on the therapeutic potential of NO3- supplementation; and 6) examining potential risk of adverse events with long term high- NO3- diets. CONCLUSION The salutary effects of dietary NO3- are well established in small, well-controlled laboratory studies. Much less is known about the feasibility and efficacy of long-term dietary NO3- enrichment for promoting health, and the factors which might explain the variable responsiveness to dietary NO3- supplementation between individuals. Future research focussing on the translation of laboratory data will provide valuable insight into the potential applications of dietary NO3- supplementation to improve population health.
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Affiliation(s)
- Oliver M Shannon
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Easton
- Institute for Clinical Exercise and Health Science, University of the West of Scotland, Blantyre, Scotland, UK
| | - Anthony I Shepherd
- School of Sport, Health & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Mario Siervo
- School of Life Sciences, The University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Stephen J Bailey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Tom Clifford
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
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Sundqvist ML, Lundberg JO, Weitzberg E, Carlström M. Renal handling of nitrate in women and men with elevated blood pressure. Acta Physiol (Oxf) 2021; 232:e13637. [PMID: 33630408 DOI: 10.1111/apha.13637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/25/2022]
Abstract
AIM The inorganic anions nitrate and nitrite are oxidation products of nitric oxide (NO) that have often been used as an index of NO generation. More than just being surrogate markers of NO, nitrate/nitrite can recycle to bioactive NO again. Nitrate is predominantly eliminated via the kidneys; however, there is less knowledge regarding tubular handling. The aim of this study, as part of a large randomized controlled trial, was to explore potential sex differences in renal nitrate handling during low and high dietary nitrate intake. We hypothesized that renal clearance and excretion of nitrate are higher in men compared to women. METHODS In prehypertensive and hypertensive individuals (n = 231), nitrate and nitrite were measured in plasma and urine at low dietary nitrate intake (baseline) and after 5 weeks supplementation with nitrate (300 mg potassium nitrate/day) or placebo (300 mg potassium chloride/day). Twenty-four hours ambulatory blood pressure recordings and urine collections were conducted. RESULTS At baseline, plasma nitrate and nitrite, as well as the downstream marker of NO signalling cyclic guanosine monophosphate, were similar in women and men. Approximately 80% of filtered nitrate was spared by the kidneys. Urinary nitrate concentration, amount of nitrate excreted, renal nitrate clearance (Cnitrate ) and fractional excretion of nitrate (FEnitrate ) were lower in women compared to men. No association was observed between plasma nitrate concentrations and glomerular filtration rate (GFR), nor between FEnitrate and GFR in either sex. After 5 weeks of nitrate supplementation plasma nitrate and nitrite increased significantly, but blood pressure remained unchanged. FEnitrate increased significantly and the sex difference observed at baseline disappeared. CONCLUSION Our findings demonstrate substantial nitrate sparing capacity of the kidneys, which is higher in women compared to men. This suggests higher tubular nitrate reabsorption in women but the underlying mechanism(s) warrants further investigation.
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Affiliation(s)
- Michaela L. Sundqvist
- Department of Physiology and PharmacologyKarolinska Institutet Stockholm Sweden
- Department of Sport and Health Sciences Swedish School of Sport and Health Sciences Stockholm Sweden
| | - Jon O. Lundberg
- Department of Physiology and PharmacologyKarolinska Institutet Stockholm Sweden
| | - Eddie Weitzberg
- Department of Physiology and PharmacologyKarolinska Institutet Stockholm Sweden
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Mattias Carlström
- Department of Physiology and PharmacologyKarolinska Institutet Stockholm Sweden
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6
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Pereira LCR, Shannon OM, Mazidi M, Babateen AM, Ashor AW, Stephan BCM, Siervo M. Relationship between urinary nitrate concentrations and cognitive function in older adults: findings from the NHANES survey. Int J Food Sci Nutr 2021; 72:805-815. [PMID: 33397165 DOI: 10.1080/09637486.2020.1868411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study evaluated the association of urinary nitrate concentrations with cognition in older subjects enrolled in the NHANES study. We also explored whether associations between urinary nitrate and cognition were modified by cardiovascular risk, vitamin D status and vitamin C intake. Two NHANES cycles were merged (2011-2012 and 2013-2014) and a total of 1,015 adults aged 60-80 (69.4 ± 0.3) years were included. Cognition was assessed using the Word List Learning, Word List Recall, Animal Fluency and the Digit Symbol Substitution tests. Urinary nitrate was analysed using electrospray tandem mass spectrometry. Urinary nitrate concentrations were not associated with cognitive performance on any of the cognitive tests. Associations were also not significant in subjects at greater risk for cognitive impairment (i.e. high cardiovascular risk and non-optimal vitamin D status). Longitudinal analyses are needed to explore the associations of urinary nitrate concentrations with dietary nitrate intake and cognitive function.
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Affiliation(s)
| | - Oliver Michael Shannon
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle on Tyne, UK
| | - Mohsen Mazidi
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Abrar Mohammed Babateen
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle on Tyne, UK.,Faculty of Applied Medical Sciences, Clinical Nutrition Department, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ammar Waham Ashor
- Department of Internal Medicine, College of Medicine, Mustansiriyah University, Baghdad, Iraq
| | | | - Mario Siervo
- School of Life Sciences, The University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
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7
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Riddell A, Kirkwood J, Smallwood M, Winyard P, Knight B, Romanczuk L, Shore A, Gilchrist M. Urinary nitrate concentration as a marker for kidney transplant rejection. BMC Nephrol 2020; 21:441. [PMID: 33081704 PMCID: PMC7576839 DOI: 10.1186/s12882-020-02096-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/09/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Early identification and treatment of kidney transplant rejection episodes is vital to limit loss of function and prolong the life of the transplanted kidney and recipient. Current practice depends on detecting a creatinine rise. A biomarker to diagnose transplant rejection at an earlier time point than current practice, or to inform earlier decision making to biopsy, could be transformative. It has previously been shown that urinary nitrate concentration is elevated in renal transplant rejection. Nitrate is a nitric oxide (NO) oxidation product. Transplant rejection upregulates NO synthesis via inducible nitric oxide synthase leading to elevations in urinary nitrate concentration. We have recently validated a urinary nitrate concentration assay which could provide results in a clinically relevant timeframe. Our aim was to determine whether urinary nitrate concentration is a useful tool to predict renal transplant rejection in the context of contemporary clinical practice. METHODS We conducted a prospective observational study, recruiting renal transplant participants over an 18-month period. We made no alterations to the patients' clinical care including medications, immunosuppression, diet and frequency of visits. We collected urine samples from every clinical attendance. We assessed the urinary nitrate to creatinine ratio (uNCR) between patient groups: routine attendances, biopsy proven rejection, biopsy proven no rejection and other call backs. uNCR was examined over time for those with biopsy proven transplant rejection. These four groups were compared using an ANOVA test. RESULTS A total of 2656 samples were collected. uNCR during biopsy proven rejection, n = 15 (median 49 μmol/mmol, IQR 23-61) was not significantly different from that of routine samples, n = 164 (median 55 μmol/mmol, IQR 37-82) (p = 0.55), or biopsy proven no rejection, n = 12 (median 39 μmol/mmol, IQR 21-89) (P = 0.77). Overall uNCR was highly variable with no diagnostic threshold for kidney transplant rejection. Furthermore, within-patient uNCR was highly variable over time, and thus it was not possible to produce individualised patient thresholds to identify rejection. The total taking Tacrolimus was 204 patients, with no statistical difference between the uNCR of all those on Tacrolimus, against those not, p = 0.18. CONCLUSION The urinary nitrate to creatinine ratio is not a useful biomarker for renal transplant rejection.
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Affiliation(s)
- Amy Riddell
- Institute of Biomedical and Clinical Sciences, University of Exeter, and NIHR Exeter Clinical Research Facility, Exeter, Devon, UK.
| | | | - Miranda Smallwood
- Institute of Biomedical and Clinical Sciences, University of Exeter, and NIHR Exeter Clinical Research Facility, Exeter, Devon, UK
| | - Paul Winyard
- Institute of Biomedical and Clinical Sciences, University of Exeter, and NIHR Exeter Clinical Research Facility, Exeter, Devon, UK
| | | | | | - Angela Shore
- Institute of Biomedical and Clinical Sciences, University of Exeter, and NIHR Exeter Clinical Research Facility, Exeter, Devon, UK
| | - Mark Gilchrist
- Institute of Biomedical and Clinical Sciences, University of Exeter, and NIHR Exeter Clinical Research Facility, Exeter, Devon, UK
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8
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Williams JK, Smallwood MJ, Benjamin N, D'Souza RJ, Shore AC, Winyard PG, Gilchrist M. Renal nitrate clearance in chronic kidney disease. Nitric Oxide 2020; 97:16-19. [PMID: 32007629 DOI: 10.1016/j.niox.2020.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Nitric oxide (NO) is rapidly oxidised in humans to nitrite and nitrate, with nitrate being present in much greater abundance. These oxidation products can be recycled back into nitric oxide via a complex entero-salivary pathway, thus preserving NO activity. Approximately 65% of circulating nitrate is excreted in the urine in 48 h, with the excretory pathway of the remainder unknown. The effect of declining renal function on nitrate clearance is unknown METHODS: Forty five subjects, 21 M, 24F, median age 69 (range 27-75 years) with renal function assessed by CKD-EPI eGFR between 9 and 89 ml/min/1.73 m2 completed the study. Following a 24 h low nitrate diet a microplate spectrophotometric method was employed to measure plasma nitrate concentration and 24 h urinary nitrate excretion were measured to determine renal nitrate clearance. RESULTS There was a strong positive correlation between urinary nitrate clearance and eGFR, (Spearman R = 0.7665, p < 0.0001) with a moderate negative correlation between plasma nitrate concentration and CKD-EPI eGFR, (Spearman's R = -0.37, p = 0.012). There was a trend between fractional excretion of nitrate and CKD-EPI eGFR (ml/min/1.73 m2) Spearman's R 0.27, p = 0.07 though this did not reach statistical significance. Plasma nitrate concentration and serum creatinine concentration were positively correlated, Spearman's R = 0.39, p = 0.008. CONCLUSIONS We have observed a strong positive association between renal nitrate clearance and renal function such that plasma nitrate rises as renal function falls. Fractional excretion of nitrate appears to decline as renal function falls. As such, urinary nitrate excretion is unlikely to be a reliable marker of endogenous NO synthesis in settings where renal function is altered.
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Affiliation(s)
- J K Williams
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Road, EX2 5AX, UK
| | - M J Smallwood
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Road, EX2 5AX, UK
| | - N Benjamin
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Road, EX2 5AX, UK
| | - R J D'Souza
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Road, EX2 5AX, UK
| | - A C Shore
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Road, EX2 5AX, UK
| | - P G Winyard
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Road, EX2 5AX, UK
| | - M Gilchrist
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Road, EX2 5AX, UK.
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9
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Fu H, Deng W, Yao L, Gong M, Lai S, Liu J, Li M, Xu H, Wang J. Urinary NO x, a novel potential biomarker for autism spectrum disorder. Free Radic Biol Med 2020; 146:350-356. [PMID: 31706990 DOI: 10.1016/j.freeradbiomed.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/20/2019] [Accepted: 11/03/2019] [Indexed: 01/12/2023]
Abstract
Nitric oxide (NO) participates in many physiological and pathological processes in human. Urine tests tell a lot about health, which are convenient and harmless. Redox stress, including imbalance of reactive nitrogen species and its metabolites NOx, has been gaining increased attention in autism spectrum disorder (ASD) research. However, concentrations of urinary nitrite and nitrate among the ASD population stay unclear. In this study, nitrite and nitrate were precisely measured in urine specimens from 44 ASD children, 30 healthy children (the control group) and 28 healthy adults with an optimized and validated analytic method. For the first time, concentrations of urinary NOx in ASD and healthy children were reported. Nitrite in the ASD population is higher than in the control group, with concentrations of 0.8708 ± 0.1121 μM (0.1556-3.0393 μM) and 0.5938 ± 0.07276 μM (0.1134-2.1004 μM) (p = 0.0420), respectively. Nitrite in the adult groups is 0.5808 ± 0.0985 μM (0.0808-1.9335 μM), which is similar to that in the control group. On the contrary, urinary nitrate concentration in ASD children is lower than that in the control group, which are 2.875 ± 0.2716 mM (0.3264-7.1835 mM) and 4.558 ± 0.5915 mM (1.1860-15.8555 mM) (p = 0.0133), respectively. Nitrate in adults is also significantly lower than that in the control, 2.799 ± 0.3640 mM (0.2507-8.6978 mM) and 4.558 ± 0.5915 mM (p = 0.0146), respectively. Nitrite/nitrate ratios for ASD and the control groups were 0.3496 ± 0.04382 x 10-3 and 0.1604 ± 0.01862 x 10-3 (p = 0.0002), which again indicated the probability of NOx as a novel biomarker. Furthermore, no correlation between NOx and gender, as well as sample collection timing was found. Taken together, the association between NOx and ASD was significant. Urinary nitrite, nitrate and NO2-/NO3-, might serve as a new biomarker for ASD diagnosis during pursuit of harmless, fast, and convenient diagnostic method. Further studies are needed for the metabolic pathways of NOx in ASD pathogenesis.
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Affiliation(s)
- Huimin Fu
- Department of Pharmacology, Bioengineering and Food College, Hubei University of Technology, Wuhan, Hubei, China; National 111 Center for Cellular Regulation and Molecular Pharmaceutics, Wuhan, Hubei, China
| | - Wenwen Deng
- Department of Pharmacology, Bioengineering and Food College, Hubei University of Technology, Wuhan, Hubei, China; National 111 Center for Cellular Regulation and Molecular Pharmaceutics, Wuhan, Hubei, China
| | - Lulu Yao
- Department of Pharmacology, Bioengineering and Food College, Hubei University of Technology, Wuhan, Hubei, China; National 111 Center for Cellular Regulation and Molecular Pharmaceutics, Wuhan, Hubei, China
| | - Miaozi Gong
- Department of Pathology, Peking University Shougang Hospital, Beijing, China
| | - Shenghan Lai
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jianhua Liu
- Er Dong Maternity and Child Health Care Hospital, Huangshi, Hubei, China
| | - Minhui Li
- Department of Child Health Care, Hubei Maternity and Child Health Care Hospital, Wuhan, Hubei, China
| | - Haiqing Xu
- National 111 Center for Cellular Regulation and Molecular Pharmaceutics, Wuhan, Hubei, China; Department of Child Health Care, Hubei Maternity and Child Health Care Hospital, Wuhan, Hubei, China.
| | - Jun Wang
- Department of Pharmacology, Bioengineering and Food College, Hubei University of Technology, Wuhan, Hubei, China; National 111 Center for Cellular Regulation and Molecular Pharmaceutics, Wuhan, Hubei, China.
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10
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Mendy A. Association of Urinary Nitrate With Lower Prevalence of Hypertension and Stroke and With Reduced Risk of Cardiovascular Mortality. Circulation 2019; 137:2295-2297. [PMID: 29784682 DOI: 10.1161/circulationaha.118.034168] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Angelico Mendy
- College of Public Health, University of Iowa, Iowa City.
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11
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Effects of Antiangiogenetic Drugs on Microcirculation and Macrocirculation in Patients with Advanced-Stage Renal Cancer. Cancers (Basel) 2018; 11:cancers11010030. [PMID: 30597890 PMCID: PMC6357121 DOI: 10.3390/cancers11010030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 12/23/2022] Open
Abstract
Adverse cardiovascular effects, including hypertension, were described in patients with different cancers treated with tyrosine kinase inhibitors (TKI). The mechanism of TKI-related hypertension is still debated. The aim of this work was to study the effects of TKI on blood pressure (BP), searching for a relationship with possible causative factors in patients with metastatic renal cell carcinoma. We included 29 patients in a prospective, observational study; 22 were treated with a first-line drug (sunitinib), while seven participated in the second-line treatment (axitinib or cabozantinib). Patients were investigated at the beginning of antiangiogenic therapy (T0) and at one (T1), three (T2), and six months (T3) after treatment. Patients were evaluated by office blood pressure (BP) and ultrasonography to measure flow-mediated dilatation (FMD), and carotid artery distensibility (cDC) by echocardiography and nailfold capillaroscopy. Plasma endothelin-1 (p-ET-1), urine nitrates, and proteins were also measured. At T1, systolic BP, along with U proteins and p-ET-1, increased significantly. In patients with a clinically significant increase in BP (defined as either the need for an antihypertensive drug or systolic blood pressure (SBP) T1–T0 ≥10 and/or SBP ≥140 mmHg and/or diastolic blood pressure (DBP) T1–T0 ≥5 and/or DBP ≥90 mmHg), the urine nitrate concentration was lower at T0, whereas there were no differences in the p-ET-1 and U proteins. Seventeen participants showed changes in the capillaroscopic pattern at T1 with no association with BP increases. There were no differences in the FMD, cDC, and echocardiographic parameters. Our findings are consistent with those of previous studies about BP increases by TKI, and suggest a role of nitric oxide in BP maintenance in this population.
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Liu AH, Bondonno CP, Russell J, Flood VM, Lewis JR, Croft KD, Woodman RJ, Lim WH, Kifley A, Wong G, Mitchell P, Hodgson JM, Blekkenhorst LC. Relationship of dietary nitrate intake from vegetables with cardiovascular disease mortality: a prospective study in a cohort of older Australians. Eur J Nutr 2018; 58:2741-2753. [PMID: 30238316 DOI: 10.1007/s00394-018-1823-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/12/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Short-term trials indicate inorganic nitrate and nitrate-rich vegetables may have vascular health benefits. However, few observational studies have explored the relationship between nitrate intake and long-term cardiovascular disease (CVD) outcomes. The primary aim of this study was to investigate the association of nitrate intake from vegetables with CVD mortality in a sample of older Australians. METHODS A subgroup of participants without diabetes or major CVD at baseline (1992-1994) were included from the Blue Mountains Eye Study, a population-based cohort study of men and women aged ≥ 49 years. Diets were evaluated using a validated food frequency questionnaire at baseline, 5 years and 10 years of follow-up. Vegetable nitrate intake was estimated using a comprehensive vegetable nitrate database. Cox proportional hazard regression was used to explore the association between vegetable nitrate intake and CVD mortality. RESULTS During 14 years of follow-up, 188/2229 (8.4%) participants died from CVD. In multivariable-adjusted analysis, participants in quartile 2 [69.5-99.6 mg/day; HR 0.53 (95% CI 0.35, 0.82)], quartile 3 [99.7-137.8 mg/day; HR 0.51 (95% CI 0.32, 0.80)], and quartile 4 [> 137.8 mg/day; HR 0.63 (95% CI 0.41, 0.95)] of vegetable nitrate intake had lower hazards for CVD mortality compared to participants in quartile 1 (< 69.5 mg/day). CONCLUSIONS In older Australian men and women, vegetable nitrate intake was inversely associated with CVD mortality, independent of lifestyle and cardiovascular risk factors. These findings confirm a recent report that intake of vegetable nitrate lowers the risk of CVD mortality in older women and extend these findings to older men.
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Affiliation(s)
- Alex H Liu
- Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia
| | - Catherine P Bondonno
- Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Joanna Russell
- School of Health and Society, Faculty of Social Sciences, The University of Wollongong, Wollongong, Australia
| | - Victoria M Flood
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.,Western Sydney Local Health District, Westmead Hospital, Westmead, NSW, Australia
| | - Joshua R Lewis
- Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia.,School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Kevin D Croft
- Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Annette Kifley
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Germaine Wong
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia.,School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Jonathan M Hodgson
- Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Lauren C Blekkenhorst
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
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Affiliation(s)
- Mark Gilchrist
- University of Exeter Medical School, Devon, United Kingdom
| | - Angela Shore
- University of Exeter Medical School, Devon, United Kingdom
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Abstract
PURPOSE OF REVIEW Early interventional trials reported improvements in cardiac and exercise outcomes with inorganic nitrate ingestion. The current review aims to provide a brief update of recent evidence regarding ergogenic and cardiovascular effects of dietary nitrate and practical recommendations. RECENT FINDINGS Recent evidence has been inconsistent and questions remain regarding effective dose, duration, and source of nitrate and cohorts likely to benefit. Dietary nitrate may be most relevant to those with vascular/metabolic impairments, those engaging in short-term, intense exercise, deconditioned individuals, and those with a low dietary nitrate intake. SUMMARY The evidence for cardiovascular/exercise benefit is plausible but inconsistent. However, dietary nitrate, in contrast to pharmacological nitrate, has a high benefit-risk ratio. Although nitrate supplementation has grown in popularity, it is suggested that increased green vegetables consumption may provide similar/superior benefits to nitrate supplementation in a cheaper, safer, and potentially tastier context.
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Affiliation(s)
- Conor P Kerley
- Physicians Committee for Responsible Medicine, 5100 Wisconsin Avenue, N.W. Ste. 400, Washington, District of Columbia, USA
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