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Webb AJ. "Every beet you take": lowering systolic blood pressure and improving vascular function/exercise capacity via the dietary nitrate-nitrite-NO pathway in patients with COPD. Eur Respir J 2024; 63:2302238. [PMID: 38302179 DOI: 10.1183/13993003.02238-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 02/03/2024]
Affiliation(s)
- Andrew J Webb
- Department of Clinical Pharmacology, King's College London British Heart Foundation Centre, School of Cardiovascular and Metabolic Medicine and Sciences, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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Vaccaro MG, Innocenti B, Cione E, Gallelli L, De Sarro G, Bonilla DA, Cannataro R. Acute effects of a chewable beetroot-based supplement on cognitive performance: a double-blind randomized placebo-controlled crossover clinical trial. Eur J Nutr 2024; 63:303-321. [PMID: 37875637 PMCID: PMC10799154 DOI: 10.1007/s00394-023-03265-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/03/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Dietary nitrate (NO3-) has been shown to be useful as an ergogenic aid with potential applications in health and disease (e.g., blood pressure control). However, there is no consensus about the effects of dietary NO3- or beetroot (BR) juice supplementation on cognitive function. OBJECTIVE The aim of this study was to evaluate the effects of a single dose of a chewable BR-based supplement on cognitive performance. METHODS A double-blind randomized placebo-controlled two-period crossover clinical trial was carried out based on the extension of the CONSORT guidelines for randomized crossover trials. A total of 44 participants (24 F; 20 M; 32.7 [12.5] years; 66.3 [9.0] kg; 170 [9.2] cm; 22.8 [1.4] kg/m2) were randomly allocated to receive first either four BR-based chewable tablets (BR-CT) containing 3 g of a Beta vulgaris extract (RedNite®) or four tablets of a placebo (maltodextrin). A 4-day washout period was used before crossover. Ninety minutes after ingestion of the treatments, a neuropsychological testing battery was administered in each period. The trial was registered at clinicaltrials.gov NCT05509075. RESULTS Significant improvements with moderate effect size were found on memory consolidation at the short and long term only after BR-CT supplementation via the Rey Auditory Verbal Learning Test immediate (+ 20.69%) and delayed (+ 12.34%) recalls. Likewise, enhancement on both frontal lobe functions (+ 2.57%) and cognitive flexibility (+ 11.16%) were detected after BR-CT. There was no significant change (p < 0.05) on verbal memory of short-term digits, working memory and information processing speed. Mixed results were found on mood and anxiety through the Beck Depression Inventory-II (BDI-II) and the State-Trait Anxiety Inventory (STAI-Y1 and STAI-Y2); however, sequence and period effects were seen on STAI-Y2. CONCLUSIONS The acute administration of a chewable BR-based supplement improves certain aspects of cognitive function in healthy females and males, particularly memory capacity and frontal skills.
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Affiliation(s)
- Maria Grazia Vaccaro
- Department of Medical and Surgical Sciences, University of Magna Graecia, Catanzaro, Italy
| | | | - Erika Cione
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
- Galascreen Laboratories, University of Calabria, Rende, Italy
| | - Luca Gallelli
- Clinical Pharmacology and Pharmacovigilance Operative Unit, Department of Health Science, University of Magna Graecia, Mater Domini Hospital, Catanzaro, Italy
| | - Giovambattista De Sarro
- Clinical Pharmacology and Pharmacovigilance Operative Unit, Department of Health Science, University of Magna Graecia, Mater Domini Hospital, Catanzaro, Italy
| | - Diego A Bonilla
- Research Division, Dynamical Business and Science Society-DBSS International SAS, 110861, Bogotá, Colombia
- Research Group in Physical Activity, Sports and Health Sciences (GICAFS), Universidad de Córdoba, 230002, Montería, Colombia
- Research Group in Biochemistry and Molecular Biology, Universidad Distrital Francisco José de Caldas, 110311, Bogotá, Colombia
| | - Roberto Cannataro
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy.
- Galascreen Laboratories, University of Calabria, Rende, Italy.
- Research Division, Dynamical Business and Science Society-DBSS International SAS, 110861, Bogotá, Colombia.
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Alasmari AM, Alsulayyim AS, Alghamdi SM, Philip KEJ, Buttery SC, Banya WAS, Polkey MI, Armstrong PC, Rickman MJ, Warner TD, Mitchell JA, Hopkinson NS. Oral nitrate supplementation improves cardiovascular risk markers in COPD: ON-BC, a randomised controlled trial. Eur Respir J 2024; 63:2202353. [PMID: 38123239 PMCID: PMC10831142 DOI: 10.1183/13993003.02353-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Short-term studies suggest that dietary nitrate (NO3 -) supplementation may improve the cardiovascular risk profile, lowering blood pressure (BP) and enhancing endothelial function. It is not clear if these beneficial effects are sustained and whether they apply in people with COPD, who have a worse cardiovascular profile than those without COPD. Nitrate-rich beetroot juice (NR-BRJ) is a convenient dietary source of nitrate. METHODS The ON-BC trial was a randomised, double-blind, placebo-controlled parallel group study in stable COPD patients with home systolic BP (SBP) measurement ≥130 mmHg. Participants were randomly allocated (1:1) using computer-generated, block randomisation to either 70 mL NR-BRJ (400 mg NO3 -) (n=40) or an otherwise identical nitrate-depleted placebo juice (0 mg NO3 -) (n=41), once daily for 12 weeks. The primary end-point was between-group change in home SBP measurement. Secondary outcomes included change in 6-min walk distance (6MWD) and measures of endothelial function (reactive hyperaemia index (RHI) and augmentation index normalised to a heart rate of 75 beats·min-1 (AIx75)) using an EndoPAT device. Plasma nitrate and platelet function were also measured. RESULTS Compared with placebo, active treatment lowered SBP (Hodges-Lehmann treatment effect -4.5 (95% CI -5.9- -3.0) mmHg), and improved 6MWD (30.0 (95% CI 15.7-44.2) m; p<0.001), RHI (0.34 (95% CI 0.03-0.63); p=0.03) and AIx75 (-7.61% (95% CI -14.3- -0.95%); p=0.026). CONCLUSIONS In people with COPD, prolonged dietary nitrate supplementation in the form of beetroot juice produces a sustained reduction in BP, associated with an improvement in endothelial function and exercise capacity.
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Affiliation(s)
- Ali M Alasmari
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
- Respiratory Therapy Department, College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia
| | - Abdullah S Alsulayyim
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Saeed M Alghamdi
- Clinical Technology Department, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Keir E J Philip
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Sara C Buttery
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Winston A S Banya
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - Paul C Armstrong
- Centre for Immunobiology, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Matthew J Rickman
- National Heart and Lung Institute, Cardiothoracic Pharmacology, Vascular Biology, Imperial College London, London, UK
| | - Timothy D Warner
- Centre for Immunobiology, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jane A Mitchell
- National Heart and Lung Institute, Cardiothoracic Pharmacology, Vascular Biology, Imperial College London, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
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Pavitt MJ, Lewis A, Buttery SC, Fernandez BO, Mikus-Lelinska M, Banya WAS, Feelisch M, Polkey MI, Hopkinson NS. Dietary nitrate supplementation to enhance exercise capacity in hypoxic COPD: EDEN-OX, a double-blind, placebo-controlled, randomised cross-over study. Thorax 2021; 77:968-975. [PMID: 34853156 DOI: 10.1136/thoraxjnl-2021-217147] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 11/04/2021] [Indexed: 11/03/2022]
Abstract
RATIONALE Dietary nitrate supplementation improves skeletal muscle oxygen utilisation and vascular endothelial function. We hypothesised that these effects might be sufficient to improve exercise performance in patients with COPD and hypoxia severe enough to require supplemental oxygen. METHODS We conducted a single-centre, double-blind, placebo-controlled, cross-over study, enrolling adults with COPD who were established users of long-term oxygen therapy. Participants performed an endurance shuttle walk test, using their prescribed oxygen, 3 hours after consuming either 140 mL of nitrate-rich beetroot juice (BRJ) (12.9 mmol nitrate) or placebo (nitrate-depleted BRJ). Treatment order was allocated (1:1) by computer-generated block randomisation. MEASUREMENTS The primary outcome was endurance shuttle walk test time. The secondary outcomes included area under the curve to isotime for fingertip oxygen saturation and heart rate parameters during the test, blood pressure, and endothelial function assessed using flow-mediated dilatation. Plasma nitrate and nitrite levels as well as FENO were also measured. MAIN RESULTS 20 participants were recruited and all completed the study. Nitrate-rich BRJ supplementation prolonged exercise endurance time in all participants as compared with placebo: median (IQR) 194.6 (147.5-411.7) s vs 159.1 (121.9-298.5) s, estimated treatment effect 62 (33-106) s (p<0.0001). Supplementation also improved endothelial function: NR-BRJ group +4.1% (-1.1% to 14.8%) vs placebo BRJ group -5.0% (-10.6% to -0.6%) (p=0.0003). CONCLUSION Acute dietary nitrate supplementation increases exercise endurance in patients with COPD who require supplemental oxygen.Trial registration number ISRCTN14888729.
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Affiliation(s)
- Matthew J Pavitt
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Adam Lewis
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sara C Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - Winston A S Banya
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Martin Feelisch
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton, UK.,Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK
| | - Michael I Polkey
- National Heart and Lung Institute, Imperial College London, London, UK.,Respiratory Medicine, Royal Brompton Hospital, London, UK
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