title: Effect of Spinach, a High Dietary Nitrate Source, on Arterial Stiffness and Related Hemodynamic Measures: A Randomized, Controlled Trial in Healthy Adults.
abstract: Diets rich in fruits and vegetables reduce risk of adverse cardiovascular events. However, the constituents responsible for this effect have not been well established. Lately, the attention has been brought to vegetables with high nitrate content with evidence that this might represent a source of vasoprotective nitric oxide. We hypothesized that short-term consumption of spinach, a vegetable having high dietary nitrate content, can affect the arterial waveform indicative of arterial stiffness, as well as central and peripheral blood pressure (BP). Using a placebo-controlled, crossover design, 27 healthy participants were randomly assigned to receive either a high-nitrate (spinach; 845 mg nitrate/day) or low-nitrate soup (asparagus; 0.6 mg nitrate/day) for 7 days with a 1-week washout period. On days 1 and 7, profiles of augmentation index, central, and brachial BP were obtained over 180 min post-consumption in 4 fasted visits. A postprandial reduction in augmentation index was observed at 180 min on high-nitrate compared to low-nitrate intervention (-6.54 ± 9.7% vs. -0.82 ± 8.0%, p = 0.01) on Day 1, and from baseline on Day 7 (-6.93 ± 8.7%, p < 0.001; high vs. low: -2.28 ± 12.5%, p = 0.35), suggesting that the nitrate intervention is not associated with the development of tolerance for at least 7 days of continued supplementation. High vs. low-nitrate intervention also reduced central systolic (-3.39 ± 5.6 mmHg, p = 0.004) and diastolic BP (-2.60 ± 5.8 mmHg, p = 0.028) and brachial systolic BP (-3.48 ± 7.4 mmHg, p = 0.022) at 180 min following 7-day supplementation only. These findings suggest that dietary nitrate from spinach may contribute to beneficial hemodynamic effects of vegetable-rich diets and highlights the potential of developing a targeted dietary approach in the management of elevated BP.
authors.affiliation: Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada. ; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
authors.forename: Elena
authors.initials: E
authors.lastname: Jovanovski
authors.affiliation: Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada. ; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Bosco
authors.affiliation: Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
authors.forename: Kashif
authors.initials: K
authors.lastname: Khan
authors.affiliation: Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
authors.forename: Fei
authors.initials: F
authors.lastname: Au-Yeung
authors.affiliation: Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada. ; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
authors.forename: Hoang
authors.initials: H
authors.lastname: Ho
authors.affiliation: Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
authors.forename: Andreea
authors.initials: A
authors.lastname: Zurbau
authors.affiliation: Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Jenkins
authors.affiliation: Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada. ; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada. ; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada. ; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada. ; Division of Endocrinology & Metabolism, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Vuksan
keywords: Augmentation index; Blood pressure; Dietary nitrate; Spinach; Vascular