Relationship of dietary nitrate intake from vegetables with cardiovascular disease mortality: a prospective study in a cohort of older Australians

Authors

Alex Liu, University of Western Australia
Catherine Bondonno, University of Western Australia, Edith Cowan University
Joanna Russell, University of WollongongFollow
Victoria M. Flood, University Of Sydney, Westmead HospitalFollow
Joshua Lewis, University of Western Australia, Edith Cowan University, Children’s Hospital at Westmead, University of Sydney
Kevin D. Croft, University of Western AustraliaFollow
Richard Woodman, Flinders University
Wai Lim, Sir Charles Gairdner Hospital
Annette Kifley, University Of Sydney
Germaine Wong, Children's Hospital, Westmead, University Of Sydney
Paul Mitchell, University of SydneyFollow
Jonathan Hodgson, University of Western Australia, Edith Cowan University
Lauren Blekkenhorst, Edith Cowan University

RIS ID

130515

Publication Details

Liu, A. H., Bondonno, C. P., Russell, J., Flood, V. M., Lewis, J. R., Croft, K. D., Woodman, R. J., Lim, W. H., Kifley, A., Wong, G., Mitchell, P., Hodgson, J. M. &Blekkenhorst, L. C. (2019). Relationship of dietary nitrate intake from vegetables with cardiovascular disease mortality: a prospective study in a cohort of older Australians. European Journal of Nutrition, 58 (7), 2741-2753.

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.