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Homem RV, Arisseto-Bragotto AP, Rodrigues E, Cladera-Olivera F. Theoretical estimation of nitrates and nitrites intake from food additives by the Brazilian population. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2023; 40:1147-1163. [PMID: 37549245 DOI: 10.1080/19440049.2023.2240439] [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: 05/10/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
Sodium and potassium nitrates and nitrites are preservatives widely used in meat products and some cheese. They are important toxicologically but there is a lack of data on the exposure of the Brazilian population to these additives. This study aimed to verify the frequency of the use of nitrates and nitrites in processed foods in Brazil and to estimate their theoretical intake by the Brazilian population. A database was built of supermarket products containing nitrates, nitrites, and antioxidants. The Theoretical Maximum Daily Intake (TMDI) and TMDI balanced by the prevalence of food consumption (TMDI BPFC) were determined using consumption data from the Household Budget Surveys (2008/2009 and 2017/2018). The TMDI for nitrates and nitrites was lower than the Acceptable Daily Intake (ADI) for all population groups. Considering the prevalence of food consumption (consumers only), the TMDI BPFC values were lower than the ADI for nitrates (between 0.4 and 0.9 times the ADI) but very high values were obtained for nitrites (between 10 and 24 times the ADI). Our results suggest that the Brazilian population, especially some population groups, may be consuming unsafe amounts of nitrite. As a consequence, their health may be at risk.
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Affiliation(s)
- Raísa Vieira Homem
- Department of Food Science, Federal University of Rio Grande do Sul - Institute of Food Science and Technology, Porto Alegre, RS, Brazil
| | - Adriana Pavesi Arisseto-Bragotto
- Department of Food Science and Nutrition, Faculty of Food Engineering, FEA UNICAMP Rua Monteiro Lobato, State University of Campinas, Campinas, SP, Brazil
| | - Eliseu Rodrigues
- Department of Food Science, Federal University of Rio Grande do Sul - Institute of Food Science and Technology, Porto Alegre, RS, Brazil
| | - Florencia Cladera-Olivera
- Department of Food Science, Federal University of Rio Grande do Sul - Institute of Food Science and Technology, Porto Alegre, RS, Brazil
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2
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Kotopoulou S, Zampelas A, Magriplis E. Risk Assessment of Nitrite and Nitrate Intake from Processed Meat Products: Results from the Hellenic National Nutrition and Health Survey (HNNHS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912800. [PMID: 36232098 PMCID: PMC9565037 DOI: 10.3390/ijerph191912800] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 05/31/2023]
Abstract
Long-term exposure to a high nitrite and nitrate intake through processed meat is of concern, as it has been related to adverse health effects. Individual consumption data from 2152 participants (46.7% males) in the Hellenic National Nutrition and Health Survey (HNNHS) were linked with current Maximum Permitted Levels (MPLs) to calculate exposure to nitrite and nitrate from processed meat products (assessed as nitrite equivalent), evaluate potential risk and identify the major contributors. Processed meat intakes were determined by combining data from 24 h recalls and frequency of consumption reported in Food Propensity Questionnaires (FPQs). Median exposure was estimated to be within safe levels for all population groups. However, 6.6% (n = 143) of the consumers exceeded the Acceptable Daily Intake (ADI) of nitrite (0.07 mg/kg bw/day), of which 20.3% were children aged 0-9 years (N = 29) (15.3% of all children participants in the study, N = 190). In total, pork meat was the major contributor (41.5%), followed by turkey meat (32.7%) and sausages (23.8%), although contribution variations were found among age groups. The outcomes are of public health concern, especially exposure among children, and future research is warranted to evaluate possible associations with health effects, by using more refined occurrence data if available.
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Affiliation(s)
- Sotiria Kotopoulou
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece
- Hellenic Food Authority, Leoforos Kifissias 124 & Iatridou 2, 11526 Athens, Greece
| | - Antonis Zampelas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece
- Hellenic Food Authority, Leoforos Kifissias 124 & Iatridou 2, 11526 Athens, Greece
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece
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Development of Healthier and Functional Dry Fermented Sausages: Present and Future. Foods 2022; 11:foods11081128. [PMID: 35454715 PMCID: PMC9031353 DOI: 10.3390/foods11081128] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/05/2022] [Accepted: 04/12/2022] [Indexed: 12/19/2022] Open
Abstract
In recent years, consumer perception about the healthiness of meat products has changed. In this scenario, the meat industry and the scientific and technological areas have put their efforts into improving meat products and achieving healthier and functional formulations that meet the demands of today’s market and consumers. This article aims to review the current functional fermented meat products, especially on sausage development. Firstly, an emphasis is given to reducing and replacing traditional ingredients associated with increased risk to consumer’s health (sodium, fat, and nitrites), adding functional components (prebiotics, probiotics, symbiotics, and polyphenols), and inducing health benefits. Secondly, a look at future fermented sausages is provided by mentioning emerging strategies to produce innovative healthier and functional meat products. Additional recommendations were also included to assist researchers in further development of healthier and functional sausages.
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Bogdanova OG, Efimova NV, Tarmaeva IY. Contamination Of Vegetable Products With Nitrates As A Public Health Risk Factor. RUSSIAN OPEN MEDICAL JOURNAL 2021. [DOI: 10.15275/rusomj.2021.0404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Our study aimed to investigate the contamination levels of vegetable products with nitrates and to evaluate the associated health risks to population of Baikalia. Materials and Methods — The characterization of VP contamination with nitrates is based on the data of the Federal Information Foundation for Public Hygiene Monitoring in the Russian Federation for 2015-2019. The computation of hazard ratios was conducted sensu the Guidelines 2.1.10.1920-04 ‘Human Health Risk Assessment Caused by Environmental Pollutants’. Results — The proportion of VP samples with augmented nitrate content in the Republic of Buryatia was 4.5 times higher than in Irkutsk Oblast. At the same time, nitrate concentrations did not differ significantly: in the Republic of Buryatia, median concentration was 164.24 (158.52–169.95) mg/kg, and 90th percentile was 940.76 (868.49–1013.03) mg/kg; in Irkutsk Oblast, corresponding amounts were 169.1 (158.55–177.55) and 978.0 (927.3–1028.7) mg/kg (p>0.05). The alimentary effect of nitrates on the child population in Republic of Buryatia led to unacceptable risk (HQ>1.0 at the level of the average centile trend). Conclusion — The results of conducted analysis confirmed the need to carry out dynamic studies of child health indicators due to the impact of nitrates in the municipalities of the cluster 1 in the course of the public hygiene monitoring (with child health as a mandatory component of the latter) for developing further predictive indicators.
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Affiliation(s)
- Olga G. Bogdanova
- East-Siberian Institute of Medical and Ecological Research, Angarsk, Russia
| | - Natalia V. Efimova
- East-Siberian Institute of Medical and Ecological Research, Angarsk, Russia
| | - Inna Yu. Tarmaeva
- Federal Research Centre of Nutrition and Biotechnology, Moscow, Russia
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Delgado-Ospina J, Martuscelli M, Grande-Tovar CD, Lucas-González R, Molina-Hernandez JB, Viuda-Martos M, Fernández-López J, Pérez-Álvarez JÁ, Chaves-López C. Cacao Pod Husk Flour as an Ingredient for Reformulating Frankfurters: Effects on Quality Properties. Foods 2021; 10:foods10061243. [PMID: 34070789 PMCID: PMC8229612 DOI: 10.3390/foods10061243] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 01/10/2023] Open
Abstract
The cocoa pod husk is considered a source of dietary fiber with a high content of water-soluble pectins, bioactive compounds which should be viewed as a by-product with the potential to be incorporated into food. This study aimed to investigate the effect of adding different cocoa pod husk flour (CPHF) levels as a starch replacement for reformulating frankfurters. Results showed that the addition of 1.5 and 3.0% pod husk proportionally increased the frankfurter’s fiber content by 0.49 ± 0.08 and 0.96 ± 0.19 g/100 g, which is acceptable for a product that does not contain fiber. Textural properties and sensory characteristics were affected when substituting the starch with CPHF, either totally or partially, although these samples had higher water content, hardness, and adhesiveness while springiness decreased. Non-adverse effects of nitrite on polyphenolic compounds content were evidenced in samples enriched with CPHF. The incorporation of CPHF did not significantly affect the color parameters (ΔE < 3). Finally, the panelists indicated a sensation of the unsalted sausage, suggesting that CPHF may have natural mucoadhesion properties. In conclusion, in formulated meat products such as sausages, plant co-products such as cacao pod husks could be a valid new ingredient to improve technological parameters, functional characteristics, and stability.
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Affiliation(s)
- Johannes Delgado-Ospina
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
- Grupo de Investigación Biotecnología, Facultad de Ingeniería, Universidad de San Buenaventura Cali, Carrera 122 # 6-65, Cali 76001, Colombia
| | - Maria Martuscelli
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
| | - Carlos David Grande-Tovar
- Grupo de Investigación de Fotoquímica y Fotobiología, Universidad del Atlántico, Carrera 30 # 8-49, Puerto Colombia 081008, Colombia
| | - Raquel Lucas-González
- IPOA Research Group, Centro de investigación e Innovación Agroalimentaria y Agroambiental de la UMH (CIAGRO), Miguel Hernández University, Orihuela, CYTED-Healthy Meat. 119RT0568 "Productos Cárnicos más Saludables", 03312 Alicante, Spain
| | - Junior Bernardo Molina-Hernandez
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
| | - Manuel Viuda-Martos
- IPOA Research Group, Centro de investigación e Innovación Agroalimentaria y Agroambiental de la UMH (CIAGRO), Miguel Hernández University, Orihuela, CYTED-Healthy Meat. 119RT0568 "Productos Cárnicos más Saludables", 03312 Alicante, Spain
| | - Juana Fernández-López
- IPOA Research Group, Centro de investigación e Innovación Agroalimentaria y Agroambiental de la UMH (CIAGRO), Miguel Hernández University, Orihuela, CYTED-Healthy Meat. 119RT0568 "Productos Cárnicos más Saludables", 03312 Alicante, Spain
| | - José Ángel Pérez-Álvarez
- IPOA Research Group, Centro de investigación e Innovación Agroalimentaria y Agroambiental de la UMH (CIAGRO), Miguel Hernández University, Orihuela, CYTED-Healthy Meat. 119RT0568 "Productos Cárnicos más Saludables", 03312 Alicante, Spain
- Faculty of Science, King Abdelaziz University, Jedda 21589, Saudi Arabia
| | - Clemencia Chaves-López
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
- IPOA Research Group, Centro de investigación e Innovación Agroalimentaria y Agroambiental de la UMH (CIAGRO), Miguel Hernández University, Orihuela, CYTED-Healthy Meat. 119RT0568 "Productos Cárnicos más Saludables", 03312 Alicante, Spain
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Toward Nitrite-Free Curing: Evaluation of a New Approach to Distinguish Real Uncured Meat from Cured Meat Made with Nitrite. Foods 2021; 10:foods10020313. [PMID: 33546285 PMCID: PMC7913322 DOI: 10.3390/foods10020313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/13/2021] [Accepted: 01/30/2021] [Indexed: 12/04/2022] Open
Abstract
After the International Agency for Research on Cancer (IARC) classified ingested nitrites and nitrates as “probably carcinogenic to humans” under conditions favoring endogenous nitrosation, several meat products labeled as “made without nitrite” were launched. In order to distinguish uncured products truly made without nitrite from cured products made with any nitrite source (vegetal or mineral), this article presents an approach to detect and quantify nitrite from different origins added to meat. The method consists on the determination of nitrous oxide as a target compound using headspace gas chromatography–mass spectrometry (HS-GC–MS). Nitrous oxide (N2O) is formed after two reduction steps: from nitrite to nitric oxide (NO) and then to N2O. The NO is bound to myoglobin (Mb) or metmyoglobin (Met-Mb), forming a complex, which is subsequently released using sulfuric acid, which also favors the reduction to N2O. The HS-GC–MS conditions were split ratio 1:10; injection temperature at 70 °C; incubation temperature at 30 °C and time 45 min; and injection volume 1 mL. As a result, a relationship was established between the concentration of nitrite in cooked ham samples and the area of the N2O peak generated, meaning that this method allows the quantification of added nitrite within a concentration range of 10 to 100 mg kg−1.
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Ferysiuk K, Wójciak KM. Reduction of Nitrite in Meat Products through the Application of Various Plant-Based Ingredients. Antioxidants (Basel) 2020; 9:E711. [PMID: 32764511 PMCID: PMC7464959 DOI: 10.3390/antiox9080711] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 01/13/2023] Open
Abstract
Nitrite is the most commonly applied curing agent in the meat industry, and is known to affect human health. Nitrites impart a better flavor, taste and aroma; preserve the red-pinkish color of the meat; and prevent the risk of bacterial contamination of the cured meat, especially from Clostridium botulinum. Unfortunately, recent research has demonstrated some negative effects of this technique. Certain N-nitroso compounds have been shown to stimulate gastric cancer; therefore, most of the research groups are studying the effects of nitrates and nitrites. In this review, we discuss the various food sources of nitrites and nitrates and their current legal requirements for use in meat products. We also discuss the possible changes that might come up in the regulations, the concerns associated with nitrates and nitrites in meat products, and the use of plant-based nitrite and nitrate substitutes. All these topics will be considered with respect to ensuring a high level of microbiological protection, oxidative stability and acceptable sensory quality (color, taste and smell) in meat products.
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Affiliation(s)
| | - Karolina M. Wójciak
- Department of Animal Raw Materials Technology, Faculty of Food Science and Biotechnology, University of Life Sciences in Lublin, Skromna 8 Street, 20-704 Lublin, Poland;
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Evaluating the Residual Nitrite Concentrations of Bacon in the United Kingdom. Foods 2020; 9:foods9070916. [PMID: 32664513 PMCID: PMC7404468 DOI: 10.3390/foods9070916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022] Open
Abstract
The preservative sodium nitrite is added to processed meat with the intention of preventing the growth of Clostridium botulinum, but this also influences product flavour and colour. The World Health Organisation has declared nitrites to be 'probably carcinogenic'. Use is permitted by the European Union but its addition is limited to 100 mg/kg in all processed meat, except bacon, which is limited to 175 mg/kg. At present, there is no independent peer-reviewed literature assessing the residual nitrite levels in bacon in the United Kingdom. Furthermore, this is the largest study of residual nitrite concentrations in bacon that has ever been conducted. A total of 89 different commercially available bacon samples were collected, and analysed using flow injection analysis to determine their residual nitrite content. The mean residual nitrite concentration for all bacon samples was 10.80 mg/kg. Residual nitrite levels did not differ between smoked and unsmoked bacon. Middle cut bacon (26.00 mg/kg) had significantly higher residual nitrite concentrations than back bacon (8.87 mg/kg; p = 0.027), and medallion bacon (4.47 mg/kg; p = 0.008). This study shows that there is large variation in the mean residual nitrite levels of bacon sold in the UK and all the reported values are within current regulatory limits. Despite this, it appears that many manufacturers could decrease the amount that they are currently using in their products.
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9
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Karwowska M, Kononiuk A. Nitrates/Nitrites in Food-Risk for Nitrosative Stress and Benefits. Antioxidants (Basel) 2020; 9:E241. [PMID: 32188080 PMCID: PMC7139399 DOI: 10.3390/antiox9030241] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 12/12/2022] Open
Abstract
In the context of impact on human health, nitrite/nitrate and related nitrogen species such as nitric oxide (NO) are a matter of increasing scientific controversy. An increase in the content of reactive nitrogen species may result in nitrosative stress-a deleterious process, which can be an important mediator of damage to cell structures, including lipids, membranes, proteins and DNA. Nitrates and nitrites are widespread in the environment and occur naturally in foods of plant origin as a part of the nitrogen cycle. Additionally, these compounds are used as additives to improve food quality and protect against microbial contamination and chemical changes. Some vegetables such as raw spinach, beets, celery and lettuce are considered to contain high concentrations of nitrates. Due to the high consumption of vegetables, they have been identified as the primary source of nitrates in the human diet. Processed meats are another source of nitrites in our diet because the meat industry uses nitrates/nitrites as additives in the meat curing process. Although the vast majority of consumed nitrates and nitrites come from natural vegetables and fruits rather than food additives, there is currently a great deal of consumer pressure for the production of meat products free of or with reduced quantities of these compounds. This is because, for years, the cancer risks of nitrates/nitrites have been considered, since they potentially convert into the nitrosamines that have carcinogenic effects. This has resulted in the development and rapid expansion of meat products processed with plant-derived nitrates as nitrite alternatives in meat products. On the other hand, recently, these two ions have been discussed as essential nutrients which allow nitric oxide production and thus help cardiovascular health. Thus, this manuscript reviews the main sources of dietary exposure to nitrates and nitrites, metabolism of nitrites/nitrates, and health concerns related to dietary nitrites/nitrates, with particular emphasis on the effect on nitrosative stress, the role of nitrites/nitrates in meat products and alternatives to these additives used in meat products.
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Affiliation(s)
- Małgorzata Karwowska
- Department of Meat Technology and Food Quality, University of Life Sciences in Lublin, ul. Skromna 8, 20-704 Lublin, Poland;
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Kalaycıoğlu Z, Erim FB. Nitrate and Nitrites in Foods: Worldwide Regional Distribution in View of Their Risks and Benefits. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2019; 67:7205-7222. [PMID: 31244197 DOI: 10.1021/acs.jafc.9b01194] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Nitrate and nitrite ions are used as food additives to inhibit the growth of microorganisms in cured and processed meats. Vegetables contain significant quantities of nitrate and nitrite. Actually, the vast majority of consumed nitrate and nitrite comes from natural vegetables and fruits rather than food additives. For years, the cancer risks of these two ions have been discussed, since they potentially convert into the carcinogenic nitrosamines. However, recently, these two ions have been considered essential nutrients which promote nitric oxide production and consequently help cardiovascular health. It seems that the role of these two ions in our diet is important now from a different point of view. In this review, the nitrate and nitrite contents of food products from different countries are displayed globally in order to reinterpret the risks/benefits of our consumption quotations. This review article is based on Science Citation Index (SCI) articles reported between 2008 and 2018.
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Affiliation(s)
- Zeynep Kalaycıoğlu
- Istanbul Technical University , Department of Chemistry , Maslak, Istanbul , Turkey
| | - F Bedia Erim
- Istanbul Technical University , Department of Chemistry , Maslak, Istanbul , Turkey
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Mills CE, Khatri J, Maskell P, Odongerel C, Webb AJ. It is rocket science - why dietary nitrate is hard to 'beet'! Part II: further mechanisms and therapeutic potential of the nitrate-nitrite-NO pathway. Br J Clin Pharmacol 2016; 83:140-151. [PMID: 26914827 DOI: 10.1111/bcp.12918] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/17/2016] [Indexed: 12/14/2022] Open
Abstract
Dietary nitrate (found in green leafy vegetables such as rocket and in beetroot) is now recognized to be an important source of nitric oxide, via the nitrate-nitrite-NO pathway. Dietary nitrate confers several cardiovascular beneficial effects on blood pressure, platelets, endothelial function, mitochondrial efficiency and exercise. Having described key twists and turns in the elucidation of the pathway and the underlying mechanisms in Part I, we explore the more recent developments which have served to confirm mechanisms, extend our understanding, and discover new properties and potential therapeutic uses of the pathway in Part II. Even the established dependency on low oxygen states for bioactivation of nitrite has recently been challenged. Dietary nitrate appears to be an important component of 'healthy diets', such as the DASH diet to lower blood pressure and the Mediterranean diet, with its potential to lower cardiovascular risk, possibly through beneficial interactions with a range of other constituents. The World Cancer Research Foundation report strong evidence for vegetables including spinach and lettuce (high nitrate-containing) decreasing cancer risk (mouth, pharynx, larynx, oesophagus and stomach), summarized in a 'Nitrate-Cancer Risk Veg-Table'. The European Space Agency recommends that beetroot, lettuce, spinach and rocket (high-nitrate vegetables) are grown to provide food for long-term space missions. Nitrate, an ancient component of rocket fuel, could support sustainable crops for healthy humans.
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Affiliation(s)
- Charlotte Elizabeth Mills
- Department of Dietetics and Nutrition, Division of Diabetes and Nutritional Sciences, King's College London, Franklins Wilkins Building, London, SE1 0NH
| | - Jibran Khatri
- King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St.Thomas, Hospital, London, SE1 7EH, UK
| | - Perry Maskell
- King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St.Thomas, Hospital, London, SE1 7EH, UK
| | - Chimed Odongerel
- King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St.Thomas, Hospital, London, SE1 7EH, UK
| | - Andrew James Webb
- King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St.Thomas, Hospital, London, SE1 7EH, UK
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