Poster Presentation Nutrition Society of Australia 50th Annual Scientific Meeting 2026

Evidence mapping of dietary inorganic nitrate interventions in ageing: An international expert-led scoping review of randomised controlled studies (146810)

Jonas Benjamim 1 , Andrey Porto 2 , Thomas Loftus 3 , Jamie Matu 4 , Leonardo da Silva Gonçalves 5 , Guilherme da Silva Rodrigues 6 , Macario Arosti Rebelo 2 , Vitor E. Valenti 7 , Zhongxu Hu 8 , Lauren Blekkenhorst 9 , Catherine Bondonno 9 10 , Simone Porcelli 11 , Raul Bescos 12 , Jose E. Tanus-Santos 2 , Stephen J. Bailey 13 , David N. Proctor 14 , Andrew R. Coggan 15 , Jon Lundberg 16 , Oliver M Shannon 17 , Mario Siervo 18
  1. Deakin Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
  2. Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
  3. School of Psychology and Neuroscience, University of St Andrews, St Andrews, United Kindgom
  4. School of Health, Leeds Beckett University, Leeds, United Kingdom
  5. Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
  6. Ribeirao Preto School of Physical Education and Sports, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
  7. Systematic Reviews Center for Cardiovascular and Metabolic Health, Sao Paulo State University, School of Philosophy and Sciences, Marilia, Sao Paulo, Brazil
  8. Curtin School of Allied Health, Curtin University, Perth, WA, Australia
  9. Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, , Joondalup, WA, Australia
  10. Medical School, The University of Western Australia, Royal Perth Hospital, Perth, WA, Australia
  11. Department of Molecular Medicine, University of Pavia, Pavia, Lombardy, Italy
  12. School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
  13. School of Sport, Exercise and Health Sciences, Loughborough University,, Loughborough, United Kingdom
  14. Department of Kinesiology, College of Health & Human Development, Pennsylvania State University, Pennsylvania, USA
  15. Department of Kinesiology, School of Health & Human Sciences, Indiana University Indianapolis and Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, USA
  16. Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
  17. Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
  18. School of Population Health, Curtin University, Perth, WA, Australia

The global increase in life expectancy has intensified the need to understand biological mechanisms underlying healthy ageing. In young adults, nitric oxide (NO) is primarily (~0.74 µmol·kg⁻¹·h⁻¹) produced via the nitric oxide synthase (NOS)-dependent oxidation of L-arginine(1). However, ageing is associated with several physiological changes, including a progressive decline in endogenous NO production and/or bioavailability, driven by reduced NOS expression, activity and coupling; endothelial dysfunction; and increased oxidative stress. An alternative NOS-independent pathway, the nitrate (NO3⁻)–nitrite (NO2⁻)–NO pathway, has been increasingly recognised as an important and complementary means for NO production(2). This pathway is initiated by the reduction of NO3⁻, from endogenous and exogenous (diet) sources, to NO2⁻and the subsequent reduction of NO2⁻ to bioactive NO through processes mediated by oral microbiota, gastric acid and systemic enzymatic reduction (e.g., via xanthine oxidoreductase, deoxyhemoglobin) in peripheral tissues(3). Dietary NO3- may support healthy ageing through the NO3-NO2-NO pathway, yet the translational scope of randomised evidence in middle-aged and older adults remains unclear. This scoping review mapped randomised controlled evidence on dietary NO3- interventions in adults aged ≥ 40 y, focusing on intervention characteristics, study design, participant profiles, mechanistic assessments, and ageing-relevant outcomes. Systematic searches were conducted across MEDLINE, PsycINFO, CINAHL, PubMed, and the Cochrane Library. Eligible studies were randomised controlled trials involving dietary NO3- interventions in adults aged ≥ 40 y. From 10,897 identified records, 127 studies were included, comprising 175 trials and 4,448 participants. The studies were published between 2011 and 2026. Most trials used crossover designs (n = 107; 61.1%), and double-blind protocols predominated (n = 139; 79.4%). Beetroot juice was the dominant NO₃⁻ source tested (n = 116; 66.3%), whereas whole-food sources, typically green leafy vegetables, accounted for fewer than 5% of trials (n = 8; 4.6%). Acute interventions were the most common, with 1-day protocols reported in 69 trials (39.4%), while 42 trials (24.0%) lasted > 1 to ≤ 21 days and 64 trials (36.6%) lasted > 21 days. Most trials administered daily NO₃⁻ doses ≥ 4 mmol (n = 155; 88.6%). Evidence was concentrated around metabolic, cardiorespiratory, and vascular outcomes, particularly blood pressure (n = 128; 73.1%). In contrast, further outcomes central to healthy ageing were underrepresented, including physical function and exercise capacity (n = 23; 13.1%), muscle strength and power (n = 25; 14.3%), brain health (n = 12; 6.9%), and body composition (n = 3; 1.7%). Current evidence on dietary NO3- remains dominated by acute and short-term, supplement-based investigations in adults over 40 years. Few studies have examined long-term interventions, low-dose strategies, whole-food NO₃⁻ sources, cognitive outcomes, body composition or functional endpoints central to healthy ageing. Longer-term, food-based trials assessing accepted ageing-related outcomes are needed to translate dietary NO3- interventions into practical healthy-ageing strategies.

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  3. 3. Benjamim J, Bailey SJ, da Silva Gonçalves L, et al. (2026) Redox Biol. 90, 104041.