ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A...
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![Page 1: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/1.jpg)
ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING
Lidder S1,2,3, Hunt J1,2, Omar S1,2, Webb A1,2
1King's College London, London, UK
2Guy's and St Thomas' NHS Foundation Trust, London, UK 3Barts and The London NHS Trust, London, UK
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Systolic BP
-1 0 1 2 3 4 5 6
-10
-5
0
5
10
24
ControlBeetroot Juice
‡‡
†††
‡‡‡
‡ ‡
‡‡
Time (h)
B
P (
mm
Hg
)
Webb A. et al., Hypertension 2008;51:1-7
(23 mmol NO3-)
![Page 3: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/3.jpg)
![Page 4: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/4.jpg)
Hypothesis
• Provision of dietary nitrate may enhance glucose handling
Aim• To establish whether ingestion of a dietary
nitrate load improves glucose handling as shown by pl. glucose response to 75 g GTT
![Page 5: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/5.jpg)
Study criteria
• Healthy subjects aged 18-45 years• BMI between 18 and 40 kg/m2
• Normotensive• Not taking systemic medication other than OCP
![Page 6: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/6.jpg)
Baseline data
Subjects (n) 8
Male 4
Female 4
Age (years) 26.5±2.5
Weight (kg) 68.8±3.0
Height (cm) 173±0.04
BMI 22.9±0.8
![Page 7: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/7.jpg)
Individual visit
• Double blind randomised placebo controlled cross-over design•KNO3 v KCl (both 24 mmol, capsules) +Gaviscon
•NO3- (24 mmol) ≈ 500 ml beetroot juice*
*Webb A. et al., Hypertension 2008;51:1-7
![Page 8: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/8.jpg)
Effect of dietary nitrate on plasma NO3
-, NO2- & exhaled NO
NO3-
-1 0 1 250
100
150NitrateChloride
***
***
******
*** ***†††
500
1000
1500
2000
2500
3000
Time (h)
pla
sm
a [
nit
rate
] m
ol/
L
NO2-
-1 0 1 20
50
100
150
NitrateChloride
*** ***
***
***
***†††
300
600
900
1200
Time (h)
pla
sm
a [
nit
rite
] n
mo
l/L
NO
-2 -1 0 1 2 320
30
40
50
60
NitrateChloride
* *
**
†††
Time (h)
NO
(p
pb
)
![Page 9: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/9.jpg)
Effect of dietary nitrate on plasma glucose & insulin during GTT (n=8)
![Page 10: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/10.jpg)
Effect of dietary nitrate on plasma glucose & insulin during GTT (n=8)
![Page 11: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/11.jpg)
Effect of dietary nitrate on BP
![Page 12: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/12.jpg)
New hypothesis
• Association between glucose response + BP response to nitrate;
• on exposure to nitrate, subjects may either:• ‘respond’ = ↓ glucose• ‘reactors’ = ↑ glucose
• & this determines the BP response to nitrate
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New study – 20 participants
Aim: • To prospectively determine whether there is an association between the glucose response and the BP response to nitrate
• Similar protocol,
• Responders or reactors: >5% Δ AUCglucose, KNO3 v KCl • KNO3 (8 mmol) ≈ 3-4 portions of green leafy veg
Primary outcome: • Difference in change in BP with nitrate, between nitrate reactors and responders (glucose)
![Page 14: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/14.jpg)
Responders Reactors
![Page 15: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/15.jpg)
Responders Reactors
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Responders Reactors
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Responders Reactors
![Page 18: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/18.jpg)
Responders Reactors
![Page 19: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/19.jpg)
Responders Reactors
![Page 20: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/20.jpg)
Responders v Reactors
![Page 21: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/21.jpg)
Responders v Reactors
![Page 22: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/22.jpg)
Summary & Conclusions
• BP ↓ by nitrate in reactors• BP ↑ by nitrate in responders
• Responders have higher glucose curves in control: ↓ by nitrate (but BP ↑)
• Reactors have higher insulin curves with nitrate than responders– may be mechanism for vasodilatation and ↓BP
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AcknowledgmentsAndrew WebbJoanne HuntSami OmarTony MarinakiLynette FairbanksGabriella PassacqualeKenneth ConnellHenry FokGanesh ArunachalamSikder Zubair RahimBenyu JiangSally BrettKaren McNeillAlbert FerroPhil ChowienczykClinical Research Facility nurses KCL BHF Centre
![Page 24: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/24.jpg)
![Page 25: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/25.jpg)
Baseline data
Subjects (n) 20
Male 9
Female 11
Age (years) 26.2±1.36
Weight (kg) 70.5±3.61
Height (cm) 174±0.03
BMI 23.1±0.63
![Page 26: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/26.jpg)
Baseline data - Responders
Subjects (n) 12
Male 7
Female 5
Age (years) 27.4±1.78
Weight (kg) 73.8±4.92
Height (cm) 176±0.03
BMI 23.5±0.84
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Baseline data - Reactors
Subjects (n) 8
Male 2
Female 6
Age (years) 24.3±2.06
Weight (kg) 65.5±5.04
Height (cm) 170±0.05
BMI 22.5±0.96
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Baseline data – Responders >5% Δ AUCglucose
Subjects (n) 10
Male 6
Female 4
Age (years) 27.4±2.14
Weight (kg) 74.6±5.73
Height (cm) 178±0.03
BMI 23.3±1.00
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Baseline data - Reactors >5% Δ AUCglucose
Subjects (n) 6
Male 2
Female 4
Age (years) 26.0±2.34
Weight (kg) 66.7±6.48
Height (cm) 172±0.05
BMI 22.2±1.27
![Page 30: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/30.jpg)
Glucose
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Insulin
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C-peptide
![Page 33: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/33.jpg)
Mean baseline SBP
![Page 34: ACUTE EFFECTS OF DIETARY NITRATE ON GLUCOSE HANDLING Lidder S 1,2,3, Hunt J 1,2, Omar S 1,2, Webb A 1,2 1 King's College London, London, UK 2 Guy's and.](https://reader031.fdocuments.us/reader031/viewer/2022032605/56649e7b5503460f94b7c155/html5/thumbnails/34.jpg)
Green leafy veg + diabetes• increasing consumption of green leafy
vegetables by one and a half UK portions a day (121.9g) could result in 14% reduction in the incidence of type 2 diabetes
• (Carter P. et al., BMJ 2010;341:c4229)
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Responders v Reactors
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Responders v Reactors
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Comparison of control glucose curves
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non-responders removed
-1.0 -0.5 0.0 0.5 1.0 1.5 2.0-15
-10
-5
0
5
RespondersReactors
††††
Time (h)
S
BP
(m
mH
g)