In this meta-analysis Pase et al. looked into dietary determinants of arterial stiffness (based on RCT trials)

1. www.pronutritionist.net
The effects of dietary and nutrient
interventions on arterial stiffness:
a systematic review
Pase M et al.
Am J Clin Nutr 2010; Dec 8
(e-pub ahead of print)
Page 1 Pase M et al. Am J Clin Nutr 2010; Dec 8
(e-pub ahead of print)

2. Page 2
Pronutritionist’s background
• Arterial stiffness is caused by aging and is often referred as
calcification of vasculature. However, age related stiffening
of arteries is not only caused by calcium, but also collagen
formation and other phenomena
• Early and a hallmark marker of arterial stiffness is
deterioration endothelial function
• Elastic (compliant) arteries are linked to vitality and long life
• Increase in arterial stiffness has detrimental effects on
cardiovascular dynamics and health outcomes
• Some dietary factors may affect arterial stiffness
– Recently Finnish investigators have shown that low intake of
vegetables increases during childhood is linked to arterial stiffness in
mid-life (Aatola et al. 2010)
– Trans fats
– -
Pase M et al. Am J Clin Nutr 2010; Dec 8
(e-pub ahead of print)
www.pronutritionist.net

3. Methods
• A systematic review of randomized controlled clinical trials
– dietary and nutrient interventions as a monotherapy for arterial
stiffness and associated wave-reflections
– Sole endothelial function studies were excluded
• 38 studies were included (127 excluded)
• Inclusion criteria:
– randomized and controlled
– sample size of >15 subjects/arm
– adults
– use of a nonactive control
– the outcome variable was a validated measure of arterial stiffness
– used a specific dietary or nutrient intervention administered orally in
the form of supplements, powder or a beverage
Page 3 Pase M et al. Am J Clin Nutr 2010; Dec 8
(e-pub ahead of print)
www.pronutritionist.net

4. Main results (1/3)
www.pronutritionist.netPase M et al. Am J Clin Nutr 2010; Dec 8 (e-
pub ahead of print)
4
1. Fish oil
2. Soy (isoflavones)
3. Salt reduction
4. Fermented milk
1. Caffeine
Worsens Improves

5. Neutral effect on arterial stiffness (2/3)
www.pronutritionist.netPase M et al. Am J Clin Nutr 2010; Dec 8 (e-
pub ahead of print)
5
Vitamin CVitamin C
Vitamin EVitamin E
Folic acidFolic acid
AlcoholAlcohol
CLACLA

6. NOT included or limited evidence
(remain unanswered) (3/3)
www.pronutritionist.netPase M et al. Am J Clin Nutr 2010; Dec 8 (e-
pub ahead of print)
6
Green/ Black teaGreen/ Black tea
Herbal productsHerbal products
Fats (TFA, SFA,
PUFA MUFA)
Fats (TFA, SFA,
PUFA MUFA)
Dietary nitrates
and nitrites
Dietary nitrates
and nitrites
CocoaCocoa

7. Factors proved to reduce arterial
stiffness
• Omega-3 fish oils
– reduces pulse wave velocity (PWV) and increases arterial
compliance
– Minimum dose required in studies: 540 mg EPA combined
with 360 mg DHA a day
• Soy isoflavones
• Consumption of fermented-milk products that
contain bioactive peptides
– In hypertensive patients with small to moderate effects
– Limited but consistent evidence
• Salt restriction
– ≈ 6 g/d
– Only in one study
www.pronutritionist.netPase M et al. Am J Clin Nutr 2010; Dec 8
(e-pub ahead of print)
Page 7

8. Factors that had neutral or negative
effects or lacked evidence
• The evidentiary support for intakes of vitamins,
micronutrients, and herbal medicines was insufficient
• Limited but consistent evidence suggested that
caffeine intake acutely increased arterial stiffness
www.pronutritionist.netPase M et al. Am J Clin Nutr 2010; Dec 8
(e-pub ahead of print)
Page 8

9. Pronutritionist’s discussion (1/2)
• Fish-oil and soy consumption are often linked to improved
cardiovascular survival. One possible explanation is that
they both improve arterial elasticity
• Coffee consumption is linked to decreased stroke and
diabetes incidence. Therefore the observed negative effects
of caffeine might be transient or they might be offset by
coffee’s polyphenols
• Even if inconclusive, some evidence exist that salt intake
per se is harmful for cardiovascular outcomes. Potential
mechanism beyond blood pressure might be worsening of
endothelial function
• In observational and animal studies trans fat is also strongly
linked to markers of arterial stiffness
(Micha & Mozaffarian 2009)
• www.pronutritionist.netPase M et al. Am J Clin Nutr 2010; Dec 8
(e-pub ahead of print)
Page 9

10. Pronutritionist’s discussion (2/2)
• This meta-analysis adds some more proof for the protective
effects of soy, fish and reduction of salt in maintaining
cardiovascular health, but has merely looked into individual
components of diet as determinants of arterial elasticity
• It is likely that that the interplay of many nutrients and some
dietary patterns (like Mediterranean diet Marin et al. 2011 or
high consumption of vegetables Aatola et al. 2010) ) are
even more powerful determinants of “arterial youth” (ie.
avoidance of arterial stiffness)
www.pronutritionist.netPase M et al. Am J Clin Nutr 2010; Dec 8
(e-pub ahead of print)
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