Dietary Nitrate Supplementation and Exercise Performance: An Umbrella Review of 20 Published Systematic Reviews with Meta-analyses

IF 9.4 1区医学 Q1 SPORT SCIENCES Sports Medicine Pub Date : 2025-03-14 DOI:10.1007/s40279-025-02194-6

Eric Tsz-Chun Poon, Jason Chun-Kit Iu, Wesley Man-Kuk Sum, Po-San Wong, Kenneth Ka-Hei Lo, Ajmol Ali, Stephen F. Burns, Eric T. Trexler

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Abstract

Background

Dietary nitrate (NO₃⁻) supplementation is purported to benefit exercise performance. However, previous studies have evaluated this nutritional strategy with various performance outcomes, exercise tasks, and dosing regimens, often yielding inconsistent results that limit the generalizability of the findings.

Objective

We aimed to synthesize the available evidence regarding the effect of NO₃⁻ supplementation on 11 domains of exercise performance.

Methods

An umbrella review was reported in accordance with the Preferred Reporting Items for Overviews of Reviews guideline. Seven databases (MEDLINE, EMBASE, Cochrane Database, CINAHL, Scopus, SPORTDiscus, and Web of Science) were searched from inception until July 2024. Systematic reviews with meta-analyses comparing NO₃⁻ supplementation and placebo-controlled conditions were included. Literature search, data extraction, and methodological quality assessment (A Measurement Tool to Assess Systematic Reviews Assessing the Methodological quality of SysTemAtic Review [AMSTAR-2]) were conducted independently by two reviewers.

Results

Twenty systematic reviews with meta-analyses, representing 180 primary studies and 2672 unique participants, met the inclusion criteria. Our meta-analyses revealed mixed effects of NO₃⁻ supplementation. It improved time-to-exhaustion tasks [standardized mean difference (SMD): 0.33; 95% confidence interval (CI) 0.19–0.47] with subgroup analyses indicating more pronounced improvements when a minimum dose of 6 mmoL/day (372 mg/day) and chronic (> 3 days) supplementation protocol was implemented. Additionally, ergogenic effects of NO₃⁻ supplementation were observed for total distance covered (SMD: 0.42; 95% CI 0.09–0.76), muscular endurance (SMD: 0.48; 95% CI 0.23–0.74), peak power output (PPO; SMD: 0.25; 95% CI 0.10 to 0.39), and time to PPO (SMD: − 0.76; 95% CI − 1.18, − 0.33). However, no significant improvements were found for other performance outcomes (all p > 0.05). The AMSTAR-2 ratings of most included reviews ranged from low to critically low.

Conclusions

This novel umbrella review with a large-scale meta-analysis provides an updated synthesis of evidence on the effects of NO₃⁻ supplementation across various aspects of exercise performance. Our review also highlights significant methodological quality issues that future systematic reviews in this field should address to enhance the reliability of evidence.

Clinical Trial Registration

This study was registered in the International Prospective Register of Systematic Review (PROSPERO) database (registration number: CRD42024577461).

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膳食硝酸盐补充与运动表现：对20篇已发表的系统综述和荟萃分析的综述

膳食硝酸盐（NO3−）的补充被认为有利于运动表现。然而，先前的研究已经用不同的表现结果、运动任务和给药方案评估了这种营养策略，通常得出的结果不一致，限制了研究结果的普遍性。目的：我们旨在综合有关补充NO3−对运动表现11个领域的影响的现有证据。方法根据综述的首选报告项目指南报告一项总括性综述。从成立到2024年7月，检索了七个数据库（MEDLINE， EMBASE, Cochrane Database， CINAHL, Scopus， SPORTDiscus和Web of Science）。纳入了比较NO3−补充和安慰剂对照条件的荟萃分析的系统综述。文献检索、数据提取和方法学质量评估（评估系统评价的测量工具[AMSTAR-2]）由两位审稿人独立进行。结果20项系统综述和荟萃分析，包括180项主要研究和2672名独特参与者，符合纳入标准。我们的荟萃分析揭示了补充NO3−的混合效果。它改进了时间到耗尽任务[标准化平均差（SMD）： 0.33；95%可信区间（CI） 0.19-0.47]，亚组分析表明，当最低剂量为6 mmoL/天（372 mg/天）和慢性（3天）补充方案时，改善更为显著。此外，在覆盖的总距离上观察到NO3−补充的人体经氧效应(SMD: 0.42；95% CI 0.09-0.76)，肌肉耐力(SMD: 0.48；95% CI 0.23-0.74)，峰值输出功率(PPO；SMD: 0.25;95% CI 0.10 ~ 0.39)，到PPO的时间(SMD:−0.76；95% ci为- 1.18,- 0.33)。然而，在其他性能结果方面没有发现显著的改善（均p >； 0.05）。大多数包括评论的AMSTAR-2评级从低到极低不等。这一新颖的综合综述和大规模荟萃分析提供了补充NO3−对运动表现各方面影响的最新综合证据。我们的综述还强调了重要的方法学质量问题，未来该领域的系统综述应该解决这些问题，以提高证据的可靠性。临床试验注册本研究已在国际前瞻性系统评价注册（PROSPERO）数据库中注册（注册号：CRD42024577461）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Sports Medicine 医学-运动科学

CiteScore

18.40

自引率

5.10%

发文量

165

审稿时长

6-12 weeks

期刊介绍： Sports Medicine focuses on providing definitive and comprehensive review articles that interpret and evaluate current literature, aiming to offer insights into research findings in the sports medicine and exercise field. The journal covers major topics such as sports medicine and sports science, medical syndromes associated with sport and exercise, clinical medicine's role in injury prevention and treatment, exercise for rehabilitation and health, and the application of physiological and biomechanical principles to specific sports. Types of Articles: Review Articles: Definitive and comprehensive reviews that interpret and evaluate current literature to provide rationale for and application of research findings. Leading/Current Opinion Articles: Overviews of contentious or emerging issues in the field. Original Research Articles: High-quality research articles. Enhanced Features: Additional features like slide sets, videos, and animations aimed at increasing the visibility, readership, and educational value of the journal's content. Plain Language Summaries: Summaries accompanying articles to assist readers in understanding important medical advances. Peer Review Process: All manuscripts undergo peer review by international experts to ensure quality and rigor. The journal also welcomes Letters to the Editor, which will be considered for publication.