Effect of dietary nitrate supplementation on metabolic rate during rest and exercise in human: A systematic review and a meta-analysis

Nitric Oxide. 2016 Feb 29:53:65-76. doi: 10.1016/j.niox.2016.01.001. Epub 2016 Jan 7.


Background: Recent randomized controlled trials have suggested that dietary nitrate (NO3(-)), found in beetroot and other vegetables, and inorganic NO3(-) salts decrease metabolic rate under resting and exercise conditions.

Objective: Our aim was therefore to determine from a systematic review and meta-analysis whether dietary NO3(-) supplementation significantly reduces metabolic rate, expressed as oxygen uptake (VO2), under resting and exercise conditions in healthy humans and those with cardiorespiratory diseases.

Design: A systematic article search was performed on electronic databases (PubMed, Scopus and Web of Science) from February to March 2015. The inclusion criteria included 1) randomized controlled trials; 2) studies reporting the effect of NO3(-) on VO2 under resting and/or exercise conditions; 3) comparison between dietary NO3(-) supplementation and placebo. Random-effects models were used to calculate the pooled effect size.

Results: Twenty nine randomized placebo-controlled trials were included in the systematic review, and 26 of which were included in the meta-analysis. Dietary NO3(-) supplementation significantly decreases VO2 during submaximal intensity exercise [-0.26 (95% IC: -0.38, -0.15), p < 0.01], but not in the sub-analysis of subjects with chronic diseases [-0.09 (95% IC: -0.50, 0.32), p = 0.67]. When data were separately analyzed by submaximal intensity domains, NO3(-) supplementation reduces VO2 during moderate [-0.29 (95% IC: -0.48,-0.10), p < 0.01] and heavy [-0.33 (95% IC: -0.54,-0.12), p < 0.01] intensity exercise. When the studies with the largest effects were excluded from the meta-analysis, there is a trend for a VO2 decrease under resting condition in dietary NO3(-) supplementation [-0.28 (95% IC: -0.62, 0.05), p = 0.10].

Conclusion: Dietary NO3(-) supplementation decreases VO2 during exercise performed in the moderate and heavy intensity domains in healthy subjects. The present meta-analysis did not show any significant effect of dietary NO3(-) supplementation on metabolic rate in subjects with chronic diseases, despite enhanced exercise tolerance.

Keywords: Chronic diseases; Dietary nitrate; Exercise; Metabolic rate; Rest.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Dietary Supplements*
  • Energy Metabolism / drug effects*
  • Exercise*
  • Humans
  • Nitrates / administration & dosage*
  • Nitrates / pharmacology*
  • Oxygen / metabolism*
  • Randomized Controlled Trials as Topic
  • Rest*


  • Nitrates
  • Oxygen