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The role of nutrition and body composition in peripheral arterial disease

Nature Reviews Cardiology volume 9, pages 634–643 (2012)Cite this article

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Abstract

Peripheral arterial disease (PAD) has not been as extensively investigated as other cardiovascular diseases. However, the available data suggest that nutrition-based treatment strategies have the potential to reduce the cost-economic burden of PAD substantially. Abdominal obesity is associated with PAD and prospective and cross-sectional studies have shown that a low dietary intake of folate and reduced synthesis of vitamin D are associated with an increased risk of PAD and severe walking impairment in patients who have the disease. However, dietary patterns that are associated with decreased cardiovascular risk might protect against PAD. A small number of clinical trials have provided evidence that increased intakes of niacin and insoluble fiber might be associated with decreased levels of LDL cholesterol and thrombogenic biomarkers, as well as increased serum levels of HDL cholesterol in patients with PAD. However, little evidence that antioxidants, vitamins B6 and B12, or essential fatty acid supplements improve clinical outcomes in these patients exists. Overall, data on the effects of nutrition, body composition, and nutritional supplementation on the risk, progression, and prognosis of PAD are scarce. Further research into these areas is required to allow the development of evidence-based nutritional guidelines for the prevention and treatment of the disease.

Key Points

  • Folate and vitamin D deficiencies are associated with an increased risk of peripheral arterial disease (PAD) and increased walking impairment in patients with PAD

  • Diets that are rich in insoluble fiber, antioxidants, and polyunsaturated fats might protect against PAD; therefore, the existing nutritional recommendations for cardiovascular disease prevention could be applied to PAD

  • Further research into the effects of nutritional supplements on the incidence, symptoms, progression, and prognosis of PAD is required

  • Abdominal obesity is significantly associated with PAD

  • The high prevalence of PAD in African American populations might be attributable to high rates of vitamin D deficiency and high levels of novel risk factors such as lipoprotein(a)

  • Preliminary evidence suggests that nutritional interventions and weight loss might be useful components of PAD prevention or treatment strategies and could substantially reduce the burden of the disease

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Figure 1: Potential effects of vitamin B12 and folate deficiencies, and the Cys66Thr variant of the MTHFR gene on homocysteine regulation and PAD etiology.
Figure 2: Potential effects of vitamin D deficiency on the risk and progression of atherosclerosis and PAD.

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Authors and Affiliations

  1. Department of Food Science and Nutrition, University of Minnesota, 1334 Eckles Avenue, Saint Paul, 55108, MN, USA

    Diana P. Brostow & Mindy S. Kurzer

  2. Cardiology Division, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, 55455, MN, USA

    Alan T. Hirsch

  3. Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, 3901 Rainbow Boulevard, MS 1008, 4004 Robinson, Kansas City, 66160, KS, USA

    Tracie C. Collins

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  1. Diana P. Brostow
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  2. Alan T. Hirsch
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  4. Mindy S. Kurzer
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D. P. Brostow researched the data for the article, provided a substantial contribution to discussions of the content, and wrote the article. M. S. Kurzer made a substantial contribution to discussions of the content. All the authors reviewed and/or edited the manuscript before submission.

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Correspondence to Mindy S. Kurzer.

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Brostow, D., Hirsch, A., Collins, T. et al. The role of nutrition and body composition in peripheral arterial disease. Nat Rev Cardiol 9, 634–643 (2012). https://doi.org/10.1038/nrcardio.2012.117

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