Diet and Nutrition in Peripheral Artery Disease: A Systematic Review

BACKGROUND: Patients with peripheral artery disease (PAD) suffer from high rates of morbidity and mortality. Dietary optimisation is recommended for patients with atherosclerotic vascular disease, but the relationship between dietary intake and PAD remains unclear. This review systematically collates the literature describing the relationship between dietary intake and nutritional status, and the presence and progression of PAD. METHODS: The MEDLINE, Embase, Emcare, and AMED databases were searched from inception to December 2020. Studies were included if they reported on the association between diet and PAD in the general population or on relationships between diet and vascular complications in individuals with established PAD. RESULTS: A total of 3536 unique articles were retrieved, and 40 were selected for inclusion. Most studies were observational. A subgroup analysis of the Prevención con Dieta Mediterránea (PREDIMED) study was the only randomised controlled trial assessing the role of diet and presence of PAD and suggested that the Mediterranean diet may be protective against the development of PAD. Nutritional risk scores, such as the Geriatric Nutritional Risk Index (GNRI), show promise in predicting major vascular complications in patients with established PAD. The GNRI and the Controlling Nutritional Status (CONUT) score are both predictors of postoperative vascular outcomes, including amputation-free survival and overall survival, in patients undergoing either open surgical or endovascular therapy. CONCLUSIONS: There is a paucity of high-quality data describing the relationship between dietary intake and PAD. The Mediterranean diet may have a role in preventing PAD, but this needs to be confirmed in larger dedicated studies.