Evaluation of Knowledge and Awareness of Dietary Nitrate Among Clinical Dietitians in Jeddah, Saudi Arabia: A Cross-Sectional Study.

Background and objectives Dietary nitrate (NO) plays an important role in human physiological processes. In the past, inorganic NO was viewed negatively due to its link with carcinogenic effects, notably nitrosamine formation in the stomach; yet, current perspectives acknowledge NO as a potentially beneficial dietary element. Nutrition professionals (NPs) are crucial in promoting NO awareness in health and academic settings. The study aimed to evaluate the knowledge of NPs in Jeddah, Saudi Arabia, regarding the biological roles of dietary NO, taking into consideration their qualifications and years of experience. Methods A cross-sectional study was conducted among NPs who had graduated from clinical nutrition programs or were employed in clinical or academic settings. A validated 12-item online questionnaire was used to assess dietary NO knowledge across five areas: health effects, dietary sources, recommendations, biomarkers of intake, and metabolism. The nitrate knowledge index (NKI) score was used to evaluate responses. Results Eighty-nine female NPs out of 144 completed the questionnaire. Most were ≤30 years old (75.4%) and had an undergraduate degree in clinical nutrition (70.8%), but 37 of them had ≤3 years of experience (62.7%). Overall, poor knowledge scores were observed among NPs, with a median (25 and 75 percentile) score of 10 (6, 13) out of 23. The majority (64%) perceived NO to be beneficial. However, most of the participants did not know its benefits in lowering blood pressure (BP) (68.5%) and were unsure about the effects of nitrate on cognitive function (60.7%) or kidney function (57.3%). Almost half of the NPs were unaware of NO sources and unsure about the mechanisms of the conversion of NO into nitrogen dioxide(NO) in the mouth (48.3%). Overall, knowledge of factors that affect NO content in food was good. No significant differences were observed in the median NKI scores among the participants based on their level of education or years of experience. Conclusion This study suggests NPs lack knowledge about dietary NO. To address this, educational programs should be developed and implemented in clinical and academic settings.