This article is a very interesting review about the role of nutrition in the prevention and management of peripheral arterial disease (PAD), a progressive atherosclerotic condition associated with high cardiovascular and limb-related morbidity and mortality. Although pharmacological and revascularization treatments are fundamental in the management of PAD, the impact of diet on this disease has been less studied, despite its relevance in the prevention of cardiovascular disease.

Evidence suggests that healthy dietary patterns, such as the Mediterranean diet, rich in fruits, vegetables, whole grains, plant-based proteins, unsaturated fats, and flavonoid-rich foods, are associated with a reduced risk of developing, progressing, and experiencing complications of PAD. Conversely, a poor-quality diet, with excessive consumption of refined carbohydrates and saturated fats and insufficient micronutrient intake, is common among patients with PAD and may contribute to worse outcomes.

With a marvelous graphical abstract, the review highlights that most patients with PAD do not follow healthy dietary patterns or receive nutritional counseling, representing a significant gap in the implementation of secondary prevention strategies. Furthermore, it notes that poor nutritional status, as measured by indices such as the Geriatric Nutritional Risk Index (GNRI), is a strong predictor of postoperative complications and long-term prognosis, especially in patients with critical limb ischemia

Although some studies have shown that targeted nutritional interventions can improve walking ability, inflammatory profiles, and cardiovascular outcomes in patients with PAD, more long-term randomized clinical trials are needed to establish causal relationships and develop evidence-based nutritional recommendations.
The document concludes that dietary modification represents a promising and underutilized strategy in the prevention and treatment of PAD, with cardiovascular benefits comparable to some pharmacological treatments. It recommends integrating nutritional assessment and dietary counseling into clinical guidelines and multidisciplinary care plans to improve outcomes in patients with PAD. In addition, areas for future research are identified, such as the impact of diet on cardiovascular risk factors, specific PAD outcomes, and the use of personalized approaches based on genetics and the microbiome.