Feeding vascular health: role of nutrition in peripheral artery disease prevention and management

Peripheral artery disease (PAD) is a prevalent and progressive atherosclerotic condition associated with high cardiovascular and limb-related morbidity and mortality. While pharmacological and revascularisation strategies form the cornerstone of PAD management, the role of nutrition is less clearly defined despite its well-established effects in coronary artery disease and cardiovascular prevention. In this narrative review, we explore the current evidence linking diet and nutrition to the prevention and management of PAD across its clinical spectrum, from asymptomatic disease to chronic limb-threatening ischaemia. We summarise findings on dietary patterns (e.g. Mediterranean diets), food groups, nutrients, fibre, and bioactives such as flavonoids. The available evidence supports that healthy dietary patterns may reduce PAD risk and improve outcomes, with effect sizes comparable to some pharmacological interventions. Most people with asymptomatic and symptomatic PAD do not adhere to healthy dietary patterns. Undernutrition as captured by indices such as the Geriatric Nutritional Risk Index is prevalent in advanced PAD and independently associated with complication and poor postoperative outcome. Despite this, most PAD patients do not receive dietary counselling, and few clinical studies have directly evaluated nutritional interventions in PAD populations. Given its low cost, safety, and potential for meaningful impact, dietary modification represents an underused but promising strategy in PAD prevention and treatment. Future research should prioritise PAD-specific dietary intervention trials and strategies for integrating nutrition into vascular care pathways.