Journal Article Review Ppublish
PubMed: 42828782 DOI: 10.1016/j.clnu.2026.106801
Lifestyle strategies and nutraceuticals in chronic venous disease: an evidence-weighted synthesis and clinical positioning.
Clin Nutr 66:106801
Authors: Federica Fogacci, Valentina Di Micoli, Ashot A Avagimyan, Naif S ALGhasab, Francesco Perone, Arrigo F G Cicero
Affiliations
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum-University of Bologna, Sant' Orsola-Malpighi Hospital, Bologna, 40138, Italy; Department of Medical Pharmacology, Medical Faculty, Ataturk University, Erzurum, 25240, Turkey; Italian Society of Nutraceuticals (SINut), Bologna, 40100, Italy.
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum-University of Bologna, Sant' Orsola-Malpighi Hospital, Bologna, 40138, Italy.
- Department of Internal Diseases Propedeutics, Yerevan State Medical University, Yerevan, 0025, Armenia.
- Department of Internal Medicine, Medical College, University of Ha'il, Ha'il, Saudi Arabia.
- Cardiac Rehabilitation Unit, Rehabilitation Clinic "Villa Delle Magnolie", Castel Morrone, Caserta, 81020, Italy.
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum-University of Bologna, Sant' Orsola-Malpighi Hospital, Bologna, 40138, Italy; Cardiovascular Medicine Unit, Heart, Chest and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, 40138, Italy.
Abstract
BACKGROUND AND AIMS
Chronic venous disease (CVD), including chronic venous insufficiency and venous leg ulcers (VLU), is common and substantially impairs quality of life. Compression is the cornerstone of conservative care, but lifestyle measures and selected nutraceuticals may provide additional benefit. This review aims to synthesize and clinically position evidence on adiposity, weight management, diet-related factors, and venoactive nutraceuticals across CVD phenotypes.
METHODS
Evidence from epidemiological studies, clinical cohorts, randomized trials, and meta-analyses was summarized using a pragmatic phenotype-aware framework distinguishing early symptomatic disease from advanced phenotypes with oedema, skin changes, or venous ulceration.
RESULTS
Excess adiposity shows a consistent, modifiable association with higher CVD prevalence, greater clinical severity, and poorer outcomes, supporting weight management as a foundational conservative strategy. Nutritional epidemiology provides mainly associative signals for dietary patterns and individual foods; these data best inform counselling within broader weight optimization and cardiometabolic risk reduction rather than disease-specific prescriptions. For symptomatic C0 to C4 disease, flavonoid-based venoactive nutraceuticals, particularly micronized purified flavonoid fraction (MPFF) and Vitis vinifera seed extract (VVSE), show the most consistent improvements in heaviness, pain, clinical severity scores, and quality of life. In advanced disease, adjunctive MPFF, Centella asiatica and omega-3 fatty acids may favorably influence VLU healing within compression-based protocols, although heterogeneity limits certainty.
CONCLUSIONS
A phenotype-stratified approach should prioritise weight control and compression as core interventions, with targeted nutraceuticals considered according to dominant clinical goals: symptom relief, quality of life, oedema control, or ulcer healing. Harmonized trials with clinically meaningful endpoints are needed.
MeSH
Quality Of Life, Life Style, Phenotype, Ulcer, Adiposity, Diet, Parenteral Nutrition, Flavonoids, Enteral Nutrition, Weight Control