Dietary nitrate supplementation for preventing and reducing the severity of winter infections, including COVID-19, in care homes (BEET-Winter): a randomised placebo-controlled feasibility trial

for BEET-Winter Investigators; Philip M Bath; Cameron J C Skinner; Charlotte S Bath; Lisa J Woodhouse; Anastasia Areti Kyriazopoulou Korovesi; Hongjiang Long; Diane Havard; Christopher M Coleman; Timothy J England; Valerie Leyland; Wei Shen Lim; Alan A Montgomery; Simon Royal; Amanda Avery; Andrew J Webb; Adam L Gordon

doi:10.1007/s41999-022-00714-5

Dietary nitrate supplementation for preventing and reducing the severity of winter infections, including COVID-19, in care homes (BEET-Winter): a randomised placebo-controlled feasibility trial

for BEET-Winter Investigators, Philip M Bath, Cameron J C Skinner, Charlotte S Bath, Lisa J Woodhouse, Anastasia Areti Kyriazopoulou Korovesi, Hongjiang Long, Diane Havard, Christopher M Coleman, Timothy J England, Valerie Leyland, Wei Shen Lim, Alan A Montgomery, Simon Royal, Amanda Avery, Andrew J Webb, Adam L Gordon

SCMMS Southbank

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

PURPOSE: Infections cause considerable care home morbidity and mortality. Nitric oxide (NO) has broad-spectrum anti-viral, bacterial and yeast activity in vitro. We assessed the feasibility of supplementing dietary nitrate (NO substrate) intake in care home residents.

METHODS: We performed a cluster-randomised placebo-controlled trial in UK residential and nursing care home residents and compared nitrate containing (400 mg) versus free (0 mg daily) beetroot juice given for 60 days. Outcomes comprised feasibility of recruitment, adherence, salivary and urinary nitrate, and ordinal infection/clinical events.

RESULTS: Of 30 targeted care homes in late 2020, 16 expressed interest and only 6 participated. 49 residents were recruited (median 8 [interquartile range 7-12] per home), mean (standard deviation) age 82 (8) years, with proxy consent 41 (84%), advance directive for hospital non-admission 8 (16%) and ≥ 1 doses of COVID-19 vaccine 37 (82%). Background dietary nitrate was < 30% of acceptable daily intake. 34 (76%) residents received > 50% of juice. Residents randomised to nitrate vs placebo had higher urinary nitrate levels, median 50 [18-175] v 18 [10-50] mg/L, difference 25 [0-90]. Data paucity precluded clinical between-group comparisons; the outcome distribution was as follows: no infection 32 (67%), uncomplicated infection 0, infection requiring healthcare support 11 (23%), all-cause hospitalisation 5 (10%), all-cause mortality 0. Urinary tract infections were most common.

CONCLUSIONS: Recruiting UK care homes during the COVID-19 pandemic was partially successful. Supplemented dietary nitrate was tolerated and elevated urinary nitrate. Together, infections, hospitalisations and deaths occurred in 33% of residents over 60 days. A larger trial is now required.

TRIAL REGISTRATION: ISRCTN51124684. Application date 7/12/2020; assignment date 13/1/2021.

Original language	English
Pages (from-to)	1343-1355
Number of pages	13
Journal	European Geriatric Medicine
Volume	13
Issue number	6
Early online date	16 Nov 2022
DOIs	https://doi.org/10.1007/s41999-022-00714-5
Publication status	Published - Dec 2022

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for BEET-Winter Investigators, Bath, P. M., Skinner, C. J. C., Bath, C. S., Woodhouse, L. J., Korovesi, A. A. K., Long, H., Havard, D., Coleman, C. M., England, T. J., Leyland, V., Lim, W. S., Montgomery, A. A., Royal, S., Avery, A., Webb, A. J., & Gordon, A. L. (2022). Dietary nitrate supplementation for preventing and reducing the severity of winter infections, including COVID-19, in care homes (BEET-Winter): a randomised placebo-controlled feasibility trial. European Geriatric Medicine, 13(6), 1343-1355. https://doi.org/10.1007/s41999-022-00714-5

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title = "Dietary nitrate supplementation for preventing and reducing the severity of winter infections, including COVID-19, in care homes (BEET-Winter): a randomised placebo-controlled feasibility trial",

abstract = "PURPOSE: Infections cause considerable care home morbidity and mortality. Nitric oxide (NO) has broad-spectrum anti-viral, bacterial and yeast activity in vitro. We assessed the feasibility of supplementing dietary nitrate (NO substrate) intake in care home residents.METHODS: We performed a cluster-randomised placebo-controlled trial in UK residential and nursing care home residents and compared nitrate containing (400 mg) versus free (0 mg daily) beetroot juice given for 60 days. Outcomes comprised feasibility of recruitment, adherence, salivary and urinary nitrate, and ordinal infection/clinical events.RESULTS: Of 30 targeted care homes in late 2020, 16 expressed interest and only 6 participated. 49 residents were recruited (median 8 [interquartile range 7-12] per home), mean (standard deviation) age 82 (8) years, with proxy consent 41 (84%), advance directive for hospital non-admission 8 (16%) and ≥ 1 doses of COVID-19 vaccine 37 (82%). Background dietary nitrate was < 30% of acceptable daily intake. 34 (76%) residents received > 50% of juice. Residents randomised to nitrate vs placebo had higher urinary nitrate levels, median 50 [18-175] v 18 [10-50] mg/L, difference 25 [0-90]. Data paucity precluded clinical between-group comparisons; the outcome distribution was as follows: no infection 32 (67%), uncomplicated infection 0, infection requiring healthcare support 11 (23%), all-cause hospitalisation 5 (10%), all-cause mortality 0. Urinary tract infections were most common.CONCLUSIONS: Recruiting UK care homes during the COVID-19 pandemic was partially successful. Supplemented dietary nitrate was tolerated and elevated urinary nitrate. Together, infections, hospitalisations and deaths occurred in 33% of residents over 60 days. A larger trial is now required.TRIAL REGISTRATION: ISRCTN51124684. Application date 7/12/2020; assignment date 13/1/2021.",

author = "{for BEET-Winter Investigators} and Bath, {Philip M} and Skinner, {Cameron J C} and Bath, {Charlotte S} and Woodhouse, {Lisa J} and Korovesi, {Anastasia Areti Kyriazopoulou} and Hongjiang Long and Diane Havard and Coleman, {Christopher M} and England, {Timothy J} and Valerie Leyland and Lim, {Wei Shen} and Montgomery, {Alan A} and Simon Royal and Amanda Avery and Webb, {Andrew J} and Gordon, {Adam L}",

note = "{\textcopyright} 2022. The Author(s). Funding Information: We thank the participating care homes, residents and their families who participated in and supported this trial. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = dec,

doi = "10.1007/s41999-022-00714-5",

language = "English",

volume = "13",

pages = "1343--1355",

journal = "European Geriatric Medicine",

issn = "1878-7649",

publisher = "Elsevier Masson",

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for BEET-Winter Investigators, Bath, PM, Skinner, CJC, Bath, CS, Woodhouse, LJ, Korovesi, AAK, Long, H, Havard, D, Coleman, CM, England, TJ, Leyland, V, Lim, WS, Montgomery, AA, Royal, S, Avery, A, Webb, AJ & Gordon, AL 2022, 'Dietary nitrate supplementation for preventing and reducing the severity of winter infections, including COVID-19, in care homes (BEET-Winter): a randomised placebo-controlled feasibility trial', European Geriatric Medicine, vol. 13, no. 6, pp. 1343-1355. https://doi.org/10.1007/s41999-022-00714-5

Dietary nitrate supplementation for preventing and reducing the severity of winter infections, including COVID-19, in care homes (BEET-Winter): a randomised placebo-controlled feasibility trial. / for BEET-Winter Investigators; Bath, Philip M; Skinner, Cameron J C et al.
In: European Geriatric Medicine, Vol. 13, No. 6, 12.2022, p. 1343-1355.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Dietary nitrate supplementation for preventing and reducing the severity of winter infections, including COVID-19, in care homes (BEET-Winter)

T2 - a randomised placebo-controlled feasibility trial

AU - for BEET-Winter Investigators

AU - Bath, Philip M

AU - Skinner, Cameron J C

AU - Bath, Charlotte S

AU - Woodhouse, Lisa J

AU - Korovesi, Anastasia Areti Kyriazopoulou

AU - Long, Hongjiang

AU - Havard, Diane

AU - Coleman, Christopher M

AU - England, Timothy J

AU - Leyland, Valerie

AU - Lim, Wei Shen

AU - Montgomery, Alan A

AU - Royal, Simon

AU - Avery, Amanda

AU - Webb, Andrew J

AU - Gordon, Adam L

N1 - © 2022. The Author(s). Funding Information: We thank the participating care homes, residents and their families who participated in and supported this trial. Publisher Copyright: © 2022, The Author(s).

PY - 2022/12

Y1 - 2022/12

N2 - PURPOSE: Infections cause considerable care home morbidity and mortality. Nitric oxide (NO) has broad-spectrum anti-viral, bacterial and yeast activity in vitro. We assessed the feasibility of supplementing dietary nitrate (NO substrate) intake in care home residents.METHODS: We performed a cluster-randomised placebo-controlled trial in UK residential and nursing care home residents and compared nitrate containing (400 mg) versus free (0 mg daily) beetroot juice given for 60 days. Outcomes comprised feasibility of recruitment, adherence, salivary and urinary nitrate, and ordinal infection/clinical events.RESULTS: Of 30 targeted care homes in late 2020, 16 expressed interest and only 6 participated. 49 residents were recruited (median 8 [interquartile range 7-12] per home), mean (standard deviation) age 82 (8) years, with proxy consent 41 (84%), advance directive for hospital non-admission 8 (16%) and ≥ 1 doses of COVID-19 vaccine 37 (82%). Background dietary nitrate was < 30% of acceptable daily intake. 34 (76%) residents received > 50% of juice. Residents randomised to nitrate vs placebo had higher urinary nitrate levels, median 50 [18-175] v 18 [10-50] mg/L, difference 25 [0-90]. Data paucity precluded clinical between-group comparisons; the outcome distribution was as follows: no infection 32 (67%), uncomplicated infection 0, infection requiring healthcare support 11 (23%), all-cause hospitalisation 5 (10%), all-cause mortality 0. Urinary tract infections were most common.CONCLUSIONS: Recruiting UK care homes during the COVID-19 pandemic was partially successful. Supplemented dietary nitrate was tolerated and elevated urinary nitrate. Together, infections, hospitalisations and deaths occurred in 33% of residents over 60 days. A larger trial is now required.TRIAL REGISTRATION: ISRCTN51124684. Application date 7/12/2020; assignment date 13/1/2021.

AB - PURPOSE: Infections cause considerable care home morbidity and mortality. Nitric oxide (NO) has broad-spectrum anti-viral, bacterial and yeast activity in vitro. We assessed the feasibility of supplementing dietary nitrate (NO substrate) intake in care home residents.METHODS: We performed a cluster-randomised placebo-controlled trial in UK residential and nursing care home residents and compared nitrate containing (400 mg) versus free (0 mg daily) beetroot juice given for 60 days. Outcomes comprised feasibility of recruitment, adherence, salivary and urinary nitrate, and ordinal infection/clinical events.RESULTS: Of 30 targeted care homes in late 2020, 16 expressed interest and only 6 participated. 49 residents were recruited (median 8 [interquartile range 7-12] per home), mean (standard deviation) age 82 (8) years, with proxy consent 41 (84%), advance directive for hospital non-admission 8 (16%) and ≥ 1 doses of COVID-19 vaccine 37 (82%). Background dietary nitrate was < 30% of acceptable daily intake. 34 (76%) residents received > 50% of juice. Residents randomised to nitrate vs placebo had higher urinary nitrate levels, median 50 [18-175] v 18 [10-50] mg/L, difference 25 [0-90]. Data paucity precluded clinical between-group comparisons; the outcome distribution was as follows: no infection 32 (67%), uncomplicated infection 0, infection requiring healthcare support 11 (23%), all-cause hospitalisation 5 (10%), all-cause mortality 0. Urinary tract infections were most common.CONCLUSIONS: Recruiting UK care homes during the COVID-19 pandemic was partially successful. Supplemented dietary nitrate was tolerated and elevated urinary nitrate. Together, infections, hospitalisations and deaths occurred in 33% of residents over 60 days. A larger trial is now required.TRIAL REGISTRATION: ISRCTN51124684. Application date 7/12/2020; assignment date 13/1/2021.

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U2 - 10.1007/s41999-022-00714-5

DO - 10.1007/s41999-022-00714-5

M3 - Article

C2 - 36385690

SN - 1878-7649

VL - 13

SP - 1343

EP - 1355

JO - European Geriatric Medicine

JF - European Geriatric Medicine

IS - 6

ER -

for BEET-Winter Investigators, Bath PM, Skinner CJC, Bath CS, Woodhouse LJ, Korovesi AAK et al. Dietary nitrate supplementation for preventing and reducing the severity of winter infections, including COVID-19, in care homes (BEET-Winter): a randomised placebo-controlled feasibility trial. European Geriatric Medicine. 2022 Dec;13(6):1343-1355. Epub 2022 Nov 16. doi: 10.1007/s41999-022-00714-5

Dietary nitrate supplementation for preventing and reducing the severity of winter infections, including COVID-19, in care homes (BEET-Winter): a randomised placebo-controlled feasibility trial

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