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

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

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.

Citation

Bath, P. M., Skinner, C. J. C., Bath, C. S., Woodhouse, L. J., Areti, A., Korovesi, K., …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, 1343-1355. https://doi.org/10.1007/s41999-022-00714-5

• Journal Article Type: Article
• Acceptance Date: Oct 31, 2022
• Online Publication Date: Nov 16, 2022
• Publication Date: 2022-12
• Deposit Date: Oct 28, 2022
• Publicly Available Date: Nov 17, 2023
• Journal: European Geriatric Medicine
• Print ISSN: 1878-7649
• Electronic ISSN: 1878-7657
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Pages: 1343-1355
• DOI: https://doi.org/10.1007/s41999-022-00714-5
• Public URL: https://nottingham-repository.worktribe.com/output/12901003
• Publisher URL: https://link.springer.com/article/10.1007/s41999-022-00714-5