{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T02:10:48Z","timestamp":1768529448011,"version":"3.49.0"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T00:00:00Z","timestamp":1668556800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T00:00:00Z","timestamp":1668556800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100020624","name":"NIHR Nottingham Biomedical Research Centre","doi-asserted-by":"publisher","award":["\/"],"award-info":[{"award-number":["\/"]}],"id":[{"id":"10.13039\/501100020624","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIHR Senior Investigator Award","award":["NF-SI-0515-10044"],"award-info":[{"award-number":["NF-SI-0515-10044"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Geriatr Med"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We performed a cluster-randomised placebo-controlled trial in UK residential and nursing care home residents and compared nitrate containing (400\u00a0mg) versus free (0\u00a0mg daily) beetroot juice given for 60\u00a0days. Outcomes comprised feasibility of recruitment, adherence, salivary and urinary nitrate, and ordinal infection\/clinical events.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 30 targeted care homes in late 2020, 16 expressed interest and only 6 participated. 49 residents were recruited (median 8 [interquartile range 7\u201312] per home), mean (standard deviation) age 82 (8) years, with proxy consent 41 (84%), advance directive for hospital non-admission 8 (16%) and\u2009\u2265\u20091 doses of COVID-19 vaccine 37 (82%). Background dietary nitrate was\u2009&lt;\u200930% of acceptable daily intake. 34 (76%) residents received\u2009&gt;\u200950% of juice. Residents randomised to nitrate vs placebo had higher urinary nitrate levels, median 50 [18\u2013175] v 18 [10\u201350] mg\/L, difference 25 [0\u201390]. 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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>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\u00a0days. A larger trial is now required.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial Registration<\/jats:title>\n                <jats:p>ISRCTN51124684. Application date 7\/12\/2020; assignment date 13\/1\/2021.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s41999-022-00714-5","type":"journal-article","created":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T17:05:09Z","timestamp":1668618309000},"page":"1343-1355","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"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"],"prefix":"10.1007","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2734-5132","authenticated-orcid":false,"given":"Philip M.","family":"Bath","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cameron J. 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The remaining authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All methods were carried out in accordance with relevant guidelines and regulations. Approvals were sought via the UK Integrated Research Application System (IRAS project 288542), and favourable opinions received from Research Ethics Committee (West Midlands: Coventry & Warwickshire Research Ethics Committee\u201420\/WM\/0278, 19\/11\/20) and Health Research Authority (25\/11\/20). Approval from the UK Medicines and Healthcare products Regulatory Agency was not sought since beetroot juice is a food.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed electronic consent (using the REDCap facility) was sought from residents if they had mental capacity to provide consent or from a family member consultee for residents who lacked capacity.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}