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 (preprint)

BackgroundInfections 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.MethodsWe 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.ResultsOf 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: 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.ConclusionsRecruiting 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.RegistrationISRCTN51124684

Impact of COVID-19 on Health-Related Behaviours, Well-Being and Weight Management (preprint)

Background: Weight management is complex even in times of stability. Supporting individuals to develop strategies to maintain a healthier weight is beneficial. This paper reports data from an ongoing mixed-methods study describing the impact the COVID-19 lockdown situation had on people engaged in weight management. Information on health-related behaviours and well-being was captured from surveys completed by Slimming World (SW) members 0-4 weeks after joining providing pre-joining and baseline (T0&T1) data, and after 3 (T2) and 6 months (T3-during COVID-19). Representative samples from the general population, not attending a weight management service, completed the same questionnaires.Results: 1884 SW members completed the baseline survey and 222 completed all three surveys up to May 2020, achieving a weight loss of 7.7±7.5% during this time. SW members were able to maintain most of the positive health-related behaviour changes they had made since joining, including increased fruit and vegetable consumption (p<0.001), having fewer sugary drinks (P<0.001), cooking from scratch more (p<0.001) and increasing activity levels (p<0.001). During the COVID-19 situation members were still reporting improvements in all behaviours compared to before joining and had healthier scores than the general population on all but alcohol intake, although still within guidelines. Qualitative data indicated that the COVID-19 situation created various challenges to managing weight for both groups with fresh foods harder to access, comfort eating, drinking more alcohol, eating more sugary foods and snacking through boredom. However, some people also reported having more free time enabling better planning, more time to cook from scratch and increased physical activity.Conclusions: The findings highlight the value of supporting individuals to develop sustainable behaviour changes and a level of resilience to draw upon and manage their weight even in challenging times.