Evidence mapPaperPMID 36385690Full record

Trial reportEuropean geriatric medicine2022

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.

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 and 7 more

Open access · hybridAbstract readRandomized Controlled Trial
In one paragraph

Trial report in European geriatric medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
0.9field-weighted citation impact, top 26% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 5 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Lessons from the PROTECT-CH COVID-19 platform trial in care homes.Health technology assessment (Winchester, England) · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 3 institutions in 1 country.

Philip M BathStroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, South Block D Floor, Nottingham, NG7 2UH, UK. Philip.bath@nottingham.ac.uk.ORCID http://orcid.org/0000-0003-2734-5132
Cameron J C SkinnerStroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, South Block D Floor, Nottingham, NG7 2UH, UK.
Charlotte S BathStroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, South Block D Floor, Nottingham, NG7 2UH, UK.
Lisa J WoodhouseStroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, South Block D Floor, Nottingham, NG7 2UH, UK.
Anastasia Areti Kyriazopoulou KorovesiSchool of Biosciences, University of Nottingham, Sutton Bonington, LE12 5RD, UK.
Hongjiang LongSchool of Biosciences, University of Nottingham, Sutton Bonington, LE12 5RD, UK.
Diane HavardStroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, South Block D Floor, Nottingham, NG7 2UH, UK.
Christopher M ColemanDivision of Infection, Immunity and Microbes, School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK.
Timothy J EnglandStroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, South Block D Floor, Nottingham, NG7 2UH, UK.
Valerie LeylandBramcote, Nottingham, NG9, UK.
Wei Shen LimRespiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
Alan A MontgomeryNottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK.
Simon RoyalUniversity of Nottingham Health Service, Cripps Health Centre, University Park, Nottingham, NG7 2QW, UK.
Amanda AverySchool of Biosciences, University of Nottingham, Sutton Bonington, LE12 5RD, UK.
Andrew J WebbClinical Pharmacology, School of Cardiovascular Medicine and Sciences, Kings College London and British Heart Foundation Centre of Research Excellence, St Thomas' Hospital, London, SE1 7EH, UK.
Adam L GordonInjury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Derby, DE22 3NE, Derbyshire, UK.
for BEET-Winter Investigators
University of Nottingham · GBNottingham University Hospitals NHS Trust · GBSt Thomas' Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeInfections 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 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.

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.

trial registrationISRCTN51124684. Application date 7/12/2020; assignment date 13/1/2021.

Indexed as

Beta vulgarisCOVID-19Aged, 80 and overCOVID-19 VaccinesDietary SupplementsFeasibility StudiesHumansNitratesNitrogen OxidesPandemicsCOVID-19 VaccinesNitratesNitrogen OxidesCare homeCOVID-19Dietary supplementationInfectionNitrateNitric oxide

Identifiers

PMID36385690
PMCPMC9668238
OpenAlexW4309347772

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.