Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Food Costs of Children and Adolescents Consuming Vegetarian, Vegan or Omnivore Diets: Results of the Cross-Sectional VeChi Youth Study

The aim was to analyse the total food costs and the impact of food groups on total food costs among vegetarian, vegan and omnivore children and adolescents in Germany. Based on three-day weighed dietary records of 6–18-year-old children and adolescents of the VeChi Youth Study, the total daily food costs and food group costs (both EUR/day, EUR/1000 kcal) of a vegetarian (n = 145 records), vegan (n = 110) and omnivore (n = 135) diet were calculated. Minimum retail prices of 1000 empirically selected foods reported in the dietary records were linked to individual food intakes. The group differences were analysed using ANCOVA or Kruskal-Wallis tests. Vegans had the highest energy adjusted total food costs at 2.98 EUR/1000 kcal, vegetarians the lowest at 2.52 EUR/1000 kcal. Omnivores also had significantly higher costs than vegetarians with 2.83 EUR/1000 kcal/1000 kcal (p = 0.01), but the total costs did not differ significantly between omnivores and vegans (EUR/d and EUR/1000 kcal). Compared to vegetarians, vegans had significantly higher expenditures (EUR/day) on fruit (p = 0.0003), vegetables (p = 0.006), dairy alternatives (p = 0.0003) and legumes/nuts/seeds (p = 0.0003). Expenditure on starchy foods was significantly higher in the vegetarian or vegan than in the omnivore diet (p = 0.0003). Omnivores spent a quarter of their total food costs on animal source foods (25%), which is equivalent to the sum of food costs for legumes/nuts/seeds, dairy alternatives and meat alternatives in vegans and additionally dairy in vegetarians. The VeChi Youth Study indicated that financial constraints are not necessarily a barrier to switching to a more plant-based diet

How Does Selenium Intake Differ among Children (1–3 Years) on Vegetarian, Vegan, and Omnivorous Diets? Results of the VeChi Diet Study

In regions with low selenium soil concentrations, selenium can be considered a critical nutrient for vegetarians and vegans. While the number of vegetarians and vegans is increasing in many countries, a large research gap remains in this field. For example, to date, no study seems to have assessed selenium intake in vegetarian and vegan children. Therefore, the selenium intake of 1- to 3-year-old vegetarian, vegan, and omnivorous children who participated in the cross-sectional VeChi Diet study was determined. Selenium intake was assessed based on 3-day food diaries (not including supplements) and food selenium concentrations provided by the European Food Safety Authority (EFSA). Between-group differences were assessed with analysis of covariance (ANCOVA). The median daily selenium intake was 17 µg, 19 µg, and 22 µg in vegetarian, vegan, and omnivorous children, respectively. However, only the difference between the vegan and omnivorous children was statistically significant. On average, all three groups met the harmonized average requirement (H-AR) for selenium of 17 µg/day. Nevertheless, the hypothesis that vegetarian and vegan children generally consume less selenium than omnivorous children could be confirmed, and 39% of vegetarians, 36% of vegans, and 16% of omnivores fell below the adequate intake for selenium (provided by EFSA) of 15 µg/day