Evaluating the Impact of the Revised Special Supplemental Nutrition Program for Women, Infants, and Children Fruit Juice Allotment on Fruit Intake, Dietary Quality, and Energy/Nutrient Intakes among Children 1-4 Years of Age

Objective: The goals of this study were to assess the impact of recent changes in the WIC allotment on fruit intake, dietary quality/adequacy, energy/nutrient intakes, and potential impact of the complete removal of 100% fruit juice (FJ) from the package.Methods: 24-hour recalls from children 1-4 years who were WIC participants or income-eligible nonparticipants in the NHANES 2007-2008 and 2011-2014 (before and after WIC package changes) were analyzed.Results: There were no differences in the Healthy Eating Index-2015 total score; subcomponent scores for “greens and beans” and for “fatty acid ratio” were higher in 2011-2014 than in 2007-2008 in children participating in WIC; scores for “sodium” were higher in 2011-2014 than in 2007-2008 in children not participating in WIC but income-eligible. In WIC participants mean intakes of riboflavin, vitamins B12 and C, and zinc were significantly (p<0.01) lower, and intake of vitamin E was significantly (p<0.01) higher in 2011-2014 compared to 2007-2008. One significant difference in nutrient adequacy in children was that of a lower (p<0.01) percentage of inadequacy for WIC participants for vitamin E and a higher (p<0.01) percentage of inadequacy for WIC participants for vitamin A in 2011-2014 as compared to those in 2007-2008. The elimination of FJ from the WIC food packages resulted in a 38-50% lower total fruit intake and a 4-5% reduction in total HEI-2015 score.Conclusion: Changes in the WIC program resulted in potential adverse effects on mean intakes of some nutrients but not on the nutrient adequacy or overall diet quality. Confirmatory studies are needed

Randomized Trial of Metformin, Ivermectin, and Fluvoxamine for Covid-19

BACKGROUND Early treatment to prevent severe coronavirus disease 2019 (Covid-19) is an important component of the comprehensive response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHODS In this phase 3, double-blind, randomized, placebo-controlled trial, we used a 2-by-3 factorial design to test the effectiveness of three repurposed drugs - metformin, ivermectin, and fluvoxamine - in preventing serious SARS-CoV-2 infection in nonhospitalized adults who had been enrolled within 3 days after a confirmed diagnosis of infection and less than 7 days after the onset of symptoms. The patients were between the ages of 30 and 85 years, and all had either overweight or obesity. The primary composite end point was hypoxemia (≤93% oxygen saturation on home oximetry), emergency department visit, hospitalization, or death. All analyses used controls who had undergone concurrent randomization and were adjusted for SARSCoV-2 vaccination and receipt of other trial medications. RESULTS A total of 1431 patients underwent randomization; of these patients, 1323 were included in the primary analysis. The median age of the patients was 46 years; 56% were female (6% of whom were pregnant), and 52% had been vaccinated. The adjusted odds ratio for a primary event was 0.84 (95% confidence interval [CI], 0.66 to 1.09; P=0.19) with metformin, 1.05 (95% CI, 0.76 to 1.45; P=0.78) with ivermectin, and 0.94 (95% CI, 0.66 to 1.36; P=0.75) with fluvoxamine. In prespecified secondary analyses, the adjusted odds ratio for emergency department visit, hospitalization, or death was 0.58 (95% CI, 0.35 to 0.94) with metformin, 1.39 (95% CI, 0.72 to 2.69) with ivermectin, and 1.17 (95% CI, 0.57 to 2.40) with fluvoxamine. The adjusted odds ratio for hospitalization or death was 0.47 (95% CI, 0.20 to 1.11) with metformin, 0.73 (95% CI, 0.19 to 2.77) with ivermectin, and 1.11 (95% CI, 0.33 to 3.76) with fluvoxamine. CONCLUSIONS None of the three medications that were evaluated prevented the occurrence of hypoxemia, an emergency department visit, hospitalization, or death associated with Covid-19