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Cited by 500Blood Pressure and Hypertension StudiesNitric Oxide and Endothelin EffectsCardiovascular Health and Disease Prevention

Dietary Nitrate Provides Sustained Blood Pressure Lowering in Hypertensive Patients: A Randomized, Phase 2, Double-Blind, Placebo-Controlled Study

Open access
Kapil, Vikas, Khambata, Rayomand S., Robertson, Amy, Caulfield, Mark J., Ahluwalia, Amrita·2015·Hypertension
DOI 10.1161/hypertensionaha.114.04675PMC PMC4288952
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Abstract

Abstract—: Single dose administration of dietary inorganic nitrate acutely reduces blood pressure (BP) in normotensive healthy volunteers, via bioconversion to the vasodilator nitric oxide. We assessed whether dietary nitrate might provide sustained BP lowering in patients with hypertension. We randomly assigned 68 patients with hypertension in a double-blind, placebo-controlled clinical trial to receive daily dietary supplementation for 4 weeks with either dietary nitrate (250 mL daily, as beetroot juice) or a placebo (250 mL daily, as nitrate-free beetroot juice) after a 2-week run-in period and followed by a 2-week washout. We performed stratified randomization of drug-naive (n=34) and treated (n=34) patients with hypertension aged 18 to 85 years. The primary end point was change in clinic, ambulatory, and home BP compared with placebo. Daily supplementation with dietary nitrate was associated with reduction in BP measured by 3 different methods. Mean (95% confidence interval) reduction in clinic BP was 7.7/2.4 mm Hg (3.6–11.8/0.0–4.9, P <0.001 and P =0.050). Twenty-four-hour ambulatory BP was reduced by 7.7/5.2 mm Hg (4.1–11.2/2.7–7.7, P <0.001 for both). Home BP was reduced by 8.1/3.8 mm Hg (3.8–12.4/0.7–6.9, P <0.001 and P <0.01) with no evidence of tachyphylaxis over the 4-week intervention period. Endothelial function improved by ≈20% ( P <0.001), and arterial stiffness was reduced by 0.59 m/s (0.24–0.93; P <0.01) after dietary nitrate consumption with no change after placebo. The intervention was well tolerated. This is the first evidence of durable BP reduction with dietary nitrate supplementation in a relevant patient group. These findings suggest a role for dietary nitrate as an affordable, readily-available, adjunctive treatment in the management of patients with hypertension (funded by The British Heart Foundation). Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01405898.

Integrity signals

Registry

Crossref · 10.1161/hypertensionaha.114.04675

Cites

44 of 44 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 7 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Dietary nitrate reduced pulse wave velocity by 0.58 m/s (95% CI 0.05-1.10, p<0.05) compared with placebo.

    “and 0.58m/s (95% CI 0.05-1.10,p<0.05) compared to placebo”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.
    • Rests on an assumption: The nitrate-depleted beetroot juice placebo did not differ from active juice in any other component that could affect blood pressure.
  • Findingown data

    Daily dietary nitrate lowered home systolic blood pressure compared with placebo by 8.1 mmHg (95% CI 3.8-12.4, p<0.001) at week 6.

    “Peak decreases in BP occurred at week 6 (i.e. last week of dietary nitrate intervention), with decreases in SBP compared to placebo of 8.1 mmHg (95%CI 3.8-12.4,p<0.001) and in DBP of 3.8mmHg (95%CI 0.7-6.8,p<0.01)”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.
    • Rests on an assumption: The nitrate-depleted beetroot juice placebo did not differ from active juice in any other component that could affect blood pressure.
  • Findingown data

    Daily dietary nitrate lowered clinic diastolic blood pressure by 2.4 mmHg (95% CI 0.0-4.9, p=0.050) relative to baseline.

    “Clinic SBP and DBP decreased compared to baseline by 7.7mmHg (95%CI 3.5-11.8,p<0.001) and 2.4 mmHg (95%CI 0.0-4.9,p=0.050) respectively”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.
  • Findingown data

    Dietary nitrate reduced augmentation index by 5.2% (95% CI 2.9-7.5, p<0.001) compared with baseline.

    “AIx was also reduced after dietary nitrate consumption by 5.2% (95%CI 2.9-7.5;p<0.001) compared to baseline”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.
  • Findingown data

    Transcutaneous arterial methaemoglobin concentrations did not change after either intervention.

    “There were no changes in transcutaneous arterial methaemoglobin concentrations after either intervention”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.
  • May combine two claims. 16
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 9

  • May combine two claims.

    Findingown data

    Dietary nitrate produced similar increases in plasma, urine, and saliva nitrite and nitrate, and in plasma cGMP, in both drug-naïve and treated subgroups.

    “Dietary nitrate consumption produced similar rises in plasma, urine, saliva nitrite and nitrate, and plasma cGMP in both stratified limbs”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Home blood pressure fell within 1 week of starting dietary nitrate and continued to decrease over the 4-week intervention, with no evidence of tachyphylaxis.

    “Home BP was reduced within 1 week of consumption of dietary nitrate, but not placebo, for both SBP and DBP and reduced over the entire 4-week intervention period”
    • Also stated in: § Abstract · plain
      “with no evidence of tachyphylaxis over the 4-week intervention period”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.

  • The quote only partly states this claim.

    Findingown data

    In hypertensive patients, daily dietary nitrate (250 mL beetroot juice, about 6.4 mmol nitrate) for 4 weeks lowered clinic systolic blood pressure by 7.7 mmHg (95% CI 3.5-11.8, p<0.001) relative to baseline.

    “Clinic SBP and DBP decreased compared to baseline by 7.7mmHg (95%CI 3.5-11.8,p<0.001) and 2.4 mmHg (95%CI 0.0-4.9,p=0.050) respectively”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.

  • May combine two claims.

    Findingown data

    In drug-naïve hypertensive patients, dietary nitrate did not alter pulse wave velocity, and endothelial function showed a non-significant trend toward improvement (p=0.06).

    “PWV velocity was not altered in drug-naïve patients after dietary nitrate consumption although endothelial function trended to improvement (p=0.06) though this failed to reach conventional levels of statistical significance”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.

  • May combine two claims.

    Findingown data

    The intervention was well tolerated, with no serious adverse events; beeturia and faecal discolouration were common expected findings.

    “Both dietary nitrate and placebo interventions were well tolerated. No serious adverse events were reported. Common, expected findings were beeturia and faecal discolouration.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.

  • May combine two claims.

    Findingown data

    Dietary nitrate increased nitrate and nitrite levels in all biological compartments measured, and these levels returned to baseline after a 2-week washout.

    “Dietary nitrate ingestion was associated with elevations in both nitrate and nitrite concentrations in all biological compartments assessed. These levels returned to baseline following a two-week washout period”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.

  • May combine two claims.

    Findingown data

    Dietary nitrate raised plasma cGMP by about 1.4-fold, while placebo produced no change (p<0.001).

    “The change in circulating NOx levels in the dietary nitrate limb was also associated with an ~1.4 fold increase in plasma cGMP concentrations with no change in the placebo limb (p<0.001,Figure 1D)”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.

  • May combine two claims.

    Findingown data

    Dietary nitrate increased peak flow-mediated dilatation by 1.0% (95% CI 0.3-1.5, p<0.001), an effect not seen with placebo.

    “dietary nitrate consumption was associated with an increase in peak FMD of 1.0% (95%CI 0.3-1.5;p<0.001) not evident in the placebo limb”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.
    • Rests on an assumption: The nitrate-depleted beetroot juice placebo did not differ from active juice in any other component that could affect blood pressure.

  • May combine two claims.

    Findingown data

    Blood pressure was reduced compared with placebo by all measurement methods in both drug-naïve and treated subgroups.

    “BP was reduced compared to placebo by all methods used in both sub-groups”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.
    • Rests on an assumption: The nitrate-depleted beetroot juice placebo did not differ from active juice in any other component that could affect blood pressure.

  • May combine two claims.

    Findingown data

    The change in plasma nitrite from baseline in the dietary nitrate arm correlated inversely with changes in clinic and home systolic blood pressure, but not with ambulatory blood pressure.

    “Change in plasma nitrite from baseline in the intervention arm correlated inversely with change in SBP measured in clinic and at home, but not with ABP”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.

  • May combine two claims.

    Findingown data

    Dietary nitrate raised plasma nitrite by about 2.7-fold (mean change 0.52 μmol/L, 95% CI 0.39-0.65), while placebo produced no change (p<0.001).

    “plasma nitrite concentrations were also elevated from baseline by ~2.7-fold with a mean Δ0.52 μmol/L (95%CI 0.39-0.65) after consumption of dietary nitrate with no change in the placebo limb (p<0.001,Figure 2A)”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The trial received ethics approval and was registered on clinicaltrials.gov with identifier NCT01405898.

    “Ethics approval was granted by the East London Research Ethics Committee and the trial registered on clinicaltrials.gov (unique identifier: NCT01405898).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Dietary nitrate provision to hypertensive patients produces robust blood pressure lowering dependent on nitrate-to-nitrite-to-NO conversion, with no suggestion of tachyphylaxis over 4 weeks.

    “Overall, our results presented in this study demonstrate that dietary nitrate provision to hypertensive patients provides robust BP lowering that is dependent on the conversion of nitrate to nitrite and thence NO, with no suggestion of tachyphylaxis over a 4-week period.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The nitrate-depleted beetroot juice placebo did not differ from active juice in any other component that could affect blood pressure.

  • Classified as probably not a substantial claim.

    Premisecitation

    Out-of-clinic blood pressure measurements (home and ambulatory) are more predictive of target organ damage and mortality than clinic measurements in population cohort studies.

    “Out-of-clinic BP measurements (i.e. home and ABP) are recognized to be more predictive of target organ damage and mortality in population cohort studies33, 34”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [33] Asayama K Thijs L Brguljan-Hitij J Risk stratification by self-measured home blood pressure across categories of conventional blood pressure: A participant-level meta-analysis PLoS Med 2014 11 e1001591 24465187 PMC3897370 source

      Not checked in the free run.

    • cites [34] Sega R Facchetti R Bombelli M Cesana G Corrao G Grassi G Mancia G Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: Follow-up results from the pressioni arteriose monitorate e loro associazioni (PAMELA) study Circulation 2005 111 1777 1783 15809377 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    There is batch-to-batch variation in the nitrate content of vegetables and their juices.

    “There is batch-to-batch variation in nitrate content of vegetables and their juices”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The study's time-frame is too short to support claims about long-term blood pressure control or to extrapolate to target organ damage reduction or cardiovascular events.

    “Although the time-frame of the study is too short to make any supported claims to long-term BP control or to be able to extrapolate with any confidence to target organ damage reduction or CVD events”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Home blood pressure was measured with a validated oscillometric device.

    “Patients recorded once-daily home BP (using a validated oscillometric BP device:705IT, Omron Corp., Tokyo, Japan)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Study design and conductnone given

    The study was adequately powered.

    “these appropriately powered data are the first to demonstrate robust, sustained BP-lowering with dietary nitrate in hypertensive patients that require BP control”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The study design was prospective, single-centre, double-blind, randomized, and placebo-controlled.

    “This study was a prospective single-centre, double-blind, randomized, placebo-controlled trial.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The two treatment groups were well matched for baseline blood pressure and heart rate.

    “The 2 treatment allocation groups were well matched for baseline (pre-intervention) BP and HR measured by the methods utilized in this study (Table S2).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Randomization was stratified by baseline hypertension treatment status, separating drug-naïve and treated patients.

    “We performed stratified randomization of drug-naïve (n=34) and treated (n=34) hypertensive patients aged 18-85 years.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premiseown data

    A 4 mmol dose of nitrate has been suggested as a threshold for blood pressure lowering in healthy volunteers.

    “Our previous studies have suggested that 4mmol is a threshold dose for BP lowering healthy volunteers”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    These findings suggest a role for dietary nitrate as an affordable, readily available adjunctive treatment in managing hypertensive patients.

    “These findings suggest a role for dietary nitrate as an affordable, readily-available, adjunctive treatment in the management of hypertensive patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The entero-salivary circulation is intact and functioning normally in hypertensive patients.

    “This is similar to the ratios identified in healthy volunteers following single dose nitrate supplementation28, 29 suggesting that the entero-salivary circulation is intact and functioning normally in hypertensive patients.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [28] Bahra M Kapil V Pearl V Ghosh S Ahluwalia A Inorganic nitrate ingestion improves vascular compliance but does not alter flow-mediated dilatation in healthy volunteers Nitric Oxide 2012 26 197 202 22285857 PMC3405527 source

      Not checked in the free run.

    • cites [29] Velmurugan S Kapil V Ghosh SM Davies S McKnight A Aboud Z Khambata RS Webb AJ Poole A Ahluwalia A Antiplatelet effects of dietary nitrate in healthy volunteers: Involvement of cGMP and influence of sex Free Rad Biol Med 2013 65 1521 1532 23806384 PMC3878381 source

      Not checked in the free run.

24 of 24

  • The paper relies on this without support.

    Patients complied with the instruction not to alter their usual diet or antihypertensive medications during the study.

    “Patients were asked not to alter their usual diet and to keep anti-hypertensive medication(s) constant (in treated hypertensive patients) over the course of the study.”

  • The paper relies on this without support.

    The nitrate-depleted beetroot juice placebo did not differ from active juice in any other component that could affect blood pressure.

    “It has been shown previously that there are no significant differences in major cationic components (i.e. sodium, potassium) of the active and placebo juices.25”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Antihypertensives and PDE inhibitors can increase NO-mediated vasodilation.

    “antihypertensives and phosphodiesterase (PDE) inhibitors, should be considered, as these can increase NO-mediated vasodilation [290].”

    From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [290]

    The Introduction describes nitric oxide as a vasodilator and discusses NO donors, while the Discussion attributes increased NO production and blood-pressure lowering to dietary nitrate. A search of our copy for phosphodiesterase inhibitors and antihypertensive drug effects found no passage saying that those drug classes increase NO-mediated vasodilation. Page numbers are unavailable in our copy. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

  • The absence of methaemoglobin with beetroot juice may relate to the use of KNO3 salt in cordial removing matrix effects of food products and increasing rates of uptake.

    “In contrast, studies exploiting beetroot juice, rich in nitrate, note no metHb (Kapil et al. 2015) and we postulate that this may relate to the use of KNO3 salt in cordial removing any potential matrix effects of food products and increasing rates of uptake.”

    From Oral nitrate and citrulline decrease blood pressure and increase vascular conductance in young adults: a potential therapy for heart failure (2016) · cites this paper as Kapil et al. 2015

  • Oral supplementation with either nitrite or nitrate increases circulating nitrite levels and prevents and reverses endothelial dysfunction in a dose-dependent manner in mice and in healthy, hypertensive, and obese individuals, or in those with hypercholesterolemia and peripheral arterial disease.

    “Oral supplementation with either nitrite or nitrate increases circulating nitrite levels and prevents and reverses endothelial dysfunction in a dose-dependent manner both in mice[68,69] and in healthy[70,71,97,111,112], hypertensive[113], and obese individuals[114], or in those with hypercholesterolemia[115] and peripheral arterial disease[116].”

    From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [113]

  • More recent evidence in both infants and adults suggests that exceptionally high concentrations of nitrite (well beyond the <75mg nitrite necessary to achieve blood pressure effects) would be necessary to pose a significant threat to safety.

    “although more recent evidence in both infants and adults suggests that exceptionally high concentrations of nitrite (and well beyond the <75mg nitrite necessary to achieve blood pressure effects) would be necessary to pose a significant threat to safety[25,51,72,113,155–158].”

    From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [113]

  • Daily dietary nitrate supplementation (250 mL beetroot juice daily) for four weeks reduces blood pressure and improves endothelial function and arterial stiffness in patients with hypertension.

    “They later presented the effects of dietary nitrate on hypertension, and showed the first evidence that daily dietary nitrate supplementation (250 mL of beetroot juice daily) for four weeks reduced the blood pressure, with improvements in the endothelial function and arterial stiffness in patients with hypertension [90].”

    From NO-Rich Diet for Lifestyle-Related Diseases (2015) · cites this paper as [90]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Home diastolic confidence interval has two upper bounds

    Minor

    For the 3.8 mmHg home diastolic blood-pressure reduction, the abstract reports an upper confidence bound of 6.9 mmHg, but the Results report 6.8 mmHg.

  • Clinic systolic confidence interval has two lower bounds

    Minor

    The abstract gives 3.6 mmHg as the lower bound for the clinic systolic blood-pressure reduction, while the Results give 3.5 mmHg for the same reduction.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. Geneva: WHO Press; 2009.
  2. European Food Standards Agency. Nitrate in vegetables: Scientific opinion of the panel on contaminants in the food chain. EFSA J. 2008;689:1–79.
  3. Food and Agriculture Organization of the United Nations, World Health Organization. Nitrate (and Potential Endogenous Formation Of N-Nitroso Compounds). Geneva: WHO Press; 2003.
  4. National Toxicology Program. NTP Technical Report on Toxicology and Carcinogenesis Studies of Sodium Nitrite in F344/N Rats and B6c3f1 Mice (Drinking Water Studies). Durham: National Institutes of Health; 2001.

Cited by

Sorted by citations

Authors
Kapil, V., Khambata, R. S., Robertson, A., Caulfield, M. J., & Ahluwalia, A.
Affiliations
Queen Mary University of London (GB)
Corresponding author
Ahluwalia, Amrita
ORCID
Venue
Hypertension
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2015-02
Volume
65
Issue
2
Pages
320-327
ISSN
  • 0194-911X (ISSN-L)
  • 1524-4563
DOI
10.1161/hypertensionaha.114.04675
PMC
PMC4288952
OpenAlex
W2122091522
Semantic Scholar
6a4ecccd6e8071f97d7cfb6c01d3183a54932a4b
Cited by
500
References
44
Citations by year
2026: 37 · 2025: 35 · 2024: 43 · 2023: 41 · 2022: 34 · 2021: 39 · 2020: 57 · 2019: 39 · 2018: 48 · 2017: 54 · 2016: 39 · 2015: 33
FWCI
28.86
Type
journal article
Language
en
Open access
Locations
  • Hypertension (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
Funders
  • National Institute for Health and Care Research (NF-SI-0512-10113, CL-2013-19-003)
  • British Heart Foundation (SP/08/006/25110, PG/10/28/28320)
  • Medical Research Council (MR/K006584/1)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords
dietary nitrate, beetroot juice, blood pressure reduction, nitric oxide, endothelial function, arterial stiffness, tachyphylaxis, dietary supplementation, ambulatory blood pressure, home blood pressure monitoring, tolerability, cost-effectiveness
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Beverages, Biotransformation, Blood Pressure, Combined Modality Therapy, Double-Blind Method, Female, Humans, Hypertension, Male, Phytotherapy, Middle Aged, Nitrates, Nitric Oxide, Nitrites, Plant Extracts, Prospective Studies, Vasodilation, Blood Pressure Monitoring, Ambulatory, Dietary Supplements, Beta vulgaris, Young Adult

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

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