Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Review › Forskning › peer review
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BACKGROUND Adverse associations of low- and no-calorie sweetened beverages (LNCSB) with cardiometabolic outcomes in observational studies may be explained by reverse causality and residual confounding. PURPOSE To address these limitations we used change analyses of repeated measures of intake and substitution analyses to synthesize the association of LNCSB with cardiometabolic outcomes. DATA SOURCES MEDLINE, Embase, and the Cochrane Library were searched up to 10 June 2021 for prospective cohort studies with ‡1 year of follow-up duration in adults. STUDY SELECTION Outcomes included changes in clinical measures of adiposity, risk of overweight/obesity, metabolic syndrome, type 2 diabetes (T2D), cardiovascular disease, and total mortality. DATA EXTRACTION Two independent reviewers extracted data, assessed study quality, and assessed certainty of evidence using GRADE. Data were pooled with a random-effects model and expressed as mean difference (MD) or risk ratio (RR) and 95% CI. DATA SYNTHESIS A total of 14 cohorts (416,830 participants) met the eligibility criteria. Increase in LNCSB intake was associated with lower weight (5 cohorts, 130,020 participants; MD 20.008 kg/year [95% CI 20.014, 20.002]). Substitution of LNCSB for sugarsweetened beverages (SSB) was associated with lower weight (three cohorts, 165,579 participants; MD, 20.12 [20.14, 20.10,] kg/y) and lower incidence of obesity (OB) (one cohort, 15,765 participants; RR 0.88 [95% CI 0.88, 0.89]), coronary heart disease (six cohorts, 233,676 participants; 0.89 [0.81, 0.98]), cardiovascular disease mortality (one cohort, 118,363 participants; 0.95 [0.90, 0.99]), and total mortality (one cohort, 118,363 participants; 0.96 [0.94, 0.98]) with no adverse associations across other outcomes. Substitution of water for SSB showed lower weight (three cohorts, 165,579 participants; MD 20.10 kg/year [20.13, 20.06]), lower waist circumference (one cohort, 173 participants; 22.71 cm/year [24.27, 21.15]) and percent body fat (one cohort, 173 participants; 21.51% per year [22.61, 20.42]), and lower incidence of OB (one cohort, 15,765 participants; RR 0.85 [0.75, 0.97]) and T2D (three cohorts, 281,855 participants; 0.96 [0.94, 0.98]). Substitution of LNCSB for water showed no adverse associations. LIMITATIONS The evidence was low to very low certainty owing to downgrades for imprecision, indirectness, and/or inconsistency. CONCLUSIONS LNCSB were not associated with cardiometabolic harm in analyses that model the exposure as change or substitutions. The available evidence provides some indication that LNCSB in their intended substitution for SSB may be associated with cardiometabolic benefit, comparable with the standard of care, water.
Originalsprog | Engelsk |
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Tidsskrift | Diabetes Care |
Vol/bind | 45 |
Nummer | 8 |
Sider (fra-til) | 1917-1930 |
Antal sider | 14 |
ISSN | 0149-5992 |
DOI | |
Status | Udgivet - aug. 2022 |
Funding Information:
Acknowledgments. The authors thank Ame- lie Keller, Jean-Phillippe Drouin-Chartier, and Dahlia Stern for data sharing and performing additional analysis. Funding. The Diabetes and Nutrition Study Group (DNSG) of the European Association of the Study of Diabetes (EASD) commissioned this systematic review and meta-analysis and provided the primary funding and logistical support for meetings as part of the development of the EASD Clinical Practice Guidelines for Nutrition Therapy. This work was also supported by the Canadian Institutes of Health Research (funding reference number, 129920) through the Canada-wide Human Nutrition Trialists’ Network (NTN). The Diet, Digestive tract, and Disease (3-D) Centre, funded through the Canada Foundation for Innovation (CFI) and the Ministry of Research and Innovation’s Ontario Research Fund (ORF), provided the infrastructure for the conduct of this project. J.J.L. was funded by a Canadian Institutes of Health Research (CIHR) Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Award and Banting and Best Diabetes Centre Novo Nordisk Studentship. T.A.K. was funded by a Toronto 3D Post-doctoral Fellowship Award. NM was funded by the CIHR Canada’s Graduate Scholarship - Master’s award. J.L.S. was funded by a PSI Graham Farquharson Knowledge Translation Fellowship, Diabetes Canada Clinician Scientist award, CIHR INMD/ CNS New Investigator Partnership Prize, and Banting and Best Diabetes Centre Sun Life Financial New Investigator Award. The Clinical Practice Guidelines Committee of the DNSG of the EASD had input on all aspects of the work. No other funders had a role in the design or conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, approval of the manuscript or decision to publish.
Funding Information:
Duality of Interest. T.A.K. has received research support from the National Honey Board. N.M. was a full-time employee with Loblaw Companies Limited from November 2011 to December 2017. V.S.M. reports personal fees from Kaplan Fox & Kilsheimer, LLP, outside the submitted work. V.S.M. has been on a pro bono retainer for expert support for the Center for Science in the Public Interest in litigation related to sugar-sweetened beverages and has served as a consultant for the City of San Francisco for a case related to health warning labels on soda. V.S.M. reports personal fees from city and county of San Francisco outside the submitted work. J.O.H. is a member of the Scientific Advisory Committee for General Mills, McCormick Science Institute, and Milk Producers Educational Program. He has equity in Gelesis and Shakabuku, LLC. J.O.H. receives research funding from National Institutes of Health and from the National Cattlemen’s Beef Association. P.B.J. is running a nonprofit public-funded research project entitled: Innosweet-integrated perception, psychology, and physiology for maintaining sweetness perception via sugar replacement and reduction for value added healthy beverage applications (6150-00037A). P.B.J. is an honorary member of European Stevia Association (EUSTAS) and was until 2018 a board member of the DNSG of the EASD. D.R. is the president of Croatian Society for Diabetes and Metabolic Disorders of Croatian Medical Association. He serves as an Executive Committee member of Croatian Endocrine Society, Croatian Society for Obesity, and Croatian Society for Endocrine Oncology. He was a board member and secretary of International Diabetes Federation (IDF) Europe and currently he is the chair of the IDF Young Leaders in Diabetes Programme. He has served as an Executive Committee member of Diabetes and Nutrition Study Group of EASD and currently, he serves as an Executive Committee member of Diabetes and Cardiovascular Disease Study Group of EASD. He has received travel support, speaker fees, and honoraria from advisory board engagements and/or consulting fees from International Sweeteners Association. D.R. is director of Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases at Merkur University Hospital, Zagreb, Croatia. He has served as principal investigator or co-investigator in clinical trials of AstraZeneca, Eli Lilly, Merck Sharp & Dohme (MSD), Novo Nordisk, Sanofi, Solvay, and Trophos. He has received travel support, speaker fees, and honoraria from advisory board engagements and/or consulting fees from Abbott, Amgen, AstraZe-neca, Bayer, Belupo, Boehringer Ingelheim, Eli Lilly, Lifescan/Johnson & Johnson, Krka, Med-tronic, Mediligo, Novartis, Novo Nordisk, MSD, Pfizer, Pliva, Roche, Salvus, Sandoz, Sanofi, and Takeda. H.K. is Director of Clinical Research at the Physicians Committee for Responsible Medicine, a nonprofit organization providing nutrition education and research, and a board member of the DNSG of the EASD. J.S.-S. reports serving on the board of and receiving grant support through his institution from Eroski Foundation. He has received research support from CIBER-obn, Instituto de Salud Carlos III, Ministerio de Educación y Ciencia, Departament de Salut Pública de la Generalitat de Catalunya, European Commission, Almond Board of California, Patri-monio Comunal Olivarero, La Morella Nuts, and Borges S.A. He reports receiving consulting fees or travel expenses from Danone, Eroski Foundation, Nuts for Life, Nestlé, Abbott Laboratories, and Aguas Font Vella y Lanjarón. J.S.-S. reports serving on the board of and receiving grant support through his institution from the International Nut and Dried Fruit Council. He reports serving on the Executive Committee of Instituto Danone (Spain). He has received research reports from the National Institutes of Health, California Walnut Commission and reports receiving consulting fees or travel expenses from Instituto Danone (Spain) and Australian Nut Industry Council. He is on the Clinical Practice Guidelines Expert Committee of the EASD and served in the Scientific Committee of the Spanish Agency for Food Safety and Nutrition and the Spanish Federation of the Scientific Societies of Food, Nutrition and Dietetics. He is a member of the International Carbohydrate Quality Consortium (ICQC) and Executive Board Member of the DNSG of the EASD. C.W.C.K. has received grants or research support from NIHR, International Nut and Dried Fruit Council, and International Tree Nut Council Research & Education Foundation. In addition, he has received in-kind research support, travel support, and/or honoraria from the California Walnut Commission, International Nut and Dried Fruit Council, International Pasta Organisation, and Oldways Preservation Trust. He has served on the scientific advisory board for the International Tree Nut Council, International Pasta Organisation, and Oldways Preservation Trust. He is a member of the ICQC, Executive Board member of the DNSG of the EASD, is on the Clinical Practice Guidelines Expert Committee for Nutrition Therapy of the EASD, and is a director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. C.W.C.K. has received grants or research support from the Advanced Foods and Materials Network, Agriculture and Agri-Food Canada, Almond Board of California, Peanut Institute, Barilla, Canola Council of Canada, Loblaw Companies Limited, Pulse Canada, and Unilever. He has received in-kind research support from the Almond Board of California, American Peanut Council, Barilla, Kellogg Canada, Loblaw Companies Limited, Quaker (PepsiCo), Primo, Unico, Unilever, and WhiteWave Foods/Danone. He has received travel support and/or honoraria from the American Peanut Council, Barilla, Canola Council of Canada, General Mills, Loblaw Companies Limited, Nutrition Foundation of Italy, Paramount Farms, Peanut Institute, Pulse Canada, Sun-Maid, Tate & Lyle, Unilever, and WhiteWave Foods/Da-none. He has served on the scientific advisory board for McCormick Science Institute. J.L.S. has received research support from the Canadian Foundation for Innovation, Ontario Research Fund, Province of Ontario Ministry of Research and Innovation and Science, CIHR, Diabetes Canada, American Society for Nutrition (A.S.N.), I.N.C. International Nut and Dried Fruit Council Foundation, National Honey Board (the U.S. Department of Agriculture [USDA] honey “Checkoff” program), Institute for the Advancement of Food and Nutrition Sciences (IAFNS), Pulse Canada, Quaker Oats Center of Excellence, The United Soybean Board (the USDA soy “Checkoff”
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© 2022 by the American Diabetes Association.
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