Dietary sugar consumption and health: umbrella review

Huang, Yin; Chen, Zeyu; Chen, Bin; Li, Jinze; Yuan, Xiang; Li, Jin; Wang, Wen; Dai, Tingting; Chen, Hongying; Wang, Yan; Wang, Ruyi; Wang, Puze; Guo, Jing; Dong, Qiang; Liu, Chengfei; Wang, Qiang; Cao, Deliang; Liu, Liangren

doi:10.1136/bmj-2022-071609

Cited by 63 publications

(56 citation statements)

References 148 publications

(443 reference statements)

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“…We included the most recent and/or largest meta-analysis study when multiple pooled analyses were available for the same adverse health outcome. This is consistent with the methods used in previous umbrella reviews 242526. In cases in which the most recent meta-analysis study examined non-dose-response and dose-response exposure to ultra-processed foods, we included both meta-analysed effect estimates.…”

Section: Methodsmentioning

confidence: 78%

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Lane,

Gamage,

et al. 2024

BMJ

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ObjectiveTo evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes.DesignSystematic umbrella review of existing meta-analyses.Data sourcesMEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manual searches of reference lists from 2009 to June 2023.Eligibility criteria for selecting studiesSystematic reviews and meta-analyses of cohort, case-control, and/or cross sectional study designs. To evaluate the credibility of evidence, pre-specified evidence classification criteria were applied, graded as convincing (“class I”), highly suggestive (“class II”), suggestive (“class III”), weak (“class IV”), or no evidence (“class V”). The quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, categorised as “high,” “moderate,” “low,” or “very low” quality.ResultsThe search identified 45 unique pooled analyses, including 13 dose-response associations and 32 non-dose-response associations (n=9 888 373). Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes. Based on the pre-specified evidence classification criteria, convincing evidence (class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality (risk ratio 1.50, 95% confidence interval 1.37 to 1.63; GRADE=very low) and type 2 diabetes (dose-response risk ratio 1.12, 1.11 to 1.13; moderate), as well as higher risks of prevalent anxiety outcomes (odds ratio 1.48, 1.37 to 1.59; low) and combined common mental disorder outcomes (odds ratio 1.53, 1.43 to 1.63; low). Highly suggestive (class II) evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all cause mortality (risk ratio 1.21, 1.15 to 1.27; low), heart disease related mortality (hazard ratio 1.66, 1.51 to 1.84; low), type 2 diabetes (odds ratio 1.40, 1.23 to 1.59; very low), and depressive outcomes (hazard ratio 1.22, 1.16 to 1.28; low), together with higher risks of prevalent adverse sleep related outcomes (odds ratio 1.41, 1.24 to 1.61; low), wheezing (risk ratio 1.40, 1.27 to 1.55; low), and obesity (odds ratio 1.55, 1.36 to 1.77; low). Of the remaining 34 pooled analyses, 21 were graded as suggestive or weak strength (class III-IV) and 13 were graded as no evidence (class V). Overall, using the GRADE framework, 22 pooled analyses were rated as low quality, with 19 rated as very low quality and four rated as moderate quality.ConclusionsGreater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes. These findings provide a rationale to develop and evaluate the effectiveness of using population based and public health measures to target and reduce dietary exposure to ultra-processed foods for improved human health. They also inform and provide support for urgent mechanistic research.Systematic review registrationPROSPERO CRD42023412732.

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Section: Methodsmentioning

confidence: 78%

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Lane,

Gamage,

et al. 2024

BMJ

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“…Long-term consumption of added sugars is associated with weight gain and ectopic fat deposition. 41 Excess intake of dietary sucrose not only increases white adipose tissue mass but also induces metabolic and endocrine changes in adipocytes, leading to obesity, 42 an independent risk factor for various chronic diseases and mental disorders, including depression. 43 However, since artificial sweeteners are calorie-free, excessive dietary intake of sucralose might limit other food intake, thereby indirectly inducing weight loss.…”

Section: Discussionmentioning

confidence: 99%

Apple polyphenol extract ameliorates sugary-diet-induced depression-like behaviors in male C57BL/6 mice by inhibiting the inflammation of the gut–brain axis

Xie,

Wu,

Qian

et al. 2024

Food Funct.

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“…Then, we will grade the strength of evidence into five levels (convincing, highly suggestive, suggestive, weak, and non-significant evidence). [108][109][110] For the SRs without meta-analysis, we will evaluate the strength of evidence of positive or negative effects using the binomial test. This test (null hypothesis is equal to 0.5) will be applied to detect whether KT has a true effect.…”

Section: Evidence Mapping Of Findingsmentioning

confidence: 99%

Effectiveness and clinical relevance of kinesio taping in musculoskeletal disorders: A protocol for an overview of systematic reviews and evidence mapping

Mo,

Xu,

et al. 2024

Preprint

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IntroductionKinesio taping (KT) has been extensively applied in the management of musculoskeletal disorders. Although plentiful systematic reviews (SRs) have evaluated its efficacy, there are no convincing conclusions due to disperse and inconclusive results, and its clinical relevance remains unclear. Hence, there is a need to summarise all the SRs for the comprehensive and consistent evidence. This overview aims to appraise the overall effectiveness of KT in musculoskeletal disorders, and provide evidence maps to visualise the findings.Method and analysisElectronic databases (Cochrane Database of Systematic Reviews, MEDLINE, Embase, Epistemonikos, PEDro, Scopus, ISI Web of Science) and reference lists will be searched from inception to September 2024 for the SRs of randomised controlled trials (RCTs). The SRs involving comparisons of the effectiveness between single or adjunctive KT and other interventions for patients with musculoskeletal disorders will be included. The primary and additional outcome to be considered will be the core outcome set, and the patient-reported outcome measure and patient-important outcome, respectively. Two reviewers will independently screen and select studies, extract the data, and evaluate the reporting and methodological quality of eligible SRs as well as the risk of bias of included RCTs. For the SRs without meta-analysis, we will collate the number of RCTs that showed any differences in outcomes. For the SRs with meta-analysis, we will provide the original summary of evidence (e.g., pooled effects and heterogeneity) for outcomes with an evaluation of missing results and clinical relevance. The certainty of each outcome will be measured, and user-friendly maps of findings will be presented graphically.Ethics and disseminationFormal ethical approval for this study is not required, since the data will be only collected from published literature in public databases. The results will be disseminated in the peer-reviewed academic journal, and relevant datasets will be preserved in the online repository.PROSPERO registration numberCRD42024517528Strengths and limitations of this study●This study will be carried out and reported following the Cochrane Collaboration Handbook for Overviews of Reviews and the Preferred Reporting items for Overviews of Reviews statement.●This study will only include systematic reviews with and without meta-analysis of randomised controlled trials.●This study will evaluate the reporting and methodological quality of systematic reviews, examine the risk of bias and degree of overlap of randomised controlled trials, and manage discordant results by selecting the most representative research.●This study will perform the assessment of missing results and certainty for the evidence, interpret the clinical relevance between effects and outcomes, and provide evidence maps of comprehensive and systematic findings.●This study may not be up-to-date as newly published randomised controlled trials will not be included, and ultimate conclusions will probably be limited by clinical heterogeneity due to variations in dose or application method of kinesio taping.

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Dietary sugar consumption and health: umbrella review

Cited by 63 publications

References 148 publications

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Apple polyphenol extract ameliorates sugary-diet-induced depression-like behaviors in male C57BL/6 mice by inhibiting the inflammation of the gut–brain axis

Effectiveness and clinical relevance of kinesio taping in musculoskeletal disorders: A protocol for an overview of systematic reviews and evidence mapping

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