Relation of Change or Substitution of Low Calorie Sweetened Beverages with Cardiometabolic Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies
Bibliographic record
Abstract
Low calorie sweetened beverages (LCSBs) are associated with increased cardiometabolic diseases using prevalent exposure of LCSBs. Although this association is at high risk of reverse causality, it has led to concerns that LCSBs may not have the intended benefits, with recommendations to replace sugar-sweetened beverage (SSBs) with water and not LCSBs. To address this issue of reverse causality as part of the update of the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of prospective cohort studies of the relation of LCSBs with cardiometabolic outcomes using change and substitution analyses. MEDLINE, EMBASE, and the Cochrane Library were searched through June 2019. We included prospective cohort studies of ≥1 year assessing change in LCSBs or substitution of LCSBs for SSBs in relation to cardiometabolic outcomes. Independent reviewers extracted data and assessed risk of bias. Data were pooled using random effects models and expressed as mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CI). GRADE assessed the certainty of evidence. Nine studies (n = 218,880) inclusive of people at risk for or with diabetes were included. An Increase of 1 serving/day of LCSBs was associated with reduced body weight (MD, −0.07 kg [95% CI, −0.10 to −0.04]) and waist circumference (−1.35 cm [−2.60 to −0.05]) in change analyses. Substitution of LCSBs for SSBs was associated with a reduction in body weight (−0.47 kg [−0.55 to - 0.39]) and risk of diabetes (RR, 0.94 [0.90 to 0.98]), cardiovascular mortality (0.95 [0.90 to 0.99]) and total mortality (0.96 [0.94 to 0.98]), while substitution of LCSBs for water was not associated with any changes. The certainty of evidence was very low for all outcomes. Substitution of LCSBs for SSBs is associated with reductions in major cardiometabolic outcomes with similar benefits to water as a replacement strategy for SSBs. The certainty of the available evidence is very low with a high likelihood that more studies will alter our estimates in people at risk for or with diabetes.(ClinicalTrials.gov identifier, NCT04245826) Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes, Canadian Institutes of Health Research, Diabetes Canada.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.013 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".