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      Sugar-sweetened beverage consumption and obesity in children's meta-analyses: wrong answers to right questions Translated title: Consumo de bebidas azucaradas y obesidad en metaanálisis de estudios realizados en niños: respuestas equivocadas para preguntas correctas

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          Abstract

          Abstract Background: recent studies assert that sugar-containing drinks may play a key role in the etiology of obesity. However, scientific reviews show contradictory results. Whether there is just association or clear causation still is a matter of debate. It is also subject to discussion whether the quality/adequacy of the different studies may influence their outcome. Objective: the aim of this study is to explore the most recent scientific evidence focused on sugar-sweetened beverages (SSB) and child obesity and to further analyze the adequacy of the meta-analyses in terms of their results, with special emphasis in the methodology, clarity and transparence of their procedures. Methods: only meta-analyses of randomized control trial studies were selected. The search was performed on PubMed and Cochrane Website until January, 2016. Adherence to PRISMA statement was assessed. Results: six meta-analyses were included. All of them showed some degree of evidence of heterogeneity in their pool estimates. Two of them showed a positive association between SSB and obesity but the other four found no association. The adherence to the PRISMA criteria was higher in two of the meta-analyses that showed opposite conclusions regarding the association or non-association of SSB and obesity in children. Thus, there is no relation between the adequacy of the meta-analyses to the PRISMA criteria and the results obtained. Conclusion: the use of meta-analysis as a scientific tool still demands more polishing, agreement and spread out use by researchers. SSB are being accused of being the main cause of the existing obesity, and obviously they are part of the problem, but this subject requires a broader approach that includes a thorough analysis of diet and lifestyle and a stronger body of scientific evidence based on data from epidemiological studies conducted in different populations.

          Translated abstract

          Resumen Antecedentes: estudios recientes afirman que las bebidas azucaradas desempeñan un papel clave en la etiología de la obesidad. Sin embargo, las revisiones científicas muestran resultados contradictorios. Si es solo una asociación o es claramente una causa continúa siendo un tema de debate. También se discute si la calidad/adecuación de los diferentes estudios puede influir en sus resultados. Objetivo: el objetivo de este estudio fue explorar la evidencia científica más reciente enfocada a las bebidas azucaradas y a la obesidad infantil y analizar la adecuación de los metaanálisis en términos de sus resultados, con especial énfasis en la metodología, claridad y transparencia de sus procedimientos. Método: se seleccionaron metaanálisis realizados con estudios de ensayos aleatorios controlados. La búsqueda se realizó en PubMed y en Cochrane hasta enero de 2016. Se evaluó la adherencia a los criterios PRISMA. Resultados: se incluyeron seis metaanálisis. Todos ellos mostraron cierto grado de heterogeneidad en sus estimaciones ponderadas. Dos de ellos mostraron asociación positiva entre bebidas azucaradas y obesidad, pero los otros cuatro no encontraron asociación. La adhesión a los criterios PRISMA fue mayor en dos metaanálisis que mostraron conclusiones opuestas sobre la asociación o no asociación de las bebidas azucaradas y la obesidad en niños. Por lo tanto, no existe relación entre la adecuación de los metaanálisis a los criterios PRISMA y los resultados obtenidos. Conclusión: el uso del metaanálisis como herramienta científica todavía requiere un mayor refinamiento, consenso y difusión por parte de los investigadores. Las bebidas azucaradas están siendo acusadas de ser la causa principal de la obesidad existente, y es obvio que son parte del problema, pero este tema requiere un enfoque más amplio que incluya un análisis exhaustivo de la dieta y del estilo de vida y una evidencia científica más sólida fundamentada en datos de estudios epidemiológicos realizados en diferentes poblaciones.

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          Most cited references28

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          Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies.

          To summarise evidence on the association between intake of dietary sugars and body weight in adults and children. Systematic review and meta-analysis of randomised controlled trials and prospective cohort studies. OVID Medline, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Web of Science (up to December 2011). Eligible studies reported the intake of total sugars, intake of a component of total sugars, or intake of sugar containing foods or beverages; and at least one measure of body fatness. Minimum duration was two weeks for trials and one year for cohort studies. Trials of weight loss or confounded by additional medical or lifestyle interventions were excluded. Study selection, assessment, validity, data extraction, and analysis were undertaken as specified by the Cochrane Collaboration and the GRADE working group. For trials, we pooled data for weight change using inverse variance models with random effects. We pooled cohort study data where possible to estimate effect sizes, expressed as odds ratios for risk of obesity or β coefficients for change in adiposity per unit of intake. 30 of 7895 trials and 38 of 9445 cohort studies were eligible. In trials of adults with ad libitum diets (that is, with no strict control of food intake), reduced intake of dietary sugars was associated with a decrease in body weight (0.80 kg, 95% confidence interval 0.39 to 1.21; P<0.001); increased sugars intake was associated with a comparable weight increase (0.75 kg, 0.30 to 1.19; P=0.001). Isoenergetic exchange of dietary sugars with other carbohydrates showed no change in body weight (0.04 kg, -0.04 to 0.13). Trials in children, which involved recommendations to reduce intake of sugar sweetened foods and beverages, had low participant compliance to dietary advice; these trials showed no overall change in body weight. However, in relation to intakes of sugar sweetened beverages after one year follow-up in prospective studies, the odds ratio for being overweight or obese increased was 1.55 (1.32 to 1.82) among groups with the highest intake compared with those with the lowest intake. Despite significant heterogeneity in one meta-analysis and potential bias in some trials, sensitivity analyses showed that the trends were consistent and associations remained after these studies were excluded. Among free living people involving ad libitum diets, intake of free sugars or sugar sweetened beverages is a determinant of body weight. The change in body fatness that occurs with modifying intakes seems to be mediated via changes in energy intakes, since isoenergetic exchange of sugars with other carbohydrates was not associated with weight change.
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            Evaluation of old and new tests of heterogeneity in epidemiologic meta-analysis.

            The identification of heterogeneity in effects between studies is a key issue in meta-analyses of observational studies, since it is critical for determining whether it is appropriate to pool the individual results into one summary measure. The result of a hypothesis test is often used as the decision criterion. In this paper, the authors use a large simulation study patterned from the key features of five published epidemiologic meta-analyses to investigate the type I error and statistical power of five previously proposed asymptotic homogeneity tests, a parametric bootstrap version of each of the tests, and tau2-bootstrap, a test proposed by the authors. The results show that the asymptotic DerSimonian and Laird Q statistic and the bootstrap versions of the other tests give the correct type I error under the null hypothesis but that all of the tests considered have low statistical power, especially when the number of studies included in the meta-analysis is small (<20). From the point of view of validity, power, and computational ease, the Q statistic is clearly the best choice. The authors found that the performance of all of the tests considered did not depend appreciably upon the value of the pooled odds ratio, both for size and for power. Because tests for heterogeneity will often be underpowered, random effects models can be used routinely, and heterogeneity can be quantified by means of R(I), the proportion of the total variance of the pooled effect measure due to between-study variance, and CV(B), the between-study coefficient of variation.
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              Effect of drinking soda sweetened with aspartame or high-fructose corn syrup on food intake and body weight.

              To examine whether artificial sweeteners aid in the control of long-term food intake and body weight, we gave free-living, normal-weight subjects 1150 g soda sweetened with aspartame (APM) or high-fructose corn syrup (HFCS) per day. Relative to when no soda was given, drinking APM-sweetened soda for 3 wk significantly reduced calorie intake of both females (n = 9) and males (n = 21) and decreased the body weight of males but not of females. However, drinking HFCS-sweetened soda for 3 wk significantly increased the calorie intake and body weight of both sexes. Ingesting either type of soda reduced intake of sugar from the diet without affecting intake of other nutrients. Drinking large volumes of APM-sweetened soda, in contrast to drinking HFCS-sweetened soda, reduces sugar intake and thus may facilitate the control of calorie intake and body weight.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                nh
                Nutrición Hospitalaria
                Nutr. Hosp.
                Grupo Arán (Madrid, Madrid, Spain )
                0212-1611
                1699-5198
                April 2018
                : 35
                : 2
                : 474-488
                Affiliations
                [4] Ciudad del Carmen Campeche orgnameUniversidad Autónoma del Carmen orgdiv1Faculty of Health Sciences Mexico
                [1] Las Palmas orgnameUniversidad de Las Palmas de Gran Canaria orgdiv1International Chair for Advanced Studies on Hydration (CIEAH) Spain
                [2] Las Palmas orgnameUniversidad de Las Palmas de Gran Canaria orgdiv1Research Institute of Biomedical and Health Sciences Spain
                [3] Madrid orgnameCarlos III Health Institute orgdiv1CIBER OBN orgdiv2Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition Spain
                Article
                S0212-16112018000200474
                10.20960/nh.1492
                25504ede-3c8c-4539-a85e-fd1559f2339b

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 09 August 2017
                : 09 October 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 50, Pages: 15
                Product

                SciELO Spain


                Obesidad,Bebidas azucaradas,Niños,Metaanálisis,Sugar-sweetened beverage,Obesity,Children,Meta-analyses

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