Grant: Knowledge Synthesis Grant

Relation of different food sources of sugars with incident cardiometabolic disease: A series of systematic reviews and meta-analyses to inform guidelines, public health policy, and future research design

<html> <body> <p> <strong>Background:</strong> Sugars have emerged as one of the most important public health targets. Attention has focused on the special role of fructose based on its unique biochemical, metabolic, and endocrine responses. These mechanisms, however, have failed to translate into clinically meaningful effects in calorie-matched comparisons with other sources of carbohydrate. Sugars-sweetened beverage (SSBs) appear to be the special case. Whereas large prospective cohort studies have shown a consistent relation of SSBs with incident obesity, diabetes, metabolic syndrome (MetS), hypertension, coronary heart disease (CHD) and stroke,^, associations have not been shown when modeling total sugars or other food sources of added/free sugars such as pure fruit juices, yogurt, or even sweets. In the absence of a clear signal for sugars alone, it is unclear whether the associations seen for SSBs hold for other important food sources of sugars. <strong>Need for a review:</strong> As dietary guidelines and public health policy have shifted toward food and dietary-pattern based recommendations, the lack of high quality syntheses and translation of the role of different food sources of sugars in cardiometabolic diseases represents an urgent call for stronger evidence to support guidelines development. <strong>Objectives:</strong> To build on our previous work, we will conduct a series of systematic reviews and meta-analyses to compare important food sources of added/free sugars (SSBs, pure fruit juice, yogurt, sweets, cereals, etc). in their relation with incident cardiometabolic diseases. <strong>Design:</strong> Our proposed series of systematic reviews and meta-analyses will follow the same successful protocol we used for our previous CIHR-funded knowledge synthesis of fructose and cardiometabolic risk (clinicaltrials.gov, NCT01363791). The knowledge syntheses will be conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). <strong>Data sources:</strong> MEDLINE, EMBASE, and The Cochrane library will be searched. <strong>Study selection:</strong> We will include cohorts assessing the relation of added/free sugars with incident type 2 diabetes, MetS, hypertension, CHD, or stroke. <strong>Data extraction:</strong> Two investigators will independently extract relevant data and assess risk of bias. <strong>Outcomes:</strong> We will assess 5 outcomes: type 2 diabetes, MetS, hypertension, CHD and stroke. <strong>Data synthesis:</strong> Risk ratios will be pooled using the generic inverse variance method. Heterogeneity will be tested (Cochran Q), quantified (I²) and explored by sensitivity and a priori subgroup analyses. Publication bias will be assessed. Grading of Recommendations Assessment Development and Evaluation (GRADE) tool will assess the strength of evidence. <strong>Knowledge translation plan:</strong> We will follow the Ottawa model. Results will be disseminated through presentations at scientific meetings and publication in high impact journals. Webcasts and social media posts on YouTube videos, Facebook, twitter and LinkedIn will also be used. Target adopters will include clinicians, allied health professionals, policy makers, industry, researchers, and patient groups. <strong>Significance:</strong> The proposed project will aid in knowledge translation related to the health effects of food sources of sugars, informing evidence-based guidelines and improving health outcomes by educating healthcare providers and patients, stimulating industry innovation, and guiding future research design.</p> </body> </html>