Gm 591 final examen

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Gm 591 final examen

Dietary sugars have been suggested as a cause of obesity, several chronic diseases, and a range of cardiometabolic risk factors, but there is no convincing evidence of a causal relation between sugars Gm 591 final examen risk factors other than body weight.

We conducted a systematic review and meta-analysis of randomized controlled trials that examined effects of the modification of dietary free sugars on blood pressure and lipids. The minimum trial duration was 2 wk. We pooled data by using inverse-variance methods with random-effects models.

A total of 39 of 11, trials identified were included; 37 trials reported lipid outcomes, and 12 trials reported blood pressure outcomes. Higher compared with lower sugar intakes significantly raised triglyceride concentrations [mean difference MD: Subgroup analyses showed the most marked relation between sugar intakes and lipids in studies in which efforts were made to ensure an energy balance and when no difference in weight change was reported.

Dietary sugars influence blood pressure and serum lipids. The relation is independent of effects of sugars on body weight. The association between free sugars and dental caries, although attenuated by fluoride, has been established beyond reasonable doubt 2and a recent meta-analysis has confirmed the relation between sugar intake and body weight 3.

The effect of dietary sugars on weight appears to result from the extent to which increasing or decreasing intakes in free-living individuals influence energy intakes because no change in weight is apparent when proportions of total energy derived from sugar are altered in the context of strict energy balance.

These observations appear to apply regardless of whether sugars are consumed in a liquid eg, sugar-sweetened beverages or solid form 3. There is no Gm 591 final examen evidence of a causal relation between sugars and other disease outcomes; hence, there has been a high degree of interest of effects on blood pressure, blood lipids, urate, and, most recently, hepatic lipid metabolism and deposition 45.

An appreciable body of data is are available that relate to effects of sugars on blood pressure and lipids. In this article, we report a systematic review and meta-analysis of randomized controlled trials that compared higher with lower dietary free-sugar intakes in adults or children free of acute illnesses, and reported fasting lipid or blood pressure outcomes.

Because our aim was to provide an indication of what might be achieved by population changes in intake of dietary sugars, we included studies in which energy intakes were not strictly controlled as well as controlled feeding studies.

METHODS Search strategy Separate electronic searches were conducted to identify randomized trials related to effects of dietary sugars on blood lipids and blood pressure in humans according to Cochrane Collaboration guidelines 6.

We applied a modified search strategy on the basis of Cochrane Collaboration methods to identify randomized controlled trials 6. Gray literature databases including Bioline, Clinicaltrials. Hand searches of reference lists of included studies and published meta-analyses were also undertaken.

Study selection Two reviewers assessed titles and abstracts of all identified studies.

Gm 591 final examen

Discrepancies in opinion as to whether a study should be included for a full review were adjudicated by a third reviewer. A similar process was undertaken to determine which studies should be included in the formal analysis. The term free sugars refers to all monosaccharides and disaccharides added to foods by the manufacturer, cook, or consumer plus sugars naturally present in honey, syrups, and fruit juices 7.

Trials that involved direct comparisons, behavioral interventions, or multifactorial lifestyle interventions in which effects of sugars could be analyzed separately from other diet or lifestyle factors were included.

Comparison groups could include a control diet on the basis of usual or unmodified dietary intakes or an intervention in which sugar intake was quantifiably different from sugar intake in the experimental group. Animal and observational studies were excluded. Studies were required to report differences between treatment groups in intake of free sugars or intake of a component of total sugars expressed in absolute amounts or a percentage of the total energy and at least one measure of blood pressure [systolic blood pressure SBP 4, diastolic blood pressure DBPor average blood pressure] or one measure of blood lipids triglycerides; total, LDL, or HDL cholesterol.


Participants included adults and children free from acute illness, but subjects with diabetes or other noncommunicable diseases in whom conditions were regarded as stable could be included.

Trials could include studies in which participants in the intervention arm were advised to either increase or decrease free sugars or foods and drinks that contained sugars.

We included both trials in which there was an isocaloric substitution of sugars with other forms of carbohydrate to control weight and studies in which there was no strict control of energy intake.

Data extraction and quality assessment Data extraction and a validity assessment were carried out independently by 2 reviewers, and any discrepancies were resolved by discussion with a third reviewer.

Data that were related to participant characteristics, study settings and designs, outcomes, exposures or interventions, and potential effect modifiers, such as the degree of weight loss, were extracted by using a piloted data-extraction form.

Cochrane Collaboration criteria 8 were used to examine the validity and risk of bias of each trial including sequence generation, blinding of participants, personal and outcome assessors, completeness of outcome data, and selective outcome reporting.

Additional review-specific criteria included whether studies were funded by industries with potential vested interests. Statistical analysis Individual trial data for each outcome measure were pooled to obtain estimates for MDs in each outcome measure between intervention and control groups with Review Manager RevMan 5.

Estimates for the SE of differences in means for treatment groups in crossover studies were derived from reported P values when the SEM of the MD was not reported.

Adjustment was made if the imputed P value produced a very small or large SE that resulted in a disproportionate weighting in meta-analyses. As in our previous systematic review of effects of sugars on body weight 3for main analyses, we have presented forest plot analyses by subgroups relating to whether energy intake was prescribed.

One group included studies that attempted to achieve an isocaloric replacement of sugars with other forms of carbohydrate, which are referred to as isocaloric trials. The other group included studies in which participants in the intervention arm were advised to decrease or increase sugars or foods and drinks that contained sugars.Multiple scoring systems are available, including a standard point method of determining accuracy of the final product 52,53 and more qualitatively based systems that include a study of subject’s organizational ability.

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