Abstract
BackgroundChronic diseases, such as cardiovascular disease and type 2 diabetes, impose significant burden to public health. Most chronic diseases are associated with underlying preventable risk factors, such as elevated blood pressure, blood glucose, and lipids, physical inactivity, excessive sedentary behaviours, overweight and obesity, and tobacco usage. Sugar-sweetened beverages are known to be significant sources of additional caloric intake, and given recent attention to their contribution in the development of chronic diseases, a systematic review is warranted. We will assess whether the consumption of sugar-sweetened beverages in adults is associated with adverse health outcomes and what the potential moderating factors are.Methods/DesignOf interest are studies addressing sugar-sweetened beverage consumption, taking a broad perspective. Both direct consumption studies as well as those evaluating interventions that influence consumption (e.g. school policy, educational) will be relevant. Non-specific or multi-faceted behavioural, educational, or policy interventions may also be included subject to the level of evidence that exists for the other interventions/exposures. Comparisons of interest and endpoints of interest are pre-specified. We will include randomized controlled trials, controlled clinical trials, interrupted time series studies, controlled before-after studies, prospective and retrospective comparative cohort studies, case-control studies, and nested case-control designs. The MEDLINE®, Embase, The Cochrane Library, CINAHL, ERIC, and PsycINFO® databases and grey literature sources will be searched. The processes for selecting studies, abstracting data, and resolving conflicts are described. We will assess risk of bias using design-specific tools. To determine sets of confounding variables that should be adjusted for, we have developed causal directed acyclic graphs and will use those to inform our risk of bias assessments. Meta-analysis will be conducted where appropriate; parameters for exploring statistical heterogeneity and effect modifiers are pre-specified. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used for determining the quality of evidence for outcomes.Systematic review registrationPROSPERO CRD42014009638
Highlights
Chronic diseases, such as cardiovascular disease and type 2 diabetes, impose significant burden to public health
We have developed a classification scheme based on the Centers for Disease Control and Prevention (CDC) definition for use during the review
Grading the quality of evidence and interpretation We will use the GRADE approach to evaluate the quality of evidence for outcomes [42]
Summary
Chronic diseases, such as cardiovascular disease and type 2 diabetes, impose significant burden to public health. We will assess whether the consumption of sugar-sweetened beverages in adults is associated with adverse health outcomes and what the potential moderating factors are Chronic diseases, such as cardiovascular disease and type 2 diabetes, cause significant morbidity and mortality worldwide. A simple, unidirectional schematic depicts the hypothesized pathways by which sugar-sweetened beverage (SSB) consumption may lead to the development of chronic cardiovascular/cerebrovascular and metabolic diseases, chronic kidney disease, cancer, and gout (Additional file 1) These mechanisms have not been conclusively established by research studies, and several conflicting theories have been put forward [1,2,3,4,5,6,7,8]. As some of the SSB constituents, notably sugar and caffeine and by-products of caramel colouring, where added, are postulated to be involved in the mechanisms of disease development, they are included in our depiction of the disease pathways
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