Dietary sugar consumption and health: umbrella review

Risk factors for hepatocellular carcinoma: an umbrella review of systematic review and meta-analysis

BACKGROUND

Numerous meta-analyses have identified various risk factors for hepatocellular carcinoma (HCC), prompting a comprehensive study to synthesize evidence quality and strength.

METHODS

This umbrella review of meta-analyses was conducted throughout PubMed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. Evidence strength was evaluated according to the evidence categories criteria.

RESULTS

We identified 101 risk factors throughout 175 meta-analyses. 31 risk factors were classified as evidence levels of class I, II, or III. HBV and HCV infections increase HCC risk by 12.5-fold and 11.2-fold, respectively. These risks are moderated by antiviral treatments and virological responses but are exacerbated by higher HBsAg levels, anti-HBc positivity, and co-infection. Smoking, obesity, non-alcoholic fatty liver disease, diabetes, low platelet, elevated liver enzymes and liver fluke infection increase HCC risk, while coffee consumption, a healthy diet, and bariatric surgery lower it. Medications like metformin, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), aspirin, statins, and selective serotonin reuptake inhibitors reduce HCC risk, while acid suppressive agents, particularly proton pump inhibitors, elevate it. Blood type O reduces the risk of HCC, while male gender and older age increase the risk.

CONCLUSIONS

HBV and HCV are major HCC risk factors, with risk mitigation through antiviral treatments. Lifestyle habits such as smoking and alcohol use significantly increase HCC risk, highlighting the importance of cessation. Certain drugs like aspirin, statins, GLP-1 RAs, and metformin may reduce HCC occurrence, but further research is needed to confirm these effects.

An Umbrella Review of Diabetes Mellitus and Hearing Impairment

AIM

This study aims to synthesize current meta-analyses to propose a potentially existing association between diabetes and hearing impairment (HI), elevating their relationship to "high" level of evidence.

METHODS

A systematic search was performed in 9 databases up to March 31, 2025. The pooled results were synthesized to elucidate the direction and magnitude of the effects. We used the AMSTAR-2 scale to assess study quality and the GRADE tool to assess the certainty of the evidence. Subgroup analysis was conducted according to age (PROSPERO-ID: CRD42024606416).

RESULTS

This umbrella review comprehensively encompassed over 22 million participants from more than 226 studies. After screening, 21 studies were finally included. Primary outcomes showed that individuals with HI were at a higher risk of developing diabetes, referring to [odds ratio (OR) = 1.88, 95% confidence interval (CI): (1.01, 3.50)] with moderate evidence certainty. Simultaneously, participants with diabetes exhibited a more prevalent occurrence of HI. Higher pure tone audiometric thresholds, lower distortion product otoacoustic emission amplitudes, and increased auditory brainstem-evoked response latency time collectively indicated an increased risk of HI associated with diabetes. Subgroup analysis results revealed that in the younger population, the association between HI and diabetes risk is also high.

CONCLUSIONS

Overall, the current body of evidence underscores a latent bidirectional association between diabetes and HI, coupled with mutually aggravating effects. Our findings suggest that HI may serve as an indicator of the risk of developing diabetes.

Relative Validity of the Food Recording Smartphone App Libro in Young People Vulnerable to Eating Disorder: A Preliminary Cross-Over Study

Background: Dietary intake plays a crucial role in health research, yet existing methods for its measurement can lead to participant burden, lengthy recording, and human errors, and do not account for age-specific variations. Libro is a real-time diet-tracking mobile-based app offering flexible features. An automated food recording program within Libro was customized for young people vulnerable to eating misbehaviour. This preliminary study assessed its relative validity using a self-administered 24 h recall method as the reference method. Methods: The relative validity of Libro was tested by adopting a cross-over design that recorded food intake over a period of 3 non-consecutive weekdays and 1 weekend day with both methods. The participants were recruited online through a mental health research charity, and this study was conducted fully online. The primary outcome was the concordance of total energy intake between the two methods, with secondary outcomes focusing on the intake of protein, carbohydrates, fats, free sugars, fibre, and trans-fatty acids. Test-retest validity was assessed per method with the intraclass correlation coefficient; a Bland-Altman plot and t-test were performed to test agreement at the group level; correlation coefficient and cross-classification were performed to assess agreement at the individual level. Results: Forty-seven participants were included in the final analysis. The average intraclass correlation coefficient for energy intake measured by Libro over four days was 0.85 (95% CI: 0.76-0.91). Compared to Intake24, the average energy intake recorded using Libro was significantly lower (mean difference: -554 Kcal, 95% CI: -804.1 to -305.6 Kcal, p < 0.001), potentially driven by the reduced reporting of foods rich in free sugars. The correlation coefficient for average energy intake measured by Libro vs. Intake24 was 0.32 (95% CI: 0.03, 0.55), with only 27.7% of subjects classified in the same quartile with both methods (κ = 0.31, 95% CI: -0.03, 0.55). Concordance varied across specific dietary component measures. Conclusions: While Libro had good test-retest reliability if adopting a multiple administration method, it underreported energy and other aspects of dietary intake, along with poor classification performance compared to Intake24 in a population vulnerable to eating misbehaviour. We suggest that future studies improve user experience to increase compliance and data accuracy.

An umbrella review of the association between dietary factors and hepatocellular carcinoma risk

Background: Several meta-analyses have summarized the associations between dietary factors and the risk of hepatocellular carcinoma (HCC). However, no research has comprehensively assessed the certainty of this evidence. Methods: PubMed, Embase, and the Cochrane Library were searched from inception to August 2024. The credibility of the evidence was assessed using the pre-specified evidence classification criteria, graded as convincing ("class I"), highly suggestive ("class II"), suggestive ("class III"), weak ("class IV"), or no evidence ("class V"). To evaluate the quality of evidence, the GRADE framework was applied, categorized as "high", "moderate", "low", or "very low" quality. This study was registered at PROSPERO (CRD42023417373). Results: In total, 22 meta-analyses describing 33 non-dose-response and 10 dose-response associations were included. In the non-dose-response associations, convincing evidence (class I) supported an inverse association between coffee intake [risk ratio (RR) 0.50, 95% confidence interval 0.42 to 0.59, GRADE = very low] and risk for HCC. Suggestive evidence (class III) supported the effect of fish (RR 0.81, 0.73 to 0.90; very low), fiber (RR 0.71, 0.61 to 0.84; low), and the Mediterranean diet (RR 0.67, 0.56 to 0.80; very low) in lowering the risk for HCC. Weak evidence (class IV) suggested the protective effects of ginseng, selenium, cruciferous vegetables, whole grains, and vegetables, against HCC, and the negative effect of saturated fat in increasing the risk for HCC. In the dose-response association, convincing evidence (class I) supported that an additional two cups of coffee per day (RR 0.71, 0.60 to 0.77; moderate) lowered HCC risk, and suggestive evidence (class III) indicated that an increase of 10 g day-1 in fiber intake (RR 0.83, 0.76 to 0.91; moderate) lowered HCC risk. Weak evidence (class IV) suggests positive associations between HCC risk and a 1% daily increase in energy from saturated fat and a 100 mg day-1 increase in cholesterol. Conclusions: Dietary factors, especially coffee, fish, fiber, and the Mediterranean diet, are associated with HCC risk. These findings provide a theoretical basis for developing and evaluating dietary interventions to reduce HCC risk.

Evaluating Feasibility and Acceptability of the "My HeartHELP" Mobile App for Promoting Heart-Healthy Lifestyle Behaviors: Mixed Methods Study

Background

Few mobile apps have strategies for self-monitoring multiple heart-healthy behaviors simultaneously, as well as automated and tailored feedback on individual behavioral outcomes for cardiovascular health. An app named "My HeartHELP" was developed for the general adult population to promote 6 heart-healthy lifestyle behaviors-physical activity, nonsedentary behaviors, healthy eating behaviors, nonsmoking, no alcohol binge drinking, and self-assessment of body weight. Three behavioral strategies were used: (1) text messaging the users for information on cardiovascular health, (2) self-monitoring of 6 heart-healthy behaviors to fill out the blanks of behavioral items, and (3) automated and tailored feedback messaging to users for behavioral outcomes obtained from self-monitoring.

objectives

This study aimed to evaluate the feasibility and acceptability of the "My HeartHELP" app.

Methods

The participants were 29 community residents in Seoul, South Korea, who met at least 1 criterion of metabolic syndrome. To evaluate the feasibility, we assessed 3 records, which are as follows: First, the "record for self-monitoring" was determined as feasible if an average percentage for each of the 6 behaviors over 4 weeks was 75% or higher based on percentages of participants who completed to record each of 6 heart-healthy behaviors. Second, the "record for access to the app" was determined as feasible if users accessed at least once a day on average per week. Third, "records for behavioral changes" over 4 weeks were collected via a self-reported questionnaire. To evaluate acceptability, we used an assessment tool comprising 12 items that included subscales for comprehensibility, ease, health benefits, technical completeness, overall satisfaction, and recommendation to others on a 5-point Likert scale. Acceptability was determined as acceptable if the average scores for the total scale and each subscale were 3.5 points or greater. Second, qualitative data were collected through 2 focus groups, each consisting of 14 or 15 participants. All data were collected in June and July 2022.

Results

During the 4 weeks, 95.6% (range: 85.8%-97.4%) of the participants adhered to more than 75% of "completion of daily self-monitoring of each heart-healthy behavior," having met the criterion. The participants accessed the app on average 1.8 (SD 1.70) times per day, meeting the criteria. Participants had positive behavioral changes in all 6 behaviors, of which nonsedentary behavior (10%-28%; χ21=1.76; P<.001) and non-fast-food intake were especially statistically significant (72%-93%; χ21=5.64; P=.03) over 4 weeks. Participants reported 3.8 points for a total score of acceptability and more than 3.5 points for all subscales, which met the criterion. Qualitative data obtained from focus groups indicated that automated and tailored feedback messages motivated participants to promote healthy lifestyles.

Conclusions

The "My HeartHELP" app may be a feasible and acceptable mobile app to promote self-monitoring and possibly behavioral changes in heart-healthy lifestyle behaviors.

Living Donor Liver Transplantation Versus Deceased Donor Liver Transplantation for Hepatocellular Carcinoma and HCV Patients: An Initial Umbrella Review

Background: Living donor liver transplantation (LDLT) has become a widely accepted alternative to deceased donor liver transplantation (DDLT). Nevertheless, the available meta-analyses shed light on a perplexing issue regarding which transplant is better. Therefore, we performed an umbrella review to summarize and evaluate the evidence from current meta-analyses. Methods: Two independent reviewers conducted a search of PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews from inception to 1 June 2024. The methodological quality of each included meta-analysis was evaluated using AMSTAR2 (A Measurement Tool to Assess Systematic Reviews). Results: The search identified 10 meta-analyses from 486 individual articles, including cohort studies and observational studies. Regrettably, the quality of these meta-analyses ranged from critically low to moderate. Receipt of LDLT offers a survival advantage to the patients with HCC compared with DDLT but with a higher complication rate. However, high-quality studies are required in the future to validate our assertions owing to the low certainty of the evidence. Conclusions: Despite the complication risks, LDLT remains a cost-effective option without compromising patient and graft survival, especially for HCC patients. Extensive, well-designed studies are essential to validate these conclusions.

A nutrient wide association study of cardiovascular disease prevalence in older adults from NHANES 2007 to 2018

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, particularly among older adults. Identifying modifiable dietary factors associated with CVD prevalence is essential for prevention. This cross-sectional study analyzed 7,341 adults aged ≥ 65 years from NHANES 2007-2018. CVD was defined based on self-reported physician-diagnosed conditions, including coronary heart disease, heart failure, angina, heart attack, or stroke. A nutrient-wide association study (NWAS) evaluated associations between 56 dietary nutrients and CVD prevalence using multivariable logistic regression. Dose-response relationships were assessed using restricted cubic spline (RCS) models. Model discrimination was evaluated using receiver operating characteristic (ROC) analysis. Eight nutrients were significantly associated with CVD prevalence after adjusting for confounders and correcting for multiple comparisons: PUFAs 20:4 (OR 0.88, 95% CI 0.80-0.97, P = 0.024), 22:5 (OR 0.72, 95% CI 0.56-0.92, P = 0.019), and 22:6 (OR 0.92, 95% CI 0.87-0.99, P = 0.032); total choline (OR 0.96, 95% CI 0.93-0.99, P = 0.024); cholesterol (OR 0.89, 95% CI 0.82-0.96, P = 0.037); protein (OR 0.82, 95% CI 0.76-0.89, P = 0.040); vitamin A (OR 0.95, 95% CI 0.91-0.99, P = 0.045); and total sugars (OR 0.97, 95% CI 0.96-0.98, P = 0.049). Clustering analysis identified protective effects of fat-soluble vitamins and unsaturated fatty acids. The inclusion of these nutrients significantly improved model discrimination (P < 0.05). This study identified key dietary nutrients and clusters associated with CVD prevalence and characterized their dose-response relationships. Integrating these nutrients into predictive models enhances CVD risk discrimination, providing actionable dietary targets for prevention strategies in older adults.

Overview of pharmacodynamical research of traditional Chinese medicine on hyperuricemic nephropathy: from the perspective of dual-regulatory effect on the intestines and kidneys

Uncontrolled hyperuricemia contributes to chronic kidney disease, characterized by renal inflammatory cell infiltration and tubulointerstitial fibrosis, eventually leading to renal failure. In addition to liver and kidney, the intestine tract plays a vital role in the development and progression of hyperuricemia and hyperuricemic nephropathy (HN) through various mechanisms. The conventional therapeutic strategy for HN is uric acid-lowering therapy (ULT) and renal protection; however, unsatisfactory results are often obtained in clinical practice. Growing evidence has demonstrated that traditional Chinese medicines (TCMs) achieve an anti-HN effect by modulating multiple targets and approaches with fewer side effects. Therefore, this paper reviews the pathogenesis of HN, including the role of soluble and insoluble urates in kidney and intestine, and the role of intestinal tract in the progression of HN. Meanwhile, the recent advancements in TCMs for the treatment of HN are summarized and analyzed, with a focus on their modulation of intestinal flora and metabolites, urate-related transporters, immuno-inflammation and barrier function in the intestines. Notably, for the first time, we propose the perspective that TCMs treat HN through a dual-regulatory effect on the intestines and kidneys. Additionally, the problems existing in current research and the feasible research strategies combined with emerging technologies such as fermentation and nanotechnology are discussed, thus providing novel ideas for HN management.

Diagnostic performance of AI-assisted endoscopy diagnosis of digestive system tumors: an umbrella review

The diagnostic performance of artificial intelligence (AI)-assisted endoscopy for digestive tumors remains controversial. The objective of this umbrella review was to summarize the comprehensive evidence for the AI-assisted endoscopic diagnosis of digestive system tumors. We grouped the evidence according to the location of each digestive system tumor and performed separate subgroup analyses on the basis of the method of data collection and form of the data. We also compared the diagnostic performance of AI with that of experts and nonexperts. For early digestive system cancer and precancerous lesions, AI showed a high diagnostic performance in capsule endoscopy and esophageal squamous cell carcinoma. Additionally, AI-assisted endoscopic ultrasonography (EUS) had good diagnostic accuracy for pancreatic cancer. In the subgroup analysis, AI had a better diagnostic performance than experts for most digestive system tumors. However, the diagnostic performance of AI using video data requires improvement.

Effects of a Sugar-Sweetened Beverages Tax on Caries in Italy: A Modelling Study

INTRODUCTION

Despite efforts to reduce sugar consumption, Italy continues to experience high levels of caries, particularly among 12-year-old children. The introduction of a sugar tax is one strategy that gained traction as a mean of curbing excessive sugar intake. This study aimed to assess the potential impact of a sugar tax on reducing caries prevalence through the analysis of two scenarios: a hypothetical implementation of the tax in 2008 (Scen1), compared against actual 2017 data, and a projection of the effects of the planned 2025 tax extending to 2034 (Scen2).

METHODS

The evaluation utilizes a Markov model to evaluate the health and economic outcomes of a 20% ad valorem tax on sugar-sweetened beverages. Outcomes included the caries experience, as DMFT index and QALYs (Quality-Adjusted Life Year/s), direct dental costs, and indirect costs as forgone earnings due to care, assuming a 100% pass-through to consumers. A 3% annual discount rate was applied to all costs. Sub-analysis also included geographical macro-areas of Italy (North-West, North-East, Centre, South, Islands), based on main socioeconomic determinants. A probabilistic sensitivity analysis, involving a Monte Carlo simulation with 1,000 iterations, was conducted to assess the robustness of the model, generating estimates of mean values and 95% uncertainty intervals.

RESULTS

In Scen1, the simulation suggested that a 20% ad valorem tax would have resulted in a 0.05 reduction of the DMFT, yielded a cost saving of EUR 18.5 million, and EUR 24,520 per QALY gained. The projected 2025-2034 implementation estimated to decrease the DMFT by 0.07, save EUR 38.6 million, and EUR 31,933 per QALY gained. Significant benefits were observed in southern Italy, an area with higher caries rates and lower dental care utilization, where the impact was pronounced in both scenarios.

CONCLUSION

Integrating a sugar tax into a broader public health strategy can significantly reduce caries and healthcare costs, especially in disadvantaged settings. These findings highlight the need for policymakers to pair sugar taxes with additional preventive measures for optimal public health outcomes.

The Validation of the Persian Version of Sugar Addiction Questionnaire: Factor Structure, Item Analysis and Model Fit

Objective: Excessive sugar consumption is a growing public health concern, with research suggesting it may function as an addictive substance. However, the lack of standardized tools to assess sugar addiction, particularly across cultures, remains a challenge. This study aims to validate the Persian version of the Sugar Addiction Questionnaire (SAQ) for use in Iran. Method : In this cross-sectional psychometric validation study, 504 Persian-speaking adults (59.1% female, mean age = 29.8 ± 19.5 years) were recruited using convenience sampling from Tehran health centers. Participants completed the SAQ and Yale Food Addiction Scale (YFAS 2.0), and participated in DSM-5-based semi-structured interviews for sugar addiction. Factor analysis and reliability measures (Cronbach's alpha, test-retest, split-half) were used to assess the SAQ's validity and reliability. Results: The Persian SAQ demonstrated strong psychometric properties. Factor analysis revealed a five-factor structure explaining 45.08% of the variance. Concurrent validity was confirmed by significant correlations with the YFAS 2.0 (r = 0.51, P < 0.001) and BMI (r = 0.55, P < 0.001). The scale showed a good model fit (CFI = 0.91, RMSEA = 0.08), with acceptable reliability (Cronbach's alpha = 0.79) and a test-retest correlation of 0.54. The optimal cutoff for diagnosing sugar addiction was 9, with the Area-Under-the-Curve (AUC) of 98%. Conclusion: The Persian version of the SAQ is a reliable and valid tool for assessing sugar addiction in Iran. This validated instrument can improve the diagnosis and understanding of sugar-related behavioral issues, supporting better public health strategies for managing excessive sugar consumption.

Interaction effect of mobile gaming addiction and excessive sugar-sweetened beverage consumption on overweight and obesity among schoolchildren: Evidence from a large population-based study in Guangzhou, China

Objective

To explore the individual and interactive associations between mobile gaming addiction (MGA), excessive consumption of sugar-sweetened beverages (SSBs), and overweight/obesity among schoolchildren, and to investigate whether these interactions vary by gender or grade level.

Methods

Data were drawn from the Children's Growth Environment, Lifestyle, and Physical and Mental Health Development project (COHERENCE) conducted in Guangzhou, China, during the 2019/20 academic year. 418,197 children aged 6-12 years were included in the study. All participants were asked to complete an eligible questionnaire to provide details of their MGA over the past three months and SSBs consumption over the past week. Multiplicative and additive interaction models were performed to evaluate the interaction effects of MGA and excessive SSBs consumption on overweight/obesity, and variations by gender and grade level were also examined.

Results

Excessive SSBs consumption was identified as a risk factor for childhood overweight/obesity, but MGA was not. However, the combination of MGA and excessive SSBs consumption was associated with an increased risk of overweight/obesity. This multiplicative interaction was significantly stronger in girls than in boys, with no differences observed across grade levels. Additionally, the additive interaction effect between MGA and excessive SSBs consumption was present only in girls and children in the lower elementary grades.

Conclusions

This cross-sectional study found that the combination of MGA and excessive SSBs consumption is linked to an increased risk of childhood overweight/obesity, particularly in girls and children in lower elementary grades. These findings highlight the importance of addressing these factors together in targeted interventions.

Level of intestinal permeability markers and selected aspects of diet and BMI of Polish e-sports players

BACKGROUND

The intestinal microbiota, also called visceral brain, exhibits high biological activity and influences health status. The aim of this study was to evaluate selected dietary determinants of the levels of intestinal permeability markers (zonulin and LPS endotoxin) in a group of e-sportsmen.

MATERIALS AND METHODS

The study was conducted among 174 male athletes (18-28 years old), training at the professional (n = 44) and semi-professional level (n = 130). The study included: weight and height measurements (Holtain anthropometer, Tanita TBF300), assessment of BMI, determination of zonulin and LPS levels in fecal samples (ELISA tests) and assessment of frequency of consumption of selected food groups (FFQ). Statistical analysis was performed using chi2 and Student's t tests and Spearman's rank correlation, at a significance level of p < 0.05.

RESULTS

The group was dominated by e-sportsmen with elevated levels of LPS endotoxin (66.67%), zonulin (85.74%) and normative BMI (59.70%), with no significant differences according to sports level. There was a positive correlation between BMI and levels of zonulin (R = 0.49; p < 0.001) and LPS (R = 0.24; p < 0.05). Zonulin levels also increased with more frequent consumption of sweet cereals (R = 0.21; p < 0.05), pork meats (R = 0.21; p < 0.05) and red meat dishes (R = 0.18; p < 0.05).

CONCLUSIONS

Excessive body weight and a poor health diet were shown to have a negative effect on increasing intestinal permeability, suggesting the rationale for monitoring and rationalizing diet and nutritional status to optimize the intestinal microbiota of e-sportsmen.

Associations of breakfast cereal consumption with all-cause and cause-specific mortality: a large-scale prospective analysis

BACKGROUND

Previous studies have explored the relationship between breakfast cereal consumption and mortality risk, but these studies reported inconsistent findings and did not distinguish between consumers of different breakfast cereal types. This prospective cohort study aims to elucidate the dose-response relationship between specific breakfast cereal types and mortality risk.

METHODS

A total of 186,168 participants aged 40 to 69 years from UK Biobank that completed at least one online 24-hour dietary recall questionnaire and reported information on breakfast cereal consumption were included. Self-reported types and amounts of dietary breakfast cereal intake, and mortality from CVD (cardiovascular disease), cancer, and all causes were estimated. Cox regression analyses were employed to illustrate the correlation between the daily intake of different breakfast cereal types and mortality risk.

RESULTS

During a median follow-up of 13.4 years, 9402 deaths were recorded (including 5073 cancer deaths and 1687 CVD deaths). The intake of muesli was significantly correlated with reduced all-cause mortality, with the HRs (hazard ratios) (95% CIs) being 0.89 (0.83-0.95) (> 0-0.5 bowls/d) and 0.85 (0.79-0.92) (> 0.5-1 bowls/d), respectively. Bran cereal consumption also exhibited inverse correlations with all-cause mortality, showing an HR of 0.88 (95% CI: 0.81-0.95) (> 0-0.5 bowls/d) and 0.88 (95% CI: 0.80-0.98) (> 0.5-1 bowls/d). Moderate intake of porridge (> 0.5-1 bowls/day) was correlated with a reduced risk of all-cause mortality, with an HR (95% CI) of 0.89 (0.84-0.96). Furthermore, moderate consumption of muesli and bran cereal correlated with reduced mortality risks related to CVD and cancer, while plain cereal intake was correlated with increased CVD-specific mortality risk, and sweetened cereal consumption was correlated with elevated cancer-specific mortality risk. Additionally, participants who reported adding dried fruit to their breakfast cereals exhibited significantly lower risks of all-cause mortality and cause-specific mortality, and those who added milk to their breakfast cereals had a reduced risk of all-cause mortality.

CONCLUSIONS

The findings support the moderate intake of several breakfast cereal types, including porridge, bran cereal, and muesli, as part of a healthy diet, while oat crunch and sweetened cereal consumption should be reduced to lower premature mortality risk.

Multi-faceted nutritional science demonstrated through the prism of sugar: a scoping review on sugar intake and association with quality of life in children and adolescents

BACKGROUND

To strengthen the scientific evidence linking dietary sugar consumption with health outcomes, it's essential to look beyond the usual focus on non-communicable diseases (NCDs) and tooth decay. We thus hypothesize that considering other dimensions of health beyond physical health will meaningfully complement the evidence and expand our understanding of the relationship between nutrition and health.

PURPOSE

The aim of this scoping review was to explore the scientific evidence of an association between dietary sugar intake and quality of life (QoL) among healthy children and adolescents.

METHODS

We performed a literature search in three databases (i.e., PubMed, Scopus, and Web of Science). The search included all types of studies assessing dietary sugar intake in association with QoL, in children and adolescents published in English between January 2001 and January 2023.

RESULTS

Twenty-one full-text eligible papers were included in this review: one intervention, two prospective cohort studies, and 18 cross-sectional studies. The number of participants ranged from 25 to 65,000 and age of the participants ranged from 4 to 19 years. The studies differed considerably in exposure and outcome measures. For further qualitative analyses, the studies were categorized into studies related to different dimensions of QoL: food security (n = 4), sleep-related outcomes (n = 5), oral (n = 3) and (mental) health-related QoL (n = 9). Altogether, one study reported a null while the remaining 20 studies found adverse associations between intake of sugar, sugar-sweetened beverages (SSB), or sweets and outcome measures of QoL.

CONCLUSION

Through this scoping review, a number of scientific studies have revealed an association between sugar intake among children and adolescents and health-related QoL. The findings underscore a negative association. Our review emphasizes the crucial imperative of embracing a broader spectrum of health dimensions to gain a more wholistic understanding of nutrition, especially in collecting science-based evidence for the development of health policies, including dietary guidelines.

Association between obstructive sleep apnea and multiple adverse clinical outcomes: evidence from an umbrella review

Background and objective

In recent years, there has been a notable rise in awareness regarding obstructive sleep apnea (OSA), and a significant number of potential OSA cases have been identified. Numerous studies have established associations between OSA and various adverse clinical outcomes. This umbrella review aims to summarize and evaluate the available evidence on the relationship between OSA and multiple adverse clinical outcomes.

Methods

PubMed, Embase, and Web of Science databases were systematically searched from inception to September 2023. The AMSTAR and GRADE were used to evaluate the quality of meta-analysis literature and classify the quality of literature evidence. Furthermore, the size of the effect size of the association between OSA and adverse clinical outcomes were assessed by using either a random or fixed-effect model and 95% confidence interval (CI).

Results

A total of 27 meta-analyses were enrolled with 43 adverse clinical outcomes. The umbrella review primarily reported the associations between sleep apnea syndrome and thyroid cancer (HR = 2.32,95%CI:1.35-3.98), kidney cancer (RR = 1.81, 95% CI: 1.20-2.74), liver cancer (RR = 1.19, 95% CI: 1.10-1.29), GERD (Gastroesophageal reflux disease)(OR = 1.53, 95% CI: 1.23-1.91), Atrial fibrillation (AF) (OR = 2.54, 95% CI: 2.20-2.92), osteoporosis (OR = 2.03, 95% CI: 1.26-3.27), and diabetes (OR = 1.40, 95% CI: 1.32-1.48). Overall, the AMSTAR rating scale and GRADE quality assessment included in the meta-analysis were generally low.

Conclusion

Our study shows that OSA is significantly associated with a variety of adverse clinical outcomes, especially an increased risk of certain malignancies, and some adverse clinical outcomes are closely related to OSA severity.

Association between the intake of potentially risky beverages and the occurrence of endometrial polyps: a case-control study

Background

This case-control study aimed to examine the association between the frequency of potentially risky beverage consumption, levels of anxiety, and the prevalence of endometrial polyps.

Methods

A total of 418 participants were enrolled in the study, comprising 206 cases and 212 controls. The case group consisted of patients who visited the gynecological clinic at the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine and were diagnosed with endometrial polyps (Eps) based on international diagnostic criteria. The control group consisted of women of childbearing age who visited the gynecological clinic with similar clinical symptoms but did not have EPs. Basic information, consumption of potentially risky beverages (PRB), and anxiety levels for both groups were collected through a questionnaire survey. Finally, the relationship between the frequency of PRB consumption, anxiety levels, and the prevalence of EPs was evaluated.

Results

In this study, we identified a significant positive association between the consumption of PRB and the prevalence of EPs. PRB intake was categorized into three groups based on the cumulative total score: 5-8 for the Low potentially risky beverages (LPRB) intake group, 9-12 for the medium potentially risky beverages (MPRB) intake group, and 13-21 for the high potentially risky beverages (HPRB) intake group. The results revealed that PRB consumption frequency was significantly associated with EPs (OR: 2.348, 95% CI: 1.153-4.78), with higher PRB intake correlating with an increased risk of EPs (p-value: 0.014). However, no significant difference was observed between the LPRB, MPRB, HPRB intake frequency groups and the different levels of anxiety (p-value: 0.793).

Conclusion

Increased consumption of PRB was clearly associated with a greater risk of EPs, and over half of the participants exhibited varying degrees of anxiety. These findings suggest that the risk of EPs can be mitigated by controlling beverage intake and highlight the need for increased attention to women's mental health.

Clinical trial registration

NCT06295510.

Could physical activity promote indicators of physical and psychological health among children and adolescents? An umbrella review of meta-analyses of randomized controlled trials

BACKGROUND

We performed an umbrella review to synthesize evidence on the effects of physical activity (PA) interventions on indicators of physical and psychological health among children and adolescents, including body mass index (BMI), blood pressure (BP), depressive symptoms, and cognitive function.

METHODS

PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched from inception through 31 July 2023. We included meta-analyses of randomized controlled trials exploring the effects of PA interventions on BMI, BP, depressive symptoms, or cognitive function in healthy or general children and adolescents. Standard Mean Difference (SMD) was calculated for continuous outcome indicators, while Relative Risk (RR) was calculated for categorical outcome indicators.

RESULTS

A total of 21 meta-analyses were included. The evidence for the effects of PA interventions on reducing BMI [n = 68,368, SMD = - 0.04, 95% confidence interval (CI) = - 0.07 to - 0.01, P = 0.012, I2 = 46.6%], relieving diastolic BP (n = 8204, SMD = - 1.16, 95% CI = - 2.12 to - 0.20, P = 0.018, I2 = 83.1%), preventing depressive symptoms (n = 5146, SMD = - 0.21, 95% CI = - 0.31 to - 0.12, P < 0.001, I2 = 29.0%), and promoting cognitive function (n = 19,955, SMD = 0.40, 95% CI = 0.27-0.54, P < 0.001, I2 = 88.0%) was all weak but significant (class IV evidence). Subgroup analyses demonstrated that school-based and after-school PA interventions, curricular PA interventions, and PA interventions emphasizing enjoyment were more effective in reducing BMI, while curricular PA and sports programs achieved greater executive function.

CONCLUSION

PA interventions could weakly reduce BMI, relieve BP, prevent depressive symptoms, and promote cognitive function in general children and adolescents. Targeted interventions on PA should be a priority to promote physical and psychological health for children and adolescents, especially the curricular PA emphasizing enjoyment in the school settings.

Free fatty acid receptor 4 modulates dietary sugar preference via the gut microbiota

Sugar preference is a key contributor to the overconsumption of sugar and the concomitant increase in the incidence of diabetes. However, the exact mechanism of its development remains ambiguous. Here we show that the expression of free fatty acid receptor Ffar4, a receptor for long-chain fatty acids, is decreased in patients and mouse models with diabetes, which is associated with high sugar intake. Deletion of intestinal Ffar4 in mice resulted in reduced gut Bacteroides vulgatus and its metabolite pantothenate, leading to dietary sugar preference. Pantothenate promoted the secretion of GLP-1 which inhibited sugar preference by stimulating hepatic FGF21 release, which in turn regulates energy metabolism. These findings uncover a previously unappreciated role of Ffar4 in negatively regulating sugar preference and suggest B. vulgatus-derived pantothenate as a potential therapeutic target for diabetes.

Risk factors for inflammatory bowel disease: an umbrella review

Introduction

Inflammatory bowel disease (IBD) represents a cluster of chronic idiopathic inflammatory disorders situated at the nexus of intricate interplays. The primary aim of the present investigation is to perform an umbrella review of metaanalyses, systematically offering a comprehensive overview of the evidence concerning risk factors for IBD.

Methods

To achieve this, we searched reputable databases, including PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews, from inception through April 2023. Two authors independently assessed the methodological quality of each metaanalysis using the AMSTAR tool and adhered to evidence classification criteria.

Results

In total, we extracted 191 unique risk factors in meta-analyses, including 92 significantly associated risk factors. The top ten risk factors were human cytomegalovirus (HCMV) infection, IBD family history, periodontal disease, poliomyelitis, campylobacter species infection, hidradenitis suppurativa, psoriasis, use of proton pump inhibitors, chronic obstructive pulmonary disease, and western dietary pattern.

Discussion

In conclusion, this umbrella review extracted 62 risk factors and 30 protective factors, most of which were related to underlying diseases, personal lifestyle and environmental factors. The findings in this paper help to develop better prevention and treatment measures to reduce the incidence of IBD, delay its progression, and reduce the burden of IBD-related disease worldwide.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023417175.

The influence of different forms of apple products on all-cause mortality in patients with hypertension

Objective

Apple consumption has a positive effect on human health. Some studies have shown that an appropriate amount of apple intake can reduce the incidence of hypertension. However, few studies have investigated whether eating different forms of apples has the same benefits as eating whole apples. This study is aimed to evaluate the effect of different forms of apple on all-cause mortality in patients with hypertension.

Methods

The study included 2,368 patients with hypertension. All participants were followed up for at least 10 years. Cox regression model was constructed to analyze the correlation between apple, apple juice, and apple sauce consumption and all-cause mortality in patients with hypertension.

Results

The consumption of apples 3-6 times/week was associated with a 48% reduction in the risk of all-cause mortality in patients with hypertension (HR = 0.52, 95% CI: 0.37-0.72, p < 0.001). However, the consumption of apple juice (HR = 1.02, 95% CI: 0.67-1.56, p = 0.930) and sauce (HR = 1.28, 95% CI: 0.59-2.74, p = 0.531) tended to increase the risk of death in patients with hypertension, although this study did not obtain a statistically result.

Conclusion

Moderate consumption of whole apples is associated with a reduced risk of all-cause death in patients with hypertension, whereas apple juice and sauce may increase the risk of death.

Impact of gout on colorectal cancer and its survival: a two-sample Mendelian randomization study

BACKGROUND

The relationship between gout and colorectal cancer (CRC) remains unclear, emphasizing the need for additional research to clarify the potential cumulative effect of gout on CRC development.

METHODS

Leveraging a single nucleotide polymorphism-based genome-wide association study, the potential causal correlation between gout and CRC was initially analyzed using Mendelian randomization (MR). Subsequently, our analysis was expanded to include an assessment of patient survival, with the aim of evaluating the potential causal correlation between gout and CRC and the impact of gout on CRC survival outcomes.

RESULTS

According to MR findings, a substantial relationship was observed between gout and the incidence of CRC when CRC was used as the outcome (OR = 0.954, 95% CI = 0.915-0.995). These results indicate a negative relationship between gout and the likelihood of developing CRC. In addition, when evaluating the overall survival (OS) or cancer-specific survival (CSS) of patients with CRC as outcomes, gout exhibited a significant relationship with survival. The inverse variance weighting approach demonstrated a progressive enhancement in CRC survival with the cumulative impact of gout (OS: OR = 2.000 × 10-4, 95% CI = 1.560 × 10-7-0.292; CSS: OR = 2.200 × 10-5, 95% CI = 4.660 × 10-9-0.104).

CONCLUSION

As gout accumulates, it exerts an inhibitory influence on CRC, indicating a potential protective effect. This study provides robust evidence that can guide the development of future clinical treatment approaches and research priorities.

Added sugar intake and its associations with incidence of seven different cardiovascular diseases in 69,705 Swedish men and women

Introduction

The adverse health effects of sugar-sweetened beverage intake are well-established, but the implications of overall added sugar intake remain unclear. We investigated the associations between intake of added sugar and various sugar-sweetened foods and beverages and risk of 7 cardiovascular diseases in 69,705 participants aged 45-83 years (47.2% female) from the Swedish Mammography cohort and Cohort of Swedish men.

Methods

Questionnaire-based diet and lifestyle assessments were administered in 1997 and 2009. National registers were used for ascertainment of ischemic stroke (n = 6,912), hemorrhagic stroke (n = 1,664), myocardial infarction (n = 6,635), heart failure (n = 10,090), aortic stenosis (n = 1,872), atrial fibrillation (n = 13,167), and abdominal aortic aneurysm (n = 1,575) until December 31st, 2019. The associations were studied using Cox regression with time-updated exposure and covariate data.

Results

Added sugar intake was positively associated with ischemic stroke and abdominal aortic aneurysm, although the highest risks of most outcomes were found in the lowest intake category. Positive linear associations were found between toppings intake and abdominal aortic aneurysm, and between sweetened beverage intake and ischemic stroke, heart failure, atrial fibrillation, and abdominal aortic aneurysm. Negative linear associations were found between treats intake (pastries, ice cream, chocolate, and sweets) and all outcomes, and between toppings intake (table sugar, honey, jams, and marmalades) and heart failure and aortic stenosis.

Discussion

The findings suggest that the associations between added sugar intake and cardiovascular diseases vary by disease and source of added sugar. The findings emphasize the adverse health effects of sweetened beverage consumption and indicate higher cardiovascular diseases risks with lower treats intake, which warrants further investigation.

The prevalence of obesity and overweight among Iranian population: an umbrella systematic review and meta-analysis

BACKGROUND

The present umbrella systematic reviews and meta-analyses aim to determine the comprehensive prevalence of obesity and overweight across different age subgroups in Iran.

METHODS

We conducted a comprehensive search across many databases, including Science Direct, Web of Science, Scopus, PubMed, and Google Scholar, to retrieve papers published until November 2023. The meta-analyses included in this study examined the prevalence of obesity and overweight in Iran. The current umbrella meta-analysis finally contained 24 meta-analyses. We evaluated the scientific reliability of the studies using the Assessment of Multiple Systematic Reviews (AMSTAR2).

RESULTS

The overall prevalence of overweight and obesity among the Iranian population was 18.38% (95% CI: 10.267, 26.496) and 10.91% (95% CI: 9.654, 12.177), respectively. The overall obesity prevalence in males was 9.93 (95%CI: 8.483, 11.388), and in females was 9.67% (95%CI: 8.317, 11.033). The prevalence of overweight and obesity among children and adolescents was 12.43% (95% CI: 10.184, 14.683) and 6.51% (95% CI: 5.866, 7.157), and in adults, it was 27.39% (95% CI: 14.878, 39.914) and 17.20% (95% CI: 13.483, 20.919), respectively. Male children and adolescents had a higher prevalence of overweight and obesity than females, but adult males had a lower prevalence than females.

CONCLUSION

This study presents the trend of obesity and overweight among the Iranian population. Since the trend of increasing overweight and obesity is alarming, policymakers and healthcare providers at the national and regional levels should design and implement preventive programs and interventions.

Fructose-mediated AGE-RAGE axis: approaches for mild modulation

Fructose is a valuable and healthy nutrient when consumed at normal levels (≤50 g/day). However, long-term consumption of excessive fructose and elevated endogenous production can have detrimental health impacts. Fructose-initiated nonenzymatic glycation (fructation) is considered as one of the most likely mechanisms leading to the generation of reactive species and the propagation of nonenzymatic processes. In the later stages of glycation, poorly degraded advanced glycation products (AGEs) are irreversibly produced and accumulated in the organism in an age- and disease-dependent manner. Fructose, along with various glycation products-especially AGEs-are present in relatively high concentrations in our daily diet. Both endogenous and exogenous AGEs exhibit a wide range of biological effects, mechanisms of which can be associated with following: (1) AGEs are efficient sources of reactive species in vivo, and therefore can propagate nonenzymatic vicious cycles and amplify glycation; and (2) AGEs contribute to upregulation of the specific receptor for AGEs (RAGE), amplifying RAGE-mediated signaling related to inflammation, metabolic disorders, chronic diseases, and aging. Therefore, downregulation of the AGE-RAGE axis appears to be a promising approach for attenuating disease conditions associated with RAGE-mediated inflammation. Importantly, RAGE is not specific only to AGEs; it can bind multiple ligands, initiating a complex RAGE signaling network that is not fully understood. Maintaining an appropriate balance between various RAGE isoforms with different functions is also crucial. In this context, mild approaches related to lifestyle-such as diet optimization, consuming functional foods, intake of probiotics, and regular moderate physical activity-are valuable due to their beneficial effects and their ability to mildly modulate the fructose-mediated AGE-RAGE axis.

Exploring fructose metabolism as a potential therapeutic approach for pancreatic cancer

Excessive fructose intake has been associated with the development and progression of pancreatic cancer. This study aimed to elucidate the relationship between fructose utilization and pancreatic cancer progression. Our findings revealed that pancreatic cancer cells have a high capacity to utilize fructose and are capable of converting glucose to fructose via the AKR1B1-mediated polyol pathway, in addition to uptake via the fructose transporter GLUT5. Fructose metabolism exacerbates pancreatic cancer proliferation by enhancing glycolysis and accelerating the production of key metabolites that regulate angiogenesis. However, pharmacological blockade of fructose metabolism has been shown to slow pancreatic cancer progression and synergistically enhance anti-tumor capabilities when combined with anti-angiogenic agents. Overall, targeting fructose metabolism may prove to be a promising therapeutic approach in the treatment of pancreatic cancer.

Association of tea consumption with life expectancy in US adults

OBJECTIVE

The association of tea consumption with life expectancy in US adults remains unclear. This study aimed to evaluate the correlation between tea consumption and life expectancy among US adults.

METHODS

Tea consumption records and available mortality data from National Health and Nutrition Examination Survey 2001 to 2018 for adults ≥ 20 years of age were used (n = 43,276). Participants were grouped based on their daily tea consumption as follows: non-drinkers, < 1 cup/day, 1 to < 3 cups/day, 3 to < 5 cups/day, and ≥ 5 cups/day. Life table method was used to evaluate the association between daily tea consumption and life expectancy.

RESULTS

During a median follow-up of 8.7 years, we documented 6275 deaths out of the 43,276 participants. The estimated life expectancy at age 50 years was 30.69 years (95% confidence interval, 30.53 to 30.89), 30.77 years (29.45 to 32.19), 31.07 years (30.35 to 31.69), 32.93 years (31.24 to 34.5), and 29.68 years (27.38 to 31.97) in tea-consuming participants with non-drinker, < 1 cup/day, 1 to < 3 cups/day, 3 to < 5 cups/day, and ≥ 5 cups/day, respectively. Equivalently, participants with 3 to < 5 cups/day consumption had a life gain of average 2.24 years (0.49 to 3.85) compared with those without tea consumption. Similar years of life gained were observed in females and White individuals, but not in males, Black and Hispanic populations. Notably, obvious health benefits weren't observed in other groups of tea consumption. The addition of sugar to tea is a potential health risk factor.

CONCLUSIONS

Consuming 3 to < 5 cups/day of tea may be a healthy recommendation for tea intake, and the addition of sugar to tea should be approached with caution.

Novel gnd_v2 Fusion Tag and Engineered TEV Protease Enable Efficient Production of Brazzein

Protein solubility and purification challenges often hinder the large-scale production of valuable proteins like brazzein, a potent sweet protein with significant health benefits and commercial potential. This study introduces two novel tools to overcome protein expression and purification bottlenecks: a gnd_v2 fusion tag and an engineered Tobacco Etch Virus (TEV) protease. The gnd_v2 tag, derived from 6-phosphogluconate dehydrogenase, was engineered to improve the soluble expression of brazzein. This tag increased brazzein's solubility by four times compared to the wild-type gnd tag, marking a significant advancement in efficient brazzein production. To address the challenge of cleaving the fusion tag, we engineered a TEV protease variant with high efficiency, particularly at the glutamine residue at brazzein's P1' site - a known difficulty for wild-type TEV proteases. We achieved streamlined production of pure, functional brazzein by integrating this tailored protease cleavage with an ultrafiltration-based purification protocol. Notably, the purified brazzein demonstrated a sweetness potency approximately 2500 times that of sucrose, highlighting its potential as a high-intensity natural sweetener. While this study focused on brazzein, the gnd_v2 tag shows promise for enhancing the solubility of other challenging proteins. More broadly, this work presents a versatile toolset for the scalable production of diverse functional proteins, with significant implications for industrial applications in food and pharmaceutical domains.

Association between added sugars intake and Parkinson's disease status in U.S. adults: a cross-sectional study from NHANES 1990-2020

BACKGROUND

Added sugars intake is common among individuals with Parkinson's disease (PD), yet the link between added sugars intake and PD is not well understood. Our study aims to investigate the association between added sugars intake and PD.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from1990 to 2020. Added sugars intake was estimated based on a 24-hour dietary recall from participants. Multivariable logistic regression analysis was employed to explore the relationship between added sugars intake and the prevalence of PD. Restricted cubic spline (RCS) was used to explore the nonlinear association between added sugars intake and PD. To further observe whether the conclusions were consistent across different subgroups, we conducted subgroup analyses to investigate the association of added sugars intake with PD in different populations.

RESULTS

The study included 12,489 participants, of which 100 had PD. When weighted, the data represented 136,959,144 participants. The study revealed a positive association between added sugars intake and the prevalence of PD. In multivariable regression models adjusted for all confounding factors, compared with the lowest quartile of added sugars intake, the third quartile (OR = 2.99; 95% CI: 1.43-6.26) and those consuming more than 25% of their calories from added sugars (OR = 3.34; 95% CI: 1.03-10.86) had the highest risk of PD. The RCS curve showed an L-shaped nonlinear association between added sugars intake and PD. Two-segment linear regression by sex revealed that PD prevalence in women was linearly related to sugar intake (nonlinear P = 0.465), while men exhibited an L-shaped nonlinear relationship (nonlinear P = 0.03). Additionally, subgroup analysis showed that alcohol consumption and diabetes significantly influenced the association between added sugars intake and the prevalence of PD.

CONCLUSION

These results highlight a positive association between added sugars intake and the prevalence of PD, particularly among women, heavy drinkers, and individuals with diabetes.

Sugary beverages intake and risk of chronic kidney disease: the mediating role of metabolic syndrome

Background

Although several studies linked the sugary beverages to chronic kidney disease (CKD), the role of different types of sugary beverages in the development of CKD remained inconsistent. This study aimed to examine the associations of sugar-sweetened beverages (SSBs), artificially-sweetened beverages (ASBs), and natural juices (NJs) with CKD risk, and assess the extent to which the associations were mediated through metabolic syndrome (MetS).

Methods

This is a prospective analysis of 191,956 participants from the UK Biobank. Participants with information on beverage consumption and no history of CKD at recruitment were included. Daily consumptions of SSBs, ASBs and NJs were measured via 24-h dietary recall. Cox models were fitted to calculate the hazard ratios (HRs) and confidence intervals (CIs) of sugary beverages intakes on CKD risk. The causal mediation analyses were conducted to investigate whether MetS explained the observed associations.

Results

We documented 4,983 CKD cases over a median of 10.63 years follow-up. Higher consumption of SSBs and ASBs (>1 units/d compared with none) was associated with an elevated risk of CKD (HR: 1.45; 95% CI: 1.30-1.61, P-trend < 0.001 for SSBs and 1.52, 95% CI: 1.36-1.70 for ASBs). In contrast, we observed a J-shaped association between NJs and CKD with the with lowest risk at 0-1 unit/day (0-1 unit/d vs. 0, HR 0.86; 95% CI 0.81-0.91). The proportions of the observed association of higher intakes of SSBs and ASB with CKD mediated by MetS were 12.5 and 18.0%, respectively.

Conclusions

Higher intakes of ASBs and SSBs were positively associated with the development of CKD, while moderate consumption of NJs was inversely associated with CKD risk. More intensified policy efforts are warranted to reduce intake of SSBs and ASBs for CKD prevention.

The environmental and social opportunities of reducing sugar intake

Sugar is the largest agricultural crop by mass and has seen a rapid increase in consumption around the world. There are widespread public health efforts to curb sugar intake through targeted policies given its association with noncommunicable diseases. Although curbing sugar intake aligns with sustainable diets that meet essential environmental and health targets, such a shift may be challenging from a political economy perspective. Utilizing sugar for other purposes such as the production of microbial protein, biofuels, and bioplastics, or using sugar lands to grow other food items, or rewilding could provide health and environmental win-wins that could be more politically palatable. Here, we explore several potential scenarios to illustrate the option space from which national and international stakeholders could choose locally appropriate pathways for alternative utilization of sugar or its lands. While beneficial, such alternative pathways would require the integration of environmental, economic, and health policies to provide a smoother diet transition that reduces stakeholder tensions. Given the trade in sugar as a commodity crop, international approaches that compensate sugar producers for avoided production or incentivize them for redirecting sugars to other uses will be needed. Such approaches could borrow concepts from Just Transition Partnerships that have been applied to energy system transitions in ensuring a transition for major exporters of sugar cash crops across low- and middle-income nations.

An umbrella review of socioeconomic status and cancer

Extensive evidence underscores the pivotal role of socioeconomic status (SES) in shaping cancer-related outcomes. However, synthesizing definitive and actionable insights from the expansive body of literature remains a significant challenge. To elucidate the associations between SES, cancer outcomes, and the overall cancer burden, we conducted a comprehensive burden estimation coupled with an umbrella review of relevant meta-analyses. Our findings reveal that robust or highly suggestive meta-analytic evidence supports only a limited number of these associations. Individuals with lower SES, compared to those with higher SES, are disproportionately disadvantaged by reduced access to immunotherapy, KRAS testing for colorectal cancer, targeted cancer therapies, and precision treatments for melanoma. Additionally, they exhibit lower rates of breast cancer screening and higher incidence rates of lung cancer. Furthermore, countries with a higher Human Development Index demonstrate a substantially greater burden related cancer incidence, with this disparity being more pronounced among men than women.

Toxic AGEs (TAGE) Cause Lifestyle-Related Diseases

Advanced glycation end-products (AGEs) play a role in the onset/progression of lifestyle-related diseases (LSRD), suggesting that the suppression of AGE-induced effects can be exploited to prevent and treat LSRD. However, AGEs have a variety of structures with different biological effects. Glyceraldehyde (GA) is an intermediate of glucose, and fructose metabolism and GA-derived AGEs (GA-AGEs) have been associated with LSRD, leading to the concept of toxic AGEs (TAGE). Elevated blood TAGE levels have been implicated in the onset/progression of LSRD; therefore, the measurement of TAGE levels may enable disease prediction at an early stage. Moreover, recent studies have revealed the structures and degradation pathways of TAGE. Herein, we provide an overview of the research on TAGE. The TAGE theory provides novel insights into LSRD and is expected to elucidate new targets for many diseases.

Effectiveness and clinical relevance of kinesio taping in musculoskeletal disorders: a protocol for an overview of systematic reviews and evidence mapping

INTRODUCTION

Kinesio taping (KT) has been extensively applied in the management of musculoskeletal disorders (MSDs). Although plentiful systematic reviews (SRs) have evaluated its efficacy, there are no convincing conclusions due to dispersed and inconclusive results, and its clinical relevance remains unclear. Hence, there is a need to summarise all the SRs for comprehensive and consistent evidence. This overview aims to appraise the overall effectiveness of KT in MSDs and provide evidence maps to visualise the findings.

METHOD AND ANALYSIS

Electronic databases (Cochrane Database of Systematic Reviews, MEDLINE, Embase, Epistemonikos, PEDro, Scopus and ISI Web of Science) and reference lists will be searched from inception to September 2024 for the SRs of randomised controlled trials (RCTs). The SRs involving comparisons of the effectiveness between single or adjunctive KT and other interventions for patients with MSDs will be included. The primary and additional outcomes to be considered will be the core outcome set, and the patient-reported outcome measure and patient-important outcome, respectively. Two reviewers will independently screen and select studies, extract the data and evaluate the reporting and methodological quality of eligible SRs as well as the risk of bias of included RCTs. For the SRs without meta-analysis, we will collate the number of RCTs that showed any differences in outcomes. For the SRs with meta-analysis, we will provide the original summary of evidence (eg, pooled effects and heterogeneity) for outcomes with an evaluation of missing results and clinical relevance. The certainty of each outcome will be measured, and user-friendly maps of findings will be presented graphically.

ETHICS AND DISSEMINATION

Formal ethical approval for this study is not required since the data will be only collected from published literature in public databases. The results will be disseminated in the peer-reviewed academic journal, and relevant datasets will be preserved in the online repository.

PROSPERO REGISTRATION NUMBER

CRD42024517528.

Food Compass 2.0 is an improved nutrient profiling system to characterize healthfulness of foods and beverages

Food Compass is a nutrient profiling system used to assess the healthfulness of diverse foods, beverages and meals. Here we present a revised version of Food Compass (Food Compass 2.0) incorporating new data on specific ingredients and the latest diet-health evidence. Food Compass 2.0 has been validated against health outcomes in a population from the United States and demonstrates enhanced ability to characterize foods and beverages based on their healthfulness.

The Consumption of Non-Sugar Sweetened and Ready-to-Drink Beverages as Emerging Types of Beverages in Shanghai

BACKGROUND

The Chinese beverage industry is experiencing rapid growth, particularly in the popularity of non-sugar sweetened beverages (NSSs) and ready-to-drink beverages (RSBs). This study aimed to assess current consumption patterns and determinants of various beverage types among retail visitors.

METHODS

A total of 44 observation points, including 22 supermarkets and 22 convenience stores, were randomly selected across Shanghai. At each location, at least 100 individuals were recruited to participate. Data were collected using an electronic self-administered questionnaire.

RESULTS

The consumption rates of total beverages, sugar-sweetened beverages, NSSs, and RSBs were 57.70%, 56.94%, 19.60%, and 29.50%, respectively; the median consumption amounts among the drinking population were 162.57 mL/day, 137.98 mL/day, 32.85 mL/day, and 32.85 mL/day, respectively. The consumption proportions of NSSs and RSBs ranked 2nd and 3rd. The multifactorial analyses showed that people aged 6-18 years consumed more beverages (p < 0.05). Males were more likely to consume sugar-sweetened beverages and NSSs, but females were more likely to consume RSBs (p < 0.05). Higher educated people and bachelors were more likely to consume beverages (p < 0.05).

CONCLUSIONS

The emerging beverage categories, NSSs and RSBs, warrant attention due to their significant consumption rates. Tailored intervention strategies should be considered for demographic groups varying by age, gender, and educational attainment.

The Impact of Non-Fiscal Mandatory and Voluntary Policies and Interventions on the Reformulation of Food and Beverage Products: A Systematic Review

Background/Objectives: Low quality diets are a risk factor for non-communicable diseases; therefore, improving diet quality is a public health and policy priority in the UK and elsewhere. Reformulating food/beverage products to make them healthier may be an effective approach. Evidence suggests that fiscal interventions, notably taxes/levies on soft drinks, can lead to reformulation but the evidence for voluntary or mandated non-fiscal interventions is less clear. We aimed to review and synthesise contemporary evidence to determine whether non-fiscal policies/interventions result in the reformulation of food/beverage products Methods: In April 2023, we systematically searched ten international academic and nine grey literature databases. We included real-world study designs, all nutrients, in- and out-of-home sectors, and studies published from 2013, to ensure policy relevancy. We excluded modelling studies. Using the Synthesis Without Meta-Analysis method we conducted vote counting of studies based on the direction of effect and narrative synthesis by intervention type. Risk of bias was assessed using a tool developed by the EPPI-Centre and quality was assessed using GRADE. Results: We included 77 real-world studies from 19 countries, reporting 100 non-fiscal policies/interventions. Most commonly, these were reduction targets (n = 44), front-of-pack labels (n = 23), and advertising standards (n = 9). Most interventions were voluntary (n = 67), compared to mandatory (n = 33), and focused on the in-home sector (n = 63). The vote counting results showed non-fiscal policies/interventions overall led to improvements in reformulation in 60/63 studies with a valid direction of effect (95%, 95% CI 0.869, 0.984, p < 0.001). Mandatory implementations were more successful than voluntary implementations with 15/15 showing an improvement (100%, 95% CI 0.796, 1], p < 0.001), compared 40/43 showing an improvement (93%, 95% CI 0.814, 0.976, p < 0.001). Most of the studies were of low quality, due to the observational nature of the studies. Sodium was the most commonly targeted nutrient (n = 56) and was found to be reformulated in most studies. Causation is difficult to establish from real-world studies, but evidence suggests that regulatory and multi-component strategies may be effective at driving reformulation. Conclusions: Non-fiscal policies/interventions can play an important role in driving reformulation, alongside fiscal measures. This work was funded by the National Institute for Health and Care Research PRP-PRU-02-15-Healthy Weight and registered on Open Science Framework.

Adverse pregnancy outcomes and multiple cancers risk in both mother and offspring: an umbrella review of systematic reviews with meta-analyses of observational studies

BACKGROUND

Adverse pregnancy outcomes have reached epidemic proportions in recent years with serious health ramifications, especially for diverse cancers risk. Therefore, we carried out an umbrella review to systematically evaluate the validity and strength of the data and the extent of potential biases of the established association between adverse pregnancy outcomes and cancers risk in both mother and offspring.

METHODS

PubMed, Embase, and Web of Science databases were searched from inception until 18 January 2024. Meta-analyses of observational studies investigating the relationship between adverse pregnancy outcomes and multiple cancers risk in both mother and offspring were included. Evidence certainty was assessed using Grading of Recommendations, Assessment, Development, and Evaluation. The protocol for this umbrella review was prospectively registered in PROSPERO (CRD42023470544).

RESULTS

The search identified 129 meta-analyses of observational studies and 42 types of cancer. Moderate certainty of evidence, exhibiting statistical significance, has been observed linking per kilogram increase in birth weight to a heightened risk of breast cancer (OR = 1.07, 95% CI = 1.02-1.12), prostate cancer (OR = 1.02, 95% CI = 1.00-1.05), leukemia (OR = 1.18, 95% CI = 1.13-1.23), and acute lymphoblastic leukemia in offspring (OR = 1.18, 95% CI = 1.12-1.23); rubella infection during pregnancy to an increased risk of leukemia in offspring (OR = 2.79, 95% CI = 1.16-6.71); and a linear dose-response association between an increase in the proportion of optimal birth weight and an elevated risk of acute lymphoblastic leukemia in offspring (OR = 1.16, 95% CI = 1.09-1.24), respectively.

CONCLUSIONS

Although some adverse pregnancy outcomes have clinically promising associations with risk of several cancers in both mother and offspring, it is essential to conduct additional research to solidify the evidence, evaluate causality, and ascertain clinical utility.

Excess dietary sugar and its impact on periodontal inflammation: a narrative review

INTRODUCTION

Sugar is omnipresent in the current food environment and sugar consumption has drastically risen over the past century. Extensive evidence highlights the negative health consequences of consuming excess dietary sugars, leading the World Health Organization (WHO) and the American Heart Association (AHA) to devise guidelines to restrict sugar intake. According to the WHO's Global Oral Health Status Report of 2022, oral diseases and severe periodontitis are a massive public health problem, and dietary sugars are a modifiable risk factor.

METHODS

We conducted a literature review using key databases to summarise the health effects of excessive sugar consumption and their potential role in periodontal inflammation.

RESULTS AND CONCLUSION

Available evidence suggests that excess dietary fructose and sucrose can cause low-grade systemic inflammation; and induce dysbiosis in both gut and the oral microbiota. Also, dietary sugar is potentially addictive and hypercaloric and its overconsumption can lead to obesity, metabolic syndrome, and other risk factors for periodontal inflammation. Hence, an unbalanced diet with excess dietary sugars holds the potential to initiate and aggravate periodontal inflammation. In the modern food environment that enables and facilitates a high-sugar diet, adopting a diverse diet and restricting sugar intake according to WHO and AHA guidelines seem beneficial to systemic and periodontal health. Since clinical evidence is limited, future research should study the effectiveness of dietary interventions that control sugar consumption in preventing and managing the global public health problem of periodontal inflammation.

Revisiting the association between pretreatment thrombocytosis and cancer survival outcomes: an umbrella review of meta-analyses

BACKGROUND

Although associations have been reported linking pretreatment thrombocytosis to cancer survival outcomes, the validity and strength of existing observational evidence have been contested. This study aimed to conduct an umbrella review to comprehensively appraise the strength, validity and credibility of these reported associations.

METHODS

We searched Medline, Embase and Cochrane Database of Systematic Reviews from inception to 8 April 2023 to retrieve meta-analyses of observational studies. Meta-analyses were re-performed using a random-effect model and the strength of evidence was graded as convincing, highly suggestive, suggestive and weak according to seven pre-defined quantitative criteria reflecting statistical significance, amount of data, heterogeneity, and evidence of bias. The quality of review was appraised using the AMSTAR2 checklist. The umbrella review was reported adhering to the PRISMA guideline and was registered on PROSPERO (CRD42023455391).

RESULTS

A total of 21 unique meta-analyses investigating ten cancer subtypes were included. All meta-analyses reported inferior survival outcome in cancer patients with pretreatment thrombocytosis, and 18 of them (85.7%) yielded statistically significant results (P < 0.05). Consistent effects were observed across meta-analyses that adopted different cut-off values (i.e. platelet count > 300 or 400 × 109 /L) to define thrombocytosis. Although evidence appraisal did not identify convincing evidence (Class I), the associations of thrombocytosis with inferior overall survival of lung, gastric, colorectal cancer and malignant mesothelioma were classified as highly suggestive evidence (Class II). According to AMSTAR2 ratings, no meta-analysis was identified with high or moderate quality.

CONCLUSIONS

Our findings consolidated the association between pretreatment thrombocytosis and poor survival outcomes in various cancers. Nonetheless, the absence of convincing associations indicates a need for further large-scale, high-quality evidence to confirm whether platelets can serve as a prognostic predictor or a therapeutic target.

Acupuncture for Aromatase Inhibitor-Induced Arthralgia in Breast Cancer: An Umbrella Review

Background

Acupuncture therapy shows promise in managing aromatase inhibitor-induced arthralgia (AIA) among breast cancer patients. An umbrella review synthesizes findings from systematic reviews and meta-analyses (SRs/MAs) to assess its effectiveness.

Summary

This umbrella review aimed to evaluate the effectiveness of acupuncture therapy in treating AIA among breast cancer patients by analyzing existing evidence from SRs/MAs.

Key Messages

Six SRs/MAs were analyzed, revealing shortcomings in reporting quality, methodological quality, and evidence quality assessment. Comprehensive searches across eight electronic databases were conducted. PRISMA, AMSTAR 2, and GRADE were utilized to assess reporting, methodological quality, and evidence quality, respectively. Despite methodological shortcomings, a recent meta-subgroup analysis suggests the efficacy of acupuncture therapy for AIA patients, recommending a 10-session treatment course.

Conclusion

Acupuncture is identified as a secure and effective remedy for AIA sufferers, yet further high-quality research is needed to strengthen the evidence base and endorse acupuncture as a viable treatment option.

Association of unsweetened and sweetened cereal consumption with all-cause and cause-specific mortality: a large prospective population-based cohort study

Background & aims: Although previous observational studies have suggested an association between whole grain consumption (including breakfast cereals) and a reduced risk of death, no study has explored in detail the association between consumption of cereal with or without added sweeteners and death. We therefore aimed to evaluate the association between unsweetened, sugar-sweetened, and artificially sweetened cereals and all-cause and cause-specific mortality. Methods: We conducted a prospective cohort study of 186 419 UK Biobank participants who met the inclusion criteria for this study. Participants with baseline demographic, lifestyle, dietary, and clinical data were recruited from 2006 to 2010 and followed up until 2023. The intake of unsweetened, sugar-sweetened, or artificially sweetened cereals was estimated through repeated 24 hour dietary recalls. The non-linear relationships between daily dosage of cereal and all-cause, cancer-specific, and cardiovascular disease (CVD)-specific mortality were calculated using a restricted cubic spline curve. Hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality were calculated using Cox regression models. Results: During a median follow-up of 13.6 years, 11 351 all-cause deaths were recorded, including 6176 cancer deaths and 2126 CVD deaths. Cox regression models with restricted cubic splines showed a non-linear association between unsweetened cereals and all-cause and cancer-specific mortality. Compared with non-consumers, consumers of different amounts of unsweetened cereals (0 to 0.5, 0.5 to 1.5, and >1.5 bowls per day) had lower risks of all-cause mortality in the multivariate Cox models, with respective HRs of 0.89 (95%CI: 0.84-0.95), 0.90 (95%CI: 0.86-0.94), and 0.89 (95%CI: 0.82-0.97). However, no association was observed between consumption of sugar or artificially sweetened cereals and the risk of mortality. When cereals were divided into those with or without dried fruit, the findings were consistent with our primary results. Conclusions: Moderate consumption of unsweetened cereals was associated with a reduced risk of all-cause mortality, suggesting caution in consuming cereals with added sugar or artificial sweeteners.

Prevalence of newly diagnosed hypertension and its associated factors in an opportunistic screening program in Addis Ababa, Ethiopia: an institution-based cross-sectional study

BACKGROUND

Hypertension is a recognized risk factor that underlies the epidemic of cardiovascular diseases. Guidelines, including those from the European Society of Hypertension, recommend opportunistic screening for hypertension in all adults. However, there have been no institution-based studies on the prevalence of hypertension and its associated factors with an opportunistic screening program in Ethiopia. Hence, this study aimed to assess the prevalence of newly diagnosed hypertension and its associated factors in an opportunistic screening program in Ethiopia.

METHODS

This was an institution-based cross-sectional study conducted on adult participants in an opportunistic hypertension screening program at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, from November 1, 2023, to February 1, 2024. Data were collected using a structured questionnaire, constructed as per the WHO STEPwise approach to non-communicable disease risk factor surveillance (STEPS). The data was analyzed using Statistical Package for Social Sciences (SPSS), version 26. Descriptive analysis was used to compile the sociodemographic and clinical characteristics of the participants, and logistic regression analyses were performed to determine the factors associated with hypertension.

RESULTS

A total of 301 adult participants were included in this study. The mean age of the participants was 47.6 years (standard deviation: 13.5), and 62.5% were males. The prevalence of newly diagnosed hypertension was 36.2% (95% confidence interval [CI]: 5.6, 66.8). Male sex (adjusted odds ratio (AOR) = 2.06, 95% (CI): 1.05, 4.04), being married (AOR = 4.8, 95% CI: 1.84, 2.77) or widowed (AOR = 5.14, 95% CI: 1.23, 1.46), less frequent intake of vegetables and/or fruits [< 3 days per week (AOR = 2.88, 95% CI: 1.12, 7.39), and 3 to 5 days per week (AOR = 2.22, 95% CI: 1.02, 4.86)], physical inactivity (AOR = 2.26, 95% CI: 1.21, 4.22), and body mass index (AOR = 1.17, 95% CI: 1.09, 1.26), had significant associations with hypertension.

CONCLUSION

This study demonstrated a high prevalence of newly diagnosed hypertension in an opportunistic screening program in Addis Ababa, Ethiopia. It also revealed that most of the factors significantly associated with hypertension were modifiable, underscoring the importance of promoting lifestyle changes. Most importantly, expanding institution-based opportunistic screening programs could be an effective approach to maximize the detection of hypertension and improve access to its treatment.

Obesity, Metabolic Syndrome, and Sugar-Sweetened Beverages (SSBs) in America: A Novel Bioethical Argument for a Radical Public Health Proposal

The prevalence of obesity, metabolic syndrome, and the associated long-term chronic diseases (cardiovascular disease, type II diabetes, cancer, Alzheimer's disease, depression) have reached epidemic levels in the United States and Western nations. In response to this public health calamity, the author of this paper presents and defends a novel bioethical argument: the consistency argument for outlawing SSBs (sugar-sweetened beverages) for child consumption (the "consistency argument"). This argument's radical conclusion states that the government is justified in outlawing SSBs consumption for child consumption. The reasoning is as follows: if one accepts that the physical harm caused by chronic alcohol consumption justifies the government outlawing alcoholic beverages for child consumption, and there is strong evidence that comparable physical harms result from chronic SSBs consumption, then, mutatis mutandis, the government is also justified in outlawing child consumption of SSBs. To support this argument, the author provides extensive evidence based on epidemiological observational studies, interventional studies, controlled trials, large meta-analyses, and the pathophysiology and biological mechanisms of action behind SSBs and chronic disease. Chronic consumption of large doses of SSBs and alcoholic beverages both drive the same diseases: obesity and insulin resistance, cardiovascular disease, hypertension, and cancer. Chronic SSB consumption carries the additional risk of Alzheimer's disease, dementia, and depression. The author concludes this paper by considering prominent objections to the consistency argument, and then demonstrating that each objection is unsound.

Carcinogenic health outcomes associated with endocrine disrupting chemicals exposure in humans: A wide-scope analysis

Endocrine-disrupting chemicals (EDCs) are persistent and pervasive compounds that pose serious risks. Numerous studies have explored the effects of EDCs on human health, among which tumors have been the primary focus. However, because of study design flaws, lack of effective exposure levels of EDCs, and inconsistent population data and findings, it is challenging to draw clear conclusions on the effect of these compounds on tumor-related outcomes. Our study is the first to systematically integrate observational studies and randomized controlled trials from over 20 years and summarize over 300 subgroup associations. We found that most EDCs promote tumor development, and that exposure to residential environmental pollutants may be a major source of pesticide exposure. Furthermore, we found that phytoestrogens exhibit antitumor effects. The findings of this study can aid in the development of global EDCs regulatory health policies and alleviate the severe risks associated with EDCs exposure.

Effect of Replacing Sucrose in Beverages with Nonnutritive Sweetener Sucralose on Cardiometabolic Risk Factors Among Asian Indian Adults with Type 2 Diabetes: A 12-Week Randomized Controlled Trial

INTRODUCTION

Country-specific evidence-based research is crucial for understanding the role of nonnutritive sweeteners (NNS) in managing type 2 diabetes (T2D). The main aim of this study was to explore the effect of replacing sucrose with sucralose in coffee/tea in Asian Indians with type 2 diabetes (T2D).

METHODS

This 12-week, parallel-arm randomized controlled trial included 210 participants with T2D, assigned to the intervention group, where sugar/sucrose in coffee or tea was substituted with sucralose, or the control group, where sugar/sucrose was continued. Lifestyle factors remained unchanged. The primary outcome was change in HbA1c. Secondary outcomes were changes in body weight (BW), body mass index (BMI), waist circumference (WC), lipid profiles, and inflammatory markers.

RESULTS

At the end of 12 weeks, no change was observed in HbA1c, fasting plasma glucose, lipid profile, and inflammatory markers between or within groups. There was a small but significant reduction in BW (- 0.5 kg [95% CI - 1.0, - 0.1]; p = 0.02), BMI (- 0.2 kg/m2 [- 0.4, 0.0]; p = 0.03), and WC (- 0.8 cm [- 1.4, - 0.3]; p = 0.002) in the intervention group. Improvements were also observed in lipid accumulation product (p = 0.01), visceral adiposity index (p = 0.04), triglyceride/glucose index (p = 0.04), total energy intake (p = 0.04), and carbohydrate intake (p < 0.0001).

CONCLUSIONS

In Asian Indians with T2D, replacing about 60 kcal of added sucrose with sucralose in coffee/ tea had no benefit on glycemia but resulted in a small reduction in body weight, body mass index, and waist circumference.

TRIAL REGISTRATION

Clinical Trials Registry of India (CTRI/2021/04/032686).

Dietary Carbohydrates, Genetic Susceptibility, and Gout Risk: A Prospective Cohort Study in the UK

This study aimed to investigate the associations between carbohydrate intake and gout risk, along with interactions between genetic susceptibility and carbohydrates, and the mediating roles of biomarkers. We included 187,387 participants who were free of gout at baseline and completed at least one dietary assessment in the UK Biobank. Cox proportional hazard models were used to estimate the associations between carbohydrate intake and gout risk. Over a median follow-up of 11.69 years, 2548 incident cases of gout were recorded. Total carbohydrate intake was associated with a reduced gout risk (Q4 vs. Q1: HR 0.67, 95% CI 0.60-0.74), as were total sugars (0.89, 0.80-0.99), non-free sugars (0.70, 0.63-0.78), total starch (0.70, 0.63-0.78), refined grain starch (0.85, 0.76-0.95), wholegrain starch (0.73, 0.65-0.82), and fiber (0.72, 0.64-0.80), whereas free sugars (1.15, 1.04-1.28) were associated with an increased risk. Significant additive interactions were found between total carbohydrates and genetic risk, as well as between total starch and genetic risk. Serum urate was identified as a significant mediator in all associations between carbohydrate intake (total, different types, and sources) and gout risk. In conclusion, total carbohydrate and different types and sources of carbohydrate (excluding free sugars) intake were associated with a reduced risk of gout.