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Gao X, Zheng Q, Jiang X, Chen X, Liao Y, Pan Y. The effect of diet quality on the risk of developing gestational diabetes mellitus: A systematic review and meta-analysis. Front Public Health 2023; 10:1062304. [PMID: 36699870 PMCID: PMC9868748 DOI: 10.3389/fpubh.2022.1062304] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To examine the effect of diet quality on the risk of gestational diabetes mellitus. Methods This review included cohort and case-control studies reporting an association between diet quality and gestational diabetes mellitus. We searched PubMed, Cochrane Library, Web of Science, Embase, PsycINFO, CINAHL Complete, Chinese Periodical Full-text Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and China Wanfang Database for studies published from inception to November 18, 2022. The Newcastle-Ottawa Scale was used for quality assessment, and the overall quality of evidence was assessed using the GRADEpro GDT. Results A total of 19 studies (15 cohort, four case-control) with 108,084 participants were included. We found that better higher diet quality before or during pregnancy reduced the risk of developing gestational diabetes mellitus, including a higher Mediterranean diet (OR: 0.51; 95% CI: 0.30-0.86), dietary approaches to stop hypertension (OR: 0.66; 95% CI: 0.44-0.97), Alternate Healthy Eating Index (OR: 0.61; 95% CI: 0.44-0.83), overall plant-based diet index (OR: 0.57; 95% CI: 0.41-0.78), and adherence to national dietary guidelines (OR: 0.39; 95% CI:0.31-0.48). However, poorer diet quality increased the risk of gestational diabetes mellitus, including a higher dietary inflammatory index (OR: 1.37; 95% CI: 1.21-1.57) and overall low-carbohydrate diets (OR: 1.41; 95% CI: 1.22-1.64). After meta-regression, subgroup, and sensitivity analyses, the results remained statistically significant. Conclusions Before and during pregnancy, higher diet quality reduced the risk of developing gestational diabetes mellitus, whereas poorer diet quality increased this risk. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022372488.
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Affiliation(s)
- Xiaoxia Gao
- School of Nursing, Fujian Maternity and Child Health Hospital, Fujian Medical University, Fuzhou, China
| | - Qingxiang Zheng
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiumin Jiang
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China,*Correspondence: Xiumin Jiang ✉
| | - Xiaoqian Chen
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yanping Liao
- School of Nursing, Fujian Maternity and Child Health Hospital, Fujian Medical University, Fuzhou, China
| | - Yuqing Pan
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Kroke A, Schmidt A, Amini AM, Kalotai N, Lehmann A, Haardt J, Bauer JM, Bischoff-Ferrari HA, Boeing H, Egert S, Ellinger S, Kühn T, Louis S, Lorkowski S, Nimptsch K, Remer T, Schulze MB, Siener R, Stangl GI, Volkert D, Zittermann A, Buyken AE, Watzl B, Schwingshackl L. Dietary protein intake and health-related outcomes: a methodological protocol for the evidence evaluation and the outline of an evidence to decision framework underlying the evidence-based guideline of the German Nutrition Society. Eur J Nutr 2022; 61:2091-2101. [PMID: 35031889 PMCID: PMC9106629 DOI: 10.1007/s00394-021-02789-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The present work aimed to delineate (i) a revised protocol according to recent methodological developments in evidence generation, to (ii) describe its interpretation, the assessment of the overall certainty of evidence and to (iii) outline an Evidence to Decision framework for deriving an evidence-based guideline on quantitative and qualitative aspects of dietary protein intake. METHODS A methodological protocol to systematically investigate the association between dietary protein intake and several health outcomes and for deriving dietary protein intake recommendations for the primary prevention of various non-communicable diseases in the general adult population was developed. RESULTS The developed methodological protocol relies on umbrella reviews including systematic reviews with or without meta-analyses. Systematic literature searches in three databases will be performed for each health-related outcome. The methodological quality of all selected systematic reviews will be evaluated using a modified version of AMSTAR 2, and the outcome-specific certainty of evidence for systematic reviews with or without meta-analysis will be assessed with NutriGrade. The general outline of the Evidence to Decision framework foresees that recommendations in the derived guideline will be given based on the overall certainty of evidence as well as on additional criteria such as sustainability. CONCLUSION The methodological protocol permits a systematic evaluation of published systematic reviews on dietary protein intake and its association with selected health-related outcomes. An Evidence to Decision framework will be the basis for the overall conclusions and the resulting recommendations for dietary protein intake.
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Affiliation(s)
- Anja Kroke
- Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Leipziger Str. 123, 36037, Fulda, Germany.
| | | | | | | | | | | | - Jürgen M Bauer
- Center for Geriatric Medicine and Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Heike A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital and University of Zurich, Zurich, Switzerland
- City Hospital Zurich-Waid, Zurich, Switzerland
| | - Heiner Boeing
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Sarah Egert
- Institute of Nutrition and Food Science, University of Bonn, Bonn, Germany
| | - Sabine Ellinger
- Institute of Nutrition and Food Science, University of Bonn, Bonn, Germany
| | - Tilman Kühn
- Institute for Global Food Security, Queen's University Belfast, Belfast, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Sandrine Louis
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
| | - Stefan Lorkowski
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Jena, Germany
| | - Katharina Nimptsch
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine (MDC) in the Helmholtz Association, Berlin, Germany
| | - Thomas Remer
- DONALD Study Center Dortmund, Department of Nutritional Epidemiology, Institute of Nutrition and Food Science, University of Bonn, Dortmund, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Roswitha Siener
- Department of Urology, University Stone Center, University Hospital Bonn, Bonn, Germany
| | - Gabriele I Stangl
- Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Anette E Buyken
- Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, Paderborn, Germany
| | - Bernhard Watzl
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Frehner A, De Boer IJM, Muller A, Van Zanten HHE, Schader C. Consumer strategies towards a more sustainable food system: insights from Switzerland. Am J Clin Nutr 2022; 115:1039-1047. [PMID: 34871355 PMCID: PMC8971011 DOI: 10.1093/ajcn/nqab401] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/06/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To improve the sustainability performance of food systems, both consumption- and production-side changes are needed. OBJECTIVES To this end, we assessed multiple sustainability impacts of 6 consumer strategies together with production-side aspects such as organic and circularity principles for Switzerland. METHODS Two strategies encompassed dietary changes: following a pescetarian diet and adhering to the national dietary guidelines. Two strategies employed alternative farming systems: increasing the share of organic production and, in addition, applying the circularity principle of avoiding feed-food competition by limiting livestock feed to low-opportunity-cost biomass. A fifth strategy reduced food waste. The sixth strategy increased the share of domestic produce. For all strategies, we assessed greenhouse gas emissions, land use, nitrogen surplus, social risks, diet quality, and diet costs. RESULTS The strategies revealed trade-offs between impact categories, unless combined in a synergistic way. Whereas dietary changes towards more plant-based diets reduced environmental impacts (≤51%) and increased diet quality (≤57%), they increased social risks due to increased sourcing from contexts with potentially bad labor conditions (≤19%). Further, when the share of organic produce was increased, land use and dietary costs were increased (≤33% and ≤42%, respectively). The effect on land use could, however, be reversed when circularity principles were introduced in addition to the organic production standard, resulting in reductions for all environmental indicators (≤75%). Reducing food waste and increasing the share of domestic produce led to better sustainability performance as well, but at lower orders of magnitude. CONCLUSIONS Combining all proposed strategies could lead to substantial favorable changes on all impact categories assessed, but would require a thorough transformation of the current food system. However, the sum of individual consumers each following only 1 of the strategies proposed would make an important contribution towards improving the sustainability performance of the Swiss food system.
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Affiliation(s)
- A Frehner
- Department of Socioeconomics, Research Institute of Organic Agriculture FiBL, Frick, Switzerland
- Animal Production Systems group, Wageningen University & Research, Wageningen, the Netherlands
- Farming Systems Ecology group, Wageningen University & Research, Wageningen, the Netherlands
| | - I J M De Boer
- Animal Production Systems group, Wageningen University & Research, Wageningen, the Netherlands
| | - A Muller
- Department of Socioeconomics, Research Institute of Organic Agriculture FiBL, Frick, Switzerland
- Institute of Environmental Decisions, Federal Institutes of Technology Zurich ETHZ, Zurich, Switzerland
| | - H H E Van Zanten
- Farming Systems Ecology group, Wageningen University & Research, Wageningen, the Netherlands
| | - C Schader
- Department of Socioeconomics, Research Institute of Organic Agriculture FiBL, Frick, Switzerland
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Schwingshackl L, Schünemann HJ, Meerpohl JJ. Improving the trustworthiness of findings from nutrition evidence syntheses: assessing risk of bias and rating the certainty of evidence. Eur J Nutr 2021; 60:2893-2903. [PMID: 33377996 PMCID: PMC8354882 DOI: 10.1007/s00394-020-02464-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023]
Abstract
Suboptimal diet is recognized as a leading modifiable risk factor for non-communicable diseases. Non-randomized studies (NRSs) with patient relevant outcomes provide many insights into diet-disease relationships. Dietary guidelines are based predominantly on findings from systematic reviews of NRSs-mostly prospective observational studies, despite that these have been repeatedly criticized for yielding potentially less trustworthy results than randomized controlled trials (RCTs). It is assumed that these are a result of bias due to prevalent-user designs, inappropriate comparators, residual confounding, and measurement error. In this article, we aim to highlight the importance of applying risk of bias (RoB) assessments in nutritional studies to improve the credibility of evidence of systematic reviews. First, we discuss the importance and challenges of dietary RCTs and NRSs, and provide reasons for potentially less trustworthy results of dietary studies. We describe currently used tools for RoB assessment (Cochrane RoB, and ROBINS-I), describe the importance of rigorous RoB assessment in dietary studies and provide examples that further the understanding of the key issues to overcome in nutrition research. We then illustrate, by comparing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach with current approaches used by United States Department of Agriculture Dietary Guidelines for Americans, and the World Cancer Research Fund, how to establish trust in dietary recommendations. Our overview shows that the GRADE approach provides more transparency about the single domains for grading the certainty of the evidence and the strength of recommendations. Despite not increasing the certainty of evidence itself, we expect that the rigorous application of the Cochrane RoB and the ROBINS-I tools within systematic reviews of both RCTs and NRSs and their integration within the GRADE approach will strengthen the credibility of dietary recommendations.
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Affiliation(s)
- Lukas Schwingshackl
- Faculty of Medicine, Institute for Evidence in Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, Department of Medicine, McMaster University, Hamilton, Canada
| | - Joerg J Meerpohl
- Faculty of Medicine, Institute for Evidence in Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
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Schwingshackl L, Zähringer J, Beyerbach J, Werner SS, Nagavci B, Heseker H, Koletzko B, Meerpohl JJ. A Scoping Review of Current Guidelines on Dietary Fat and Fat Quality. ANNALS OF NUTRITION AND METABOLISM 2021; 77:65-82. [PMID: 34139694 DOI: 10.1159/000515671] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We conducted a scoping review of dietary guidelines with the intent of developing a position paper by the "IUNS Task force on Dietary Fat Quality" tasked to summarize the available evidence and provide the basis for dietary recommendations. METHODS We systematically searched several databases and Web sites for relevant documents published between 2015 and 2019. RESULTS Twenty documents were included. Quantitative range intake recommendations for daily total fat intake included boundaries from 20 to 35% of total energy intake (TEI), for monounsaturated fat (MUFA) 10-25%, for polyunsaturated fat (PUFA) 6-11%, for saturated-fat (SFA) ≤11-≤7%, for industrial trans-fat (TFA) ≤2-0%, and <300-<200 mg/d for dietary cholesterol. The methodological approaches to grade the strength of recommendations were heterogeneous, and varied highly between the included guidelines. Only the World Health Organization applied the GRADE approach and graded the following recommendation as "strong": to reduce SFA to below 10%, and TFA to below 1% and replace both with PUFA if SFA intake is greater than 10% of TEI. CONCLUSION Although the methodological approaches of the dietary guidelines were heterogeneous, most of them recommend total fat intakes of 30-≤35% of TEI, replacement of SFA with PUFA and MUFA, and avoidance of industrial TFA.
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Affiliation(s)
- Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jasmin Zähringer
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jessica Beyerbach
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sarah S Werner
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Helmut Heseker
- Department of Sports and Health, Paderborn University, Paderborn, Germany
| | - Berthold Koletzko
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr. von Hauner Children's Hospital, LMU - Ludwig-Maximilians-Universität Munich, University of Munich Medical Center, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
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