PECOTS
What is the "E"?
High consumption of sugar-sweetened beverages
Which studies were excluded during the database search and why?
Cross-sectional studies excluded due to high potential of confounding and reverse causation
What database was searched? What time period?
MEDLINE database from 1966 to May 2010
What is publication bias?
When one study is more likely to be published than another; Not publishing studies that show less or no benefit will lead to publication bias
What is the "O"?
Developing metabolic syndrome and/or Type 2 diabetes
List some inclusion/exclusion criteria used to eliminate studies during the database search
Inclusion: A prospective cohort design, end points of type 2 diabetes and metabolic syndrome, definition, and metric for SSB intake and description of adjustment for potential confounders
Exclusion: Cross sectional studies, etc.
What key words were searched? (Provide 3)
“soda,” “soda-pop,” and “sugar-sweetened beverage” combined with “diabetes,” “type 2 diabetes,” and “metabolic syndrome”
What was the highest quantile of SSB intake?
2 or more servings/day
What is the "P"?
Individuals at risk for metabolic syndrome or type 2 diabetes
Adjustments were done for what potential confounding factors.
Diet, lifestyle factors, adiposity, duration of follow-up
What was the questionnaire to evaluate dietary intake called in many of the studies? Bonus: Why was this a strength?
Food Frequency Questionnaire (FFQs). It is better at estimating “usual diet” due to longer recall periods than others such as 24-hour Recall. Faster to implement if the food list is short, as opposed to recall.
What is the standard serving size?
12oz
What was the "C"?
Individuals who do not consume sugar-sweetened beverages, or those with lower consumption levels (0-1 servings)
List some criteria for metabolic syndrome (there were 5, list 2)
waist circumference ≥102 (men) or ≥88 cm (women),
triglycerides ≥150 mg/dl,
HDL cholesterol ≤40 (men) or ≤50 mg/dl (women),
blood pressure ≥135/85 mmHg or antihypertensive treatment,
fasting glucose ≥100 mg/dl or antihyperglycemic treatment/insulin.
What is the minimum number of criteria that need to be met for a person to be diagnosed with metabolic syndrome according to the modified National Cholesterol Education Program Adult Treatment Panel III definition?
Three or more criteria need to be met for a diagnosis of metabolic syndrome.
What does a pooled RR of 1.26 indicate? (___% higher risk of developing type 2 diabetes)
26% higher risk of developing type 2 diabetes in individuals with hig consumption of SSB compared to lower consumption of SSB
What is the "T" and "S"?
Time: Meta-analysis on prospective cohort studies (4-20 years in follow up duration)
Setting: US, Finland, Singapore
How did we know that the meta-analysis had significant heterogeneity among studies? (hint: what measured this heterogeneity)
A statistic called I2 was used to quantify the degree of heterogeneity among studies, and an I2 value of greater than 50% is general considered to represent significant heterogeneity.
How can a person be diagnosed with type 2 diabetes if they are not meeting the fasting glucose criteria, according to the guidelines?
A person can be diagnosed with type 2 diabetes if they are on current hypoglycemic medications or have a self-reported physician diagnosis, in addition to other criteria.
What implications does this meta-analysis have on the public perception of SSBs? (describe 1)
Suggest that SSBs should be limited and replaced by healthier alternatives
Prioritization of public health problems
SSBs being perceived in negative light because of adverse effects (Decline in sales, shift in consumer preferences, government regulations)