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Food groups and intermediate disease markers: a systematic review and network meta-analysis of randomized trials

Schwingshackl, Lukas; Hoffmann, Georg; Iqbal, Khalid; Schwedhelm, Carolina; Boeing, Heiner

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Background: In previous meta-analyses of prospective observational studies, we investigated the association between food groups and risk of chronic disease. Objective: The aim of the present network meta-analysis (NMA) was to assess the effects of these food groups on intermediate-disease markers across randomized intervention trials. Design: Literature searches were performed until January 2018. The following inclusion criteria were defined a priori: 1) randomized trial (≥4 wk duration) comparing ≥2 of the following food groups: refined grains, whole grains, nuts, legumes, fruits and vegetables, eggs, dairy, fish, red meat, and sugar-sweetened beverages (SSBs); 2) LDL cholesterol and triacylglycerol (TG) were defined as primary outcomes; total cholesterol, HDL cholesterol, fasting glucose, glycated hemoglobin, homeostasis model assessment insulin resistance, systolic and diastolic blood pressure, and C-reactive protein were defined as secondary outcomes. For each outcome, a random NMA was performed, and for the ranking, the surface under the cumulative ranking curves (SUCRA) was determined. Results: A total of 66 randomized trials (86 reports) comparing 10 food groups and enrolling 3595 participants was identified. Nuts were ranked as the best food group at reducing LDL cholesterol (SUCRA: 93%), followed by legumes (85%) and whole grains (70%). For reducing TG, fish (97%) was ranked best, followed by nuts (78%) and red meat (72%). However, these findings are limited by the low quality of the evidence. When combining all 10 outcomes, the highest SUCRA values were found for nuts (66%), legumes (62%), and whole grains (62%), whereas SSBs performed worst (29%). Conclusion: The present NMA provides evidence that increased intake of nuts, legumes, and whole grains is more effective at improving metabolic health than other food groups. For the credibility of diet-disease relations, high-quality randomized trials focusing on well-established intermediate-disease markers could play an important role.

Automatic Tags

Insulin Resistance; Fasting; Homeostasis; Blood Glucose; Human; Meat; Dairy Products; network meta-analysis; Systematic Review; Eggs; Fruit; Vegetables; Nuts; Randomized Controlled Trials; Cholesterol -- Blood; Fish; Biological Markers; Cereals; Lipoproteins, HDL Cholesterol -- Blood; Lipoproteins, LDL Cholesterol -- Blood; Triglycerides -- Blood; Legumes; Chronic Disease -- Risk Factors; Sweetened Beverages; C-Reactive Protein -- Blood; Hemoglobin A, Glycosylated -- Blood; Diastolic Pressure; evidence synthesis; intermediate disease markers; intervention trials; Systolic Pressure

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