Do sugar-sweetened beverages cause adverse health outcomes in children? A systematic review protocol The 2015 Dutch food-based dietary guidelines Impact of Diets Rich in Whole Grains and Fruits and Vegetables on Cardiovascular Risk Factors in Overweight and Obese Women: A Randomized Clinical Feeding Trial Energy compensation following consumption of sugar-reduced products: a randomized controlled trial The Association between Carbohydrate-Rich Foods and Risk of Cardiovascular Disease Is Not Modified by Genetic Susceptibility to Dyslipidemia as Determined by 80 Validated Variants Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. Household factors, family behavior patterns, and adherence to dietary and physical activity guidelines among children at risk for obesity. L-arginine supplementation and risk factors of cardiovascular diseases in healthy men: a double-blind randomized clinical trial. What do review papers conclude about food and dietary patterns? Dietary macronutrients and food consumption as determinants of long-term weight change in adult populations: a systematic literature review Effect of sugar-sweetened beverages on body weight in children: design and baseline characteristics of the Double-blind, Randomized INtervention study in Kids. Contextual socioeconomic determinants of cardiovascular risk factors in rural south-west China: a multilevel analysis Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis The effect of alpha-lipoic acid (ALA) supplementation on cardiovascular risk factors in men with chronic spinal cord injury: a clinical trial Mediterranean dietary components and body mass index in adults: the peel nutrition and heart health survey. Intake of Sweets, Snacks and Soft Drinks Predicts Weight Gain in Obese Pregnant Women: Detailed Analysis of the Results of a Randomised Controlled Trial Sweetened Beverage Consumption, Incident Coronary Heart Disease, and Biomarkers of Risk in Men
Background Cardiovascular disease and type 2 diabetes are examples of chronic diseases that impose significant morbidity and mortality in the general population worldwide . Most chronic diseases are associated with underlying preventable risk factors , such as elevated blood pressure , high blood glucose or glucose intolerance , high lipid levels , physical inactivity , excessive sedentary behaviours , and overweight/obesity . The occurrence of intermediate outcomes during childhood increases the risk of disease in adulthood . Sugar-sweetened beverages are known to be significant sources of additional caloric intake , and given recent attention to their contribution in the development of chronic diseases , a systematic review is warranted . We will assess whether the consumption of sugar-sweetened beverages in children is associated with adverse health outcomes and what the potential moderating factors are . Methods / Design Of interest are studies addressing sugar-sweetened beverage consumption , taking a broad perspective . Both direct consumption studies as well as those evaluating interventions that influence consumption ( e.g. school policy , educational ) will be relevant . Non-specific or multi-faceted behavioural , educational , or policy interventions may also be included subject to the level of evidence that exists for the other interventions /exposures . Comparisons of interest and endpoints of interest are pre-specified . We will include r and omized controlled trials , controlled clinical trials , interrupted time series studies , controlled before-after studies , prospect i ve and retrospective comparative cohort studies , case – control studies , and nested case – control design s. The MEDLINE ® , Embase , The Cochrane Library , CINAHL , ERIC , and PsycINFO ® data bases and grey literature sources will be search ed . The processes for selecting studies , abstract ing data , and resolving conflicts are described . We will assess risk of bias using design -specific tools . To determine sets of confounding variables that should be adjusted for , we have developed causal directed acyclic graphs and will use those to inform our risk of bias assessment s. Meta- analysis will be conducted where appropriate ; parameters for exploring statistical heterogeneity and effect modifiers are pre-specified . The Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach will be used to determine the quality of evidence for outcomes . Systematic review registration PROSPERO CRD42014009641 The objective of this study was to derive food-based dietary guidelines for the Dutch population . The dietary guidelines are based on 29 systematic review s of English language meta-analyses in PubMed summarizing r and omized controlled trials and prospect i ve cohort studies on nutrients , foods and food patterns and the risk of 10 major chronic diseases : coronary heart disease , stroke , heart failure , diabetes , breast cancer , colorectal cancer , lung cancer , chronic obstructive pulmonary disease , dementia and depression . The committee also selected three causal risk factors for cardiovascular diseases or diabetes : systolic blood pressure , low-density lipoprotein cholesterol and body weight . Findings were categorized as strong or weak evidence , inconsistent effects , too little evidence or effect unlikely for experimental and observational data separately . Next , the committee selected only findings with a strong level of evidence for deriving the guidelines . Convincing evidence was based on strong evidence from the experimental data either or not in combination with strong evidence from prospect i ve cohort studies . Plausible evidence was based on strong evidence from prospect i ve cohort studies only . A general guideline to eat a more plant food-based dietary pattern and limit consumption of animal-based food and 15 specific guidelines have been formulated . There are 10 new guidelines on legumes , nuts , meat , dairy produce , cereal products , fats and oils , tea , coffee and sugar-containing beverages . Three guidelines on vegetables , fruits , fish and alcoholic beverages have been sharpened , and the 2006 guideline on salt stayed the same . A separate guideline has been formulated on  nutrient supplements .  Completely food-based dietary guidelines can be derived in a systematic and transparent way ABSTRACT Objective : Previous interventions have reported desirable effects of diets rich in whole grains or rich in fruits and vegetables on cardiovascular disease ( CVD ) risk factors and weight management . However , data are lacking regarding the effect of these fiber sources separately . The aim of this r and omized clinical feeding trial was to investigate the effects of fiber-rich diets with different sources of fiber ( fruits , vegetables , and whole grains ) on weight loss and CVD risk factors in overweight and obese women . Methods : Overweight and obese women ( N = 75 ) were r and omized to one of three weight loss diets that were rich in whole grains , fruits and vegetables , or both for 10 weeks . Body weight , waist circumference , and risk factors of CVD were examined at baseline and 10 weeks . Results : During the 10-week dietary intervention phase , the reductions in weight ( p = 0.03 ) , waist circumference ( p = 0.001 ) , systolic blood pressure ( p = 0.04 ) , fasting blood sugar ( p = 0.03 ) , and triglycerides ( p = 0.001 ) were higher in the whole grains group compared with the fruits and vegetables group or the combination diet group . Also , the whole grain group had a greater increase ( p = 0.01 ) in high-density lipoprotein cholesterol compared to the other groups . The change in other risk factors , including diastolic blood pressure and low-density lipoprotein cholesterol , was not different among the three diet groups . Within-group comparisons revealed significant reductions in weight , waist circumference , and fasting blood sugar in all groups . Only the fruits and vegetables group and the whole grains group had significant decreases in low-density lipoprotein cholesterol over 10 weeks ( p ≤ 0.03 ) . Conclusions : This trial suggests that in overweight and obese women , a weight loss diet rich in whole grains may have a more beneficial effect on CVD risk factors than diets rich in fruits and vegetables or a combination of whole grains and fruits and vegetables . Trial registration : Clinical Trial.gov identifier : NCT03340298 Purpose Consumption of sugar-reformulated products ( commercially available foods and beverages that have been reduced in sugar content through reformulation ) is a potential strategy for lowering sugar intake at a population level . The impact of sugar-reformulated products on body weight , energy balance ( EB ) dynamics and cardiovascular disease risk indicators has yet to be established . The REFORMulated foods ( REFORM ) study examined the impact of an 8-week sugar-reformulated product exchange on body weight , EB dynamics , blood pressure , arterial stiffness , glycemia and lipemia . Methods A r and omized , controlled , double-blind , crossover dietary intervention study was performed with fifty healthy normal to overweight men and women ( age 32.0 ± 9.8 year , BMI 23.5 ± 3.0 kg/m2 ) who were r and omly assigned to consume either regular sugar or sugar-reduced foods and beverages for 8 weeks , separated by 4-week washout period . Body weight , energy intake ( EI ) , energy expenditure and vascular markers were assessed at baseline and after both interventions . Results We found that carbohydrate ( P < 0.001 ) , total sugars ( P < 0.001 ) and non-milk extrinsic sugars ( P < 0.001 ) ( % EI ) were lower , whereas fat ( P = 0.001 ) and protein ( P = 0.038 ) intakes ( % EI ) were higher on the sugar-reduced than the regular diet . No effects on body weight , blood pressure , arterial stiffness , fasting glycemia or lipemia were observed . Conclusions Consumption of sugar-reduced products , as part of a blinded dietary exchange for an 8-week period , result ed in a significant reduction in sugar intake . Body weight did not change significantly , which we propose was due to energy compensation Background It is still unclear whether carbohydrate consumption is associated with cardiovascular disease ( CVD ) risk . Genetic susceptibility might modify the associations between dietary intakes and disease risk . Objectives The aim was to examine the association between the consumption of carbohydrate-rich foods ( vegetables , fruits and berries , juice , potatoes , whole grains , refined grains , cookies and cakes , sugar and sweets , and sugar-sweetened beverages ) and the risk of incident ischemic CVD ( iCVD ; coronary events and ischemic stroke ) , and whether these associations differ depending on genetic susceptibility to dyslipidemia . Methods Among 26,445 individuals ( 44–74 years ; 62 % females ) from the Malmö Diet and Cancer Study cohort , 2,921 experienced an iCVD event during a mean follow-up time of 14 years . At baseline , dietary data were collected using a modified diet history method , and clinical risk factors were measured in 4,535 subjects . We combined 80 vali date d genetic variants associated with triglycerides and HDL-C or LDL-C , into genetic risk scores and examined the interactions between dietary intakes and genetic risk scores on the incidence of iCVD . Results Subjects in the highest intake quintile for whole grains had a 13 % ( 95 % CI : 3–23 % ; p-trend : 0.002 ) lower risk for iCVD compared to the lowest quintile . A higher consumption of foods rich in added sugar ( sugar and sweets , and sugar-sweetened beverages ) had a significant cross-sectional association with higher triglyceride concentrations and lower HDL-C concentrations . A stronger positive association between a high consumption of sugar and sweets on iCVD risk was observed among those with low genetic risk score for triglycerides ( p-interaction=0.05 ) . Conclusion In this prospect i ve cohort study that examined food sources of carbohydrates , individuals with a high consumption of whole grains had a decreased risk of iCVD . No convincing evidence of an interaction between genetic susceptibility for dyslipidemia , measured as genetic risk scores of dyslipidemia-associated variants , and the consumption of carbohydrate-rich foods on iCVD risk was observed CONTEXT Sugar-sweetened beverages like soft drinks and fruit punches contain large amounts of readily absorbable sugars and may contribute to weight gain and an increased risk of type 2 diabetes , but these relationships have been minimally addressed in adults . OBJECTIVE To examine the association between consumption of sugar-sweetened beverages and weight change and  risk of type 2 diabetes in women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort analyses conducted from 1991 to 1999 among women in the Nurses ' Health Study II . The diabetes analysis included 91,249 women free of diabetes and other major chronic diseases at baseline in 1991 . The weight change analysis included 51,603 women for whom complete dietary information and body weight were ascertained in 1991 , 1995 , and 1999 . We identified 741 incident cases of confirmed type 2 diabetes during 716,300 person-years of follow-up . MAIN OUTCOME MEASURES Weight gain and incidence of type 2 diabetes . RESULTS Those with stable consumption patterns had no difference in weight gain , but weight gain over a 4-year period was highest among women who increased their sugar-sweetened soft drink consumption from 1 or fewer drinks per week to 1 or more drinks per day ( multivariate-adjusted means , 4.69 kg for 1991 to 1995 and 4.20 kg for 1995 to 1999 ) and was smallest among women who decreased their intake ( 1.34 and 0.15 kg for the 2 periods , respectively ) after adjusting for lifestyle and dietary confounders . Increased consumption of fruit punch was also associated with greater weight gain compared with decreased consumption . After adjustment for potential confounders , women consuming 1 or more sugar-sweetened soft drinks per day had a relative risk [ RR ] of type 2 diabetes of 1.83 ( 95 % confidence interval [ CI ] , 1.42 - 2.36 ; P<.001 for trend ) compared with those who consumed less than 1 of these beverages per month . Similarly , consumption of fruit punch was associated with increased diabetes risk ( RR for > or = 1 drink per day compared with < 1 drink per month , 2.00 ; 95 % CI , 1.33 - 3.03 ; P = .001 ) . CONCLUSION Higher consumption of sugar-sweetened beverages is associated with a greater magnitude of weight gain and an increased risk for development of  type 2 diabetes in women , possibly by providing excessive calories and large amounts of rapidly absorbable sugars OBJECTIVE To describe the proportion of children adhering to recommended physical activity and dietary guidelines , and examine demographic and household correlates of guideline adherence . DESIGN Cross-sectional ( pre-r and omization ) data from a behavioral intervention trial design ed to prevent unhealthy weight gain in children . PARTICIPANTS A total of 421 children ( aged 5 - 10 years ) at risk for obesity ( body mass index percentile , 70 - 95 ) . MAIN OUTCOMES MEASURED Physical activity ( accelerometry ) , screen time ( parent survey ) , and fruit and vegetable and sugar-sweetened beverage intake ( 24-hour dietary recall ) . ANALYSIS Proportions meeting guidelines were calculated . Logistic regression examined associations between demographic and household factors and whether children met recommended guidelines for ( 1 ) physical activity ( ≥ 60 min/d ) , ( 2  ) screen time  ( ≤ 2 h/d ) , ( 3 ) fruit and vegetable intake ( ≥ 5 servings/d ) , and ( 4 ) sugar-sweetened beverage avoidance . RESULTS Few children met more than 1 guideline . Only 2 % met all 4 recommended guidelines and 19 % met none . Each guideline had unique sociodemographic and domain-specific household predictors ( ie , availability of certain foods and beverages , media , and active play and exercise equipment ) . CONCLUSIONS AND IMPLICATION S Families equipped to promote healthy child behavior patterns in 1 activity or dietary domain may not be in others . Results have implication s for the development of interventions to affect children 's weight-related behaviors and growth trajectories Context : The effect of L-arginine on risk factors of cardiovascular diseases ( CVD ) has mostly focused on western countries . Since cardiovascular diseases is the second cause of death in Iran and , as far as we are aware , there have been no studies about the effect of L-arginine on CVD risk factors , the aim of this trial was to assess the effects of L-arginine supplementation on CVD risk factors in healthy men . Objective : The purpose of this study was to evaluate the effect of low-dose L-arginine supplementation on CVD risk factors ( lipid profile , blood sugar and blood pressure ) in Iranian healthy men . Design , setting , participants : We conducted a double-blind r and omized controlled trial in 56 patients selected from sport clubs at the Isfahan University of Medical Science between November 2013 and December 2013 . Interventions : Healthy men received L-arginine supplementation ( 2000 mg daily ) in the intervention group or placebo ( 2000 mg maltodextrin daily ) in the control group for 45 days . Main outcome measure : The primary outcome measures were we measured the levels of fasting blood sugar , blood pressure and lipid profile including triglyceride ( TG ) , cholesterol , LDL and HDL in healthy subjects . It was hypothesized that these measures would be significantly improved in those receiving L-arginine supplementation . at the beginning and end of the study . Results : In this trial , we had complete data for 52 healthy participants with mean age of 20.85±4.29 years . At the end of study , fasting blood sugar ( P=0.001 ) and lipid profile ( triglycerideTG ( P<0.001 ) , cholesterol ( P<0.001 ) , LDL ( P=0.04 ) , HDL ( P=0.015 ) ) decreased in the L-arginine group but we found no significant change in the placebo group . In addition , the reduction of fasting blood sugar and lipid profile in L-arginine was significant compared with placebo group . No significant changes were found about systolic ( P=0.81 ) and diastolic blood pressure either in L-arginine or placebo group . ( P=0.532 ) . Conclusion : The use of L-arginine significantly improved outcomes compared to placebo Nutrients and other bioactive constituents of foods may interact with each other and the surrounding food matrix in complex ways . Therefore , associations between single nutrients and chronic disease may be difficult to identify and interpret , but when dietary patterns ( DPs ) are examined the combination of many food factors will be considered . An explorative literature search of published review articles was conducted to obtain a fuller underst and ing of current DPs in epidemiological research , to discuss pros and cons of DPs in nutrition research , and to identify results of studies linking DPs to chronic disease risk in adults . R and omized feeding trials providing the experimental diets to study participants have repeatedly demonstrated that diets based on current dietary recommendations are associated with important health benefits . Systematic review s of feeding trials and prospect i ve population studies of DPs and chronic disease risk reach similar conclusions regardless of the methodology used to construct DPs . However , to date only a few review articles of DP studies have followed a systematic process using independent review ers with strict inclusion , exclusion , and study quality criteria . Diets with plenty of plants foods , fish , and seafood that preferably include vegetable oils and low-fat dairy products are associated with a lower risk of most chronic diseases . In contrast , Western-type DPs with food products low in essential nutrients and high in energy , like sugar-sweetened beverages , sweets , refined cereals and solid fats ( e.g. butter ) , and high in red and processed meats , are associated with adverse health effects . An emphasis on high- quality original research , and systematic review s following a structured process to objective ly select and judge studies , is needed in order to enforce a strong future knowledge base regarding DPs and chronic disease This systematic literature review examined the role of dietary macronutrient composition , food consumption and dietary patterns in predicting  weight or waist circumference ( WC ) change , with and without prior weight reduction . The literature search covered year 2000 and onwards . Prospect i ve cohort studies , case – control studies and interventions were included . The studies had adult ( 18–70 y ) , mostly Caucasian participants . Out of a total of 1,517 abstract s , 119 full papers were identified as potentially relevant . After a careful scrutiny , 50 papers were quality grade d as A ( highest ) , B or C. Forty-three papers with grading A or B were included in evidence grading , which was done separately for all exposure- outcome combinations . The grade of evidence was classified as convincing , probable , suggestive or no conclusion . We found probable evidence for high intake of dietary fibre and nuts predicting less weight gain , and for high intake of meat in predicting more weight gain . Suggestive evidence was found for a protective role against increasing weight from whole grains , cereal fibre , high-fat dairy products and high scores in an index describing a prudent dietary pattern . Likewise , there was suggestive evidence for both fibre and fruit intake in protection against larger increases in WC . Also suggestive evidence was found for high intake of refined grains , and sweets and desserts in predicting more weight gain , and for refined ( white ) bread and high energy density in predicting larger increases in WC . The results suggested that the proportion of macronutrients in the diet was not important in predicting changes in weight or WC . In contrast , plenty of fibre-rich foods and dairy products , and less refined grains , meat and sugar-rich foods and drinks were associated with less weight gain in prospect i ve cohort studies . The results on the role of  dietary macronutrient composition  in prevention of weight regain ( after prior weight loss ) were inconclusive BACKGROUND Intake of sugar-sweetened beverages is associated with overweight in observational studies . A possible explanation is that liquid sugars do not satiate and that their intake is not compensated by reduced caloric intake from other foods . However , evidence from intervention studies for this hypothesis is inconclusive because previous studies were not blinded . Hence results may have been influenced by expectations and behavioral cues rather than by physiological mechanisms . METHODS We design ed the Double-blind , R and omized INtervention study in Kids ( DRINK ) to examine the effect on body weight of covertly replacing sugar-sweetened by sugar-free beverages .  Children were only eligible if they habitually drank sugar-sweetened beverages . We recruited 642 healthy children ( mean age 8.2 , range 4.8 - 11.9 ) . We design ed , tested and produced custom-made beverages containing 10 % sugar and sugar-free beverages with the same sweet taste and look . Children receive one 250 mL can of study beverage daily for 18 months . We perform body measurements at 0 , 6 , 12 and 18 months . The primary outcome is the z-score of BMI for age . The maximum predicted difference in this score between groups is 0.72 , which corresponds with a difference in body weight of 2.3 kg . DISCUSSION The double-blind design eliminates behavioral factors that affect body weight . If children gain less body fat when drinking sugar-free than when drinking sugar-sweetened beverages that would show that liquid sugar indeed bypasses biological satiation mechanisms . It would also suggest that a reduction in liquid sugars could decrease body fat more effectively than reduction of other calorie sources Background We examined independent influences of context ual variables on  cardiovascular risk factors in Shilin county , Yunnan province , South-west China . Methods Three villages were selected from each of the ten townships based on probability proportional to size . In each selected village , 200 individuals aged ≥ 45 years were chosen based on simple r and om sampling method . From 6006 individuals , information on demographic characteristics , smoking and drinking status was obtained by interview . Blood pressure , height , weight , and waist and hip girth were measured .  Fasting blood sugar  was measured in a 10-percent sub sample . Context ual data were from official reports . Multi-level regression modelling with adjustment for individual and context ual variables was used . Results Context ual variables associated with CVD risk factors included : remoteness of village with higher blood pressure and fasting blood sugar , high proportion of Yi minority with drinking , high literacy rate with a lower rate of smoking and a lower mean waist-hip ratio , and high average income with lower systolic blood pressure and body mass index ( BMI ) but higher FBS . Conclusion While context ual SES is associated with a few CVD risk factors , villages with high level of income are worse off in fasting blood sugar . Strategies of economic development should be review ed to avoid adverse effects on health BACKGROUND The rising prevalence of obesity in children has been linked in part to the consumption of sugar-sweetened drinks . Our aim was to examine this relation . METHODS We enrolled 548 ethnically diverse schoolchildren ( age 11.7 years , SD 0.8 ) from public schools in four Massachusetts communities , and studied them prospect ively for 19 months from October , 1995 , to May , 1997 . We examined the association between baseline and change in consumption of sugar-sweetened drinks ( the independent variables ) , and difference in measures of obesity , with linear and logistic regression analyses adjusted for potentially confounding variables and clustering of results within schools . FINDINGS For each additional serving of sugar-sweetened drink consumed , both body mass index ( BMI ) ( mean 0.24 kg/m2 ; 95 % CI 0.10 - 0.39 ; p=0.03 ) and frequency of obesity ( odds ratio 1.60 ; 95 % CI 1.14 - 2.24 ; p=0.02 ) increased after adjustment for anthropometric , demographic , dietary , and lifestyle variables . Baseline consumption of sugar-sweetened drinks was also independently associated with change in BMI ( mean 0.18 kg/m2 for each daily serving ; 95 % CI 0.09 - 0.27 ; p=0.02 ) . INTERPRETATION Consumption of sugar-sweetened drinks is associated with obesity in children Study design : A r and omized , double-blind , placebo-controlled clinical trial . Objective : To assess the effect of alpha-lipoic acid ( ALA ) supplementation on IL-6 , hs-CRP , FBS , anthropometric indices , food intake and blood pressure in male patients with chronic spinal cord injury ( SCI ) . Setting : Imam Khomeini Hospital , Tehran University of Medical Sciences , Tehran , Iran . Methods : Fifty-eight men with chronic SCI participated in the study . Participants were divided in two groups : one group received 600 mg of supplemental ALA ( n=28 ) and the other group received placebo ( n=30 ) for 12 weeks . At the beginning and end of the study , biochemical parameters , anthropometric indices , blood pressure and dietary intakes were measured . Dietary intake was measured using N4 software , and statistical analyses were carried out using SPSS16 . Results : No significant reduction was found in IL-6 ( P=0.97 ) and hs-CRP levels ( P=0.23 ) . There was significant reduction in fasting blood sugar ( P=0.001 ) , body weight ( P=0.001 ) , BMI ( P=0.001 ) , waist circumference ( P=0.001 ) and blood pressure ( P=0.001 ) . Dietary intake was significantly reduced , including fat ( P=0.001 ) , carbohydrate ( P=0.001 ) , protein ( P=0.002 ) and energy intakes ( P=0.001 ) . Conclusion : Lipoic acid supplementation had no significant effect on the measured inflammatory markers but it reduces fasting blood sugar , anthropometric parameters , food intake and blood pressure in men with chronic SCI Diet is a lifestyle factor that contributes to the risk of overweight/obesity and cardiovascular disease . The objective of this study was to examine the hypothesis that a Mediterranean-type dietary pattern ( M ) is associated with healthy body weights in a large suburban municipality in Ontario . A r and om cross-sectional sample of 759 adults , 18 to 65 years of age , participated in a telephone survey , which included questions on the frequency of consumption of 60 food categories . Principal components analysis showed that food categories aggregated into six low-order dietary factors and two high-order dietary patterns . The M pattern reflected higher consumption of fruits and vegetables , olive oil and garlic , and fish and shellfish . The non-M pattern reflected high fat/nutrient poor , meats and poultry , and foods high in added sugars . The M-score was inversely related to body mass index ( BMI ) ( p = 0.027 ) . After adjustment for gender , education , income and marital status , a higher M-score predicted a lower BMI in the 40 to 49 year age group . Heart health promotion strategies aim ed at preventing adult obesity should emphasize components of a Mediterranean-type diet pattern Background Lifestyle interventions targeting obese pregnant women often result in modest reduction in gestational weight gain , pregnancy complications and related risk factors . Examining adherence to the intervention can , however , provide valuable information on the importance of the different factors targeted . Objective To evaluate improvements and relevance of different dietary factors targeted with respect to gestational weight gain in a 3-arm R and omised Controlled Trial ( n=342 ) among obese pregnant women with BMI ≥30 kg/m2 . Methods R and omisation 1:1:1 to either hypocaloric Mediterranean type of diet and physical activity intervention ( D+PA ) ; physical activity intervention alone ( PA ) ; or control ( C ) . Diet was assessed at baseline ( weeks 11–14 ) and endpoint ( weeks 36–37 ) using a vali date d food frequency question naire . Results During the intervention women in the D+PA group significantly lowered their intakes of added sugars and saturated fat and increased their protein intake by ~1 % of total energy compared to controls . Of these dietary variables only intakes of added sugar appeared to be related to GWG , while no association was observed for saturated fat or protein . Further analyses revealed that foods that contributed to intake of added sugars , including sweets , snacks , cakes , and soft drinks were strongly associated with weight gain , with women consuming sweets ≥2/day having 5.4 kg ( 95 % CI 2.1 - 8.7 ) greater weight gain than those with a low ( < 1wk ) intake . The results for soft drinks were more conflicting , as women with high weight gain tended to favour artificially sweetened soft drinks . Conclusion In our sample of obese pregnant women , craving for sweets , snacks , and soft drinks strongly predicts GWG . Emphasis on reducing intakes of these foods may be more relevant for limiting gestational weight gain than encouraging strict compliance to more specific diets . Trial Registration Clinical Trials.gov Background — Sugar-sweetened beverage consumption is associated with weight gain and risk of type 2 diabetes mellitus .  Few studies have tested for a relationship with coronary heart disease ( CHD ) or intermediate biomarkers . The role of artificially sweetened beverages is also unclear . Methods and Results — We performed an analysis of the Health Professionals Follow-Up Study , a prospect i ve cohort study including 42 883 men . Associations of cumulatively averaged sugar-sweetened ( eg , sodas ) and artificially sweetened ( eg , diet sodas ) beverage intake with incident fatal and nonfatal CHD ( myocardial infa rct ion ) were examined with proportional hazard models . There were 3683 CHD cases over 22 years of follow-up . Participants in the top quartile of sugar-sweetened beverage intake had a 20 % higher relative risk of CHD than those in the bottom quartile ( relative risk=1.20 ; 95 % confidence interval , 1.09–1.33 ; P for trend < 0.01 ) after adjustment for age , smoking , physical activity , alcohol , multivitamins , family history , diet quality , energy intake , body mass index , pre-enrollment weight change , and dieting . Artificially sweetened beverage consumption was not significantly associated with CHD ( multivariate relative risk=1.02 ; 95 % confidence interval , 0.93–1.12 ; P for trend=0.28 ) . Adjustment for self-reported high cholesterol , high triglycerides , high blood pressure , and diagnosed type 2 diabetes mellitus slightly attenuated these associations . Intake of sugar-sweetened but not artificially sweetened beverages was significantly associated with increased plasma triglycerides , C-reactive protein , interleukin-6 , and tumor necrosis factor receptors 1 and 2 and decreased high-density lipoprotein , lipoprotein(a ) , and leptin ( P<0.02 ) . Conclusions — Consumption of sugar-sweetened beverages was associated with increased risk of CHD and some adverse changes in lipids , inflammatory factors , and leptin . Artificially sweetened beverage intake was not associated with CHD risk or biomarkers
Subgroup analyses showed the most marked relation between sugar intakes and lipids in studies in which efforts were made to ensure an energy balance and when no difference in weight change was reported .
CONCLUSIONS Dietary sugars  influence blood pressure and serum lipids .
The relation is independent of effects of  sugars on body weight .
BACKGROUND Dietary sugars have been suggested as a cause of obesity , several chronic diseases , and a range of cardiometabolic risk factors , but there is no convincing evidence of a causal relation between sugars and risk factors other than body weight .
OBJECTIVE We conducted a systematic review and meta- analysis of r and omized controlled trials that examined effects of the modification of dietary free sugars on blood pressure and lipids .