Evidence map of effectiveness of dietary sugar reduction_Chinese Journal of Evidence-Based Medicine

Authors：

HU Xiaoye ^1,2,3 , WANG Yongsheng ^1,2,3 , NIAN Tao ^1,2,3 ,  YANG Kehu ^1,2,3 ,  LI Xiuxia ^1,2,3

1. Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, P. R. China;
2. Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, P. R. China;
3. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, P. R. China;

Corresponding author：

YANG Kehu, Email: yangkh-ebm@lzu.edu.cn; LI Xiuxia, Email: lixiuxia@lzu.edu.cn

Keywords：

Diet sugar; Strategy; Systematic review; Validity; Evidence map

DOI：

10.7507/1672-2531.202306091

Video：

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Objective The effectiveness of systematic identification, description and evaluation of dietary sugar reduction strategies through the evidence diagram method. Methods The CNKI, WanFang Data, VIP, CBM, PubMed, Embase, Web of Science and Cochrane Library database were electronically searched to collect systematic reviews/meta-analysis on the effectiveness of dietary sugar reduction strategies from inception to November 10, 2022, AMSTAR-2 was used to evaluate the methodological quality of the included studies. Microsoft Excel 2019 was used to design a data extraction table to extract relevant key information. Bubble charts were used to comprehensively present information such as study population, intervention type, number of primary studies included, and outcome measures. Results A total of 11 papers were included, all of which were systematic reviews/meta-analysis. The studies included ten interventions. Among them, the research ending of behavioral changes strategies, healthy diet, sugar tax, material substitution, sugar label, and community intervention showed obvious effectiveness, while social cognitive models, sugar reduction guidelines, health literacy, and knowledge attitude behavior models had not shown a clear and beneficial effect, indicating that the intervention effect on the theoretical basis was very small. Conclusion The current evidence diagram shows that the sugar reduction strategy is effective, but there are also intervention conclusions that the effectiveness of the conclusion is not clear and intervention blank. And based on the theoretical dietary sugar reduction strategy, the validity evidence is relatively scarce. In the future, high quality research will still be required.

Citation： HU Xiaoye, WANG Yongsheng, NIAN Tao, YANG Kehu, LI Xiuxia. Evidence map of effectiveness of dietary sugar reduction. Chinese Journal of Evidence-Based Medicine, 2024, 24(5): 591-597. doi: 10.7507/1672-2531.202306091 Copy

1.	曾晓娟, 台保军. 现代膳食模式与口腔健康. 中华口腔医学杂志, 2020, 55(10): 704-709.
2.	World Health Organization. Guideline: Sugars intake for adultsand children. Geneva: World Health Organization, 2015.
3.	Swan GE, Powell NA, Knowles BL, et al. A definition of free sugars for the UK. Public Health Nutr, 2018, 21(9): 1636-1638.
4.	Malik VS, Li Y, Pan A, et al. Long-term consumption of sugar-sweetened and artificially sweetened beverages and risk of mortality in US adults. Circulation, 2019, 139(18): 2113-2125.
5.	Rodda SN, Booth N, Brittain M, et al. I was truly addicted to sugar: a consumer-focused classification system of behaviour change strategies for sugar reduction. Appetite, 2020, 144: 104456.
6.	Kazuhiro N. Review of WHO guideline: sugars intake for adults and children. J-STAGE home, 2020, 63(8): 447-453.
7.	中国营养学会. 中国居民膳食指南2016. 北京: 人民卫生出版社, 2016.
8.	闻唱. “减糖”“戒糖”刻不容缓. 就业与保障, 2019, (9): 58-59.
9.	Madera Anaya M, Franco JVA, Ballesteros M, et al. Evidence mapping and quality assessment of systematic reviews on therapeutic interventions for oral cancer. Cancer Manag Res, 2018, 11: 117-130.
10.	Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
11.	陈耀龙, 姚亮, 杜亮, 等. GRADE在系统评价中应用的必要性及注意事项. 中国循证医学杂志, 2013, 13(12): 1401-1404.
12.	Lewin S, Booth A, Glenton C, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series. Implement Sci, 2018, 13(Suppl 1): 2.
13.	Nicholas AP, Soto-Mota A, Lambert H, et al. Restricting carbohydrates and calories in the treatment of type 2 diabetes: a systematic review of the effectiveness of 'low-carbohydrate' interventions with differing energy levels. J Nutr Sci, 2021, 10: e76.
14.	Al Rawahi SH, Asimakopoulou K, Newton JT. Theory based interventions for caries related sugar intake in adults: systematic review. BMC Psychol, 2017, 5(1): 25.
15.	Erickson J, Sadeghirad B, Lytvyn L, et al. The scientific basis of guideline recommendations on sugar intake: a systematic review. Ann Intern Med, 2017, 166(4): 257-267.
16.	Buja A, Grotto G, Montecchio L, et al. Association between health literacy and dietary intake of sugar, fat and salt: a systematic review. Public Health Nutr, 2021, 24(8): 2085-2097.
17.	Baghlaf K, Muirhead V, Moynihan P, et al. Free sugars consumption around bedtime and dental caries in children: a systematic review. JDR Clin Trans Res, 2018, 3(2): 118-129.
18.	Andreyeva T, Marple K, Marinello S, et al. Outcomes following taxation of sugar-sweetened beverages: a systematic review and meta-analysis. JAMA Netw Open, 2022, 5(6): e2215276.
19.	Hashem KM, He FJ, MacGregor GA. Effects of product reformulation on sugar intake and health-a systematic review and meta-analysis. Nutr Rev, 2019, 77(3): 181-196.
20.	Gupta A, Billich N, George NA, et al. The effect of front-of-package labels or point-of-sale signage on consumer knowledge, attitudes and behavior regarding sugar-sweetened beverages: a systematic review. Nutr Rev, 2021, 79(10): 1165-1181.
21.	Gupta A, Smithers LG, Harford J, et al. Determinants of knowledge and attitudes about sugar and the association of knowledge and attitudes with sugar intake among adults: a systematic review. Appetite, 2018, 126: 185-194.
22.	Nikniaz Z, Tabrizi JS, Farhangi MA, et a1. Community-based interventions to reduce sugar intake in healthy populations: a systematic review. World Med Health Pol. 2022, 14(4): 698-749.
23.	Knai C, Petticrew M, Durand MA, et a1. Has a public-private partnership resulted in action on healthier diets in England? An analysis of the public health responsibility deal food pledges. Food Policy, 2015, 54: 1-10.
24.	Sørensen K, Van den Broucke S, Fullam J, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health, 2012, 12: 1471-2458.
25.	Huizinga MM, Beech BM, Cavanaugh KL, et al. Low numeracy skills are associated with higher BMI. Obesity (Silver Spring), 2008, 16(8): 1966-1968.
26.	Guntzviller LM, King AJ, Jensen JD, et al. Self-efficacy, health literacy, and nutrition and exercise behaviors in a low-income, Hispanic population. J Immigr Minor Health, 2017, 19(2): 489-493.
27.	Huizinga MM, Carlisle AJ, Cavanaugh KL, et al. Literacy, numeracy, and portion-size estimation skills. Am J Prev Med, 2009, 36(4): 324-328.
28.	Lawman HG, Bleich SN, Yan J, et al. Unemployment claims in Philadelphia one year after implementation of the sweetened beverage tax. PLoS One, 2019, 14(3): e0213218.
29.	Cawley J, Frisvold D, Hill A, et al. Oakland's sugar-sweetened beverage tax: impacts on prices, purchases and consumption by adults and children. Econ Hum Biol, 2020, 37: 100865.
30.	Macgregor GA, Hashem KM. Action on sugar--lessons from UK salt reduction programme. Lancet, 2014, 383(9921): 929-931.
31.	陆婉瑶, 王健, 孟庆佳, 等. 减糖产品现状与发展趋势分析. 甘蔗糖业, 2020, 49(4): 83-91.
32.	Wang Y, Zhang Q. Are we ready for the sugar reduction policy in China. Current situation and public awareness of sugar intake in China. Nutrients, 2019, 11(4): 826.
33.	Hawkes C, Smith TG, Jewell J, et al. Smart food policies for obesity prevention. Lancet, 2015, 385(9985): 2410-2421.
34.	Cornelsen L, Green R, Turner R, et al. What happens to patterns of food consumption when food prices change. Evidence from a systematic review and meta-analysis of food price elasticities globally. Health Econ, 2015, 24(12): 1548-1559.
35.	Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev, 2012, 70(1): 3-21.
36.	米玉倩, 吴静, 梁晓峰. 欧美国家减糖政策分析及其对我国慢性病防控的启示. 中国卫生事业管理, 2017, 34(4): 247-248, 251.
37.	Krieger J, Bleich SN, Scarmo S, et al. Sugar-sweetened beverage reduction policies: progress and promise. Annu Rev Public Health, 2021, 42: 439-461.

1. 曾晓娟, 台保军. 现代膳食模式与口腔健康. 中华口腔医学杂志, 2020, 55(10): 704-709.
2. World Health Organization. Guideline: Sugars intake for adultsand children. Geneva: World Health Organization, 2015.
3. Swan GE, Powell NA, Knowles BL, et al. A definition of free sugars for the UK. Public Health Nutr, 2018, 21(9): 1636-1638.
4. Malik VS, Li Y, Pan A, et al. Long-term consumption of sugar-sweetened and artificially sweetened beverages and risk of mortality in US adults. Circulation, 2019, 139(18): 2113-2125.
5. Rodda SN, Booth N, Brittain M, et al. I was truly addicted to sugar: a consumer-focused classification system of behaviour change strategies for sugar reduction. Appetite, 2020, 144: 104456.
6. Kazuhiro N. Review of WHO guideline: sugars intake for adults and children. J-STAGE home, 2020, 63(8): 447-453.
7. 中国营养学会. 中国居民膳食指南2016. 北京: 人民卫生出版社, 2016.
8. 闻唱. “减糖”“戒糖”刻不容缓. 就业与保障, 2019, (9): 58-59.
9. Madera Anaya M, Franco JVA, Ballesteros M, et al. Evidence mapping and quality assessment of systematic reviews on therapeutic interventions for oral cancer. Cancer Manag Res, 2018, 11: 117-130.
10. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
11. 陈耀龙, 姚亮, 杜亮, 等. GRADE在系统评价中应用的必要性及注意事项. 中国循证医学杂志, 2013, 13(12): 1401-1404.
12. Lewin S, Booth A, Glenton C, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series. Implement Sci, 2018, 13(Suppl 1): 2.
13. Nicholas AP, Soto-Mota A, Lambert H, et al. Restricting carbohydrates and calories in the treatment of type 2 diabetes: a systematic review of the effectiveness of 'low-carbohydrate' interventions with differing energy levels. J Nutr Sci, 2021, 10: e76.
14. Al Rawahi SH, Asimakopoulou K, Newton JT. Theory based interventions for caries related sugar intake in adults: systematic review. BMC Psychol, 2017, 5(1): 25.
15. Erickson J, Sadeghirad B, Lytvyn L, et al. The scientific basis of guideline recommendations on sugar intake: a systematic review. Ann Intern Med, 2017, 166(4): 257-267.
16. Buja A, Grotto G, Montecchio L, et al. Association between health literacy and dietary intake of sugar, fat and salt: a systematic review. Public Health Nutr, 2021, 24(8): 2085-2097.
17. Baghlaf K, Muirhead V, Moynihan P, et al. Free sugars consumption around bedtime and dental caries in children: a systematic review. JDR Clin Trans Res, 2018, 3(2): 118-129.
18. Andreyeva T, Marple K, Marinello S, et al. Outcomes following taxation of sugar-sweetened beverages: a systematic review and meta-analysis. JAMA Netw Open, 2022, 5(6): e2215276.
19. Hashem KM, He FJ, MacGregor GA. Effects of product reformulation on sugar intake and health-a systematic review and meta-analysis. Nutr Rev, 2019, 77(3): 181-196.
20. Gupta A, Billich N, George NA, et al. The effect of front-of-package labels or point-of-sale signage on consumer knowledge, attitudes and behavior regarding sugar-sweetened beverages: a systematic review. Nutr Rev, 2021, 79(10): 1165-1181.
21. Gupta A, Smithers LG, Harford J, et al. Determinants of knowledge and attitudes about sugar and the association of knowledge and attitudes with sugar intake among adults: a systematic review. Appetite, 2018, 126: 185-194.
22. Nikniaz Z, Tabrizi JS, Farhangi MA, et a1. Community-based interventions to reduce sugar intake in healthy populations: a systematic review. World Med Health Pol. 2022, 14(4): 698-749.
23. Knai C, Petticrew M, Durand MA, et a1. Has a public-private partnership resulted in action on healthier diets in England? An analysis of the public health responsibility deal food pledges. Food Policy, 2015, 54: 1-10.
24. Sørensen K, Van den Broucke S, Fullam J, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health, 2012, 12: 1471-2458.
25. Huizinga MM, Beech BM, Cavanaugh KL, et al. Low numeracy skills are associated with higher BMI. Obesity (Silver Spring), 2008, 16(8): 1966-1968.
26. Guntzviller LM, King AJ, Jensen JD, et al. Self-efficacy, health literacy, and nutrition and exercise behaviors in a low-income, Hispanic population. J Immigr Minor Health, 2017, 19(2): 489-493.
27. Huizinga MM, Carlisle AJ, Cavanaugh KL, et al. Literacy, numeracy, and portion-size estimation skills. Am J Prev Med, 2009, 36(4): 324-328.
28. Lawman HG, Bleich SN, Yan J, et al. Unemployment claims in Philadelphia one year after implementation of the sweetened beverage tax. PLoS One, 2019, 14(3): e0213218.
29. Cawley J, Frisvold D, Hill A, et al. Oakland's sugar-sweetened beverage tax: impacts on prices, purchases and consumption by adults and children. Econ Hum Biol, 2020, 37: 100865.
30. Macgregor GA, Hashem KM. Action on sugar--lessons from UK salt reduction programme. Lancet, 2014, 383(9921): 929-931.
31. 陆婉瑶, 王健, 孟庆佳, 等. 减糖产品现状与发展趋势分析. 甘蔗糖业, 2020, 49(4): 83-91.
32. Wang Y, Zhang Q. Are we ready for the sugar reduction policy in China. Current situation and public awareness of sugar intake in China. Nutrients, 2019, 11(4): 826.
33. Hawkes C, Smith TG, Jewell J, et al. Smart food policies for obesity prevention. Lancet, 2015, 385(9985): 2410-2421.
34. Cornelsen L, Green R, Turner R, et al. What happens to patterns of food consumption when food prices change. Evidence from a systematic review and meta-analysis of food price elasticities globally. Health Econ, 2015, 24(12): 1548-1559.
35. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev, 2012, 70(1): 3-21.
36. 米玉倩, 吴静, 梁晓峰. 欧美国家减糖政策分析及其对我国慢性病防控的启示. 中国卫生事业管理, 2017, 34(4): 247-248, 251.
37. Krieger J, Bleich SN, Scarmo S, et al. Sugar-sweetened beverage reduction policies: progress and promise. Annu Rev Public Health, 2021, 42: 439-461.

Chinese Journal of Evidence-Based Medicine

Evidence map of effectiveness of dietary sugar reduction

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