Meta-analysiscited by the Tayebat archiveabstract only checked A-SOD-23 standard review
Sweetened drinks dose-response
Sugar and artificially sweetened beverages and risk of obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality: a dose-response meta-analysis of prospective cohort studies.
Overview
Qin P et al.. Eur J Epidemiol 2020 · PMID 32529512 · DOI 10.1007/s10654-020-00655-y
Each extra 250 mL/day of sugary drinks was linked with 12-19% higher risks of obesity and diabetes; diet drinks showed similar links.
Does the study support the specific claim? Yes · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Dose-response of SSB/ASB with obesity, T2D, hypertension, mortality.
- How was the study done?
Dose-response meta-analysis of prospective cohorts.
- How many people, animals or samples were studied?
39 articles; Adults
- What was actually found?
Per 250 mL/day SSB vs ASB: obesity RR 1.12 vs 1.21; T2D 1.19 vs 1.15; hypertension 1.10 vs 1.08; all-cause mortality 1.04 vs 1.06 (with I2 up to 92.6%).
- How large was the observed effect?
T2D RR 1.19 per 250 mL/d (SSB)
- What do the results mean in everyday life?
More sweetened drinks, more risk in observational data.
- What are the study's limitations?
High heterogeneity; Cohorts only; Reverse causation for ASB
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
Causation, especially for diet drinks.
Scientific in-depth review
1. Full reference
- Authors
- Qin P, Li Q, Zhao Y, Chen Q, Sun X, Liu Y, Li H, Wang T, Chen X, Zhou Q, Guo C, Zhang D, Tian G, Liu D, Qie R, Han M, Huang S, Wu X, Li Y, Feng Y, Yang X, Hu F, Hu D, Zhang M
- Journal
- Eur J Epidemiol
- Year
- 2020
- Identifier
- PMID 32529512 DOI 10.1007/s10654-020-00655-y
- Verification
- verified – PubMed E-utilities efetch, 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
No COI statement; Chinese research grants
2. Research question
Dose-response of SSB/ASB with obesity, T2D, hypertension, mortality.
3. Study design and population
- Study design
- Meta-analysis – Dose-response meta-analysis of prospective cohorts.
- Population
Adults
- Country
Multinational
- Period
Literature to Sept 2019
- Sample size
39 articles
- Inclusion and exclusion criteria
Prospective cohorts in adults
4. Methods and endpoints
- Exposure / intervention
Per 250 mL/day SSB or ASB
- Comparator
Lower intake
- Endpoints
Obesity, T2D, hypertension, mortality
- Statistical methods
Random effects; restricted cubic splines
5. Actual results
- Results
Per 250 mL/day SSB vs ASB: obesity RR 1.12 vs 1.21; T2D 1.19 vs 1.15; hypertension 1.10 vs 1.08; all-cause mortality 1.04 vs 1.06 (with I2 up to 92.6%).
- Absolute risks
not reported
- Authors' conclusion
SSB and ASB associated with these outcomes; interpret cautiously as based only on cohorts.
6. Strengths
- Dose-response
7. Weaknesses
- High heterogeneity
- Cohorts only
- Reverse causation for ASB
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Heterogeneity.
9. Assessment of the statistical interpretation
Small per-unit effects.
10. Relevance to the specific claim
Supports C-SOD-01, C-SOD-02, C-SOD-03; mixed for C-SOD-10.
11. Independent contrary findings
None.
12. Transferability to Germany and Europe
High.
13. Overall methodological judgement
Useful summary; overlapping with others.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Causality for ASB.
15. Linked fact checks
- Regular consumption of sugar-sweetened soft drinks increases the risk of type 2 diabetes (and metabolic syndrome); one to two cans per day raise type 2 diabetes risk by about 26%, and each daily serving by about 18%. – Studies supporting the claim
- Sugar-sweetened soft drinks deliver liquid calories that do not satisfy hunger and therefore promote weight gain in children and adults. – Studies supporting the claim
- Sugar-sweetened soft drinks raise the risk of coronary heart disease, cardiovascular death and early death (e.g., two or more daily servings: +35% coronary heart disease in women; +31% cardiovascular and +21% total mortality). – Studies supporting the claim
- Diet soda is not a safe alternative to sugary soda: artificially sweetened drinks are linked to higher mortality, especially circulatory deaths. – Studies with mixed or unclear results
Use by the Tayebat archive
Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.
- What the archive says about the study
Listed in the archive bibliography only (no archive interpretation card).
- A. What was actually studied?
Dose-response SSB/ASB.
- B. What did the authors find?
As above.
- C. What conclusions do the authors themselves draw?
Interpret cautiously.
- D. What does the archive derive from it?
Supports both SSB and diet-drink harms.
- E. Is this derivation scientifically justified?
Consistent for SSB; ASB results subject to reverse causation which the authors partly acknowledge.
- Adequacy of the interpretation (by the archive)
- not applicable