Cohort studyindependent cross-checkabstract only checked I-SOD-06 standard review

Diet drinks and stroke in 81,000 women

Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women's Health Initiative.

Overview

Mossavar-Rahmani Y et al.. Stroke 2019 · PMID 30802187 · DOI 10.1161/STROKEAHA.118.023100

Women drinking two or more diet drinks daily had 31% more ischaemic strokes; far less than the 'triple' figure.

Does the study support the specific claim? Partly · Methodological quality: high

Study explained simply

What did the researchers want to find out?: Is ASB intake associated with stroke, CHD and mortality?
How was the study done?: Prospective cohort (WHI Observational Study).
How many people, animals or samples were studied?: 81,714; Postmenopausal women 50-79
What was actually found?: >=2 ASB/day vs <1/week: all stroke HR 1.23 (1.02-1.47); ischaemic stroke 1.31 (1.06-1.63); CHD 1.29 (1.11-1.51); all-cause mortality 1.16 (1.07-1.26); small-artery occlusion stroke 2.44 in women without CVD/diabetes.
How large was the observed effect?: HR 1.31 (1.06-1.63) ischaemic stroke
What do the results mean in everyday life?: A modest association, possibly confounded.
What are the study's limitations?: Reverse causation; Single population; Observational design; residual confounding possible; Self-reported dietary intake
What does it say about Elawady's specific claim?: Mixed/limiting for C-SOD-06 (direction supported, magnitude much smaller).
Do the results apply to Germany and Europe?: Moderate.
What can explicitly not be concluded from this study?: Causation.

Is ASB intake associated with stroke, CHD and mortality?

Results: >=2 ASB/day vs <1/week: all stroke HR 1.23 (1.02-1.47); ischaemic stroke 1.31 (1.06-1.63); CHD 1.29 (1.11-1.51); all-cause mortality 1.16 (1.07-1.26); small-artery occlusion stroke 2.44 in women without CVD/diabetes.
Absolute risks: not reported
Authors' conclusion: Higher ASB intake associated with stroke, CHD and mortality; requires replication.

Modest HRs; much smaller than Pase 2017.

Mixed/limiting for C-SOD-06 (direction supported, magnitude much smaller).

None.

Moderate.

Larger, more precise estimate than Pase 2017.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	high
Risk of bias	some concerns
Precision of results	high
Directness	direct
Reproducibility	partly replicated
Consistency with the overall evidence	mixed
Regional transferability	moderate
Adequacy of the interpretation (by the archive)	not applicable

Causality.