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Cited by 103Nutritional Studies and DietCardiovascular Health and Risk FactorsMeta-analysis and systematic reviews

Evaluation of the Quality of Evidence of the Association of Foods and Nutrients With Cardiovascular Disease and Diabetes: A Systematic Review

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Miller, Victoria, Micha, Renata, Choi, Erin, Karageorgou, Dimitra, Webb, Patrick, Mozaffarian, Dariush·2022·JAMA Network Open
DOI 10.1001/jamanetworkopen.2021.46705PMC PMC8814912
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Abstract

Importance: Poor diet is a leading global factor associated with cardiometabolic disease (CMD). Understanding the quality of evidence of the associations between specific dietary factors and CMD, including effect size (relative risk [RR]) and uncertainty, is essential to guide policy and consumer actions to achieve healthy diet and public health goals. Objective: To assess the quality of evidence of the associations between specific dietary factors and CMD as well as the quantitative evidence for RRs and the uncertainty of these risk estimates. Evidence Review: PubMed and the reference lists of eligible articles were searched between May 1, 2015, and February 26, 2021, for systematic reviews with meta-analyses of randomized clinical trials and prospective cohort studies that analyzed the consumption of 1 or more of the dietary factors of interest; reported dose-response meta-analyses; included healthy adults; and assessed 1 or more of the outcomes of interest. Study characteristics and RR estimates were extracted in duplicate. For identified associations, quality of evidence was assessed using the Bradford-Hill criteria for causation. Findings: A total of 2058 potentially relevant reports were identified, from which 285 full-text articles were assessed for eligibility. The final selection of articles included 28 meta-analyses representing 62 associations between diet and CMD. Among these associations, 10 foods, 3 beverages, and 12 nutrients had at least probable evidence of associations with coronary heart disease, stroke, and/or diabetes. Most RRs ranged from 0.87 to 0.96 per daily serving change for protective associations and from 1.06 to 1.15 per daily serving change for harmful associations. Most identified associations were protective (n = 38) and a smaller number were harmful (n = 24), with a higher risk associated with higher intake. Conclusions and Relevance: This systematic review summarized the current quality of evidence of the associations of specific dietary factors with coronary heart disease, stroke, and diabetes. These findings may inform dietary guidance, the assessment of disease burden in specific populations, policy setting, and future research.

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  • Prebiotic fiber improves cardiometabolic risk factors.

    “However, these products dually lack the addition of prebiotic fiber-which improves cardiometabolic risk factors (14,15), and include non-nutritive synthetic sweeteners-which are contraindicated for weight management and chronic disease risk (16).”

    From Prebiotic soda lowers postprandial glucose compared to traditional soda pop: a randomized controlled trial (2025) · cites this paper as [15]

    The Results (Quality of Evidence of Associations for CVD; page not provided) report an association between dietary fiber intake and lower cardiovascular disease risk. The Results on diabetes also report a protective association for fiber. Neither passage specifically evaluates prebiotic fiber or shows that adding it improves cardiometabolic risk factors; the paper reports associations with disease outcomes rather than that intervention effect. (LLM, conf=0.86)

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Cited by

Sorted by citations

Authors
Miller, V., Micha, R., Choi, E., Karageorgou, D., Webb, P., & Mozaffarian, D.
Affiliations
  • Tufts University (US)
  • Northeastern University (US)
Corresponding author
Miller, Victoria
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2022-02-03
Volume
5
Issue
2
Pages
e2146705
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2021.46705
PMC
PMC8814912
OpenAlex
W4210530167
Cited by
103
References
16
Citations by year
2026: 18 · 2025: 23 · 2024: 23 · 2023: 27 · 2022: 11
FWCI
17.75
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Thessaly Institutional Repository (University of Thessaly) (submittedVersion)
Funders
American Heart Association (20POST35200069)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Keywords
quality of evidence, dietary factors, cardiometabolic disease, cardiovascular disease, diabetes mellitus, coronary artery disease, stroke, relative risk, dose-response relationship, Bradford Hill criteria, nutrients, dietary recommendations
MeSH terms
Diet, Healthy, Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Diabetes Mellitus, Eating, Female, Humans, Male, Middle Aged, Prospective Studies, Guidelines as Topic

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