CoChat
Sign Up
Cited by 507Nutritional Studies and DietCardiovascular Health and Risk FactorsAgriculture Sustainability and Environmental Impact

Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System

Open access
Anand, Sonia S., Hawkes, Corinna, de Souza, Russell J., Mente, Andrew, Dehghan, Mahshid, Nugent, Rachel, Zulyniak, Michael A., Weis, Tony +10 more·2015·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2015.07.050PMC PMC4597475
Open this paper in CoChat — free account

Abstract

Major scholars in the field, on the basis of a 3-day consensus, created an in-depth review of current knowledge on the role of diet in cardiovascular disease (CVD), the changing global food system and global dietary patterns, and potential policy solutions. Evidence from different countries and age/race/ethnicity/socioeconomic groups suggesting the health effects studies of foods, macronutrients, and dietary patterns on CVD appear to be far more consistent though regional knowledge gaps is highlighted. Large gaps in knowledge about the association of macronutrients to CVD in low- and middle-income countries particularly linked with dietary patterns are reviewed. Our understanding of foods and macronutrients in relationship to CVD is broadly clear; however, major gaps exist both in dietary pattern research and ways to change diets and food systems. On the basis of the current evidence, the traditional Mediterranean-type diet, including plant foods and emphasis on plant protein sources provides a well-tested healthy dietary pattern to reduce CVD.

AI snapshot

Written from the paper’s full text.

TL;DR

This consensus review summarizes evidence linking foods, macronutrients, and dietary patterns to cardiovascular disease (CVD) and argues that the globalized food system shapes unhealthy diets. It concludes that a Mediterranean-type pattern emphasizing whole grains, fruits/vegetables, legumes, nuts, fish, poultry, moderate dairy, and heart-healthy oils, while limiting refined grains, added sugars, trans fats, sugar-sweetened beverages (SSBs), and red/processed meats, is optimal and likely reduces CVD risk by about one third.

Key findings

  • The optimal dietary pattern to reduce CVD emphasizes whole grains, fruits and vegetables, legumes, nuts, fish, poultry, moderate dairy, and heart-healthy vegetable oils; it should be low in refined grains, added sugars, trans-fats, SSBs, and red and processed meats, and likely reduces CVD risk by about a third. The traditional Mediterranean-type diet is described as a well-tested prototype.
  • In meta-analyses, a 1-serving/day increase in SSB consumption was associated with RR 1.17 (95% CI 1.10–1.24) for CHD and RR 1.08 (95% CI 1.04–1.12) for incident hypertension, with no clear effect for total stroke; 1–2 SSB servings/day was associated with a 26% increased T2DM risk versus non-consumers, and ≥7 SSB servings/week was associated with a 29% increased CVD mortality risk versus <1 serving/week.
  • A Cochrane Review of 23 epidemiological studies (n=274,683) found the lowest risk of CVD events and deaths at sodium intake between 2.7 and 5.0 g/day; PURE found both high (>6 g/day) and low (<3 g/day) sodium excretion associated with higher mortality and CVD events compared with average (4.00–5.99 g/day).
  • In INTERSTROKE, 1 serving of fruit/day was protective against stroke (OR 0.61, 95% CI 0.50–0.73); a meta-analysis of 20 prospective cohort studies found highest versus lowest fruit and vegetable consumption associated with decreased stroke risk (RR 0.79, 95% CI 0.75–0.84); and PREDIMED found a Mediterranean diet with 50 g/day extra virgin olive oil reduced CVD events by 30% over five years. Replacing saturated fat with high-GI carbohydrate increased MI risk by 33%.

Methods

  • Design: consensus review based on a 3-day World Heart Federation international workshop; the authors state it is not based on new systematic reviews or meta-analyses but represents a careful review of published meta-analyses, seminal primary studies, and recent research by participating scholars.
  • Data/sample: evidence from different countries and age/race/ethnicity/socioeconomic groups, with major gaps noted for low- and middle-income countries (LMIC); cited global studies include PURE (138,926 individuals in 628 communities, 17 countries), INTERSTROKE, and INTERHEART, alongside meta-analyses and randomized trials.
  • Analysis: narrative synthesis of macronutrients, foods, dietary patterns, global food-system changes, environmental impacts, and policy solutions; no formal quantitative pooling is reported.

Limitations

  • Stated: major gaps exist in dietary pattern research and in ways to change diets and food systems; large gaps remain in LMIC macronutrient–CVD evidence; few RCTs have CVD outcomes; sodium studies have methodological issues, and large RCTs are needed for definitive evidence.
  • Stated: data relating diet to CVD have predominantly come from high-income countries, although over 80% of CVD deaths occur in LMIC; regional heterogeneity and limited LMIC data are noted for SSBs, meat, dairy, and other foods.
  • Evident: as a consensus/narrative review, it lacks a systematic search and formal quality appraisal, and it relies in places on unpublished data from PURE, ONTARGET, and INTERHEART; findings are not based on new meta-analyses.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.jacc.2015.07.050

Cites

300 of 300 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 363 cited sources checked · 0 supported · 0 flagged

  • Premisenone given

    Non-communicable diseases are forecasted to increase substantially in LMIC because of lifestyle transitions associated with increasing urbanization, economic development and globalization.

    “Non-communicable diseases (NCDs) are forecasted to increase substantially in LMIC because of lifestyle transitions associated with increasing urbanization, economic development and globalization.”
    Quote in the paperNot a substantial claim
  • Interpretationcitation

    The problem of unhealthy diets facilitated by modern food environments is likely to become more widespread as food environments in LMIC shift to resemble those of HIC.

    “These unhealthy diets are facilitated by modern food environments, a problem that is likely to become more widespread as food environments in LMIC shift to resemble those of HIC (5,7,8).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [5] 2007

      Not checked in the free run.

    • cites [7] 2010

      Not checked in the free run.

    • cites [8] Popkin, 2012, Global nutrition transition and the pandemic of obesity in developing countries, Nutr Rev source

      Not checked in the free run.

  • Interpretationnone given

    Major gaps exist in ways to change diets and food systems.

    “Our understanding of foods and macronutrients in relationship to CVD is broadly clear; however major gaps exist both in dietary pattern research and ways to change diets and food systems.”
    Quote in the paperSubstantial claim
  • Premisecitation

    These unhealthy diets are facilitated by modern food environments.

    “These unhealthy diets are facilitated by modern food environments, a problem that is likely to become more widespread as food environments in LMIC shift to resemble those of HIC (5,7,8).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [5] 2007

      Not checked in the free run.

    • cites [7] 2010

      Not checked in the free run.

    • cites [8] Popkin, 2012, Global nutrition transition and the pandemic of obesity in developing countries, Nutr Rev source

      Not checked in the free run.

  • Premisenone given

    Data relating diet to cardiovascular diseases has predominantly been generated from high-income countries (HIC).

    “Data relating diet to cardiovascular diseases (CVDs) has predominantly been generated from high-income countries (HIC), but over 80% of CVD deaths occur in low- and middle-income countries (LMIC).”
    Quote in the paperSubstantial claim
  • May combine two claims. 109
  • Classified as probably not a substantial claim. 32
  • The quote only partly states this claim. 2

  • May combine two claims.

    Premisecitation

    The shift to a global food system started in the US and other high income industrialized countries, and was driven initially by government investment and intervention in markets, infrastructure and research intended to raise farm-sector productivity.

    “The shift to a global food system started in the US and other high income industrialized countries, and was driven initially by government investment and intervention in markets, infrastructure and research intended to raise farm-sector productivity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    This coincided with huge technological innovations in food processing, the rise of mass marketing to persuade consumers to eat more, supermarket retailing and fast food.

    “This coincided with huge technological innovations in food processing, (24–28), the rise of to mass marketing to persuade consumers to eat more, supermarket retailing and fast food (29) (30),”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [24] Connor, 1997

      Not checked in the free run.

    • cites [25] Wilkinson, 2004, The food processing industry, globalization and developing countries, Electron J Agr Dev Econ

      Not checked in the free run.

    • cites [26] Welch, 2000, Food processing: a century of change, Br Med Bull source

      Not checked in the free run.

    • cites [27] Fellows, 2009

      Not checked in the free run.

    • cites [28] Moss, 2013

      Not checked in the free run.

    • cites [29] Packard, 1957

      Not checked in the free run.

    • cites [30] Burch, 2007

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Unhealthy dietary patterns have negative environmental impacts, notably on climate change.

    “Furthermore, unhealthy dietary patterns have negative environmental impacts, notably on climate change.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Global Burden of Disease study cites diet as a major factor behind the rise in hypertension, diabetes, obesity, and other CVD components.

    “The Global Burden of Disease study cites diet as a major factor behind the rise in hypertension, diabetes, obesity, and other CVD components (3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Lim, 2012, A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Evidence from different countries, age/race/ethnicity/socioeconomic groups suggests that health effects studies of foods, macronutrients, and dietary patterns on CVD appear to be far more consistent, though regional knowledge gaps are highlighted.

    “Evidence from different countries, age/race/ethnicity/socioeconomic groups suggest the health effects studies of foods, macronutrients, and dietary patterns on CVD appear to be far more consistent though regional knowledge gaps are highlighted.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    The modern food system is characterized by a global web of interactions between multiple actors from farm to fork, geared towards maximizing efficiency to reduce costs and increase production.

    “In contrast, the modern food system is characterized by a global web of interactions between multiple actors from farm to fork, geared towards maximizing efficiency to reduce costs and increase production (Figure 1).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    Over 80% of CVD deaths occur in low- and middle-income countries (LMIC).

    “Data relating diet to cardiovascular diseases (CVDs) has predominantly been generated from high-income countries (HIC), but over 80% of CVD deaths occur in low- and middle-income countries (LMIC).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Our understanding of foods and macronutrients in relationship to CVD is broadly clear.

    “Our understanding of foods and macronutrients in relationship to CVD is broadly clear; however major gaps exist both in dietary pattern research and ways to change diets and food systems.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Relatively sparse data on diet and CVD exist from LMIC, though new data sources are rapidly emerging.

    “Relatively sparse data on diet and CVD exist from these countries though new data sources are rapidly emerging (1,2).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Imamura, 2015, Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment, Lancet Global Health source

      Not checked in the free run.

    • cites [2] Micha, 2014, Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The productivity boom provided the basis of cheap feed for livestock and cheap inputs for processed foods, in turn creating incentives for the growth of manufacturers of processed foods.

    “In addition to vastly increasing the calorie supply, the ensuing productivity boom also provided the basis of cheap feed for livestock and cheap inputs for processed foods, in turn creating incentives for the growth of manufacturers of processed foods (24).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Connor, 1997

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The 1960s saw the start of significant agricultural transformation in LMIC, with the "Green Revolution" focused on increasing productivity of corn, rice and wheat.

    “The 1960s also saw the start of significant agricultural transformation in LMIC, with the “Green Revolution” in which focused on increasing productivity of corn, rice and wheat.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Snacking and snack foods have grown in frequency and number.

    “Snacking and snack foods have grown in frequency and number (43–48); eating frequency has increased;”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [43] Adair, 2005, Are child eating patterns being transformed globally?, Obes Res source

      Not checked in the free run.

    • cites [44] Duffey, 2013, Prevalence and energy intake from snacking in Brazil: analysis of the first nationwide individual survey, Eur J Clin Nutr source

      Not checked in the free run.

    • cites [45] Ng, 2011, Nutrition transition in the United Arab Emirates, Eur J Clin Nutr source

      Not checked in the free run.

    • cites [46] Popkin, 2010, Does hunger and satiety drive eating anymore? Increasing eating occasions and decreasing time between eating occasions in the United States, Am J Clin Nutr source

      Not checked in the free run.

    • cites [47] Wang, 2008, Dynamic shifts in Chinese eating behaviors, Asia Pac J Clin Nutr

      Not checked in the free run.

    • cites [48] Duffey, 2014, Snacking is prevalent in Mexico, J Nutr

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many countries retain various forms of state intervention in agriculture and food systems, but policies to liberalize trade and private sector investment have revolutionized the entire sector in many regions.

    “Many countries retain various forms of state intervention in agriculture and food systems (18,38–41), but policies to liberalize trade and private sector investment have revolutionized the entire sector in many regions (13,42).”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [18] Popkin, 2008

      Not checked in the free run.

    • cites [38] Khandelwal, 2013, Eliciting a policy response for the rising epidemic of overweight-obesity in India, Obes Rev source

      Not checked in the free run.

    • cites [39] Wilde, 2013

      Not checked in the free run.

    • cites [40] 2006

      Not checked in the free run.

    • cites [41] Hawkes, 2010, An overview of global food trade

      Not checked in the free run.

    • cites [13] Reardon, 2014, The quiet revolution in Asia's rice value chains, Ann N Y Acad Sci source

      Not checked in the free run.

    • cites [42] Bruinsma, 2003

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    The way people eat has changed greatly across the globe, and the pace of change in LMIC is quickening.

    “The way people eat has changed greatly across the globe; moreover the pace of change in LMIC’s is quickening.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Both at home and away-from-home-eating increasingly involve fried and processed food.

    “both at home and away-from-home-eating increasingly involve fried and processed food (47,49);”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [47] Wang, 2008, Dynamic shifts in Chinese eating behaviors, Asia Pac J Clin Nutr

      Not checked in the free run.

    • cites [49] Monteiro, 2010, The snack attack, Am J Public Health source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the 1985 to 2005 period extensive added sugar intake occurred across HIC, but more recently large increases have occurred in LMIC, particularly in consumption of sugar-sweetened beverages and processed foods.

    “In the 1985 to 2005 period extensive added sugar intake occurred across HIC (55) but more recently large increases have occurred in LMIC, particularly in consumption of sugar-sweetened beverages and processed foods (56–59).”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [55] Duffey, 2008, High-fructose corn syrup: is this what's for dinner?, Am J Clin Nutr source

      Not checked in the free run.

    • cites [56] Basu, 2013, The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data, PLoS One source

      Not checked in the free run.

    • cites [57] Kleiman, 2012, Drinking to our health: can beverage companies cut calories while maintaining profits?, Obes Rev source

      Not checked in the free run.

    • cites [58] Monteiro C. The big issue is ultra-processing. Journal of the World Public Health Nutrition Association 2010. Available at: http://www.wphna.org/wn_commentary_ultraprocessing_nov2010.asp. Accessed August 7, 2015.

      Not checked in the free run.

    • cites [59] Monteiro, 2011, Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil, Public Health Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Production of less processed foods such as coarse grains, roots, tubers, and legumes has declined while animal source food production has grown dramatically.

    “Meanwhile, production of less processed foods such as coarse grains (e.g., millet, sorghum), roots, tubers, and legumes has declined (32,33) while animal source food production grown dramatically (34).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [32] Starmer, 2006

      Not checked in the free run.

    • cites [33] Schaffer, 2007

      Not checked in the free run.

    • cites [34] Weis, 2013

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    White bread, once rarely consumed in Latin America, became widespread after the introduction of high-yield wheat varieties.

    “White bread, for example, once rarely consumed in Latin America, became widespread after the introduction of high-yield wheat varieties.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    While the process originated with companies in industrialized countries looking for growth in foreign markets, companies based in LMICs are now also investing back into HICs.

    “While this process originated with companies in industrialized countries looking for growth in foreign markets, companies based in LMICs are now also investing back into HICs.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Interpretationreasoning

    These changes in the global food system coupled with food behavior shifts have enabled critical changes to the global food supply, all with dietary implications.

    “These changes in the global food system coupled with these food behavior shifts have enabled some critical changes to the global food supply, all with dietary implications.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In Asia, white rice became dominant as a staple over legumes and coarse grains, with a more recent trend being rapidly rising consumption of instant noodles as a staple.

    “In Asia, white rice became dominant as a staple over legumes and coarse grains, with a more recent trend being rapidly rising consumption of instant noodles as a staple (52,53).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [52] Reddy, 2002, Cardiovascular diseases in the developing countries: dimensions, determinants, dynamics and directions for public health action, Public Health Nutr source

      Not checked in the free run.

    • cites [53] Reddy, 2004, Diet, nutrition and the prevention of hypertension and cardiovascular diseases, Public Health Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    With urbanization there is some evidence that refined carbohydrate consumption is increasing, whereas consumption of traditional grains is decreasing in LMIC.

    “With urbanization there is some evidence to show that refined carbohydrate consumption is increasing, whereas consumption of traditional grains (i.e. millet, maize) is decreasing in LMIC (61,62).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [61] Radhika, 2009, Refined grain consumption and the metabolic syndrome in urban Asian Indians (Chennai Urban Rural Epidemiology Study 57), Metabolism source

      Not checked in the free run.

    • cites [62] Wang, 2005

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Since 1964, average total carbohydrate intake in the US has increased from about 375 g/d to 500 g/d, but the percent of carbohydrate that is fiber has not substantially changed, reflecting increased refined carbohydrates and sugar sweetened beverages high in HIC.

    “Since 1964, average total carbohydrate intake in the US has increased from about 375 g/d to 500 g/d (from 2 to 6 kg/year of ready-to-eat cereals), but the percent of carbohydrate that is fiber has not substantially changed over this time, reflecting increased refined carbohydrates and sugar sweetened beverages (SSBs) is high in HIC (54).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Gross, 2004, Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment, Am J Clin Nutr source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Dietary consumption patterns of other protein sources have been mixed.

    “Dietary consumption patterns of other protein sources have been mixed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    North and South America, Europe, and Australia/New Zealand have the highest meat intake, whereas Asia and Africa have the lowest.

    “North and South America, Europe, and Australia/New Zealand have the highest meat intake, whereas Asia and Africa have the lowest (72,73).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [72] Anand, 2014

      Not checked in the free run.

    • cites [73] 2009

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Meat consumption has increased considerably worldwide, and there is substantially greater production of meat in HIC than in LMIC.

    “Meat consumption has increased considerably worldwide, and there is substantially greater production of meat in HIC than in LMIC (71).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] Kearney, 2010, Food consumption trends and drivers, Philos Trans R Soc Lond B Biol Sci source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    HIC such as Canada, US, and Western Europe tend to consume the lowest quantities of legumes per capita in the world, whereas LMIC within Africa and India consume the greatest quantities of legumes, along with certain South American countries where beef is uncommon.

    “Relatively, HIC such as Canada, US, and Western Europe, tend to consume the lowest quantities of legumes per capita in the world, whereas LMIC within Africa and India consume the greatest quantities of legumes, along with certain South American countries where beef is uncommon, such as Colombia and Peru (77–79).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [77] Schneider, 2002, Overview of the market and consumption of puises in Europe, Br J Nutr source

      Not checked in the free run.

    • cites [78] Oniang, 2003, Contemporary African food habits and their nutritional and health implications, Asia Pac J Clin Nutr

      Not checked in the free run.

    • cites [79] Aykroyd, 1982, Legumes in human nutrition. Food and Agriculture Organization of the United Nations, FAO Food Nutr Rep

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    China has the highest per capita consumption of fish in the world, followed by Oceania, North America, and Europe.

    “China has the highest per capita consumption of fish in the world, followed by Oceania, North America, and Europe (74).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] 2012

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Total production of tree nuts in 2012 was 3.5 million metric tons, a 5.5% increase from 2011; world consumption of tree nuts in 2011 exceeded 3 million metric tons.

    “Total production of tree nuts in 2012 was 3.5 million metric tons, a 5.5% increase from 2011. World consumption of tree nuts in 2011 exceeded 3 million metric tons (81).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] 2012

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    58% of calories consumed by Mexicans come from packaged foods and beverages, which is similar throughout the Americas and even with the US (66%).

    “For example, 58% of calories consumed by Mexicans come from packaged foods and beverages, which is similar throughout the Americas (83) and even with the US (66%) (65,84).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [83] Popkin, 2014, Nutrition, agriculture and the global food system in low and middle income countries, Food Policy source

      Not checked in the free run.

    • cites [65] Micha, 2014, Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys, Br Med J source

      Not checked in the free run.

    • cites [84] Slining, 2013, Food companies' calorie-reduction pledges to improve U.S. diet, Am J Prev Med source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Trans-fat consumption is very high in many LMIC while decreasing markedly in HIC.

    “However, trans-fat consumption is very high in many LMIC while decreasing markedly in HIC.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In 1958-1962, soybean, palm, and rapeseed/canola oils represented 20% of the 29 million metric tons of fat produced globally/year, while butter, lard, and tallow represented 37%; by 1996-2001, these oils accounted for 52% of the 103 million metric tons of fat produced globally/year, while butter, lard, and tallow contributed 20%.

    “In 1958–1962, soybean, palm, and rapeseed/canola oils represented 20% of the 29 million metric tons of fat produced globally/year, while butter, lard, and tallow represented 37%. By 1996–2001, these oils accounted for 52% of the 103 million metric tons of fat produced globally/year, while butter, lard, and tallow contributed 20% (64).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [64] Aldersey C. Consumer trends and usage of fats and oils. Paper presented at: 14th Biennial Sunflower Conference; June 24-26, 2003; Australia.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    This shift has implications for consumption of fatty acids.

    “This has implications for consumption of fatty acids.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A third key change has been the increasing global consumption of meat, which has been made economically feasible by subsidized production of crops for animal feed - most importantly corn and soybeans.

    “A third key change has been the increasing global consumption of meat, which has been made economically feasible by subsidized production of crops for animal feed – most importantly corn and soybeans (soybean oil is a byproduct of soymeal production for animals) (66–69).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [66] Delgado, 1999

      Not checked in the free run.

    • cites [67] Delgado, 2003, Rising consumption of meat and milk in developing countries has created a new food revolution, J Nutr

      Not checked in the free run.

    • cites [68] Popkin, 2003, Dynamics of the nutrition transition toward the animal foods sector in China and its implications: a worried perspective, J Nutr

      Not checked in the free run.

    • cites [69] 2007

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Palm oil (deodorized) has become an increasing source of saturated fatty acids; and partially hydrogenated fats are the main source of trans-fatty acids.

    “Palm oil (deodorized) has become an increasing source of saturated fatty acids; and partially hydrogenated fats are the main source of trans-fatty acids”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Oilseeds are now among the most widely traded crops, and are also processed to create margarines and vegetable shortenings and into partially hydrogenated fats and bleached deodorized oils for use in processed foods.

    “Oilseeds are now among the most widely traded crops, and are also processed to create margarines and vegetable shortenings and into partially hydrogenated fats and bleached deodorized oils for use in processed foods, (see also Supplementary Box 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    This was initially driven by rising production of soybeans in the US, later in Argentina and Brazil, and then palm oil in East Asia.

    “This was initially driven by rising production of soybeans in the US, later in Argentina and Brazil, and then palm oil in East Asia.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The consumption of legumes declined in the US from 1960 and into the 1980's, with reduced consumption patterns observed globally.

    “The consumption of legumes declined in the US from 1960 and into the 1980’s, with reduced consumption patterns observed globally (8).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] Popkin, 2012, Global nutrition transition and the pandemic of obesity in developing countries, Nutr Rev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In 75 countries representing 61.8% of the world's adult population, global saturated fat consumption was ≈9% of energy, with considerable variation across countries (range: 2 to 28%).

    “In 75 countries representing 61.8% of the world’s adult population, global saturated fat consumption was ≈9% of energy; though considerable variation existed across countries (range: 2 to 28%).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] Micha, 2014, Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys, Br Med J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A second key change has been the increasing intake of vegetable oils, including processed vegetable oils, and a decline in consumption of animal fats.

    “A second key change has been the increasing intake of vegetable oils, including processed vegetable oils, and a decline in consumption of animal fats (2,63).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [2] Micha, 2014, Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys, BMJ source

      Not checked in the free run.

    • cites [63] Drewnowski, 1997, The nutrition transition: new trends in the global diet, Nutr Rev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    On average, fish consumption is 2 to 3 times higher in HIC than LMIC, although with marked heterogeneity within income categories.

    “On average, fish consumption is 2 to 3 times higher in HIC than LMIC (74), although with marked heterogeneity within income categories.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] 2012

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Processed meats account for a modest proportion of all meat consumed in HIC.

    “Processed meats (which refers to post-butchering modifications of foods such as curing, smoking, or addition of sodium nitrate), account for a modest proportion of all meat consumed in HIC (unpublished data from the PURE study) (71).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] Kearney, 2010, Food consumption trends and drivers, Philos Trans R Soc Lond B Biol Sci source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The proportion for China is 28.5% and rising rapidly.

    “The proportion for China is 28.5% and rising rapidly (36,82,83).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [36] Reardon, 2012, Supermarket revolution in Asia and emerging development strategies to include small farmers, Proceedings of the National Academy of Sciences source

      Not checked in the free run.

    • cites [82] Zhou, 2015, The food retail revolution in China and its association with diet and health, Food Policy source

      Not checked in the free run.

    • cites [83] Popkin, 2014, Nutrition, agriculture and the global food system in low and middle income countries, Food Policy source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    At very low levels of intake animal food consumption may not induce harm, providing high quality protein and iron, whereas excess animal food intake in HIC may be linked to adverse health outcomes, particularly from processed meats.

    “At very low levels of intake animal food consumption may not induce harm, providing high quality protein and iron, whereas excess animal food intake in HIC may be linked to adverse health outcomes, particularly from processed meats (70).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] Sinha, 2009, Meat intake and mortality: A prospective study of over half a million people, Arch Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    In India, vanaspati, a vegetable ghee used in bakery products, fried snacks and foods sold by street vendors, is a leading source of trans-fats, as is bakery shortening.

    “In India, for example, vanaspati, a vegetable ghee used in bakery products, fried snacks and foods sold by street vendors is a leading source of trans-fats, as is bakery shortening.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Between 1990 and 2010, global saturated fat, dietary cholesterol, and trans-fat intakes remained stable (trans-fats going down in HIC and up in LMIC), while n-6, seafood n-3, and plant n-3 fat intakes each increased.

    “Between 1990 and 2010, global saturated fat, dietary cholesterol, and trans-fat intakes remained stable (trans-fats going down in HIC and up in LMIC), while n-6, seafood n-3, and plant n-3 fat intakes each increased (65).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] Micha, 2014, Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys, Br Med J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Eggs are consumed in higher quantities (2-6 times) in HIC relative to LMIC, with a 14% decline in consumption in HIC observed between 1980-2000, and no change observed in LMIC.

    “Eggs are similarly consumed in higher quantities (2–6 times) in HIC relative to LMIC, with a 14% decline in consumption in HIC observed between 1980–2000, and no change was observed in LMIC (76).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [76] 2003

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Between 1973 and 1997, dairy consumption per capita increased in LMIC by ~48% and is projected to almost double (93% increase) by 2020.

    “Between 1973 and1997, dairy consumption per capita (kg) increased in LMIC by ~48% and is projected to almost double (93% increase) by 2020.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Globally, although there has been little or no increase in sea fish consumption per capita since the 1960s, catches per year have risen exponentially and freshwater fish intake has increased during this time.

    “Globally, although there has been little or no increase in sea fish consumption per capita since the 1960s, catches per year have risen exponentially (75) and freshwater fish intake has intake has increased during this time (71).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [75] Watson, 2001, Systematic distortions in world fisheries catch trends, Nature source

      Not checked in the free run.

    • cites [71] Kearney, 2010, Food consumption trends and drivers, Philos Trans R Soc Lond B Biol Sci source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the US, 32.6% of adults consumed fruit two or more times per day and 27.2% ate vegetables three or more times per day.

    “In the US, 32.6% of adults consumed fruit two or more times per day and 27.2% ate vegetables three or more times per day (90).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [90] 2007, Fruit and vegetable consumption among adults–United States, 2005, Morb Mortal Wkly Rep

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Carbohydrate refinement is common in HICs and increasing in LMIC.

    “Carbohydrate refinement is common in HICs and increasing in LMIC (111,112).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [111] Hu, 2012, White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review, BMJ source

      Not checked in the free run.

    • cites [112] Aune, 2013, Whole grain and refined grain consumption and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis of cohort studies, Eur J Epidemiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The FAO estimates that one-third of all food produced for human consumption globally is wasted before it is consumed, which has both social and environmental costs that have been precisely measured in the US.

    “It is also noteworthy that the FAO estimates that one-third of all food produced for human consumption globally is wasted before it is consumed, which has both social and environmental costs that have been precisely measured in the US (100–102).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [100] 2013

      Not checked in the free run.

    • cites [101] Hall, 2009, The progressive increase of food waste in America and its environmental impact, PLoS One source

      Not checked in the free run.

    • cites [102] Parfitt, 2010, Food waste within food supply chains: quantification and potential for change to 2050, Phil Trans R Soc B: Bio Sci source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    World agriculture is also extremely vulnerable to climate change, biodiversity loss, declining freshwater availability, and the inevitable limits of non-renewable resources, although vulnerability is highly uneven on a world scale.

    “In addition to being a major force in many environmental problems, world agriculture is also extremely vulnerable to climate change, biodiversity loss, declining freshwater availability, and the inevitable limits of non-renewable resources (e.g., fossil energy, high grade phosphorous) although vulnerability is highly uneven on a world scale (96).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [96] McIntyre, 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2012, 40.6% of Canadians aged 12 and older reported consuming fruit and vegetables five or more times per day.

    “In 2012, 40.6% of Canadians aged 12 and older, reported consuming fruit and vegetables five or more times per day (91).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [91] Wang, 2003, Why do some overweight children remain overweight, whereas others do not?, Public Health Nutr source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    This study suggests that the adverse effect on CHD risk may not be mediated by short term effects on classical risk factors, but that postprandial hyperglycemia and hyperinsulinemia or hyperlipidemia may play a mediating role.

    “This study suggests that the adverse effect on CHD risk may not be mediated by short term effects on classical risk factors, but that postprandial hyperglycemia and hyperinsulinemia or hyperlipidemia may play a mediating role;”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [109] Mensink, 2003, Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials, Am J Clin Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a 5-week controlled-feeding trial of 163 generally healthy but overweight adults, low compared with high-glycemic index diets did not improve insulin sensitivity, lipid levels, or systolic blood pressure in the context of a healthy, DASH-like dietary pattern, and a low compared with high-glycemic index diet increased LDL-C when the carbohydrate content of the diet was high.

    “However, in a 5-week controlled-feeding trial of 163 generally healthy but overweight adults, low compared with high-glycemic index diets did not improve insulin sensitivity, lipid levels, or systolic blood pressure in the context of a healthy, DASH-like dietary pattern, and a low compared with high-glycemic index diet increased LDL-C when the carbohydrate content of the diet was high (109).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [109] Mensink, 2003, Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials, Am J Clin Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The major causes are beef and other large animals for GHG and the metabolic losses associated with shifting the product of nearly one third of the world's arable land to concentrated animals, which effectively magnifies the resource budgets and pollution loads of industrial monocultures.

    “The major causes are beef and other large animals for GHG and the metabolic losses associated with shifting the product of nearly one third of the world’s arable land to concentrated animals, which effectively magnifies the resource budgets and pollution loads of industrial monocultures (34).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Weis, 2013

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In controlled-feeding studies, replacing saturated fat with carbohydrates lowers low-density lipoprotein and high-density lipoprotein cholesterol and increases triglycerides.

    “In controlled-feeding studies, replacing saturated fat with carbohydrates lowers low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol and increases triglycerides (109).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [109] Mensink, 2003, Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials, Am J Clin Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Dietary interventions which raise HDL-C may not necessarily translate into CVD risk reduction, as serum HDL-c has recently been called into question regarding its role in the causal pathway of CVD.

    “Dietary interventions which raise HDL-C may not necessarily translate into CVD risk reduction, as serum HDL-c has recently been called into question regarding its role in the causal pathway of CVD (110).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [110] Voight, 2012, Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The component that is "ultra-processed" varies depending on the method of measurement but is increasing wherever it is studied at all income levels.

    “The component that is “ultra-processed” – ready to eat, of snack, foods – varies depending on the method of measurement but is increasing wherever it is studied at all income levels (50,85,86).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [50] Monteiro, 2013, Ultra-processed products are becoming dominant in the global food system, Obes Rev source

      Not checked in the free run.

    • cites [85] Monteiro, 2012, The impact of transnational “Big Food” companies on the south: A view from Brazil, PLoS Med source

      Not checked in the free run.

    • cites [86] Monteiro, 2011, Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil, Public Health Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many of the world's poorest regions are poised to be most adversely affected by rising average temperatures, aridity, and water stress, as well as through increasingly severe extreme weather events like drought or flooding; some feel this is already occurring.

    “Many of the world’s poorest regions are poised to be most adversely affected by rising average temperatures, aridity, and water stress, as well as through increasingly severe extreme weather events like drought or flooding; in fact some feel this is already occurring (97–99).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [97] Hertel, 2010, The poverty implications of climate-induced crop yield changes by 2030, Global Environ Change source

      Not checked in the free run.

    • cites [98] Cline, 2007

      Not checked in the free run.

    • cites [99] 2014

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    While all of these changes across LMIC display great heterogeneity, the global food system has clearly reached all corners of the LMIC urban and rural sector and major shifts in diets appear to be accelerating.

    “While all of these changes across LMIC display great heterogeneity (92), the global food system has clearly reached all corners of the LMIC urban and rural sector and major shifts in diets appear to be accelerating.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [92] Hall, 2009, Global variability in fruit and vegetable consumption, Am J Prev Med source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    The expansion of low-input agriculture and extensive ranching are also major factors in deforestation, which bear heavily on both climate change and biodiversity loss.

    “The expansion of low-input agriculture and extensive ranching are also major factors in deforestation, which bear heavily on both climate change (as carbon is released from vegetation and soils and sequestration capacity diminishes) and biodiversity loss.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    According to the National Health and Nutrition Examination Survey, between 1999 and 2006 the average US full-calorie carbonated soft drink intake decreased, while intake of diet carbonated soft drinks, low-calorie fruit drinks, and other sweetened beverages increased.

    “According to the NHANES, between 1999 and 2006 the average US full-calorie CSD intake decreased, while intake of diet CSDs, low-calorie fruit drinks, and other sweetened beverages increased (122).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [122] World Health Organization. Draft Guidelines on free sugars released for public consultation. 2014. Geneva, Switzerland.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    These products will gradually enter the markets in China, Brazil, and other LMICs.

    “These products will gradually enter the markets in China, Brazil, and other LMICs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Vegetable oils that are primarily comprised of mono- and polyunsaturated fatty acids appear to reduce CHD risk, and sources of the n-3 polyunsaturated fat alpha-linolenic acid, such as rapeseed or canola oil, are cardioprotective.

    “Vegetable oils that are primarily comprised of mono- (e.g., olive oil) and polyunsaturated fatty acids appear to reduce CHD risk, and sources of the n-3 polyunsaturated fat alpha-linolenic acid (ALA), such as rapeseed or canola oil, are cardioprotective.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In the National Health and Nutrition Examination Survey III, with 831 CVD deaths during 163,039 person-years of follow-up, consumption of ≥7 SSB servings/week was associated with a 29% increased CVD mortality risk compared with <1 serving/week, with no increased risk up to 6 drinks/week.

    “In the National Health and Nutrition Examination Survey III (NHANES III), with 831 CVD deaths during 163,039 person-years of follow-up, consumption of ≥ 7 SSB servings/week was associated with a 29% increased CVD mortality risk compared with < 1 serving/week (120), with no increased risk up to 6 drinks/week.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [120] Yang, 2014, Added sugar intake and cardiovascular diseases mortality among US adults, JAMA Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Few studies have investigated the association between SSBs and CVD events; those that have report increased CHD and stroke risk with SSB consumption.

    “Few studies have investigated the association between SSBs and CVD events. Those that have report increased CHD and stroke risk with SSB consumption.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a meta-analysis of prospective studies of SSB and hypertension, CHD, and stroke, the RR for a 1-serving increase in SSB/d was 1.17 (95% CI 1.10, 1.24) for CHD and 1.08 (95% CI 1.04 to 1.12) for incident hypertension, but no clear effect was seen for total stroke (RR 1.06, 95% CI 0.97, 1.15).

    “In a meta-analysis of prospective studies of SSB and hypertension, CHD, and stroke, the RR for a 1-serving increase in SSB/d was 1.17 (95 % CI 1.10, 1.24) for CHD and 1.08 (95% CI: 1.04 to 1.12) for incident hypertension, but no clear effect was seen for total stroke (RR 1.06, 95 % CI 0.97, 1.15) (123).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [123] Xi, 2015, Sugar-sweetened beverages and risk of hypertension and CVD: a dose-response meta-analysis, Br J Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Replacing saturated fat with monounsaturated or polyunsaturated fat reduces low-density lipoprotein cholesterol and preserves HDL-C.

    “Replacing saturated fat with monounsaturated or polyunsaturated fat reduces low-density lipoprotein cholesterol (LDL-C) and preserves HDL-C (109).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [109] Mensink, 2003, Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials, Am J Clin Nutr source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    A potential explanation of the SSB-T2DM association is the high content of rapidly-absorbed sugar from corn syrup, which increases blood glucose and insulin and de novo lipogenesis, which may contribute to pancreatic beta cell dysfunction and eventually T2DM.

    “A potential explanation of the SSB-T2DM association is the high content of rapidly-absorbed sugar from corn syrup, which increases blood glucose and insulin and de novo lipogenesis –which may contribute to pancreatic beta cell dysfunction and eventually T2DM (131).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [131] Janssens, 1999, Effects of soft drink and table beer consumption on insulin response in normal teenagers and carbohydrate drink in youngsters, Eur J Cancer Prev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Low-glycemic index diets improve glycemic control and serum lipids in RCTs of participants with T2DM with major implications for CHD risk reduction in this vulnerable segment of the population.

    “Furthermore, low-glycemic index diets improve glycemic control and serum lipids in RCTs of participants with T2DM with major implications for CHD risk reduction in this vulnerable segment of the population whose numbers are increasing rapidly globally (116–119).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [116] Brand-Miller, 2003, Low–Glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials, Diabetes Care source

      Not checked in the free run.

    • cites [117] Livesey, 2008, Glycemic response and health—a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes, Am J Clin Nutr source

      Not checked in the free run.

    • cites [118] Jenkins, 2008, Effect of a low–glycemic index or a high–cereal fiber diet on type 2 diabetes: A randomized trial, JAMA source

      Not checked in the free run.

    • cites [119] Goff, 2013, Low glycaemic index diets and blood lipids: A systematic review and meta-analysis of randomised controlled trials, Nutr Metab Cardiovasc Dis source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Trans-fatty acids increase CHD risk compared with other macronutrients, with strong evidence of adverse effects of small amounts of trans-fats on lipids and CVD risk.

    “Trans-fatty acids increase CHD risk compared with other macronutrients, with strong evidence of adverse effects of small amounts of trans-fats on lipids (109,139) and CVD risk (140,141).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [109] Mensink, 2003, Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials, Am J Clin Nutr source

      Not checked in the free run.

    • cites [139] Brouwer, 2010, Effect of animal and industrial trans fatty acids on HDL and LDL cholesterol levels in humans–a quantitative review, PLoS One source

      Not checked in the free run.

    • cites [140] Bendsen, 2011, Consumption of industrial and ruminant trans fatty acids and risk of coronary heart disease: a systematic review and meta-analysis of cohort studies, Eur J Clin Nutr source

      Not checked in the free run.

    • cites [141] Mozaffarian, 2006, Trans fatty acids and cardiovascular disease, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a pooled analysis of Nurses' Health and Health Professionals Follow-up Study data, a one SSB serving/day increment is associated with a 1-kg weight gain over a four-year period, possibly due to incomplete compensation for this energy at other meals.

    “In a pooled analysis of Nurses’ Health (NHS) and Health Professionals Follow-up Study (HPFS) data, a one SSB serving/day increment is associated with a 1-kg weight gain over a four-year period (126), possibly due to incomplete compensation for this energy at other meals.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [126] Mozaffarian, 2011, Changes in diet and lifestyle and long-term weight gain in women and men, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Macronutrient exchange generally does not influence markers of glucose homeostasis, though in two relatively large trials, replacing SFA with either MUFA or carbohydrate improved indices of glucose homeostasis.

    “Macronutrient exchange generally does not influence markers of glucose homeostasis, though in two relatively large trials, replacing SFA with either MUFA or carbohydrate improved indices of glucose homeostasis (150,151).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [150] Vessby, 2001, Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: the KANWU Study, Diabetologia source

      Not checked in the free run.

    • cites [151] Perez-Jimenez, 2001, A Mediterranean and a high-carbohydrate diet improve glucose metabolism in healthy young persons, Diabetologia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Associations have been seen between major food sources of saturated fat, such as red and processed meat, and development of T2DM, though dairy products, notably fermented dairy, may be protective.

    “Associations have been seen between major food sources of saturated fat, such as red and processed meat, and development of T2DM (152,153), though dairy products, notably fermented dairy, may be protective (154,155).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [152] Pan, 2013, Changes in red meat consumption and subsequent risk of type 2 diabetes mellitus: three cohorts of US men and women, JAMA Intern Med source

      Not checked in the free run.

    • cites [153] Micha, 2012, Unprocessed red and processed meats and risk of coronary artery disease and type 2 diabetes–an updated review of the evidence, Curr Atheroscler Rep source

      Not checked in the free run.

    • cites [154] Gao, 2013, Dairy products consumption and risk of type 2 diabetes: systematic review and dose-response meta-analysis, PLoS One source

      Not checked in the free run.

    • cites [155] Sluijs, 2012, The amount and type of dairy product intake and incident type 2 diabetes: results from the EPIC-InterAct Study, Am J Clin Nutr source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Both unprocessed and processed red meats are associated with higher T2DM risk, with a larger effect size for processed meats.

    “Both types of meat are associated with higher T2DM risk, although gram-for-gram the effect size is notably larger for processed meats.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This review is based on a World Heart Federation international workshop to review the state of knowledge on this topic.

    “The paper is based on a World Heart Federation international workshop to review the state of knowledge on this topic.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Meat can contain significant amounts of cholesterol and saturated fatty acids, which raise LDL-C and lower triglyceride.

    “Meat is rich in protein, iron, zinc, and B-vitamins, but can also contain significant amounts of cholesterol and saturated fatty acids, which raise LDL-C and lower triglyceride (157).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [157] Mozaffarian, 2010, Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials, PLoS Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    High red meat intake increases endogenous formation of N-nitroso compounds in the GI tract, which are associated with increased epithelial proliferation, oxidative stress, and iron-induced hypoxia signaling.

    “A high red meat intake (rich in heme iron), increases endogenous formation of N-nitroso compounds in the gastrointestinal tract that are associated with increased epithelial proliferation, oxidative stress, and iron-induced hypoxia signaling (166–168).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [166] Bingham, 2002, Effect of white versus red meat on endogenous N-nitrosation in the human colon and further evidence of a dose response, J Nutr

      Not checked in the free run.

    • cites [167] Bastide, 2011, Heme iron from meat and risk of colorectal cancer: a meta-analysis and a review of the mechanisms involved, Cancer Prev Res source

      Not checked in the free run.

    • cites [168] Joosen, 2009, Effect of processed and red meat on endogenous nitrosation and DNA damage, Carcinogenesis source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    This review of diet, dietary patterns and CVD is not based on new systematic reviews or meta-analyses but represents a careful review of many published meta-analyses, seminal primary studies, and recent research by the scholars who participated in the Consensus conference.

    “This review of diet, dietary patterns and CVD is not based on new systematic reviews or meta-analyses but represents a careful review of many published meta-analyses, seminal primary studies, and recent research by the scholars who participated in the Consensus conference.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Increased low-fat dairy consumption is associated with lower LDL-C, triglycerides, plasma insulin, insulin resistance, waist circumference, BMI, possibly BP, and reduced diabetes risk.

    “However, increased low-fat dairy consumption is associated with lower LDL-C, triglycerides, plasma insulin, insulin resistance, waist circumference, BMI, possibly blood pressure (BP); and reduced diabetes risk (174–182).”
    Quote in the paperNot a substantial claim0 of 9 sources checked
    • cites [174] Chen, 2012, Effects of dairy intake on body weight and fat: a meta-analysis of randomized controlled trials, Am J Clin Nutr source

      Not checked in the free run.

    • cites [175] Kai, 2013, Low-fat and high-fat dairy products are differently related to blood lipids and cardiovascular risk score, Eur J Prev Cardiol source

      Not checked in the free run.

    • cites [176] Pereira, 2002, Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the CARDIA Study, JAMA source

      Not checked in the free run.

    • cites [177] Fumeron, 2011, Dairy consumption and the incidence of hyperglycemia and the metabolic syndrome results from a French prospective study, Data from the Epidemiological Study on the Insulin Resistance Syndrome (DESIR), Diabetes Care source

      Not checked in the free run.

    • cites [178] Rideout, 2013, Consumption of low-fat dairy foods for 6 months improves insulin resistance without adversely affecting lipids or bodyweight in healthy adults: a randomized free-living cross-over study, Nutr J source

      Not checked in the free run.

    • cites [179] Choi, 2005, Dairy consumption and risk of type 2 diabetes mellitus in men: a prospective study, Arch Internal Med source

      Not checked in the free run.

    • cites [180] Liu, 2006, A prospective study of dairy intake and the risk of type 2 diabetes in women, Diabetes Care source

      Not checked in the free run.

    • cites [181] Elwood, 2010, The consumption of milk and dairy foods and the incidence of vascular disease and diabetes: an overview of the evidence, Lipids source

      Not checked in the free run.

    • cites [182] Tong, 2011, Dairy consumption and risk of type 2 diabetes mellitus: a meta-analysis of cohort studies, Eur J Clin Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In more recent analyses, red meats, particularly processed red meats, were associated with increased CVD, CHD, stroke, and cancer mortality, while poultry was not.

    “In more recent analyses, red meats, particularly processed red meats, were associated with increased CVD, CHD, stroke, and cancer mortality, while poultry was not (170–172).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [170] Rohrmann, 2013, Meat consumption and mortality–results from the European prospective investigation into cancer and nutrition, BMC Med source

      Not checked in the free run.

    • cites [171] Pan, 2012, Red meat consumption and mortality: results from 2 prospective cohort studies, Arch Intern Med source

      Not checked in the free run.

    • cites [172] Bernstein, 2010, Major dietary protein sources and risk of coronary heart disease in women, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Compared to saturated fat, vegetable oils rich in polyunsaturated fats reduce the TC:HDL-C ratio and CHD incidence.

    “compared to saturated fat, vegetable oils rich in polyunsaturated fats reduce the TC:HDL-C ratio and CHD incidence”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    In PURE, fish intake was inversely associated with CVD outcomes in South America, China, North America, and Europe (RR 0.76-0.84) but positively associated in South Asia (RR 1.97).

    “In the PURE study fish intake was inversely associated with CVD outcomes in South America, China, North America, and Europe (RR: 0.76–0.84) but positively associated in South Asia (RR: 1.97).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In INTERHEART, fish intake was beneficial in North America and Europe (RR 0.73, 95% CI 0.62-0.87) but harmful in the Middle East (RR 1.59, 95% CI 1.32-1.93).

    “INTERHEART found fish intake beneficial in North America and Europe (RR: 0.73; 95% CI: 0.62–0.87) but harmful in the Middle East (RR: 1.59; 95% CI: 1.32–1.93).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A medium egg contains ~225 mg cholesterol.

    “Eggs are also a source of dietary cholesterol (a medium egg contains ~225 milligrams of cholesterol) (187).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [187] McCance, 1960

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In DART-2, oily fish did not affect all-cause mortality or CVD events after 3-9 years, and increased sudden cardiac death, largely in the fish oil capsule subgroup.

    “In DART-2 oily fish did not affect all-cause mortality or CVD events after 3–9y, and increased sudden cardiac death, largely confined to the subgroup given fish oil capsules (200).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [200] Ness, 2003, Advice to eat fish and mood: a randomised controlled trial in men with angina, Nutr Neurosci source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In DART-1, fish lowered all-cause mortality and trended towards reducing CVD events after 2 years.

    “In DART-1, fish lowered all-cause mortality and trended towards reducing CVD events after 2 y (194).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [194] Shin, 2013, Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis, Am J Clin Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Despite high energy density, nuts do not contribute to weight gain, changes in waist circumference, or obesity.

    “Despite their high energy density, nuts do not contribute to weight gain, changes in waist circumference, or obesity perhaps owing to their satiating effects and increased fecal energy losses. (215,216).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [215] Flores-Mateo, 2013, Nut intake and adiposity: meta-analysis of clinical trials, Am J Clin Nutr source

      Not checked in the free run.

    • cites [216] Smith, 2015, Changes in intake of protein foods, carbohydrate amount and quality, and long-term weight change: results from 3 prospective cohorts, Am J Clin Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Fish are a source of protein, vitamin D, B vitamins, essential amino acids, trace elements, and long-chain omega-3 fatty acids DHA and EPA, though amounts vary over tenfold across seafood species.

    “Fish are a source of protein, vitamin D, multiple B vitamins, essential amino acids, and trace elements; and the long-chain omega-3 (n-3) fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) (195,196), though amounts vary over tenfold across seafood species.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [195] Zheng, 2012, Fish consumption and CHD mortality: an updated meta-analysis of seventeen cohort studies, Public Health Nutr source

      Not checked in the free run.

    • cites [196] Mente, 2009, A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease, Arch Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    There are significant variations across regions in the association of egg consumption with CVD, with benefit in China but possible harm in South Asia.

    “However, significant variations exist across regions, with a benefit of daily egg consumption in China but possible harm in South Asia.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In observational studies, nuts lower CHD and hypertension risk but not stroke.

    “In observational studies, nuts lower CHD (196,212,213) and hypertension risk (213); but not stroke (207, (213).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [196] Mente, 2009, A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease, Arch Intern Med source

      Not checked in the free run.

    • cites [212] Kris-Etherton, 2001, The effects of nuts on coronary heart disease risk, Nutr Rev source

      Not checked in the free run.

    • cites [213] Zhou, 2014, Nut consumption in relation to cardiovascular disease risk and type 2 diabetes: a systematic review and meta-analysis of prospective studies, Am J Clin Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Follow-up of DART-1 at 5 years showed increased rates of CVD in the fish/fish oil group that did not persist through 10 years.

    “Follow-up of DART-1 at 5y also showed increased rates of CVD in the fish/fish oil group that did not persist through the 10y assessment (202).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [202] Ness, 2002, The long-term effect of dietary advice in men with coronary disease: follow-up of the Diet and Reinfarction trial (DART), Eur J Clin Nutr source

      Not checked in the free run.

  • The quote only partly states this claim.

    Premisenone given

    In ONTARGET, no associations between fish consumption and CVD outcomes were observed.

    “However, no associations between fish consumption and CVD outcomes were observed in a high-risk secondary population in ONTARGET.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Available evidence suggests cardiovascular benefits with fish consumption in secondary prevention, but evidence is inconsistent for primary prevention.

    “Available evidence suggests cardiovascular benefits with fish consumption in secondary prevention, but the evidence is inconsistent regarding primary prevention.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a meta-analysis of 16 prospective cohort studies, egg consumption was not associated with overall CVD, CHD, stroke, or CHD/stroke mortality, but was associated with T2DM.

    “In a meta-analysis (194) of 16 prospective cohort studies (90,735 participants) (191), egg consumption was not associated with overall CVD or CHD, stroke, or CHD or stroke mortality; but was associated with T2DM.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [194] Shin, 2013, Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis, Am J Clin Nutr source

      Not checked in the free run.

    • cites [191] Wenzel, 2006, A 12-wk egg intervention increases serum zeaxanthin and macular pigment optical density in women, J Nutr

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Reducing red meats, especially processed meats, and increasing fish, nuts, legumes, and possibly fermented dairy products are likely beneficial.

    “Reducing red meats, especially processed meats, and increasing fish, nuts, legumes, and possibly fermented dairy products are likely beneficial.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Meta-analyses found no association between legumes and diabetes or stroke.

    “However, that study and another meta-analysis of eight prospective cohort studies found no association between legumes and diabetes (207) or stroke (232,233).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [207] Iso, 2006, Intake of fish and n3 fatty acids and risk of coronary heart disease among Japanese: the Japan Public Health Center-Based (JPHC) Study Cohort I, Circulation source

      Not checked in the free run.

    • cites [232] Afshin, 2014, Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis, Am J Clin Nutr source

      Not checked in the free run.

    • cites [233] Shi, 2014, Consumption of nuts and legumes and risk of stroke: a meta-analysis of prospective cohort studies, Nutr Metab Cardiovas Dis source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the DASH RCT, higher intake of fruits and vegetables reduced BP, TC, LDL-C, and HDL-C without affecting triglycerides.

    “In the Dietary Approaches to Stop Hypertension (DASH) RCT, higher intake of fruits and vegetables, either as part of a typical Western diet or the DASH eating plan, reduced BP, TC, LDL-C, and HDL-C without affecting triglycerides (242).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [242] Appel, 1997, A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group, N Engl J Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Increased refined grains, starches, and added sugar has paralleled the rise in obesity and T2DM.

    “Increased refined grains, starches, and added sugar (i.e., carbohydrates of lower quality) has paralleled the rise in obesity and T2DM.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a meta-analysis of eight RCTs, legumes reduce SBP by 2 mmHg and lower mean arterial pressure.

    “Legumes also reduce SBP (by 2 mmHg) and lowered mean arterial pressure(231) in a meta-analysis of eight RCTs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [231] Jayalath, 2013, Effect of dietary pulses on blood pressure: a systematic review and meta-analysis of controlled feeding trials, Am J Hypertens source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    Collectively, the data support emphasizing low-GI whole grains, legumes, fruits, and vegetables and minimizing high-GI refined grains and foods with added sugars, including SSBs.

    “Collectively, the data support emphasizing low-GI whole grains, legumes, fruits, and vegetables and minimizing high-GI refined grains and foods with added sugars, including SSBs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a meta-analysis of 20 prospective cohort studies, fruit and vegetable consumption was associated with decreased stroke risk (RR 0.79, 95% CI 0.75-0.84), as were fruits (RR 0.77) and vegetables (RR 0.86) separately.

    “A meta-analysis of 20 prospective cohort studies (16,981 stroke events) found that fruit and vegetable consumption was associated with decreased stroke risk (RR: 0.79; 95% CI: 0.75–0.84 for highest vs. lowest categories), as were fruits (RR: 0.77; 95% CI: 0.71–0.84) and vegetables (RR: 0.86; 95% CI: 0.79–0.93) separately (245).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [245] Hu, 2014, Fruits and vegetables consumption and risk of stroke a meta-analysis of prospective cohort studies, Stroke source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In observational studies and RCTs, legume consumption improves CVD risk factors (waist circumference, cholesterol, BP, CRP, glucose) and is protective against T2DM.

    “In observational studies and RCTs consumption of legumes improves CVD risk factors, such as waist circumference, cholesterol, BP, C-reactive protein, glucose; and is protective against T2DM (224–231).”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [224] Venn, 2010, The effect of increasing consumption of pulses and wholegrains in obese people: a randomized controlled trial, J Am Coll Nutr source

      Not checked in the free run.

    • cites [225] Hermsdorff, 2011, A legume-based hypocaloric diet reduces proinflammatory status and improves metabolic features in overweight/obese subjects, Eur J Nutr source

      Not checked in the free run.

    • cites [226] Jenkins, 2012, Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: a randomized controlled trial, Arch Internal Med source

      Not checked in the free run.

    • cites [227] Mollard, 2012, Regular consumption of pulses for 8 weeks reduces metabolic syndrome risk factors in overweight and obese adults, Br J Nutr source

      Not checked in the free run.

    • cites [228] Liu, 2014, Serum free fatty acid biomarkers of lung cancer, Chest source

      Not checked in the free run.

    • cites [229] Anderson, 2002, Pulses and lipaemia, short-and long-term effect: potential in the prevention of cardiovascular disease, Br J Nutr source

      Not checked in the free run.

    • cites [230] Bazzano, 2011, Non-soy legume consumption lowers cholesterol levels: a meta-analysis of randomized controlled trials, Nutr Metab Cardiovasc Dis source

      Not checked in the free run.

    • cites [231] Jayalath, 2013, Effect of dietary pulses on blood pressure: a systematic review and meta-analysis of controlled feeding trials, Am J Hypertens source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Increasing sodium intake well beyond physiological requirements increases BP and CVD mortality.

    “Increasing sodium intake well beyond physiological requirements increases BP (241–243) and CVD mortality (95–97).”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [241] Hawkes, 2015, Can the sustainable development goals reduce the burden of nutrition-related non-communicable diseases without truly addressing major food system reforms?, BMC Med source

      Not checked in the free run.

    • cites [242] Appel, 1997, A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group, N Engl J Med source

      Not checked in the free run.

    • cites [243] Esposito, 2014, Which diet for prevention of type 2 diabetes? A meta-analysis of prospective studies, Endocrine source

      Not checked in the free run.

    • cites [95] Hoekstra, 2007, Water footprints of nations: Water use by people as a function of their consumption pattern, Water Resour Manage source

      Not checked in the free run.

    • cites [96] McIntyre, 2009

      Not checked in the free run.

    • cites [97] Hertel, 2010, The poverty implications of climate-induced crop yield changes by 2030, Global Environ Change source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Population recommendations for low sodium intake (<2.0 g/day) have been achieved in short-term feeding trials but not sustained in longer-term trials (>6 months).

    “Population- recommendations for low sodium intake (252–254) (< 2.0 grams/day) have been achieved in short-term feeding clinical trials (254), but not sustained in longer-term clinical trials (> 6 months) (255) (256,257).”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [252] Graudal, 2011, Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride, Cochrane Database Syst Rev

      Not checked in the free run.

    • cites [253] He, 2013, Effect of longer-term modest salt reduction on blood pressure, Cochrane Database Syst Rev

      Not checked in the free run.

    • cites [254] Sacks, 2001, Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group, N Engl J Med source

      Not checked in the free run.

    • cites [255] 1997, Arch Intern Med source

      Not checked in the free run.

    • cites [256] Bibbins-Domingo, 2010, Projected effect of dietary salt reductions on future cardiovascular disease, N Engl J Med source

      Not checked in the free run.

    • cites [257] Coxson, 2013, Mortality benefits from US population-wide reduction in sodium consumption: projections from 3 modeling approaches, Hypertension source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In women, greatest protection from CHD was at 11 g/d, with increased risk beginning at 14 g/d.

    “In a dose-response meta-analysis of 24 prospective cohort studies (275), the association of drinking with CHD was J-shaped: non-drinkers were at slightly increased risk; in men the greatest protection was at 31 g/d with a trend for increased risk beginning at 63 g/d; for women, the greatest protection was at 11 g/d with a trend for increased risk beginning at 14 g/d.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [275] Zhang, 2014, Alcohol intake and risk of stroke: a dose-response meta-analysis of prospective studies, Int J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In men, greatest protection from CHD was at 31 g/d, with increased risk beginning at 63 g/d.

    “In a dose-response meta-analysis of 24 prospective cohort studies (275), the association of drinking with CHD was J-shaped: non-drinkers were at slightly increased risk; in men the greatest protection was at 31 g/d with a trend for increased risk beginning at 63 g/d; for women, the greatest protection was at 11 g/d with a trend for increased risk beginning at 14 g/d.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [275] Zhang, 2014, Alcohol intake and risk of stroke: a dose-response meta-analysis of prospective studies, Int J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Prospective cohort studies suggest a J-shaped association between sodium intake and CVD events, consistent across methods of sodium estimation.

    “Prospective cohort studies suggest a J-shaped association between sodium intake and CVD events, consistent across methods of sodium estimation (259–265).”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [259] Ekinci, 2011, Dietary salt intake and mortality in patients with type 2 diabetes, Diabetes Care source

      Not checked in the free run.

    • cites [260] O'Donnell, 2011, Urinary sodium and potassium excretion and risk of cardiovascular events, JAMA source

      Not checked in the free run.

    • cites [261] Stolarz-Skrzypek, 2011, Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion, JAMA source

      Not checked in the free run.

    • cites [262] Thomas, 2011, The association between dietary sodium intake, ESRD, and all-cause mortality in patients with type 1 diabetes, Diabetes Care source

      Not checked in the free run.

    • cites [263] O'Donnell, 2014, Urinary sodium and potassium excretion, mortality, and cardiovascular events, N Engl J Med source

      Not checked in the free run.

    • cites [264] Pfister, 2014, Estimated urinary sodium excretion and risk of heart failure in men and women in the EPIC-Norfolk study, Eur J Heart Fail source

      Not checked in the free run.

    • cites [265] Saulnier, 2014, Sodium and cardiovascular disease, N Engl J Med

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In PURE, both high (>6 g/day) and low (<3 g/day) sodium excretion were associated with higher mortality and CVD events compared to average (4.00-5.99 g/day) sodium excretion, despite a positive association between sodium excretion and BP.

    “PURE study findings (263) are consistent with this evidence, with both high (> 6 grams/day) and low (< 3 grams/day) sodium excretion associated with higher mortality and CVD events compared to average (4.00–5.99 grams/day) sodium excretion despite a positive association between sodium excretion and BP (251,263).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [263] O'Donnell, 2014, Urinary sodium and potassium excretion, mortality, and cardiovascular events, N Engl J Med source

      Not checked in the free run.

    • cites [251] Mente, 2014, Association of urinary sodium and potassium excretion with blood pressure, N Engl J Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In all regions, men were more likely to be current drinkers than women.

    “In all regions, men were more likely to be current drinkers than women (272).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [272] Smyth, 2015, Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The DASH diet was associated with lower SBP, DBP, and cholesterol.

    “The DASH diet was associated with lower SBP, DBP, and cholesterol.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [254] Sacks, 2001, Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The U.S. Dietary Guidelines Advisory Committee modeled 3 dietary patterns for healthfulness and nutritional adequacy, and all 3 include components associated with health benefits.

    “The U.S. Dietary Guidelines Advisory Committee modeled 3 dietary patterns--the Healthy-US type Pattern, the Healthy Mediterranean style Pattern and the Healthy Vegetarian Pattern--for healthfulness and nutritional adequacy. All 3 include components of a dietary pattern associated with health benefits (277).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [277] 2015

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a meta-analysis of RCTs, moderate alcohol consumption compared with no alcohol raised HDL-C, Apo-A1, and adiponectin and reduced LDL-C and fibrinogen.

    “In a meta-analysis of randomized controlled intervention studies of 2–8 weeks’ duration (273), moderate alcohol consumption (up to one drink or 15 g/d in women; or up to 2 drinks or 30 g/d in men) compared with no alcohol: raised HDL-C, Apo-A1, and adiponectin and reduced LDL-C and fibrinogen.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [273] Brien, 2011, Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Dietary pattern analysis assesses overall diet quality and is easier to translate into dietary recommendations than recommendations for single foods or nutrients.

    “Dietary pattern analysis assesses overall diet quality and is easier to translate into dietary recommendations than recommendations for single foods or nutrients (277).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [277] 2015

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Heavy alcohol use (>45 g/d) increased total stroke risk (RR 1.20, 95% CI 1.01-1.43), particularly hemorrhagic stroke (RR 1.29, 95% CI 0.98-1.71).

    “In a meta-analysis of 27 prospective studies of alcohol and stroke, no association was found between light or moderate alcohol use and stroke, but heavy alcohol use (>45 g/d) was shown to increase total stroke risk (RR: 1.20; 95% CI: 1.01 to 1.43), particularly hemorrhagic stroke (RR: 1.29; 95% CI: 0.98 to 1.71) (275).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [275] Zhang, 2014, Alcohol intake and risk of stroke: a dose-response meta-analysis of prospective studies, Int J Cardiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In PURE, 31% of participants were current drinkers, with variation across income regions (13-80%).

    “In the PURE study, 31% of participants identified as current drinkers, with considerable variation across income regions (13–80%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Industrial poultry production has additional public health impacts, such as foodborne disease, antimicrobial residues, and avian flu.

    “Additional public health impacts of industrial poultry production are also well-reported, such as food borne disease (e.g., e coli, salmonella, listeria), antimicrobial residues, and avian flu (287).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [287] Davis, 2006

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Low-fat diets have not been particularly effective for long-term CVD risk reduction, partly due to difficulty sustaining such a diet long-term.

    “It bears mention that low-fat diets have not been particularly effective for long-term CVD risk reduction, partly due to the difficulty sustaining such a diet long-term (284,285).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [284] Howard, 2006, Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial, JAMA source

      Not checked in the free run.

    • cites [285] Look, 2013, Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mexico has taxation of sugar-sweetened beverages and unessential foods (junk foods in general).

    “- Taxation of sugar-sweetened beverages (SSB’s) and unessential foods (junk foods in general) in Mexico.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [302] Popkin, 2013, Overview: Bellagio conference on program and policy options for preventing obesity in the low- and middle-income countries, Obes Rev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Portfolio Diet lowers LDL-C by up to 30% within four weeks, similar to statins.

    “The Portfolio Diet (281), which includes 30 grams/day of nuts, 20 grams/day of viscous fiber (i.e., oats, barley, legumes), 80 grams/day of vegetable protein (soy, beans, chickpeas, lentils), and 2 grams/day of plant sterols (plant sterol margarine) from plant foods lowers LDL-C by up to 30% within four weeks, similar to statins (281).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [281] Jenkins, 2003, Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein, JAMA source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Families and individuals play a major role in selecting the quality of their diet, particularly in HIC and among middle- and higher-income LMIC.

    “Clearly families and individuals also play a major role in selecting the quality of their diet, particularly in HIC and among middle- and higher-income LMIC, but our focus herein is on the broader environmental factors affecting this system.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several Asian countries are developing a healthier choices option.

    “Several Asian countries are developing a healthier choices option.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [302] Popkin, 2013, Overview: Bellagio conference on program and policy options for preventing obesity in the low- and middle-income countries, Obes Rev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There are huge political, economic, and environmental challenges to changing the food system, including government capacity.

    “There are also huge political, economic and environmental challenges to changing the food system, not least the capacity of governments to implement change (288).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [288] Babu, 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A number of other LMICs are considering these taxes, and several European countries have introduced taxes on different food groups.

    “A number of other LMIC’s are considering these taxes, and several European countries have introduced taxes on different food groups.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [302] Popkin, 2013, Overview: Bellagio conference on program and policy options for preventing obesity in the low- and middle-income countries, Obes Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The DASH trials were not designed to evaluate the impact of this diet on CVD clinical events.

    “However, the DASH trials were not designed to evaluate the impact of this diet on CVD clinical events.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Mexico, South Korea, the UK and Ireland present rare exceptions, but the regulations have loopholes and do not comprehensively restrict marketing.

    “Mexico, South Korea, the UK and Ireland present rare exceptions, but the regulations have loopholes and do not comprehensively restrict marketing.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [302] Popkin, 2013, Overview: Bellagio conference on program and policy options for preventing obesity in the low- and middle-income countries, Obes Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    It may be possible to translate this healthy dietary pattern to other regions, with appropriate similar food replacements based on food availability and preferences.

    “Given that we now understand the components of this diet sufficiently, it may be possible to translate this pattern to other regions, with appropriate similar food replacements based on food availability and preferences (see attached Table S1).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: We now understand the components of the healthy dietary pattern sufficiently to translate it to other regions.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    The traditional Mediterranean-type diet provides a well-tested prototype for this healthy dietary pattern.

    “The traditional Mediterranean-type diet provides a well-tested prototype for this healthy dietary pattern.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Several Latin American countries have regulated front-of-pack labels, including Ecuador's traffic light label implemented in 2014 and Chile's warning label being implemented over the next 4 years.

    “Several Latin American countries have regulated FOP labels, including Ecuador’s traffic light label (implemented in 2014), and Chile’s warning label (being implemented over the next 4 years).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [302] Popkin, 2013, Overview: Bellagio conference on program and policy options for preventing obesity in the low- and middle-income countries, Obes Rev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Chile's new program is the most extensive, implemented over the 2015-19 period.

    “Chile’s new program is the most extensive (implemented over the 2015–19 period).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [302] Popkin, 2013, Overview: Bellagio conference on program and policy options for preventing obesity in the low- and middle-income countries, Obes Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    A healthier food supply enables individuals to make healthier choices.

    “At the same time, a healthier food supply enables individuals to make healthier choices.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The healthy dietary pattern needs also to be low in refined grains, added sugars, trans-fats, SSBs, and red and processed meats.

    “This healthy dietary pattern needs also to be low in refined grains, added sugars, trans-fats, SSBs, and red and processed meats.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Actions by key actors have potential to improve food systems, many with simultaneous health and environmental benefits.

    “Experience indicates actions by the following key actors have potential to improve food systems, many of which can simultaneously have health and environmental benefits:”
    Quote in the paperNot a substantial claim
135 of 135

  • The paper relies on this without support.

    Changes to the global food system can address current diet-related public health problems and simultaneously have beneficial impacts on climate change.

    “an outline of how changes to the global food system can address current diet-related public health problems, and simultaneously have beneficial impacts on climate change.”

  • The paper relies on this without support.

    The consensus of scholars participating in the workshop adequately represents current knowledge on diet and CVD.

    “Major scholars in the field, based on a 3-day consensus, created an in-depth review of current knowledge on the role of diet in CVD, the changing global food system and global dietary patterns, and potential policy solutions.”

  • The paper relies on this without support.

    Current red meat consumption in Asian countries does not reflect long-term patterns.

    “current consumption does not likely reflect long-term patterns.”

  • The paper relies on this without support.

    Low-input, biodiverse farming systems are more sustainable than high-input monocultures and tend to be more productive per land area.

    “Low-input, biodiverse farming systems are more sustainable than high-input monocultures and tend to be more productive per land area, making greater use of ecological space.”

  • The paper relies on this without support.

    Dietary patterns differ in various regions of the world and the context in which foods are accessed differs markedly.

    “However, similar data are needed from LMIC as dietary patterns differ in various regions of the world and the context in which foods are accessed differs markedly.”

  • The paper relies on this without support.

    We now understand the components of the healthy dietary pattern sufficiently to translate it to other regions.

    “Given that we now understand the components of this diet sufficiently, it may be possible to translate this pattern to other regions, with appropriate similar food replacements based on food availability and preferences (see attached Table S1).”

  • The paper relies on this without support.

    Policy actions and interventions that improve food supplies and dietary patterns have social, cultural and environmental benefits.

    “Policy actions and interventions that improve food supplies and dietary patterns have social, cultural and environmental benefits.”

  • The paper relies on this without support.

    There are many opportunities to increase access to healthy food that are also likely to have significant environmental benefits.

    “There are many opportunities to increase access to healthy food that are also likely to have significant environmental benefits.”
8 of 8

Cites

2 retracted

Flagged first, then by citations

25 of the 325 references couldn’t be matched to a known paper.

Research works printed but not linked: 6

  1. Wang, 2008, Dynamic shifts in Chinese eating behaviors, Asia Pac J Clin Nutr, 17, 123
  2. Monteiro C. The big issue is ultra-processing. Journal of the World Public Health Nutrition Association 2010. Available at: http://www.wphna.org/wn_commentary_ultraprocessing_nov2010.asp. Accessed August 7, 2015.
  3. Aldersey C. Consumer trends and usage of fats and oils. Paper presented at: 14th Biennial Sunflower Conference; June 24-26, 2003; Australia.
  4. Micha, 2014, Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys, Br Med J, 348, g2272, 10.1136/bmj.g2272 · DOI · Paper page
  5. Hall, 2009, The progressive increase of food waste in America and its environmental impact, PLoS One, 4, e7940, 10.1371/journal.pone.0007940 · DOI · Paper page
  6. Godfray, 2010, The future of the global food system, Phil Trans R Soc B: Bio Sci, 365, 2769, 10.1098/rstb.2010.0180 · DOI

Cited by

Sorted by citations

Related

Authors
Anand, S. S., Hawkes, C., de Souza, R. J., Mente, A., Dehghan, M., Nugent, R., Zulyniak, M. A., Weis, T., Bernstein, A. M., Krauss, R. M., Kromhout, D., Jenkins, D. J. A., Malik, V., Martinez-Gonzalez, M. A., Mozaffarian, D., Yusuf, S., Willett, W. C., & Popkin, B. M.
Affiliations
  • Population Health Research Institute (CA)
  • City, University of London (GB)
  • University of Washington (US)
  • McMaster University (CA)
  • Western University (CA)
  • Cleveland Clinic (US)
  • Wageningen University & Research (NL)
  • St. Michael's Hospital (CA)
  • Harvard University (US)
  • Tufts University (US)
  • Universidad de Navarra (ES)
  • University of North Carolina at Chapel Hill (US)
Corresponding author
Popkin, Barry M.
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2015-10
Volume
66
Issue
14
Pages
1590-1614
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2015.07.050
PMC
PMC4597475
OpenAlex
W1778213696
Cited by
507
References
325
Citations by year
2026: 22 · 2025: 38 · 2024: 68 · 2023: 44 · 2022: 68 · 2021: 74 · 2020: 50 · 2019: 40 · 2018: 35 · 2017: 37 · 2016: 27 · 2015: 3 · 2013: 1
FWCI
4.90
Type
journal article
Language
en
Update notices
erratum (2015-10-27)
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Socio-Environmental Systems Modeling (acceptedVersion)
  • City Research Online (City University London) (acceptedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • UNC Libraries
Funders
  • World Health Organization
  • California Strawberry Commission
  • Danone
  • Almond Board of California
  • Hamilton Health Sciences
  • McMaster University
  • Amarin Corporation
  • Australian Government
  • Government of Canada
  • Alpro Foundation
  • World Heart Federation
  • National Institutes of Health (2r24hd050924-06)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK098072, P30DK098722)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24 HD-050924, P2CHD050924)
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
  • Physical Sciences › Environmental Science › Ecology › Agriculture Sustainability and Environmental Impact
Keywords
cardiovascular disease, diet, global food system, dietary habits, macronutrients, Mediterranean diet, plant-based foods, plant proteins, low- and middle-income countries, food globalization, health disparities
MeSH terms
Cardiovascular Diseases, Diet, Feeding Behavior, Food Supply, Humans, Risk Factors, Global Health, Climate Change

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review