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Carbohydrate quality and human health: a series of systematic reviews and meta-analyses
Open accessAbstract
BACKGROUND Previous systematic reviews and meta-analyses explaining the relationship between carbohydrate quality and health have usually examined a single marker and a limited number of clinical outcomes. We aimed to more precisely quantify the predictive potential of several markers, to determine which markers are most useful, and to establish an evidence base for quantitative recommendations for intakes of dietary fibre. METHODS We did a series of systematic reviews and meta-analyses of prospective studies published from database inception to April 30, 2017, and randomised controlled trials published from database inception to Feb 28, 2018, which reported on indicators of carbohydrate quality and non-communicable disease incidence, mortality, and risk factors. Studies were identified by searches in PubMed, Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, and by hand searching of previous publications. We excluded prospective studies and trials reporting on participants with a chronic disease, and weight loss trials or trials involving supplements. Searches, data extraction, and bias assessment were duplicated independently. Robustness of pooled estimates from random-effects models was considered with sensitivity analyses, meta-regression, dose-response testing, and subgroup analyses. The GRADE approach was used to assess quality of evidence. FINDINGS Just under 135 million person-years of data from 185 prospective studies and 58 clinical trials with 4635 adult participants were included in the analyses. Observational data suggest a 15-30% decrease in all-cause and cardiovascular related mortality, and incidence of coronary heart disease, stroke incidence and mortality, type 2 diabetes, and colorectal cancer when comparing the highest dietary fibre consumers with the lowest consumers Clinical trials show significantly lower bodyweight, systolic blood pressure, and total cholesterol when comparing higher with lower intakes of dietary fibre. Risk reduction associated with a range of critical outcomes was greatest when daily intake of dietary fibre was between 25 g and 29 g. Dose-response curves suggested that higher intakes of dietary fibre could confer even greater benefit to protect against cardiovascular diseases, type 2 diabetes, and colorectal and breast cancer. Similar findings for whole grain intake were observed. Smaller or no risk reductions were found with the observational data when comparing the effects of diets characterised by low rather than higher glycaemic index or load. The certainty of evidence for relationships between carbohydrate quality and critical outcomes was graded as moderate for dietary fibre, low to moderate for whole grains, and low to very low for dietary glycaemic index and glycaemic load. Data relating to other dietary exposures are scarce. INTERPRETATION Findings from prospective studies and clinical trials associated with relatively high intakes of dietary fibre and whole grains were complementary, and striking dose-response evidence indicates that the relationships to several non-communicable diseases could be causal. Implementation of recommendations to increase dietary fibre intake and to replace refined grains with whole grains is expected to benefit human health. A major strength of the study was the ability to examine key indicators of carbohydrate quality in relation to a range of non-communicable disease outcomes from cohort studies and randomised trials in a single study. Our findings are limited to risk reduction in the population at large rather than those with chronic disease. FUNDING Health Research Council of New Zealand, WHO, Riddet Centre of Research Excellence, Healthier Lives National Science Challenge, University of Otago, and the Otago Southland Diabetes Research Trust.
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TL;DR
This series of systematic reviews and meta-analyses found that higher intakes of dietary fibre and whole grains are associated with lower risk of non-communicable disease incidence and mortality, with dietary fibre intakes of 25–29 g/day showing greatest benefit. Glycaemic index/load were less useful markers, with low or very-low quality evidence and inconsistent trial effects.
Key findings
- Across 135 million person-years of prospective data and 58 trials with 4,635 adults, higher versus lowest total dietary fibre was associated with a 15–31% lower risk of critical outcomes; all-cause mortality RR 0.85 (95% CI 0.79–0.91), CHD incidence RR 0.76 (0.69–0.83), type 2 diabetes incidence RR 0.84 (0.78–0.90), and colorectal cancer incidence RR 0.84 (0.78–0.89).
- Greatest risk reduction for fibre occurred at 25–29 g/day (improvement in 6 of 7 critical outcomes); dose-response curves were often linear with no plateau, suggesting higher intakes may confer additional protection against cardiovascular diseases, type 2 diabetes, and colorectal and breast cancer.
- Higher whole grain intake was associated with a 13–33% lower risk; per 15 g/day higher intake, RRs were 0.94 (0.92–0.95) for all-cause mortality, 0.93 (0.89–0.98) for CHD incidence, 0.88 (0.81–0.95) for type 2 diabetes, and 0.97 (0.95–0.99) for colorectal cancer.
- Low glycaemic index diets showed an 11% (95% CI 3–18%) relative risk reduction in type 2 diabetes, attenuated to 5% (13% less to 4% more) in sensitivity analysis; evidence was graded low to very-low, and trials showed no consistent benefits.
Methods
- Systematic reviews and meta-analyses of prospective studies published before April 2017 and randomised controlled trials published before February 2018, identified via PubMed, Ovid Medline, Embase, Cochrane CENTRAL, and other sources, with duplicate independent searches, extraction, and bias assessment.
- Included 185 publications of prospective studies involving just under 135 million person-years and 58 clinical trials with 4,635 adult participants; outcomes included NCD incidence, mortality, and cardiometabolic risk factors.
- Random-effects models for high-versus-low quantile analyses, dose-response testing (linear and spline), sensitivity analyses, meta-regression, subgroup analyses, and GRADE assessment of evidence quality.
Limitations
- Stated: Evidence was most often graded moderate or low rather than high because GRADE typically requires RCTs with disease endpoints for high quality, and unexplained heterogeneity led to downgrading; data on other dietary exposures and specific fibre sources/subcategories were limited.
- Stated: High fibre and whole grain intakes may have deleterious effects in populations with borderline iron/mineral status, where very high whole grain intakes may further compromise iron status.
- Evident from text: Observational associations cannot prove causality, though authors argue consistency and dose-response make causality likely; glycaemic index/load findings were inconsistent and attenuated in sensitivity analyses; trials excluded weight-loss trials, fibre supplement powders, and people with diabetes or marked hyperlipidaemia, limiting generalisability.
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39 Own result · 23 Own method · 18 Not checked yet · 17 Own interpretation · 10 No basis given · accuracy not yet measured
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“The findings from prospective studies of glycaemic load are inconsistent.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
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“Higher intakes of whole grains were associated with a 13-33% reduction in the risk.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Whole grains
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“Smaller or no risk reductions were found with the observational data when comparing the effects of diets characterised by low rather than higher glycaemic index or load.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Abstract
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“The randomised controlled trials involving an increase in the amount of whole grains showed improvements in body weight and lipids.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
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In the paper
“Risk reduction associated with a range of critical outcomes was greatest when daily intake of dietary fibre was between 25-29 grams.”
- Also stated in: § Dietary fibre · plain
“When comparing the lowest fibre intakes with pre-specified ranges the greatest benefits were observed for those consuming 25-29g per day (improvement in 6 of the 7 critical outcomes), more so than those consuming between 15-19g per day (improvement in 3 of the 7 critical outcomes), or 20-24g per day (improvement in 4 of the 7 critical outcomes).”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Abstract
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- Also stated in: § Dietary fibre · plain
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“The results from trials show no consistent benefits on the clinical outcomes when changing the glycaemic index of a diet.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
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In the paper
“Observational data suggest a 15-30% decrease in all-cause and cardiovascular related mortality, and incidence of coronary heart disease, stroke, type 2 diabetes, and colorectal cancer when comparing the highest dietary fibre consumers with the lowest.”
- Also stated in: § Dietary fibre · plain
“The observational data in Table 1 show that higher intakes of total dietary fibre are associated with a 15-31% reduction in the risk of specified critical outcomes.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Abstract
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- Also stated in: § Dietary fibre · plain
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In the paper
“Assuming linearity a reduced risk ratio of 0•92 (0•89 to 0•95) was observed for every 8 grams more fibre consumed per day.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
plaincorrelationaln = 9- Asserted: passes — The authors put it forward as true.
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- The authors state this as an assumption: The dose-response relationship between dietary fibre or wholegrain intake and the clinical outcomes is linear.
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In the paper
“However sensitivity analysis due to high heterogeneity attenuated the relative risk reduction to 5% (95%CI 13% less to 4% more).”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Glycaemic index
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Assuming linearity a reduced risk ratio of 0•93 (0•90 to 0•95) was observed for every 8 grams more fibre consumed per day.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
plaincorrelationaln = 3- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Assuming linearity a reduced risk ratio of 0•85 (0•82 to 0•89) was observed for every 8 grams more fibre consumed per day.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
plaincorrelationaln = 2- Asserted: passes — The authors put it forward as true.
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“Stroke mortality was lower amongst those consuming lower glycaemic index diets.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Glycaemic index
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Assuming linearity a reduced risk ratio of 0•81 (0•73 to 0•90) was observed for every 8 grams more fibre consumed per day.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
plaincorrelationaln = 5- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“An 11% (95%CI 3% to 18%) relative risk reduction of type 2 diabetes was observed for those consuming low glycaemic index diets.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Glycaemic index
plaindirect- Asserted: passes — The authors put it forward as true.
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“whilst we found a reduced risk of stroke only.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
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In the paper
“Assuming linearity a risk ratio of 1•05 (1•00 to 1•10) was observed for every 10 glycaemic index unit increase per day.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
plaincorrelationaln = 5 ·- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Assuming linearity a risk ratio of 1•09 (0•94 to 1•27)was observed for every 10 glycaemic index unit increase per day.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
plaincorrelationaln = 4- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Assuming linearity a risk ratio of 1•10 (1•00 to 1•20) was observed for every 10 glycaemic index unit increase per day.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
plaincorrelationaln = 9 ·- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Change in body weight (kg) | 27 | randomised trials | 1,294 | 1201 | MD 0•37 lower (0•63 kg lower to 0•11 kg lower) | High”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
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“We were unable to confirm an effect of low glycaemic index or glycaemic load diets on haemoglobin A1 c or blood cholesterol which have been reported in many short and medium term trials.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
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“Change in HbA1c (%) | 6 | randomised trials | 191 | 189 | SMD 0•35 lower (0•73 lower to 0•03 higher) | Low”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
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In the paper
“Assuming linearity a reduced risk ratio of 0•97 (0•95 to 0•99) was observed for every 15 grams more whole grains consumed per day.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
plaincorrelationaln = 7- Asserted: passes — The authors put it forward as true.
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“Cancer mortality | 5 | observational | 29,593 | 11•2 million PY | RR 0•87 (0•79 to 0•95) | Moderate”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
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In the paper
“CHD incidence | 9 | observational | 7,155 | 2•7 million PY | RR 0•76 (0•69 to 0•83) | Moderate”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
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In the paper
“Assuming linearity a reduced risk ratio of 0•93 (0•89 to 0•98) was observed for every 15 grams more whole grains consumed per day.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
plaincorrelationaln = 4- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CHD mortality | 10 | observational | 7,243 | 6•9 million PY | RR 0•69 (0•60 to 0•81)* | Moderate”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
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“All-cause mortality | 10 | observational | 80,139 | 12•3 million PY | RR 0•85 (0•79 to 0•91) | Moderate”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
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“Stroke mortality | 2 | observational | 1,103 | 1•3 million PY | RR 0•80 (0•56 to 1•14) | Very low”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
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“Type 2 diabetes incidence | 17 | observational | 48,468 | 6•9 million PY | RR 0•84 (0•78 to 0•90) | Moderate”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
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In the paper
“Change in total cholesterol (mmol/L) | 36 | randomised trials | 1,832 | 1,671 | MD 0•15 lower** (0•22 lower to 0•07 lower) | Moderate”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
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“Assuming linearity a risk ratio of 1•16 (0•90 to 1•49) was observed for every 10 glycaemic index unit increase per day.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
plaincorrelationaln = 6- Asserted: passes — The authors put it forward as true.
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In the paper
“Colorectal cancer incidence | 22 | observational | 22,920 | 16•9 million PY | RR 0•84 (0•78 to 0•89) | Moderate”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
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In the paper
“Assuming linearity a reduced risk ratio of 0•94 (0•92 to 0•95) was observed for every 15 grams more whole grains consumed per day.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
plaincorrelationaln = 2- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Change in systolic blood pressure (mm Hg) | 15 | randomised trials | 1,064 | 988 | MD 1•27 lower** (2•50 lower to 0•04 lower) | Moderate”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
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In the paper
“Stroke incidence | 9 | observational | 13,134 | 4•6 million PY | RR 0•78 (0•69 to 0•88)** | Low”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
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In the paper
“Assuming linearity a reduced risk ratio of 0•88 (0•81 to 0•95) was observed for every 15 grams more whole grains consumed per day.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
plaincorrelationaln = 5- Asserted: passes — The authors put it forward as true.
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- The authors state this as an assumption: The dose-response relationship between dietary fibre or wholegrain intake and the clinical outcomes is linear.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The types of studies we have considered did not identify risks associated with dietary fibre.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Evidence relating to body weight, cholesterol, and blood pressure is graded as moderate, downgraded due to unexplained heterogeneity.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Whole grains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The prospective studies generated evidence that is graded as low or very-low quality as a result of high risk of bias, imprecision, and inconsistencies.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Glycaemic index
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Less useful markers of carbohydrate quality are glycaemic index, glycaemic load, and sources of dietary fibre where inconsistent findings or insufficient data provide low or very low quality evidence.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“That the evidence for the associations between the quality markers and outcomes was most frequently rated as 'moderate' or 'low' rather than 'high' may be regarded as a limitation.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The complementary findings from prospective studies and clinical trials relating to the reduction in mortality, NCD incidence, and their risk factors associated with relatively high intakes of dietary fibre and whole grains as well as striking dose response evidence indicate that the relationships may be causal.”
- Also stated in: § Discussion · hedged
“The consistency between the trial and prospective study results together with the dose response relationships are evidence that the effect on cardiometabolic diseases are likely to be causal and not a consequence of confounding.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Abstract
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: The dose-response analysis assumes a linear relationship between intake and outcome.
- Also stated in: § Discussion · hedged
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The quality of evidence contributing to the meta analyses of the cohort studies was, with the exception of the data relating to stroke, considered to be moderate.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Dietary fibre
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The similar protective effects of higher intakes of wholegrain foods and of dietary fibre suggest that the beneficial effects of whole grains may be due to their typically high dietary fibre content.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Sensitivity analyses did not typically change the direction or significance of any pooled effect.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Whole grains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Trial data were usually of moderate quality.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Glycaemic index
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Sensitivity analyses of the tested associations did not change the direction or significance of any observed result.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Dietary fibre
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Our findings are broadly comparable with other reviews and meta analyses that have reported on the association between dietary fibre and whole grains and one or more disease outcomes.[25][26][27][28]”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
What the sources say
- Not checked yetcites [25] Liu, 2015, Fiber consumption and all-cause, cardiovascular, and cancer mortalities: a systematic review and meta-analysis of cohort studies, Mol Nutr Food Res source
- Not checked yetcites [26] Barclay, 2008, Glycemic index, glycemic load, and chronic disease risk—a meta-analysis of observational studies, Am J Clin Nutr source
- Not checked yetcites [27] Dong, 2011, Dietary glycaemic index and glycaemic load in relation to the risk of type 2 diabetes: a meta-analysis of prospective cohort studies, Br J Nutr source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“There is limited, but quite striking evidence that increased processing of whole grains can result in a deterioration of a several biomarkers of cardiometabolic disease.48”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
What the sources say
- Not checked yetcites [48]
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“While we have not considered the evidence regarding total carbohydrate intake, epidemiological evidence and relatively long term clinical trials 46 suggest that a wide range of intakes is acceptable, a finding which is endorsed by authoritative dietary guidelines.47”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
What the sources say
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This coming together of the epidemiological and experimental work on fibre allows conclusions to be drawn that increased fibre intakes should result in improvements in population health.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our study contributes to the growing body of evidence that carbohydrate quality rather than quantity determines major health outcomes.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However there is less consistency in our findings than in earlier reports with regard to the potential benefit of low glycaemic index or glycaemic load diets.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our complementary findings from randomised controlled trials and prospective studies together with the dose response effects, supported by much experimental work, are evidence that diets characterised by a low content of dietary fibre contribute to the cause of a number of NCDs and that benefit will accrue from implementation of quantitative recommendations regarding dietary fibre intake.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“High intakes of dietary fibre and whole grains are more clearly associated with good health outcomes than measures of glycaemic index or glycaemic load.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Probably not a substantial claim. 25
- It may state two separate claims as one. 31
- The quote only partly states this claim. 3
None of the sources cited for this claim have been checked yet.
In the paper
“Publication bias was assessed with Egger's and Begg's tests, 18 and the trim and fill method.19”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Data analysis
What the sources say
- Not checked yetcites [18] Duval, 2000, Trim and fill: a simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis, Biometrics source
- Could not verifycites [19] Guyatt, 2008, GRADE: an emerging consensus on rating quality of evidence and strength of recommendations, BMJ sourceExperimental — accuracy not yet measured
The copy’s ‘Imprecision’ section mentions reporting bias, but neither it nor the other retrieved passages discusses Egger’s test, Begg’s test, or the trim-and-fill method. Searches for those methods and for publication-bias assessment found no passage addressing the claim. (LLM, conf=0.76)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Figure 2 shows dose response relationships for total fibre intake and total mortality, incidence of coronary heart disease, type 2 diabetes and colorectal cancer, many of which are linear with no sign of a plateau within the available data.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Dietary fibre
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However the risk estimates, other than for stroke mortality, are modest when compared with those for dietary fibre and following sensitivity analyses were reduced and associated with confidence intervals which included 1.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“As with dietary fibre the observed reductions in risk are considerable, typically around 20% with significant dose response relationships.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: The dose-response analysis assumes a linear relationship between intake and outcome.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Prospective studies showed a reduction in allcause mortality, coronary heart disease, cancer deaths, and incidence of type 2 diabetes.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Clinical trials show significantly lower body weight, systolic blood pressure and total cholesterol when comparing higher with lower intakes.”
- Also stated in: § Discussion · plain
“In randomised trials higher intakes of dietary fibre reduce body weight, lower blood cholesterol and systolic blood pressure.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Abstract
plaindirectn = 4,635- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § Discussion · plain
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“For all-cause mortality and coronary heart disease incidence this translates into 26 fewer deaths (95%CI 14 to 39) and 7 fewer cases (95%CI 3 to 10) per 1000 participants over the duration of the studies.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Whole grains
plaindirectn = 7- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We have found that diets with a lower overall glycaemic index appear to be associated with a reduced risk of stroke and type 2 diabetes.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Dose response curves showing clear associations with increasing wholegrain intake and all-cause mortality or risk of coronary heart disease, type 2 diabetes, and colorectal cancer incidence are shown in Figure 3.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Whole grains
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: The dose-response analysis assumes a linear relationship between intake and outcome.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“For all-cause mortality and coronary heart disease incidence this translates into 13 fewer deaths (95%CI 8 to 18) and 6 fewer cases of CHD (95%CI 4 to 7) per 1000 participants over the duration of the studies.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Dietary fibre
plaindirectn = 1,000- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In the present study sensitivity analyses due to high heterogeneity reduced risk reduction and confidence intervals included 1.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The quality of evidence contributing to the meta analyses of the trial data relating to body weight is high and total cholesterol and systolic blood pressure moderate because of unexplained heterogeneity between the trials.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Dietary fibre
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Searches, data extraction, and bias assessment were duplicated independently.”
- Also stated in: § Methods · plain
“Literature searches, identification of eligible studies, data extraction and bias assessment were undertaken independently by at least two researchers, with discrepancies resolved with an additional reviewer.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Also stated in: § Methods · plain
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“For prospective studies analyses excluding those that scored less than six out of a possible nine with the NOS were conducted.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Data analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our approach has enabled us to use these indicators of carbohydrate quality to provide a stronger justification than had previously been available for a quantitative recommendation relating to dietary fibre intake.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“With the exception of WHO, the funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing the report.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Role of the funding source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Higher intakes of total dietary fibre or whole grains result in reduced incidence and mortality from several NCDs.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The quality of evidence relating to colorectal cancer incidence is moderate, whilst for other critical outcomes it is low due to high heterogeneity not fully explained by sensitivity analysis.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Whole grains
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Dose response curves suggested that higher intakes may confer even greater benefit with regard to protection against cardiovascular diseases, type 2 diabetes and colorectal and breast cancer.”
- Also stated in: § Discussion · hedged
“These findings together with the comparisons of clinical outcomes amongst those with different intakes of dietary fibre suggest that individual adult intakes of total dietary fibre should be no less than 25 to 29 grams per day with additional benefits likely to accrue with higher intakes.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Abstract
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: The dose-response analysis assumes a linear relationship between intake and outcome.
- Also stated in: § Discussion · hedged
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“For clinical trials, analyses excluding trials with a high risk of bias for at least one criterion were conducted to examine the influence of potential bias on outcomes.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Data analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However this is an inevitable consequence of the use of GRADE criteria for assessment which typically require evidence from randomised controlled trials with disease endpoints in order to be rated as being of 'high'.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Meta regression analyses further examined effects of potential explanatory factors including trial design (crossover or parallel), study or trial duration, global region, differences in fibre intake achieved, source of fibre or starch and nutrition status of participants.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Data analysis
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Furthermore when using the GRADE approach downgrading frequently occurs as a consequence of unexplained heterogeneity amongst the results of the different studies, even when all trend in a similar direction.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall the certainty of evidence regarding the relationships between carbohydrate quality and critical outcomes was graded as moderate for dietary fibre, low to moderate for whole grains, and low to very-low for glycaemic index.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Abstract
plainn = 4,635- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“We used GRADE 22 protocols, to judge the quality of the body of evidence as either high, moderate, low, or very-low.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Data analysis
What the sources say
- Not checked yetcites [22] Aune, 2016, Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies, BMJ source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“For prospective studies the most adjusted values for effect size were extracted, where that value did not also specifically include adjustment for other carbohydrates.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Data extraction
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Where there were multiple publications from the same cohort, we used data for the longest follow-up period.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Study selection
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“We used the ROBIS assessment tool 8 to assess systematic reviews and meta analyses for quality and risk of bias, and the Newcastle Ottawa Scale (NOS) 9 to assess risk of bias of each prospective study.For clinical trials we used Cochrane criteria.10”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Risk of bias assessment
What the sources say
- Not checked yetcites [8] Whiting, 2016, ROBIS: a new tool to assess risk of bias in systematic reviews was developed, J Clin Epidemiol source
- Not checked yetcites [9] Wells, 2011
- Not checked yetcites [10] Higgins, 2011, The Cochrane collaboration's tool for assessing risk of bias in randomised trials, BMJ source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“A major strength of the present study is that it has related key markers of carbohydrate quality to total mortality and mortality and incidence of the major nutrition-related non-communicable diseases and that prospective studies have been considered alongside randomised controlled trials.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Quality of the evidence was assessed by the research team and revised if required after discussion with the NUGAG Subgroup on Diet and Health.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Data analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Data were extracted using pre-tested forms.7”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Data extraction
What the sources say
- Not checked yetcites [7] Te Morenga, 2013, Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies, BMJ source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“We followed reporting standards for systematic reviews and meta analyses.6”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Methods
What the sources say
- Not checked yetcites [6] Moher, 2009, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, PLoS Med source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Role of the funding source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“** The high heterogeneity of the pooled effect size (>50%) is unexplained by sensitivity analyses.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
In the paper
“Diets high in total dietary fibre especially from whole grains and, on the basis of another recent systematic review, 36 vegetables and fruits, are associated with a significant reduction in a range of NCDs when compared with lower dietary fibre and refined rather than whole grain intakes.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
What the sources say
- Not checked yetcites [36] Cummings, 1973, Dietary fibre, Gut source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our study does not exclude the value of these indicators of carbohydrate quality in this clinical context.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Whole foods that require chewing and retain much of their structure in the gut are more likely to increase satiety through a variety of mechanisms leading to weight loss and to modulation of carbohydrate and lipid metabolism.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“There is a considerable body of evidence relating to the adverse consequences of high intakes of sugar sweetened beverages and strong recommendations to reduce the intake of free sugars.3”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
What the sources say
- Not checked yetcites [3] 2015
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our complementary findings from randomised controlled trials and prospective studies together with the dose response effects, supported by much experimental work, are evidence that diets characterised by a low content of dietary fibre contribute to the cause of a number of NCDs and that benefit will accrue from implementation of quantitative recommendations regarding dietary fibre intake.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However we excluded trials which involved only people with diabetes or marked hyperlipidaemia who were the participants in the majority of trials reporting reduction in these important risk indicators.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Other studies have reported a lower incidence of stroke and CHD amongst those consuming low glycaemic index or glycaemic load diets, 29,[33][34][35][36]”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
What the sources say
- Not checked yetcites [29] Turati, 2015, High glycemic index and glycemic load are associated with moderately increased cancer risk, Mol Nutr Food Res source
- Not checked yetcites [33] Rossi, 2015, Relation of dietary glycemic load with ischemic and hemorrhagic stroke: a cohort study in Greece and a meta-analysis, Eur J Nutr source
- Not checked yetcites [34] Aune, 2017, Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality—a systematic review and dose-response meta-analysis of prospective studies, Int J Epidemiol source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“They report risk reductions of around 10% per 200g fruit and vegetables combined for CHD, stroke and total mortality and smaller but still significant reductions for total cardiovascular disease and cancer.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
What the sources say
- Not checked yetcites [37] Spiller, 2001
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Foods containing added fructose or sucrose and composite foods containing both saturated fat and carbohydrate (e.g.confectionary products) may have a low glycaemic index.50”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
What the sources say
- Not checked yetcites [50]
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The benefits of fibre reported in the present and other papers are supported by over 100 years of research into its chemistry, physical properties, physiology and metabolic effects.23,[38][39][40]”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
What the sources say
- Not checked yetcites [23] Aune, 2011, Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies, BMJ source
- Not checked yetcites [38] Clark, 2013, The effect of fiber on satiety and food intake: a systematic review, J Am Coll Nutr source
- Not checked yetcites [39] Wanders, 2011, Effects of dietary fibre on subjective appetite, energy intake and body weight: a systematic review of randomized controlled trials, Obes Rev source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Whole grains offer a useful means of increasing dietary fibre intake and reducing risk of NCDs.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“A review of prospective studies by Turati et al. 32 suggested a small but significant increase in colorectal cancer incidence associated with high glycaemic index or glycaemic load.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
What the sources say
- Not checked yetcites [32] Mirrahimi, 2012, Associations of glycemic index and load with coronary heart disease events: a systematic review and meta-analysis of prospective cohorts, J Am Heart Assoc source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“* Egger's test for bias p = 0•0040. Trim and fill analysis did not change the direction or significance of the pooled estimate.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Figure 5c
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our findings based on a series of systematic reviews and meta analyses provide strong evidence for the importance of including advice regarding the nature and source of other carbohydrates in dietary guidelines aimed at reducing the risk of NCDs.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“However the principal function of the microbiome is digestion of fibre and other carbohydrates that escape breakdown in the small bowel and it is the availability of fibre in the diet that dominates the metabolism of the gut microbiome and leads to protection from conditions such as colorectal cancer.44,45”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
What the sources say
- Not checked yetcites [44]
- Not checked yetcites [45] Järvi, 1999, Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low-glycemic index diet in type 2 diabetic patients, Diabetes Care source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Intakes in the range of 25 to 29g daily are optimal whilst the dose response data show that amounts greater than 30g per day confer additional benefits.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Three systematic reviews have shown a reduced incidence of type 2 diabetes associated with the consumption of diets of lower glycaemic index or glycaemic load, [29][30][31] though the effect was modest when compared with the protective effect of total dietary fibre or wholegrains.”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
What the sources say
- Not checked yetcites [29] Turati, 2015, High glycemic index and glycemic load are associated with moderately increased cancer risk, Mol Nutr Food Res source
- Not checked yetcites [30] Cai, 2015, Carbohydrate intake, glycemic index, glycemic load, and stroke: a meta-analysis of prospective cohort studies, Asia Pac J Public Health source
- Not checked yetcites [31] Fan, 2012, Dietary glycemic index, glycemic load, and risk of coronary heart disease, stroke, and stroke mortality: a systematic review with meta-analysis, PLoS One source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“However high intakes may be associated with deleterious effects in populations with borderline iron/mineral status, amongst whom very high whole grain intakes may further compromise iron status.49”
§ Carbohydrate quality and human health: a series of systematic reviews and meta analyses > Discussion
What the sources say
- Not checked yetcites [49]
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The authors state this as an assumption.
The dose-response analysis assumes a linear relationship between intake and outcome.
“assuming linearity with a two-stage dose response random-effects analysis.”
The authors state this as an assumption.
The dose-response relationship between dietary fibre or wholegrain intake and the clinical outcomes is linear.
“Assuming linearity a reduced risk ratio of 0•93 (0•90 to 0•95) was observed for every 8 grams more fibre consumed per day.”
“Assuming linearity a reduced risk ratio of 0•94 (0•92 to 0•95) was observed for every 15 grams more whole grains consumed per day.”
“Assuming linearity a risk ratio of 1•16 (0•90 to 1•49) was observed for every 10 glycaemic index unit increase per day.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source says what the claim attributes to it.
In the citing paper
“Regular intake of sufficient dietary fiber is associated with lower all-cause mortality in people with diabetes (173,174), and prospective cohort studies have found dietary fiber intake is inversely associated with risk of type 2 diabetes (175-177).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [176]
In the citing paper
“Dietary fiber is an important dietary component for the prevention of chronic diseases 1 , 2 and to ensure gut microbiome diversity and metabolic functionality. 3”
From Adaptation to tolerate high doses of arabinoxylan is associated with fecal levels of Bifidobacterium longum (2024) · cites this paper as [1]
In the citing paper
“Thus, suggestions have been made that higher doses of dietary fiber may be necessary for consistent health benefits, 3 , 11 a notion supported by systematic reviews and meta-analyses. 1 , 12 , 13”
From Adaptation to tolerate high doses of arabinoxylan is associated with fecal levels of Bifidobacterium longum (2024) · cites this paper as [1]
Citations
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., & Schünemann, H. J. (2008) · BMJ · doi:10.1136/bmj.39489.470347.ad · Cited by 23,305
(2014) · Medical Entomology and Zoology · Cited by 17,633
Duval, S., & Tweedie, R. (2000) · Biometrics · doi:10.1111/j.0006-341x.2000.00455.x · Cited by 14,099
The combination of estimates from different experiments
Cochran, W. G. (1954) · Biometrics · doi:10.2307/3001666 · Cited by 5,380
Research works printed but not linked: 1
- Aune, 2011, Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies, BMJ, 343, d6617, 10.1136/bmj.d6617 · DOI · Paper page
Cited by
Sorted by citations
Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association
Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Delling, F. N., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000757 · Cited by 9,175
Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001123 · Cited by 8,300
2021 ESC Guidelines on cardiovascular disease prevention in clinical practice
Visseren, F. L. J., Mach, F., Smulders, Y. M., Carballo, D., Koskinas, K. C., Bäck, M., Benetos, A., Biffi, A., Boavida, J.-M., Capodanno, D., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab484 · Cited by 6,485
Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S., Boehme, A. K., Buxton, A. E., Carson, A. P., Commodore-Mensah, Y., et al. (2022) · Circulation · doi:10.1161/cir.0000000000001052 · Cited by 5,987
Heart Disease and Stroke Statistics—2021 Update: A Report From the American Heart Association
Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Cheng, S., Delling, F. N., et al. (2021) · Circulation · doi:10.1161/cir.0000000000000950 · Cited by 5,784
Metadata
- Authors
- Reynolds, A., Mann, J., Cummings, J., Winter, N., Mete, E., & Te Morenga, L.
- Affiliations
- University of Otago (NZ)
- Riddet Institute (NZ)
- University of Dundee (GB)
- Corresponding author
- Mann, Jim
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 393
- Issue
- 10170
- Pages
- 434-445
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2910727162
- Semantic Scholar
- 4d32053514c1f32591141e1cb35a4f5e2fa8821f
- Cited by
- 1,630
- References
- 46
- Citations by year
- 2026: 196 · 2025: 239 · 2024: 227 · 2023: 249 · 2022: 243 · 2021: 206 · 2020: 163 · 2019: 106
- FWCI
- 24.38
- Type
- journal article
- Language
- en
- Update notices
- erratum (2019-02-02)
- Open access
- bronze
- doi.org
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (publishedVersion, cc-by-nc-nd)
- Funders
- World Health Organization
- University of Otago
- Health Research Council of New Zealand
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Keywords
- carbohydrate quality, dietary fiber, whole grains, glycemic index, glycemic load, non-communicable diseases, cardiovascular disease, type 2 diabetes, colorectal cancer, breast cancer, all-cause mortality, stroke, coronary artery disease, body weight, blood pressure, total cholesterol, dose-response relationship, dietary recommendations, dietary diversity
- MeSH terms
- Noncommunicable Diseases, Dietary Carbohydrates, Dietary Fiber, Humans, Primary Prevention
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.
A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
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 ›
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