Does high-carbohydrate intake lead to increased risk of obesity? A systematic review and meta-analysis.

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metabolic syndrome 5634 The protocol was also formally peer reviewed and published in BMJ Open. Carbohydrate intake, obesity, metabolic syndrome and cancer risk? A two-part systematic review and meta-analysis protocol to estimate attributability.[12]This
metabolic syndrome 23152 labelled as the cause of ‘saccharine disease’ involving a wide variety of vascular disorders,[9] metabolic syndrome and type 2 diabetes,[33] cardiovascular and kidney disease.[34] Conversely, the protective role of unrefined
obesity 71 Title: BMJ OpenDoes high-carbohydrate intake lead to increased risk of obesity ? A systematic review and meta-analysisKurt SartoriusBenn SartoriusThandinkosi E MadibaCristina Stefan
obesity 416 2/2018AbstractObjectivesThe present study aimed to test the association between high and low carbohydrate diets and obesity , and second, to test the link between total carbohydrate intake (as a percentage of total energy intake)
obesity 533 second, to test the link between total carbohydrate intake (as a percentage of total energy intake) and obesity .Setting, participants and outcome measuresWe sought MEDLINE, PubMed and Google Scholar for observation
obesity 734 observation studies published between January 1990 and December 2016 assessing an association between obesity and high-carbohydrate intake. Two independent reviewers selected candidate studies, extracted data and
obesity 1022 the inclusion and exclusion criteria and quantified an association between carbohydrate intake and obesity . The first pooled strata (high-carbohydrate versus low-carbohydrate intake) suggested a weak increased
obesity 1141 pooled strata (high-carbohydrate versus low-carbohydrate intake) suggested a weak increased risk of obesity . The second pooled strata (increasing percentage of total carbohydrate intake in daily diet) showed
obesity 1274 (increasing percentage of total carbohydrate intake in daily diet) showed a weak decreased risk of obesity . Both these pooled strata estimates were, however, not statistically significant.ConclusionsOn the basis
obesity 1560 diet or increased percentage of total energy intake in the form of carbohydrates increases the odds of obesity . A central limitation of the study was the non-standard classification of dietary intake across the
obesity 2278 explore this angle as far as we are aware.The scarcity of studies and/or data that either measured obesity risk versus total carbohydrate intake or alternatively measured obesity risk on the basis of a high
obesity 2350 and/or data that either measured obesity risk versus total carbohydrate intake or alternatively measured obesity risk on the basis of a high versus low carbohydrate intake is a limitation.The non-standardised instruments
obesity 3253 life lost, and 3.8% of disability-adjusted life-years worldwide, were attributed to overweight and obesity .[2] The rate of change of obesity in this global study indicated significant increases in both men and
obesity 3287 disability-adjusted life-years worldwide, were attributed to overweight and obesity.[2] The rate of change of obesity in this global study indicated significant increases in both men and women. In men the proportion of
obesity 3660 occurred in both developed and low income, middle income countries. In addition, significant increases in obesity were also recorded among children and adolescents in developed countries that indicated 23.8% of boys
obesity 3837 countries that indicated 23.8% of boys were either overweight or obese and 22.6% of girls. Overweight and obesity is also increasing in children and adolescents in low income, middle income countries and has risen
obesity 4114 for girls.[2] The relationship between dietary intake, and specifically the role of carbohydrates and obesity at a population level, is also unclear.The aetiology of obesity increasingly reflects excessive calorie
obesity 4178 specifically the role of carbohydrates and obesity at a population level, is also unclear.The aetiology of obesity increasingly reflects excessive calorie intake matched with higher levels of sedentary activity that
obesity 4900 Although there is no consistent evidence that carbohydrates have driven the current levels of global obesity , carbohydrates form a major component of most national diets.[11]The objective of this systematic review/meta-analysis
obesity 5094 systematic review/meta-analysis is to investigate the relationship between carbohydrate intake and obesity . More specifically, the first question is whether a high versus low carbohydrate diet is a risk factor
obesity 5209 specifically, the first question is whether a high versus low carbohydrate diet is a risk factor for obesity and second, whether total carbohydrate intake is a risk factor related to obesity?Materials and methodsRegistration
obesity 5291 a risk factor for obesity and second, whether total carbohydrate intake is a risk factor related to obesity ?Materials and methodsRegistration of protocol with PROSPEROIn accordance with the guidelines, the systematic
obesity 5625 2015. The protocol was also formally peer reviewed and published in BMJ Open. Carbohydrate intake, obesity , metabolic syndrome and cancer risk? A two-part systematic review and meta-analysis protocol to estimate
obesity 6150 used MEDLINE/PubMed and Google Scholar to identify suitable studies that evaluated the determinants of obesity including the effect of high versus low carbohydrate diets, as well as the percentage of carbohydrates
obesity 6820 AND (‘composition’ OR ‘diet’ OR ‘dietary’ OR ‘intake’ OR ‘determinant’) AND (‘ obesity ’ OR ‘obese’) AND (‘attributable’ OR ‘odds’ OR ‘risk’ OR ‘hazard’ OR ‘prevalence’).Study
obesity 7318 disorders. Of specific interest were general population studies that investigated the prevalence of obesity in relation to detailed dietary intake.[11] Studies quantifying dietary intake in terms of total carbohydrate
obesity 7543 as a percentage of total energy, and high versus low carbohydrate intake in relation to the odds of obesity , were included.Two authors (KS, BS) independently screened study titles and abstracts for potential
obesity 8680 ensure that an OR was developed to assess the relationship between carbohydrate intake and the risk of obesity .Two reviewers (BS, KS) also evaluated studies for quality and bias using an adapted version of the Risk
obesity 10517 exclusion criteriaWe included cross-sectional, case–control or cohort studies assessing risk factors for obesity including dietary carbohydrate intake (carbohydrate percentage intake of total energy and high vs low
obesity 10853 dietary interventions as our primary objective was to assess reported carbohydrate intake and measured obesity in normal diet. Studies not performed in human participants were excluded, as were studies lacking primary
obesity 11085 explicit method description. Studies with major ethical issues were also excluded. The classification of obesity was based on BMI or visceral obesity (waist circumference). We considered both published and unpublished
obesity 11122 major ethical issues were also excluded. The classification of obesity was based on BMI or visceral obesity (waist circumference). We considered both published and unpublished studies. No language restriction
obesity 15506 CI: 0.933 to 1.154) indicating a slight positive relationship between high-carbohydrate intake and obesity (figure 4). Within this stratum, eight studies showed an increased risk of obesity and five studies
obesity 15589 high-carbohydrate intake and obesity (figure 4). Within this stratum, eight studies showed an increased risk of obesity and five studies a reduced risk of obesity. Of the eight studies showing an increased risk, four Korean-based
obesity 15632 this stratum, eight studies showed an increased risk of obesity and five studies a reduced risk of obesity . Of the eight studies showing an increased risk, four Korean-based studies, making up 51.92% of the
obesity 15789 four Korean-based studies, making up 51.92% of the total pooled sample, showed an increased risk of obesity related to high-carbohydrate diets (ID 420, 2616), a high-carbohydrate rice-based diet (1206) and a
obesity 16035 diet (2226). Two studies in the South Western United States showed contrasting odds in the risk of obesity across two ethnic groups. In these two studies, Hispanic women indicated a reduced risk of obesity in
obesity 16134 obesity across two ethnic groups. In these two studies, Hispanic women indicated a reduced risk of obesity in relation to a high-carbohydrate diet, whereas white women indicated an increased risk of obesity.
obesity 16234 obesity in relation to a high-carbohydrate diet, whereas white women indicated an increased risk of obesity . The highest odds of increased obesity were indicated in a Sri Lankan study involving high levels of
obesity 16273 high-carbohydrate diet, whereas white women indicated an increased risk of obesity. The highest odds of increased obesity were indicated in a Sri Lankan study involving high levels of inactivity, as well as a high-carbohydrate
obesity 16434 levels of inactivity, as well as a high-carbohydrate intake.Table 1ORs (and log odds) for developing obesity as a result of high versus low carbohydrate diet (strata 1) or increasing carbohydrate intake percentage
obesity 17197 dietary pattern1.051.02 to 1.090.020.01 to 0.04103011526Meng et al[54]Staple food and vegetables higher obesity (Q4 vs Q1 higher proportion carb intake)1.281.00 to 1.640.110 to 0.2276811532Merchant et al[55]Quartiles
obesity 19250 Examination Surveys.Figure 4Forest plot of association (logs OR) between high and low carbohydrate intake and obesity .In strata 2, 11 adult-based studies investigated the relationship between total calorie intake of carbohydrates
obesity 19386 studies investigated the relationship between total calorie intake of carbohydrates and the odds of obesity . Six studies showed a reduced risk and five an increased risk (figure 5), once more with a non-significant
obesity 19776 population (ID 1480), making up 66% of the total pooled sample, indicated a 7.7% increased risk of obesity in response to a higher percentage of total carbohydrate intake. Conversely, the three US-based National
obesity 20047 up 15.71% of the total pooled sample indicated no increased risk (ID 130, 130) or a reduced risk of obesity (ID 2591).Figure 5Forest plot of association (log OR) between percentage of total carbohydrate intake
obesity 20161 2591).Figure 5Forest plot of association (log OR) between percentage of total carbohydrate intake and obesity .The results of the meta-analyses by strata both suggested prominent heterogeneity across individual
obesity 20882 review/meta-analysis study, suggest that a higher proportion of carbohydrates in unrestricted diets do not increase obesity levels. Our paper, therefore, cannot contradict the assumption of the total energy intake/expenditure
obesity 22683 satiety thus positively re-enforcing reduced calorie intake.[28]The linkage between carbohydrates and obesity continues to be an intense debate with no clear resolution at this stage. A major issue that needs to
obesity 22895 addressed is whether the opposing roles of carbohydrates in disease is paralleled by their role in obesity . The good and bad role of refined versus unrefined carbohydrates is well documented in disease.[30]
obesity 23775 aspect of the diets of the four leading countries.[37] The opposing roles of dietary carbohydrates and obesity is also supported in the literature that demonstrates bad carbohydrates (unrefined carbohydrates and
obesity 23899 supported in the literature that demonstrates bad carbohydrates (unrefined carbohydrates and sugar) promote obesity while unrefined carbohydrates may have the opposite effect.[7] However, the same evidence of good and
obesity 24030 carbohydrates may have the opposite effect.[7] However, the same evidence of good and bad carbohydrates in obesity is far from conclusive and the studies included in this paper provided insufficient evidence of the
obesity 24146 from conclusive and the studies included in this paper provided insufficient evidence of the risk of obesity relating to different categories of carbohydrates as envisaged in our initial research protocol.Many
obesity 24356 limitations persist to establish whether there is a direct link between high-carbohydrate intake and obesity . First, the non-standard nature of dietary records used across different settings make it difficult
obesity 26121 carbohydrates, increases the odds of being obese. Mounting evidence exists, however, to indicate that the obesity epidemic has occurred during the industrial food era that has promoted the increased intake of refined
obesity 26315 intake of refined carbohydrates and sugars. Further studies are needed that specifically investigate obesity as a function of different carbohydrate groups including refined versus unrefined carbohydrate intake.
obesity 26508 carbohydrate intake. In parallel, prospective studies are needed to ascertain the relationship between obesity and long term high fat, high unrefined carbohydrates–sugar diets. We, therefore, advise readers that
obesity 26675 carbohydrates–sugar diets. We, therefore, advise readers that the assumption that all carbohydrates are not linked to obesity , is potentially erroneous.Supplementary MaterialReviewer commentsAuthor's manuscrip

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