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We examined risks of bias in concordance with the Cochrane tools, including a Cochrane risk of bias assessment tool for non-randomised studies of interventions.19–21 Seven domains were assessed: confounding, selection, exposure measurement, misclassification over time, missing data, outcome measurement, and selective reporting.Bias specific to this meta-analysis included the likelihood of misclassifying sugar sweetened fruit drink as fruit juice (for example, fruit punch).Time and language of publications were not restricted.After the removal of duplicates, one author (FI) screened the articles on the basis of the titles and abstracts and three authors (FI, LO'C, and ZY) independently reviewed them in duplicate.Artificially sweetened beverages included low caloric soft drinks as reported in each study.Fruit juice was defined as 100% fruit juice, or fruit juice assessed separately from fruit drinks.For artificially sweetened beverages, publication bias and residual confounding were indicated.For fruit juice the finding was non-significant in studies ascertaining type 2 diabetes objectively (P for heterogeneity=0.008).
Overall quality of evidence was assessed based on study quality, results from sensitivity analysis, and principles of the grades of recommendation, assessment, development, and evaluation (GRADE).22 One author (FI) first summarised the results of bias assessment and quality of overall evidence and these results were discussed among the other authors (FI, LOC, YZ, and NGF) for consensus.
The population attributable fraction was estimated in national surveys in the USA, 2009–10 (n=4729 representing 189.1 million adults without diabetes) and the UK, 2008–12 (n=1932 representing 44.7 million).
Results Prespecified information was extracted from 17 cohorts (38 253 cases/10 126 754 person years).
Under assumption of causality, consumption of sugar sweetened beverages over years may be related to a substantial number of cases of new onset diabetes.
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