title: Do sugar-sweetened beverages cause adverse health outcomes in children? A systematic review protocol.
abstract: BACKGROUND
  Cardiovascular disease and type 2 diabetes are examples of chronic diseases that impose significant morbidity and mortality in the general population worldwide. Most chronic diseases are associated with underlying preventable risk factors, such as elevated blood pressure, high blood glucose or glucose intolerance, high lipid levels, physical inactivity, excessive sedentary behaviours, and overweight/obesity. The occurrence of intermediate outcomes during childhood increases the risk of disease in adulthood. Sugar-sweetened beverages are known to be significant sources of additional caloric intake, and given recent attention to their contribution in the development of chronic diseases, a systematic review is warranted. We will assess whether the consumption of sugar-sweetened beverages in children is associated with adverse health outcomes and what the potential moderating factors are.
  
  
  METHODS
  Of interest are studies addressing sugar-sweetened beverage consumption, taking a broad perspective. Both direct consumption studies as well as those evaluating interventions that influence consumption (e.g. school policy, educational) will be relevant. Non-specific or multi-faceted behavioural, educational, or policy interventions may also be included subject to the level of evidence that exists for the other interventions/exposures. Comparisons of interest and endpoints of interest are pre-specified. We will include randomized controlled trials, controlled clinical trials, interrupted time series studies, controlled before-after studies, prospective and retrospective comparative cohort studies, case-control studies, and nested case-control designs. The MEDLINE®, Embase, The Cochrane Library, CINAHL, ERIC, and PsycINFO® databases and grey literature sources will be searched. The processes for selecting studies, abstracting data, and resolving conflicts are described. We will assess risk of bias using design-specific tools. To determine sets of confounding variables that should be adjusted for, we have developed causal directed acyclic graphs and will use those to inform our risk of bias assessments. Meta-analysis will be conducted where appropriate; parameters for exploring statistical heterogeneity and effect modifiers are pre-specified. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used to determine the quality of evidence for outcomes.
  
  
  BACKGROUND
  PROSPERO CRD42014009641.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Stevens
authors.forename: Candyce
authors.initials: C
authors.lastname: Hamel
authors.forename: Kavita
authors.initials: K
authors.lastname: Singh
authors.forename: Mohammed T
authors.initials: MT
authors.lastname: Ansari
authors.forename: Esther
authors.initials: E
authors.lastname: Myers
authors.forename: Paula
authors.initials: P
authors.lastname: Ziegler
authors.forename: Brian
authors.initials: B
authors.lastname: Hutton
authors.forename: Arya
authors.initials: A
authors.lastname: Sharma
authors.forename: Lise M
authors.initials: LM
authors.lastname: Bjerre
authors.forename: Shannon
authors.initials: S
authors.lastname: Fenton
authors.forename: Robert
authors.initials: R
authors.lastname: Gow
authors.forename: Stasia
authors.initials: S
authors.lastname: Hadjiyannakis
authors.forename: Kathryn
authors.initials: K
authors.lastname: O'Hara
authors.forename: Catherine
authors.initials: C
authors.lastname: Pound
authors.forename: Erinn
authors.initials: E
authors.lastname: Salewski
authors.forename: Ian
authors.initials: I
authors.lastname: Shrier
authors.forename: Noreen
authors.initials: N
authors.lastname: Willows
authors.forename: David
authors.initials: D
authors.lastname: Moher
authors.affiliation: Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada. mtremblay@cheo.on.ca.
authors.forename: Mark
authors.initials: M
authors.lastname: Tremblay
mesh_terms: D000293:Adolescent; D001628:Beverages / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003731:Dental Caries / Q000209:etiology; D019422:Dietary Sucrose / Q000009:adverse effects*; D050171:Dyslipidemias / Q000209:etiology; D050723:Fractures, Bone / Q000209:etiology; D006266:Health Education; D006291:Health Policy; D006801:Humans; D006973:Hypertension / Q000209:etiology; D009765:Obesity / Q000209:etiology; D011236:Prediabetic State / Q000209:etiology; D012107:Research Design; D012574:Schools; D013549:Sweetening Agents / Q000009:adverse effects*; D000078202:Systematic Reviews as Topic
chemical_list: D019422:Dietary Sucrose; D013549:Sweetening Agents