Randomised Controlled Trials
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BMJ ◽  
2021 ◽  
pp. n1864
Lukas Schwingshackl ◽  
Sara Balduzzi ◽  
Jessica Beyerbach ◽  
Nils Bröckelmann ◽  
Sarah S Werner ◽  

Abstract Objective To evaluate the agreement between diet-disease effect estimates of bodies of evidence from randomised controlled trials and those from cohort studies in nutrition research, and to investigate potential factors for disagreement. Design Meta-epidemiological study. Data sources Cochrane Database of Systematic Reviews, and Medline. Review methods Population, intervention or exposure, comparator, outcome (PI/ECO) elements from a body of evidence from cohort studies (BoE(CS)) were matched with corresponding elements of a body of evidence from randomised controlled trials (BoE(RCT)). Pooled ratio of risk ratios or difference of mean differences across all diet-disease outcome pairs were calculated. Subgroup analyses were conducted to explore factors for disagreement. Heterogeneity was assessed through I 2 and τ 2 . Prediction intervals were calculated to assess the range of possible values for the difference in the results between evidence from randomised controlled trials and evidence from cohort studies in future comparisons. Results 97 diet-disease outcome pairs (that is, matched BoE(RCT) and BoE(CS)) were identified overall. For binary outcomes, the pooled ratio of risk ratios comparing estimates from BoE(RCT) with BoE(CS) was 1.09 (95% confidence interval 1.04 to 1.14; I 2 =68%; τ 2 =0.021; 95% prediction interval 0.81 to 1.46). The prediction interval indicated that the difference could be much more substantial, in either direction. We further explored heterogeneity and found that PI/ECO dissimilarities, especially for the comparisons of dietary supplements in randomised controlled trials and nutrient status in cohort studies, explained most of the differences. When the type of intake or exposure between both types of evidence was identical, the estimates were similar. For continuous outcomes, small differences were observed between randomised controlled trials and cohort studies. Conclusion On average, the difference in pooled results between estimates from BoE(RCT) and BoE(CS) was small. But wide prediction intervals and some substantial statistical heterogeneity in cohort studies indicate that important differences or potential bias in individual comparisons or studies cannot be excluded. Observed differences were mainly driven by dissimilarities in population, intervention or exposure, comparator, and outcome. These findings could help researchers further understand the integration of such evidence into prospective nutrition evidence syntheses and improve evidence based dietary guidelines.

2021 ◽  
Vol 10 (18) ◽  
pp. 4163
Ross Lilley ◽  
Evangeline Chan ◽  
Nicklaus Ng ◽  
Amber Orr ◽  
Marcin Szostok ◽  

Background: Colorectal cancer (CRC) is a leading cause of mortality worldwide and in the UK. Surgical resection is the main curative treatment modality available and using a laparoscopic vs. an open approach may have a direct influence on the inflammatory response, influencing cancer biology and potentially the recurrence kinetics by promoting cancer growth. Methods: This systematic review aims to compare laparoscopic with open surgery for the treatment of colon cancer with a specific focus on the moment of the recurrence. We included randomised controlled trials in intended curative surgery for colon cancer in adults. Interventions: Studies investigating laparoscopic vs. open resection as an intended curative treatment for patients with confirmed carcinoma of the colon. The two co-primary outcomes were the time to recurrence and the overall survival (OS) and disease-free survival (DFS) at three and five years. Meta-analyses were done on the mean differences. Results: After selection, we reviewed ten randomised controlled trials. Most of the trials did not display a statistically significant difference in either DFS or OS at three or at five years when comparing laparoscopic to open surgery. Groups did not differ for the OS and DFS, especially regarding the time needed to observe the median recurrence rate. The quality of evidence (GRADE) was moderate to very low. Conclusion: We observed no difference in the recurrence kinetics, OS or DFS at three or five years when comparing laparoscopic to open surgery in colon cancer.

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 957
Nur Nadiah Syuhada Ramli ◽  
Areej A. Alkhaldy ◽  
Abbe Maleyki Mhd Jalil

Coffee is rich in phenolic acids, such as caffeic acid and chlorogenic acid (CGA). Polyphenol-rich diets were shown to reduce the risk of metabolic syndrome (MeTS). Background and Objectives: This systematic review and meta-analysis discusses the effects of coffee consumption and its dose-response on MeTS parameters. Materials and Methods: PubMed and Scopus® were searched for relevant articles published between 2015 and 2020. This review focused on randomised controlled trials (RCTs) investigating the effect of coffee consumption on anthropometric measurements, glycaemic indices, lipid profiles, and blood pressure. Data from relevant studies were extracted and analysed using random, fixed, or pooled effects models with 95% confidence intervals (CIs). Results: Green coffee extract (GCE) supplementation (180 to 376 mg) was found to reduce waist circumference (weighted mean difference (WMD) = −0.39; 95% CI: −0.68, −0.10), triglyceride levels (WMD = −0.27; 95% CI: −0.43, −0.10), high−density lipoprotein−cholesterol levels (WMD = 0.62; 95% CI: 0.34, 0.90), systolic blood pressure (WMD = −0.44; 95% CI: −0.57, −0.32), and diastolic blood pressure (WMD = −0.83; 95% CI: −1.40, −0.26). Decaffeinated coffee (510.6 mg) reduced fasting blood glucose levels (WMD = −0.81; 95% CI: −1.65, 0.03). The meta-analysis showed that the intake of GCE containing 180 to 376 mg of CGA (administered in a capsule) and liquid decaffeinated coffee containing 510.6 mg of CGA improved the MeTS outcomes in study participants. Conclusions: The findings of the review suggested that the effect of coffee on MeTS parameters varies depending on the types and doses of coffee administered. A more detailed RCT on specific coffee doses (with adjustment for energy and polyphenol intake) and physical activity is needed to further confirm the observed outcomes.

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