John L Sievenpiper

University of Toronto | U of T · Department of Nutritional Sciences

Introduction: The Portfolio Diet, a dietary pattern that combines cholesterol-lowering plant foods, reduces several cardiovascular disease (CVD) risk factors in clinical trials and has been associated with reduced CVD risk predominately in White populations. As NHANES III (1988-1994) purposely over-sampled non-Hispanic Blacks and Mexican Americans,...

Objective: The evidence for liquid meal replacements in diabetes has not been summarized. Our objective was to synthesize the evidence of the effect of liquid meal replacements on cardiometabolic risk factors in overweight/obese individuals with type 2 diabetes. Research design and methods: Data sources included MEDLINE, EMBASE, and the Cochrane...

Diets that have been shown to reduce chronic disease risk focus on increasing intake of foods naturally high in fiber with minimal processing including fruits, vegetables, legumes, and whole grains. Despite evidence for reduced disease burden from both epidemiological and clinical trials, current intake levels of such foods are well below dietary r...

Aims Dietary fiber intake, especially viscous soluble fiber, has been established as a means to reduce cardiometabolic risk factors. Whether this is true for blood pressure remains controversial. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to investigate the effects of viscous soluble fiber supplementa...

Background and aim: Preliminary findings indicate that consumption of Salba-chia (Salvia hispanica L.), an ancient seed, improves management of type 2 diabetes and suppresses appetite. The aim of this study was to assesse the effect of Salba-chia on body weight, visceral obesity and obesity-related risk factors in overweight and obese adults with...

Since the publication of the 2012 guidelines new literature has emerged to inform decision making. The 2016 guidelines primary panel selected a number of clinically relevant questions and has produced updated recommendations, based on important new findings. In subjects with clinical atherosclerosis, abdominal aortic aneurysm, most subjects with di...

Introduction Type 2 diabetes (T2DM) produces macrovascular and microvascular damage, significantly increasing the risk of cardiovascular disease (CVD), renal failure and blindness. As rates of T2DM rise, the need for effective dietary and other lifestyle changes to improve diabetes management become more urgent. Low-glycaemic index (GI) diets may i...

Background/objectives: There has been recent interest in barley as a therapeutic food owing to its high content of beta-glucan (β-glucan), a viscous soluble fiber recognized for its cholesterol-lowering properties. The objective of this study was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating...

Pre-clinical evidence indicates the potential for ginseng to reduce cardiovascular disease risk and acutely aid in blood pressure (BP) control. Clinical evidence evaluating repeated ginseng exposure, however, is controversial, triggering consumer and clinician concern. A systematic review and meta-analysis were conducted to assess whether ginseng h...

Unlabelled: Previous research on the effect of replacing sources of animal protein with plant protein on glycemic control has been inconsistent. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of this replacement on glycemic control in individuals with diabetes. We searched M...

Background and aim: Compared to a DASH-type diet, an intensively applied dietary portfolio reduced diastolic blood pressure at 24 weeks as a secondary outcome in a previous study. Due to the importance of strategies to reduce blood pressure, we performed an exploratory analysis pooling data from intensively and routinely applied portfolio treatmen...

Background: Debate over the role of fructose in mediating cardiovascular risk remains active. To update the evidence on the effect of fructose on established therapeutic lipid targets for cardiovascular disease (low-density lipoprotein cholesterol [LDL]-C, apolipoprotein B, non-high-density lipoprotein cholesterol [HDL-C]), and metabolic syndrome...

Background: The role of sugar-sweetened beverages (SSBs) that contain free or bound fructose in the pathogenesis of hypertension remains unclear. Objective: We conducted a systematic review and meta-analysis of prospective cohort studies to quantify the association between fructose-containing SSBs and risk of hypertension. Design: MEDLINE, Emb...

Sugars have replaced fat as the dominant public health nutrition concern. A fructose-centric view of cardiometabolic disease has emerged whereby fructose-containing sugars are thought to have deleterious effects on body weight, fasting and postprandial blood lipids, glycemia, blood pressure, uric acid, and markers of nonalcoholic fatty liver diseas...

Sugars containing fructose are emerging as the dominant public health targets for their role in the epidemic of overweight and obesity. This position is largely supported by ecological observations, rodent models of overfeeding and select human trials. Higher level evidence from systematic reviews and meta-analyses of controlled dietary trials has...

The positive and negative health effects of dietary carbohydrates are of interest to both researchers and consumers. International experts on carbohydrate research held a scientific summit in Stresa, Italy, in June 2013 to discuss controversies surrounding the utility of the glycemic index (GI), glycemic load (GL) and glycemic response (GR). The ou...

Background: Sugar-sweetened beverages (SSBs) containing fruc-tose are emerging as important public health targets in the epidemic of obesity. Objectives: To conduct a systematic review and meta-analysis of controlled feeding trials assessing the effect of fructose-containing SSBs on body weight. DATA SOURCES: MEDLINE, EMBASE, CINAHL, and the Cochra...

Background: Obesity is a risk factor for developing several diseases, and although dietary pulses (nonoil seeds of legumes such as beans, lentils, chickpeas, and dry peas) are well positioned to aid in weight control, the effects of dietary pulses on weight loss are unclear. Objective: We summarized and quantified the effects of dietary pulse co...

Background/objectives: Chronic kidney disease (CKD) is a major health concern associated with increased risk of cardiovascular disease, morbidity and mortality. Current CKD practice guidelines overlook dietary fiber, which is chronically low in the renal diet. However, increasing dietary fiber has been proposed to ameliorate the progress of CKD. W...

A number of meta-analyses of cohort studies have assessed the impact of glycemic load (GL) and glycemic index (GI) on cardiovascular outcomes. The picture that emerges is that for women, a significant association appears to exist between the consumption of high GL/GI diets and increased cardiovascular disease (CVD) risk. This association appears to...

Objectives: Although most controlled feeding trials have failed to show an adverse effect of fructose on blood pressure, concerns continue to be raised regarding the role of fructose in hypertension. To quantify the association between fructose-containing sugar (high-fructose corn syrup, sucrose, and fructose) intake and incident hypertension, a sy...

Consumption of almonds has been shown to be associated with a decreased risk of CHD, which may be related to their fatty acid (FA) composition. However, the effect of almond consumption on the serum FA composition is not known. Therefore, in the present study, we investigated whether almond consumption would alter the serum FA profile and risk of C...

Objective To assess the effect of dietary pulses (beans, peas, chickpeas, lentils) on acute satiety and second meal intake, a systematic review and meta-analysis was conducted.MethodsMEDLINE, EMBASE, CINAHL, and the Cochrane Registry (through May 6, 2013) were searched for acute controlled trials examining the effect of dietary pulses on postprandi...

Background and Aims Nut consumption has been associated with decreased risk of coronary heart disease (CHD) and type 2 diabetes which has been largely attributed to their healthy fatty acid profile, yet this has not been ascertained. Therefore, we investigated the effect of nut consumption on serum fatty acid concentrations and how these relate to...

Background: Tree nut consumption has been associated with reduced diabetes risk, however, results from randomized trials on glycemic control have been inconsistent. Objective: To provide better evidence for diabetes guidelines development, we conducted a systematic review and meta-analysis of randomized controlled trials to assess the effects of...

Objective To provide a broader evidence summary to inform dietary guidelines of the effect of tree nuts on criteria of the metabolic syndrome (MetS). Design We conducted a systematic review and meta-analysis of the effect of tree nuts on criteria of the MetS. Data sources We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library (through 4 April...

Objective: Despite their independent cardiovascular disease (CVD) advantages, effects of α-linolenic acid (ALA), monounsaturated fatty acid (MUFA), and low-glycemic-load (GL) diets have not been assessed in combination. We therefore determined the combined effect of ALA, MUFA, and low GL on glycemic control and CVD risk factors in type 2 diabetes....

National food supply data and dietary surveys are essential to estimate nutrient intakes and monitor trends, yet there are few published studies estimating added sugars consumption. The purpose of this report was to estimate and trend added sugars intakes and their contribution to total energy intake among Canadians by, first, using Canadian Commun...

Background: Evidence from controlled trials encourages the intake of dietary pulses (beans, chickpeas, lentils and peas) as a method of improving dyslipidemia, but heart health guidelines have stopped short of ascribing specific benefits to this type of intervention or have graded the beneficial evidence as low. We conducted a systematic review an...

In the preceding point narrative, Drs. Bray and Popkin provide their opinion and review data that suggest to them that we need to reconsider the consumption of dietary sugar based on the growing concern of obesity and type 2 diabetes. In the counterpoint narrative below, we argue that there is no clear or convincing evidence that any dietary or add...

AimsGinseng root and its derivatives remain atop the most widely used medicinal herbs in cardiovascular disease, despite inadequate substantiation of efficacy. We previously reported the potential of Korean red ginseng (KRG) to affect vascular tone by decreasing arterial wave reflection via an unknown mechanism. Given the preclinical link between g...

We read with interest the review by Lakhan and Kirchgessner, proposing that high fructose intake promotes obesity, metabolic syndrome, diabetes, and cognitive decline. Their focus on the role of fructose seems premature due to confounding from energy and the heavy reliance on low quality evidence from animal models. There is a lack of high quality...

Background/Objectives: In the absence of consistent clinical evidence, there are concerns that fructose contributes to non-alcoholic fatty liver disease (NAFLD). To determine the effect of fructose on markers of NAFLD, we conducted a systematic review and meta-analysis of controlled feeding trials. Subjects/Methods: We searched MEDLINE, EMBASE, CI...

Background In the absence of consistent clinical evidence, concerns have been raised that fructose raises postprandial triglycerides. Purpose A systematic review and meta-analysis was conducted to assess the effect of fructose on postprandial triglycerides. Data sources Relevant studies were identified from MEDLINE, EMBASE, and Cochrane databases...

The Transcultural Diabetes Nutrition Algorithm (tDNA) is a clinical tool designed to facilitate implementation of therapeutic lifestyle recommendations for people with or at risk for type 2 diabetes. Cultural adaptation of evidence-based clinical practice guidelines (CPG) recommendations is essential to address varied patient populations within and...

Concerns are growing regarding the role of dietary sugars in the development of obesity and cardiometabolic diseases, including diabetes. High-fructose corn syrup (HFCS) and sucrose are the most important dietary sweeteners. Both HFCS and sucrose have overlapping metabolic actions with adverse effects attributed to their fructose moiety. Ecologic s...

Fructose is seen as uniquely contributing to the pandemics of obesity and its cardiometabolic complications. Much of the evidence for this view derives from the unique biochemical, metabolic, and endocrine responses that differentiate fructose from glucose. To understand whether these proposed mechanisms result in clinically meaningful modification...

On behalf of Health Canada, Aziz et al. ( 1 ) recently published their evaluation of the use of glycaemic index (GI) claims on food labels. Although the importance of controlling postprandial glycaemia (PPG) was recognised in the position statement, they expressed the view that the GI could be ‘misleading’ and ‘would not add value’ to the existing...

Current guidelines recommend diet and lifestyle modifications for primary prevention and treatment of hypertension, but do not encourage dietary pulses specifically for lowering blood pressure (BP). To quantify the effect of dietary pulse interventions on BP and provide evidence for their inclusion in dietary guidelines, a systematic review and met...

Excessive fructose intake from high-fructose corn syrup (HFCS) and sucrose has been implicated as a driving force behind the increasing prevalence of obesity and its downstream cardiometabolic complications including hypertension, gout, dyslidpidemia, metabolic syndrome, diabetes, and non-alcoholic fatty liver disease (NAFLD). Most of the evidence...

Objective α-Linolenic acid (ALA) is considered to be a cardioprotective nutrient; however, some epidemiological studies have suggested that dietary ALA intake increases the risk of prostate cancer. The main objective was to conduct a systematic review and meta-analysis of case–control and prospective studies investigating the association between di...

Background: The lack of accuracy of point of care (POC) glucose monitors has limited their use in the diagnosis of neonatal hypoglycemia. Hematocrit plays an important role in explaining discordant results. The objective of this study was to to assess the effect of hematocrit on the diagnostic performance of Abbott Precision Xceed Pro (PXP) and No...

To stimulate discussion around the topic of 'carbohydrates' and health, the Brazilian branch of the International Life Sciences Institute held the 11th International Functional Foods Workshop (1-2 December 2011) in which consolidated knowledge and recent scientific advances specific to the relationship between carbohydrates and health were presente...

Clinical practice guidelines (CPGs) for the nutritional management of diabetes mellitus have evolved considerably over the last 25 years. As major diabetes associations have focussed on the individualization of nutrition therapy, there has been a move toward a broader more flexible macronutrient distribution that emphasizes macronutrient quality ov...

KEY MESSAGES People with diabetes should receive nutrition counselling by a registered dietitian. Nutrition therapy can reduce glycated hemoglobin (A1C) by 1.0% to 2.0% and, when used with other components of diabetes care, can further improve clinical and metabolic outcomes. Reduced caloric intake to achieve and maintain a healthier body weight sh...

To the Editor: We read with interest the report by Koenig et al. (1) showing the value of high-sensitivity cardiac troponin T (hs-cTnT)1 assays for predicting long-term cardiovascular events in patients after an acute coronary syndrome (ACS) or coronary artery bypass grafting. Although studies have demonstrated long-term cardiovascular events with...

Background: Legumes, including beans, chickpeas, and lentils, are among the lowest glycemic index (GI) foods and have been recommended in national diabetes mellitus (DM) guidelines. Yet, to our knowledge, they have never been used specifically to lower the GI of the diet. We have therefore undertaken a study of low-GI foods in type 2 DM with a foc...

Glycemic index (GI) and glycemic load (GL) have been associated with coronary heart disease (CHD) risk in some but not all cohort studies. We therefore assessed the association of GI and GL with CHD risk in prospective cohorts. We searched MEDLINE, EMBASE, and CINAHL (through April 5, 2012) and identified all prospective cohorts assessing associati...

Laboratory medicine practice guidelines (LMPGs) are an important part of clinical laboratory medicine. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument has been developed to evaluate the process of practice-guideline development and the quality of reporting. We assessed the applicability of AGREE II in assessing the...

The effect of fructose on cardiometabolic risk in humans is controversial. We conducted a systematic review and meta-analysis of controlled feeding trials to clarify the effect of fructose on glycemic control in individuals with diabetes. We searched MEDLINE, EMBASE, and the Cochrane Library (through 22 March 2012) for relevant trials lasting ≥7 da...