Lukas Schwingshackl

University Medical Center Freiburg · Medical Center-University of Freiburg

The aim of the present meta-analysis was to investigate the long-term effects of glycemic index-related diets in the management of obesity with a special emphasis on the potential benefits of low glycemic index/load (GI/GL) in the prevention of obesity-associated risks. Electronic searches for randomized controlled trials (RCTs) comparing low glyce...

Background Meta-analyses of short-term studies indicate favorable effects of higher protein vs. lower protein diets on health outcomes like adiposity or cardiovascular risk factors, but their long-term effects are unknown. Methods Electronic databases (MEDLINE, EMBASE, Cochrane Trial Register) were searched up to August 2012 with no restriction to...

Background: For a growing number of food-based dietary guidelines (FBDGs), diet optimization is the tool of choice to account for the complex demands of healthy and sustainable diets. However, decisions about such optimization models' parameters are rarely reported nor systematically studied. Objectives: The objectives were to develop a framework f...

Background Suboptimal diet quality is a key risk factor for premature death. Assuming relatively stable energy intake among individuals, changes in nutrient intakes occur by exchanging different nutrients. Therefore we aimed to examine the association of isocaloric substitution of dietary (macro)nutrients with all-cause mortality using network meta...

Introduction Expert opinion is widely used in clinical guidelines. No research has ever been conducted investigating the use of expert opinion in international infectious disease guidelines. This study aimed to create an analytical map by describing the prevalence and utilization of expert opinion in infectious disease guidelines and analyzing the...

Background: Systematic reviews are performed manually despite the exponential growth of scientific literature. Objective: To investigate the sensitivity and specificity of GPT-3.5 Turbo, from OpenAI, as a single reviewer, for title and abstract screening in systematic reviews. Design: Diagnostic test accuracy study. Setting: Unannotated bibl...

Purpose It has been proposed that a higher habitual protein intake may increase cancer risk, possibly via upregulated insulin-like growth factor signalling. Since a systematic evaluation of human studies on protein intake and cancer risk based on a standardised assessment of systematic reviews (SRs) is lacking, we carried out an umbrella review of...

Substitution models in epidemiologic studies specifying both substitute and substituted food in relation to disease risk may be useful to inform dietary guidelines. A systematic review of prospective observational studies was performed to quantify the risks of all-cause mortality, cardiovascular disease, and type 2 diabetes (T2D) associated with th...

Introduction This umbrella review aimed to investigate the evidence of an effect of dietary intake of total protein, animal and plant protein on blood pressure (BP), and hypertension (PROSPERO: CRD42018082395). Methods PubMed, Embase and Cochrane Database were systematically searched for systematic reviews (SRs) of prospective studies with or with...

Background: Pressure ulcers are localized injuries to the skin or the underlying tissue, or both, and are common in older and immobile people, people with diabetes, vascular disease, or malnutrition, as well as those who require intensive or palliative care. People with pressure ulcers often suffer from severe pain and exhibit social avoidance beh...

Background: Food service operations in universities and colleges, such as cafeterias and canteens, may support healthy and sustainable diets among students and staff and contribute to a transformation of the wider food system. Multiple studies on interventions to promote health and sustainability in this setting have been conducted, but no up-to-da...

This meta-research study aims to evaluate the agreement of effect estimates between bodies of evidence (BoE) from RCTs and cohort studies included in the same nutrition evidence synthesis, to identify factors associated with disagreement, and to replicate the findings of a previous study. We searched Medline, Epistemonikos and the Cochrane Database...

Background: Researchers and decision-makers often use evidence from randomised controlled trials (RCTs) to determine the efficacy or effectiveness of a treatment or intervention. Studies with observational designs are often used to measure the effectiveness of an intervention in 'real world' scenarios. Numerous study designs and their modification...

Importance: Systematic reviews are time-consuming and are still performed predominately manually by researchers despite the exponential growth of scientific literature. Objective: To investigate the sensitivity, specificity and estimate the avoidable workload when using an AI-based large language model (LLM) (Generative Pre-trained Transformer [GPT...

Introduction: Dietary fat intake in pregnancy, lactation and childhood determines child growth, neurodevelopment and long-term health. Methods: We performed a scoping review of dietary guidelines on fat intake for pregnant and lactating women, infants, children and adolescents. We systematically searched several databases and websites for relevant...

Background Improving nutrition and physical activity is a global health priority. Within Cochrane’s new production model (https://futurecochrane.org), Thematic Groups (TG) with specialist content and review methods expertise have been established. The purpose of TGs is to support the development and dissemination of high-quality evidence syntheses...

Background There is growing evidence that substituting animal-based with plant-based foods is associated with a lower risk of cardiovascular diseases (CVD), type 2 diabetes (T2D), and all-cause mortality. Our aim was to summarize and evaluate the evidence for the substitution of any animal-based foods with plant-based foods on cardiometabolic healt...

OBJECTIVE To systematically summarise and evaluate the existing evidence on the effect of diet on the management of type 2 diabetes and prevention of complications. DESIGN Umbrella review of systematic reviews with meta-analyses of randomised controlled trials. DATA SOURCES PubMed, Embase, Epistemonikos, and Cochrane, from inception up to 5 Ju...

Creating effective dietary guidance requires a rigorous evidence base that is predominantly developed from robust clinical trials or large scale cohort studies, with the quality of the data available depending on the completeness and accuracy of their reporting. An international group of academics from 14 institutions in 12 different countries and...

Purpose This umbrella review aimed to assess whether dietary protein intake with regard to quantitative (higher vs. lower dietary protein intake) and qualitative considerations (total, plant-based or animal-based protein intake) affects body weight (BW), fat mass (FM) and waist circumference (WC). Methods A systematic literature search was conduct...

Purpose Protein-rich foods show heterogeneous associations with the risk of type 2 diabetes (T2D) and it remains unclear whether habitual protein intake is related to T2D risk. We carried out an umbrella review of systematic reviews (SR) of randomised trials and/or cohort studies on protein intake in relation to risks of T2D. Methods Following a p...

Introduction: Dietary fat intake during pregnancy and childhood is important for health. However several health aspects are inconclusive. Methods: We systematically searched Medline, Cochrane Library and Epistemonikos for systematic reviews (SRs) of randomized controlled trials (RCTs) and/or prospective cohort studies published from 01.01.2015 t...

The number of cancer survivors is growing rapidly; however, specific lifestyle recommendations for these patients are still sparse, including dietary approaches. Thus, the aim of the present systematic review and meta-analysis was to examine the associations between adherence to diet-quality indices and dietary patterns on overall mortality, cancer...

Purpose Changes in dietary protein intake metabolically affect kidney functions. However, knowledge on potential adverse consequences of long-term higher protein intake (HPI) for kidney health is lacking. To summarise and evaluate the available evidence for a relation between HPI and kidney diseases, an umbrella review of systematic reviews (SR) wa...

This umbrella review aimed at assessing whether a protein intake exceeding the current recommendation for younger (0.8 g/kg body weight [BW]/day) and older (1.0 g/kg BW/day) adults affects bone mineral density and fracture risk. Moreover, the effect of animal or plant protein was evaluated. A systematic literature search was conducted in PubMed, Em...

PurposeReporting guidelines facilitate quality and completeness in research reporting. The CONsolidated Standards Of Reporting Trials (CONSORT) statement is widely applied to dietary and nutrition trials but has no extension specific to nutrition. Evidence suggests poor reporting in nutrition research. The Federation of European Nutrition Societies...

Purpose of Review This narrative review summarizes the current peer-reviewed literature and mechanisms surrounding the cardiovascular health impact of coconut oil. Recent Findings No randomized controlled trials (RCTs) and/or prospective cohort studies have investigated the effect or association of coconut oil with cardiovascular disease. Evidence...

Health effects of dairy products are still a matter of scientific debate due to inconsistent findings across trials. Therefore, this systematic review and network meta-analysis (NMA) aimed to compare the effects of different dairy products on markers of cardio-metabolic health. A systematic search was conducted in three electronic databases (MEDLIN...

Objective: Our aim was to investigate if and how Cochrane nutrition reviews assess dietary adherence to a specific dietary regimen. Study design and setting: Cochrane nutrition reviews fulfilling the following criteria were included: systematic review of randomized controlled trials including adults and investigating the effect of caloric restri...

BACKGROUND Type 2 diabetes is a major health concern associated with mortality. Diet may influence the progression of diabetes; however, systematic reviews are lacking. PURPOSE This study systematically summarized the evidence on diet and all-cause mortality in individuals with type 2 diabetes. DATA SOURCES PubMed and Web of Science were searched...

Objective To examine the effects of different nutritional intervention strategies in the school setting on anthropometric and quality of diet outcomes by comparing and ranking outcomes in a network meta-analysis. Design Systematic review and network meta-analysis. Data sources PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web...

Background Bread is a major source of grain-derived carbohydrates worldwide. High intakes of refined grains, low in dietary fiber and high in glycemic index, are linked with increased risk for type 2 diabetes mellitus (T2DM) and other chronic diseases. Hence, improvements of the composition of bread could influence population health. Objective Thi...

Background: Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks are well-known tools that enable guideline panels to structure the process of developing recommendations and making decisions in healthcare and public health. To date, they have not regularly been used for health policy-maki...

Objective: Back pain is common in the working population. This systematic review with network meta-analysis (NMA) aimed to compare the effects of interventions for preventing back pain among office workers. Methods: We searched eight databases and additional sources up to March 2021. We included randomized controlled trials (RCT) and cluster RCT...

Background Randomized controlled trials (RCTs) and cohort studies are the most common study design types used to assess treatment effects of medical interventions. We aimed to hypothetically pool bodies of evidence (BoE) from RCTs with matched BoE from cohort studies included in the same systematic review. Methods BoE derived from systematic revie...

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess in hospitalised older people with (risk of) malnutrition the effects of different nutrition interventions (e.g. supportive interventions, nutritional counselling, food modifications, oral nutritional supplements, comprehensive individualise...

Background Instruments to critically appraise randomised controlled trials (RCTs) are based on evidence from meta-epidemiological studies. We aim to conduct a meta-epidemiological study on the average bias associated with reported methodological trial characteristics such as random sequence generation, allocation concealment, blinding, incomplete o...

Introduction In case of patients without indications to statin therapy, those being close to the target and especially with statin intolerance, nutraceuticals might be an additional option of hypercholesterolemia therapy. Despite a large number of nutraceuticals, little is known on their comparative efficacy due to the paucity of head-to-head compa...

Background Reducing the intake of total fat, saturated fatty acids (SFA) and dietary cholesterol was a cornerstone of dietary guidance in past decades. This emphasis shifted recently from lowering the intake of total fat to focusing on the quality of dietary fat intake, the avoidance of industrial trans-fatty acids (TFA), and the substitution of SF...

It is estimated that 2.6 million deaths worldwide can be attributed to hypercholesterolemia. The main reason for non-adherence to statin therapy are the statin-associated muscle symptoms (including nocebo/drucebo effect). In this case, apart from ezetimibe, nutraceuticals are prescribed. We aimed to assess the comparative efficacy of different nutr...

Background Reducing the intake of total fat, saturated fatty acids (SFA) and dietary cholesterol was a cornerstone of dietary guidance in past decades. This emphasis shifted recently from lowering the intake of total fat to focussing on the quality of dietary fat intake, the avoidance of industrial trans-fatty acids (TFA), and the substitution of S...

Obesity and sarcopenic obesity (SO) are characterized by excess body fat with or without low muscle mass affecting bio‐psycho‐social health, functioning, and subsequently quality of life in older adults. We mapped outcomes addressed in randomized controlled trials (RCTs) on lifestyle interventions in community‐dwelling older people with (sarcopenic...

Objectives Bread is a main carbohydrate sources in most diets and may hence be relevant for several health outcomes. This systematic review evaluated the effect of bread consumption on glycemic control in adults with and without type 2 diabetes mellitus (T2DM). Methods A systematic literature search was performed in September 2020 using Medline, E...

Purpose The present work aimed to delineate (i) a revised protocol according to recent methodological developments in evidence generation, to (ii) describe its interpretation, the assessment of the overall certainty of evidence and to (iii) outline an Evidence to Decision framework for deriving an evidence-based guideline on quantitative and qualit...

Background: Appropriate feeding of infants and young children is essential for healthy growth and the prevention of stunting, wasting, and overweight. We aimed to assess the beneficial versus harmful effects of providing fortified complementary foods to children in the complementary feeding period. Methods: In this systematic review and meta-ana...

To summarize and evaluate the evidence on the health impact of a vegan diet, we conducted an umbrella review of systematic reviews and meta-analyses. PubMed, Cochrane Library, Web of Science and Epistemonikos were searched up to September 2021. Meta-analyses were recalculated by using a random effects model. The certainty of evidence (CoE) was eval...

Background Randomized controlled trials (RCTs) and cohort studies are the most common study design types used to assess the treatment effects of medical interventions. To evaluate the agreement of effect estimates between bodies of evidence (BoE) from randomized controlled trials (RCTs) and cohort studies and to identify factors associated with dis...

Only very few Cochrane nutrition reviews include cohort studies (CSs), but most evidence in nutrition research comes from CSs. We aimed to pool bodies of evidence (BoE) from randomized controlled trials (RCTs) derived from Cochrane reviews with matched BoE from CSs. The Cochrane Database of Systematic Reviews, and MEDLINE were searched for systemat...

Background “Biological plausibility” is a concept frequently referred to in environmental and public health when researchers are evaluating how confident they are in the results and inferences of a study or evidence review. Biological plausibility is not, however, a domain of one of the most widely-used approaches for assessing the certainty of evi...

BACKGROUND Due to the rapidly increasing availability of metabolomics data in prospective studies, an update of the meta evidence on metabolomics and type 2 diabetes risk is warranted. PURPOSE To conduct an updated systematic review and meta-analysis of plasma, serum, and urine metabolite markers and incident type 2 diabetes. DATA SOURCES We sear...

Objective There is little empirical evidence of the impact of pooling randomized controlled trials (RCTs) and cohort studies (CSs) on the certainty-of-evidence. To evaluate the hypothetical-scenario of pooling bodies-of-evidence from RCTs with matched bodies-of-evidence from CSs on the certainty-of-evidence. Study design and setting We extracted G...

Purpose Food-derived bioactive peptides may influence important physiological functions. An important example is beta-casomorphins, which are opioid peptides derived from A1 beta-casein in bovine milk and have been associated to be risk factors for non-communicable diseases in humans. A1 and A2 beta-casein are different with respect to the release...

Background: Cardiovascular diseases (CVD) are a major cause of disability and the leading cause of death worldwide. To reduce mortality and morbidity, prevention strategies such as following an optimal diet are crucial. In recent years, low-gluten and gluten-free diets have gained strong popularity in the general population. However, study results...

Background “Biological plausibility” is a concept frequently referred to in environmental and public health when researchers are evaluating how confident they are in the results and inferences of a study or evidence review. Biological plausibility is not, however, a domain of one of the most widely-used approaches for assessing the certainty of evi...

Objective To identify and describe the use of the GRADE dose-response-gradient domain to upgrade the certainty-of-evidence (CoE) in nutrition systematic-reviews (SRs). Study design and setting We searched for SRs of observational studies of nutrition topics that used GRADE and upgraded the CoE of at least one outcome for a dose-response-gradient,...

Small relative effect sizes are common in observational studies of exposure in environmental and public health. However, such effects can still have considerable policy importance when the baseline rate of the health outcome is high, and many persons are exposed. Assessing the certainty of the evidence based on these effect sizes is challenging bec...

Rationale: As in younger ages, obesity is highly prevalent in older people and lifestyle-interventions (LSI) are recommended as first-line treatment. We conducted a systematic review of randomized-controlled trials (RCTs) with network meta-analyses (NMA) to describe effects of LSI on body weight (BW) and fat-free mass (FFM) in older people with obe...

This is the 24th in the ongoing series of articles describing the GRADE approach for assessing the certainty of a body of evidence in systematic reviews and health technology assessments and how to move from evidence to recommendations in guidelines. Guideline developers and authors of systematic reviews and other evidence syntheses use randomized...

According to previous cohort studies it is suggested that a high intake of poultry does not adversely affect cardiovascular disease (CVD) risk. Therefore, the aim of this systematic review and meta-analysis is to summarize and analyze the association between dietary poultry intake and the risk for CVDs, coronary heart disease (CHD), stroke and all-...

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...

Suboptimal diet is recognized as a leading modifiable risk factor for non-communicable diseases. Non-randomized studies (NRSs) with patient relevant outcomes provide many insights into diet–disease relationships. Dietary guidelines are based predominantly on findings from systematic reviews of NRSs—mostly prospective observational studies, despite...

Background Intake of most foods show correlations with other foods implying that change in the intake of one food affects the intake of other foods. However, it is unclear whether such relationships are quantitatively meaningful and should be considered when a change in dietary intake is suggested. Methods We used data from European Prospective In...

Background: Observational studies have described associations between multiple sclerosis (MS) and heart diseases, but the results were mixed. Methods: Medline, Embase, and Cochrane CENTRAL were searched up to 5 October 2020 according to a protocol (PROSPERO registration number CRD42020184493). We included longitudinal non-randomized studies of expo...