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Source of bias in sugar-sweetened beverage research: a systematic review

  • Ethan A Litman (a1), Steven L Gortmaker (a2), Cara B Ebbeling (a3) (a4) and David S Ludwig (a3) (a4)
Abstract
Objective

Financial conflicts of interest involving the food industry have been reported to bias nutrition studies. However, some have hypothesized that independently funded studies may be biased if the authors have strong a priori beliefs about the healthfulness of a food product (‘white hat bias’). The extent to which each source of bias may affect the scientific literature has not been examined. We aimed to explore this question with research involving sugar-sweetened beverages (SSB) as a test case, focusing on a period during which scientific consensus about the adverse health effects of SSB emerged from uncertainty.

Design

PubMed search of worldwide literature was used to identify articles related to SSB and health risks published between 2001 and 2013. Financial relationships and article conclusions were classified by independent groups of co-investigators. Associations were explored by Fischer’s exact tests and regression analyses, controlling for covariates.

Results

A total of 133 articles published in English met inclusion criteria. The proportion of industry-related scientific studies decreased significantly with time, from approximately 30 % at the beginning of the study period to <5 % towards the end (P=0·003). A ‘strong’ or ‘qualified’ scientific conclusion was reached in 82 % of independent v. 7 % of industry-related SSB studies (P<0·001). Industry-related studies were overwhelmingly more likely to reach ‘weak/null’ conclusions compared with independent studies regarding the adverse effects of SSB consumption on health (OR=57·30, 95 % CI 7·12, 461·56).

Conclusion

Industry-related research during a critical period appears biased to underestimate the adverse health effects of SSB, potentially delaying corrective public health action.

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Corresponding author
* Corresponding author: Email david.ludwig@childrens.harvard.edu
References
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