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Review
Low-energy sweeteners and body weight: a citation network analysis
  1. Mie Normand1,
  2. Christian Ritz1,
  3. David Mela2 and
  4. Anne Raben1,3
  1. 1 Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
  2. 2 Valkenswaard, The Netherlands
  3. 3 Steno Diabetes Center Copenhagen, Copenhagen, Denmark
  1. Correspondence to Professor Anne Raben, Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark; ara{at}nexs.ku.dk

Abstract

Objective Reviews on the relationship of low-energy sweeteners (LES) with body weight (BW) have reached widely differing conclusions. To assess possible citation bias, citation analysis was used to quantify the relevant characteristics of cited articles, and explore citation patterns in relation to review conclusions.

Design A systematic search identified reviews published from January 2010 to March 2020. Different characteristics (for example, type of review or research, journal impact factor, conclusions) were extracted from the reviews and cited articles. Logistic regression was used to estimate likelihood of articles with particular characteristics being cited in reviews. A qualitative network analysis linked reviews sub-grouped by conclusions with the types of articles they cited.

Main outcome measures (OR; 95% CI) for likelihood that articles with particular characteristics were cited as evidence in reviews.

Results From 33 reviews identified, 183 different articles were cited (including other reviews). Narrative reviews were 62% less likely to be cited than systematic reviews with meta-analysis (OR 0.38; 0.16 to 0.86; p=0.03). Likelihood of being cited was higher for evidence on children than adults (OR 2.27; 1.59 to 3.25; p<0.0001), and with increased journal impact factor (OR 1.15; 1.00 to 1.31; p=0.04). No other factors were statistically significant in the main analysis, and few factors were significant in subgroup analyses. Network analysis showed that reviews concluding a beneficial relationship of LES with BW cited mainly randomised controlled trials, whereas reviews concluding an adverse relationship cited mainly observational studies.

Conclusions Overall reference to the available evidence across reviews appears largely arbitrary, making citation bias likely. Differences in the conclusions of individual reviews map onto different types of evidence cited. Overall, inconsistent and selective use of the available evidence may account for the diversity of conclusions in reviews on LES and BW.

Trial registration number Prior to data analysis, the protocol was registered with the Open Science Framework (https://osf.io/9ghws).

  • weight management
  • nutritional treatment

Data availability statement

Data are available from UCPH upon request to the first author, e-mail: mino@nexs.ku.dk. Protocol is available at https://osf.io/9ghws.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjnph-2020-000210

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    Data availability statement

    Data are available from UCPH upon request to the first author, e-mail: mino@nexs.ku.dk. Protocol is available at https://osf.io/9ghws.

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    Footnotes

    • Contributors The project was initiated by DM. All authors (MN, DM, AR and CR) made substantial contributions to the development of idea and methods. The protocol was drafted by MN with support from DM, AR and CR. Extraction of data was done by MN and DM and discussed with AR, where needed. The manuscript draft was written by MN, and carefully revised by DM, AR and CR. All authors were involved in both the analysis and interpretation of the data. MN and CR were responsible for the statistical analyses. The final manuscript was approved by all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests AR has received financial support from Unilever and International Sweeteners Association (ISA) and project co-coordinator of the EU Horizon 2020 project SWEET, grant number 884293. DM is an advisor to project SWEET and a former employee of Unilever.

    • Provenance and peer review Not commissioned; externally peer reviewed by Kees de Graaf, Wageningen, the Netherlands (kees.degraaf@wur.nl) and Peter Rogers, United Kingdom (peter.rogers@bristol.ac.uk).

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.