Outcome	Strength of evidence	Conclusions and comments	Baseline	Downgrade	Upgrade
Outcome	High	Summary of findings	High Level I/II studies	No Consistent, direct, and precise estimates	No
Outcome	Moderate	Summary of findings	Low Level III studies	No Consistent, direct, and precise estimates	Yes Large effect
Outcome	Low	Summary of findings	High Level I/II studies	Yes (2) Inconsistent Indirect	No

^aRequired domains: risk of bias, consistency, directness, precision. Plausible confounding that would decrease observed effect is accounted for in our baseline risk of bias assessment through individual article evaluation. Additional domains: dose-response, strength of association, publication bias.

^bSingle study = “consistency unknown.”