Fig. 4.

Substitution trials. The meta-analyses are of isocaloric substitution trials, in which fructose was exchanged for other carbohydrate sources under energy-matched conditions. Summary estimates (diamonds) were derived from pooled trial-level data. To allow the summary estimates for each endpoint to be displayed on the same axis, mean differences were transformed to standardized mean differences (SMDs). Pseudo-95% CIs for each transformed SMD were derived directly from the original mean difference and 95% CI. The scales were also flipped for high-density lipoprotein cholesterol (HDL-C), whole-body insulin sensitivity and hepatic insulin sensitivity so that the direction of the effect for benefit or harm was in the same direction as that for the other endpoints. Asterisks indicate significant interstudy heterogeneity as assessed by the Cochran Q statistic and quantified by the I ² statistic at a significance level of P < .10 (the higher significance level was chosen owing to the poor sensitivity of the test). ALT alanine aminotransferase, Apo-B apolipoprotein B, DBP diastolic blood pressure, FBG fasting blood glucose, FBI fasting blood insulin, GBP glycated blood proteins, HOMA-IR homoeostatic model assessment-insulin resistance, IHCL intrahepatocellular lipid, LDL-C low-density lipoprotein cholesterol, MAP mean arterial pressure, SBP systolic blood pressure, TG triglycerides, No. total number of participants included in the meta-analysis of the controlled dietary trials