Figure 3.

Summary plot for the effect of important food sources of fructose-containing sugars on alanine aminotransferase (ALT). Data are weighted mean differences (95% confidence intervals) for summary effects of individual food sources and total food sources on ALT. Analyses conducted by generic, inverse variance random effects models (at least five trials available) or fixed effects models (fewer than five trials available). Between-study heterogeneity was assessed by the Cochrane Q statistic, where P_Q < 0.100 is considered statistically significant, and quantified by the I² statistic, where I² ≥ 50% is considered evidence of substantial heterogeneity. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) of randomized controlled trials are rated as “High” certainty of evidence and can be downgraded by five domains and upgraded by one domain. The white squares represent no downgrades, while filled black squares indicate a single downgrade or upgrades for each outcome, and the black square with a white “2” indicates a double downgrade for each outcome. ALT = alanine aminotransferase; CI = confidence interval; GRADE = Grading of Recommendations, Assessment, Development and Evaluation; MD = mean difference; N = number; SMD = standardized mean difference; SSB = sugar-sweetened beverage. ^a For the interpretation of the magnitude, we used the MIDs to assess the importance of magnitude of our point estimate using the effect size categories according to new GRADE guidance. † Not upgraded for dose–response (see Table S7 for details). * Where there was a significant interaction by food source in substitution and addition trials and SSBs and mixed sources were the sole food sources in subtraction and ad libitum trials, we performed the GRADE analysis for each individual food source. To convert U/L to ukat/L, multiply U/L by 0.0167.