Summary plot for the effect of important food sources of fructose-containing sugars on diastolic blood pressure (DBP).

Data are weighted mean differences (95% confidence intervals). The bolded lines present the effect estimates for total fructose-containing sugars on DBP at each of the 4 levels of energy control. Where there was significant interaction or influence by food source, effect estimates for each individual food source are presented. 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 Cochran Q statistic, where PQI2 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. CI = confidence interval; DBP = diastolic blood pressure; GRADE = Grading of Recommendations, Assessment, Development and Evaluation; MD = mean difference; N = number; 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. *Where there was a significant interaction by food source (in substitution and addition trials) or influence by food source (in subtraction and ad libitum trials where SSBs and/or Mixed sources (with SSBs) were the sole food sources), we performed the GRADE analysis for each individual food source. †Not upgraded for dose-response (see S8 Table in S1 File for details).