Inclusion criteria were defined for interventions, comparators, outcomes and participants, but not for study design. Only one database was searched for published studies, so publication bias could not be ruled out (as the authors acknowledged). It was not reported whether language restrictions were applied. The review process was only reported for study selection, so it was not known whether steps were taken to reduce bias and error during data extraction.
Study quality was not assessed, so the reliability of the individual studies was not known, but all of the included studies were observational, so somewhat prone to bias. Heterogeneity was assessed and significant heterogeneity was reported, so the results of the meta-analysis may not be reliable.
Although this review was prone to publication bias and there was no quality assessment and significant heterogeneity, the authors' cautious conclusions appear appropriate.