Making nutrition guidelines fit for purpose

Bero, Lisa; Norris, Susan L.; Lawrence, Mark

doi:10.1136/bmj.l1579

Cited by 20 publications

(27 citation statements)

References 50 publications

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“…They found the reporting of results in such studies tended to be skewed in favor of the sponsoring industry, and that authors’ financial conflicts of interest were frequently undisclosed in journal publications. Such reporting bias and lack of transparency is especially problematic as it can lead to the development of inappropriate dietary guidelines [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

High impact nutrition and dietetics journals’ use of publication procedures to increase research transparency

Gorman

Ferdinand

2020

Res Integr Peer Rev

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Background The rigor and integrity of the published research in nutrition studies has come into serious question in recent years. Concerns focus on the use of flexible data analysis practices and selective reporting and the failure of peer review journals to identify and correct these practices. In response, it has been proposed that journals employ editorial procedures designed to improve the transparency of published research. Objective The present study examines the adoption of editorial procedures designed to improve the reporting of empirical studies in the field of nutrition and dietetics research. Design The instructions for authors of 43 journals included in Quartiles 1 and 2 of the Clarivate Analytics’ 2018 Journal Citation Report category Nutrition and Dietetics were reviewed. For journals that published original research, conflict of interest disclosure, recommendation of reporting guidelines, registration of clinical trials, registration of other types of studies, encouraging data sharing, and use of the Registered Reports were assessed . For journals that only published reviews, all of the procedures except clinical trial registration were assessed. Results Thirty-three journals published original research and 10 published only reviews. Conflict of interest disclosure was required by all 33 original research journals. Use of guidelines, trial registration and encouragement of data sharing were mentioned by 30, 27 and 25 journals, respectively. Registration of other studies was required by eight and none offered Registered Reports as a publication option at the time of the review. All 10 review journals required conflict of interest disclosure, four recommended data sharing and three the use of guidelines. None mentioned the other two procedures. Conclusions While nutrition journals have adopted a number of procedures designed to improve the reporting of research findings, their limited effects likely result from the mechanisms through which they influence analytic flexibility and selective reporting and the extent to which they are properly implemented and enforced by journals.

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Section: Introductionmentioning

confidence: 99%

High impact nutrition and dietetics journals’ use of publication procedures to increase research transparency

Gorman

Ferdinand

2020

Res Integr Peer Rev

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“…Although the methodology for developing CPGs is well known and a variety of tools exist for guidelines development and appraisal, the present study showed that guidelines are not actually following the guidelines for CPG development . Many CPGs are falling short in selected AGREE domains, indicating that improvements are needed to increase guidelines’ transparency, fluency, and objectivity to ameliorate CPG adherence …”

Section: Discussionmentioning

confidence: 60%

“…Several recent studies have suggested that nutrition guidelines are not adequately adhering to the standards for CPG development . This is why a collective initiative to ameliorate nutrition guideline quality has been proposed, using novel tools such as the NutriRECS . Nutrition guidelines must adhere to international guideline standards (like the AGREE II); provide recommendations based on systematic review of existing evidence; suggest facilitators and monitoring and screening tools to ameliorate adherence and outcome; suggest recommendations formulated based on a holistic dietetic approach, like the Nutrition Care Process; provide clear, unambiguous recommendations concerning dietary manipulations and nutrient intakes; suggest sample menus or diet plans for each condition; disclose funding and conflicts of interest; and include dietitians and nutritionists in their development .…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Medical Nutrition Therapy Guidelines for Liver Cirrhosis: Do We Agree?

et al. 2019

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Background Nutrition can play a significant role in the management of liver cirrhosis and its complications. However, adherence to the clinical practice guidelines (CPGs) is essential for the practice of evidence‐based medicine and is considered as a health‐quality indicator. Methods A systematic search was conducted in scientific databases, and retrieved CPGs fulfilling the inclusion criteria were independently reviewed and appraised from 3 experienced researchers, based on the Appraisal of Guidelines for Research and Evaluation II instrument. Results A total of 13 relevant CPGs were retrieved, published by 7 associations/societies, focusing on the nutrition management (enteral nutrition and/or parenteral nutrition) on cirrhosis, decompensated cirrhosis, liver transplantation, and cirrhosis‐related complications. Most CPGs scored low in the stakeholder, rigor of development, and applicability domains. Half of the CPGs recognized the need for counseling patients with cirrhosis on nutrition‐related issues. Small meals spread throughout the day, including a late‐night snack, were suggested, with protein intake ranging between 1.2 and 1.5 g/kg of body weight. In ascites, Na restriction recommendation appeared unanimous. Conclusions Several shortcomings and bias were recognized in cirrhosis‐related medical nutrition therapy CPGs, indicating the need of improving CPG methodology.

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“…Further, the 2014 WHO standards seem to lack adequate methods to evaluate evidence relevant to the shifts in nutrition priorities, such as food sustainability and food practice, including eating together and home cooking (18,19) . Because current evidence-based methods primarily rely on clinical trial findings (27) , we propose using approaches such as the logical maps to guide research questions in dietary guideline development. This may ensure evidence collection and evaluation are driven by the research questions rather than by the available methods, such as the hierarchy of evidence (27) .…”

Section: Discussionmentioning

confidence: 99%

“…Because current evidence-based methods primarily rely on clinical trial findings (27) , we propose using approaches such as the logical maps to guide research questions in dietary guideline development. This may ensure evidence collection and evaluation are driven by the research questions rather than by the available methods, such as the hierarchy of evidence (27) . Therefore, future methods in developing dietary guidelines could consider allowing high-quality observational studies to address emerging food and nutrition priorities, which are not always suitable for randomised controlled trials.…”

Section: Discussionmentioning

confidence: 99%

Comparison of methodological quality between the 2007 and 2019 Canadian dietary guidelines

Kroeger

Lawrence

Scrinis

et al. 2020

Public Health Nutr.

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Objective: With significant shifts in the dietary recommendations between the 2007 and 2019 Canadian dietary guidelines, such as promoting plant-based food intake, reducing highly processed food intake and advocating the practice of food skills, we compared their differences in guideline development methods. Design: Two reviewers used twenty-five guided criteria to appraise the methods used to develop the most recent dietary guidelines against those outlined in the 2014 WHO Handbook for Guideline Development. Setting: Canada. Participants: 2007 and 2019 dietary guidelines. Results: We found that the 2019 guidelines were more evidence-based and met 80 % (20/25) of the WHO criteria. For example, systematic reviews and health organisation authoritative reports, but not industry reports, constituted the evidence base for the dietary recommendations. However, recommendations on food sustainability and food skill practice were driven primarily by stakeholders’ interests. By contrast, less information was recorded about the process used to develop the 2007 guidelines, resulting in 24 % (6/25) consistency with the WHO standards. Conclusions: Our analysis suggests that a more transparent and evidence-based approach is used to develop the 2019 Canadian dietary guidelines and that method criteria should support further incorporation of nutrition priorities (food sustainability and food skills) in future dietary guideline development.

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Making nutrition guidelines fit for purpose

Abstract: Guidelines must ask the right questions and incorporate complexity to improve their relevance and quality, argue Lisa Bero and colleagues

Cited by 20 publications

References 50 publications

High impact nutrition and dietetics journals’ use of publication procedures to increase research transparency

High impact nutrition and dietetics journals’ use of publication procedures to increase research transparency

A Systematic Review of Medical Nutrition Therapy Guidelines for Liver Cirrhosis: Do We Agree?

Comparison of methodological quality between the 2007 and 2019 Canadian dietary guidelines

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