1
|
Kanukula R, Page MJ, Turner SL, McKenzie JE. Identification of application and interpretation errors that can occur in pairwise meta-analyses in systematic reviews of interventions: a systematic review. J Clin Epidemiol 2024; 170:111331. [PMID: 38552725 DOI: 10.1016/j.jclinepi.2024.111331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/27/2024] [Accepted: 03/18/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES To generate a bank of items describing application and interpretation errors that can arise in pairwise meta-analyses in systematic reviews of interventions. STUDY DESIGN AND SETTING MEDLINE, Embase, and Scopus were searched to identify studies describing types of errors in meta-analyses. Descriptions of errors and supporting quotes were extracted by multiple authors. Errors were reviewed at team meetings to determine if they should be excluded, reworded, or combined with other errors, and were categorized into broad categories of errors and subcategories within. RESULTS Fifty articles met our inclusion criteria, leading to the identification of 139 errors. We identified 25 errors covering data extraction/manipulation, 74 covering statistical analyses, and 40 covering interpretation. Many of the statistical analysis errors related to the meta-analysis model (eg, using a two-stage strategy to determine whether to select a fixed or random-effects model) and statistical heterogeneity (eg, not undertaking an assessment for statistical heterogeneity). CONCLUSION We generated a comprehensive bank of possible errors that can arise in the application and interpretation of meta-analyses in systematic reviews of interventions. This item bank of errors provides the foundation for developing a checklist to help peer reviewers detect statistical errors.
Collapse
Affiliation(s)
- Raju Kanukula
- Methods in Evidence Synthesis Unit, School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Matthew J Page
- Methods in Evidence Synthesis Unit, School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Simon L Turner
- Methods in Evidence Synthesis Unit, School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Joanne E McKenzie
- Methods in Evidence Synthesis Unit, School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia.
| |
Collapse
|
2
|
Wang Y, Pitre T, Wallach JD, de Souza RJ, Jassal T, Bier D, Patel CJ, Zeraatkar D. Grilling the data: application of specification curve analysis to red meat and all-cause mortality. J Clin Epidemiol 2024; 168:111278. [PMID: 38354868 DOI: 10.1016/j.jclinepi.2024.111278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES To present an application of specification curve analysis-a novel analytic method that involves defining and implementing all plausible and valid analytic approaches for addressing a research question-to nutritional epidemiology. STUDY DESIGN AND SETTING We reviewed all observational studies addressing the effect of red meat on all-cause mortality, sourced from a published systematic review, and documented variations in analytic methods (eg, choice of model, covariates, etc.). We enumerated all defensible combinations of analytic choices to produce a comprehensive list of all the ways in which the data may reasonably be analyzed. We applied specification curve analysis to data from National Health and Nutrition Examination Survey 2007 to 2014 to investigate the effect of unprocessed red meat on all-cause mortality. The specification curve analysis used a random sample of all reasonable analytic specifications we sourced from primary studies. RESULTS Among 15 publications reporting on 24 cohorts included in the systematic review on red meat and all-cause mortality, we identified 70 unique analytic methods, each including different analytic models, covariates, and operationalizations of red meat (eg, continuous vs quantiles). We applied specification curve analysis to National Health and Nutrition Examination Survey, including 10,661 participants. Our specification curve analysis included 1208 unique analytic specifications, of which 435 (36.0%) yielded a hazard ratio equal to or more than 1 for the effect of red meat on all-cause mortality and 773 (64.0%) less than 1. The specification curve analysis yielded a median hazard ratio of 0.94 (interquartile range: 0.83-1.05). Forty-eight specifications (3.97%) were statistically significant, 40 of which indicated unprocessed red meat to reduce all-cause mortality and eight of which indicated red meat to increase mortality. CONCLUSION We show that the application of specification curve analysis to nutritional epidemiology is feasible and presents an innovative solution to analytic flexibility.
Collapse
Affiliation(s)
- Yumin Wang
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Tyler Pitre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joshua D Wallach
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tanvir Jassal
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Dennis Bier
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Dena Zeraatkar
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
3
|
Karakasis P, Bougioukas KI, Pamporis K, Fragakis N, Haidich AB. Appraisal methods and outcomes of AMSTAR 2 assessments in overviews of systematic reviews of interventions in the cardiovascular field: A methodological study. Res Synth Methods 2024; 15:213-226. [PMID: 37956538 DOI: 10.1002/jrsm.1680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023]
Abstract
This study aimed to assess the methods and outcomes of The Measurement Tool to Assess systematic Reviews (AMSTAR) 2 appraisals in overviews of reviews (overviews) of interventions in the cardiovascular field and identify factors that are associated with these outcomes. MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews were searched until November 2022. Eligible were overviews of cardiovascular interventions, analyzing systematic reviews (SRs) of randomized controlled trials (RCTs). Extracted data included characteristics of overviews and SRs and AMSTAR 2 appraisal methods and outcomes. Data were synthesized using descriptive statistics and logistic regression to explore potential associations between the characteristics of SRs and extracted AMSTAR 2 overall ratings ("High-Moderate" vs. "Low-Critically low"). The original results on individual AMSTAR 2 items were entered into the official AMSTAR 2 online tool and the recalculated overall confidence ratings were compared to those provided in overviews. All 34 overviews identified were published between 2019 and 2022. Rating of overall confidence following the algorithm suggested by AMSTAR 2 developers was noted in 74% of overviews. The 679 unique included SRs were mainly of "Critically low" (53%) or "Low" (18.7%) confidence and underperformed in items 2 (Protocol, no = 65.2%) and 7 (List of excluded studies, no = 84%). The following characteristics of SRs were significantly associated with higher overall ratings: Cochrane origin, pharmacological interventions, including exclusively RCTs, citation of methodological and reporting guidelines, protocol, absence of funding and publication after AMSTAR 2 release. Generally, overviews' authors tended to deviate from the original rating scheme and ascribe higher ratings to SRs compared to the official AMSTAR 2 online tool. Most SRs included in overviews of cardiovascular interventions have critically low or low confidence in their results. Overviews' authors should be more transparent about the methods used to derive the overall confidence in SRs.
Collapse
Affiliation(s)
- Paschalis Karakasis
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Second Cardiology Department, Hippokration General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos I Bougioukas
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Pamporis
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Second Cardiology Department, Hippokration General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
4
|
Wang Z, Wang Y, Shang W, Liu W, Lu C, Huang J, Lei C, Chen Z, Wang Z, Yang K, Li X, Lu C. Reporting quality and risk of bias of systematic reviews of ultra-processed foods: a methodological study. Eur J Clin Nutr 2024; 78:171-179. [PMID: 38093096 DOI: 10.1038/s41430-023-01383-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 03/13/2024]
Abstract
A dramatic shift in the global food system is occurring with the rapid growth of ultra-processed foods (UPFs) consumption, which poses potentially serious health risks. Systematic review (SR) method has been used to summarise the association between UPF consumption and multiple health outcomes; however, a suboptimal-quality SR may mislead the decision-making in clinical practices and health policies. Therefore, a methodological review was conducted to identify the areas that can be improved regarding the risk of bias and reporting quality of relevant SRs. Systematic searches to collect SRs with meta-analyses of UPFs were performed using four databases from their inception to April 14, 2023. The risk of bias and reporting quality were evaluated using ROBIS and PRISMA 2020, respectively. The key characteristics of the included SRs were summarised descriptively. Excel 2019 and R 4.2.3 were used to analyse the data and draw graphs. Finally, 16 relevant SRs written in English and published between 2020 and 2023 in 12 academic journals were included. Only one SR was rated as low risk of bias, and the others were rated as higher risk of bias mainly because the risk of bias in the original studies was not explicitly addressed when synthesising the evidence. The reporting was required to be advanced significantly, involving amendments of registration and protocol, data and analytic code statement, and lists of excluded studies with justifications. The reviews' results could improve the quality, strengthen future relevant SRs' robustness, and further underpin the evidence base for supporting clinical decisions and health policies.
Collapse
Affiliation(s)
- Ziyi Wang
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Yan Wang
- Shangluo Central Hospital of Shaanxi Provincial, Shangluo, 726000, China
| | - Wenru Shang
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Wendi Liu
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Cui Lu
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Jiayi Huang
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Chao Lei
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Zijia Chen
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Zhifei Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Kehu Yang
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Xiuxia Li
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China.
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China.
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.
| | - Cuncun Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, 100700, Beijing, China.
| |
Collapse
|
5
|
Talukdar JR, Cooper M, Lyutvyn L, Zeraatkar D, Ali R, Berbrier R, Janes S, Ha V, Darling PB, Xue M, Chu A, Chowdhury F, Harnack HE, Huang L, Malik M, Powless J, Lavergne FV, Zhang X, Ehrlich S, Jenkins DJ, Sievenpiper JL, Banfield L, Mbuagbaw L, de Souza RJ. The effects of inulin-type fructans on cardiovascular disease risk factors: systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2024; 119:496-510. [PMID: 38309832 DOI: 10.1016/j.ajcnut.2023.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Inulin-type fructans (ITF) are the leading prebiotics in the market. Available evidence provides conflicting results regarding the beneficial effects of ITF on cardiovascular disease risk factors. OBJECTIVES This study aimed to evaluate the effects of ITF supplementation on cardiovascular disease risk factors in adults. METHODS We searched MEDLINE, EMBASE, Emcare, AMED, CINAHL, and the Cochrane Library databases from inception through May 15, 2022. Eligible randomized controlled trials (RCTs) administered ITF or placebo (for example, control, foods, diets) to adults for ≥2 weeks and reported one or more of the following: low, very-low, or high-density lipoprotein cholesterol (LDL-C, VLDL-C, HDL-C); total cholesterol; apolipoprotein A1 or B; triglycerides; fasting blood glucose; body mass index; body weight; waist circumference; waist-to-hip ratio; systolic or diastolic blood pressure; or hemoglobin A1c. Two reviewers independently and in duplicate screened studies, extracted data, and assessed risk of bias. We pooled data using random-effects model, and assessed the certainty of evidence (CoE) using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS We identified 1767 studies and included 55 RCTs with 2518 participants in meta-analyses. The pooled estimate showed that ITF supplementation reduced LDL-C [mean difference (MD) -0.14 mmol/L, 95% confidence interval (95% CI: -0.24, -0.05), 38 RCTs, 1879 participants, very low CoE], triglycerides (MD -0.06 mmol/L, 95% CI: -0.12, -0.01, 40 RCTs, 1732 participants, low CoE), and body weight (MD -0.97 kg, 95% CI: -1.28, -0.66, 36 RCTs, 1672 participants, low CoE) but little to no significant effect on other cardiovascular disease risk factors. The effects were larger when study duration was ≥6 weeks and in pre-obese and obese participants. CONCLUSION ITF may reduce low-density lipoprotein, triglycerides, and body weight. However, due to low to very low CoE, further well-designed and executed trials are needed to confirm these effects. PROSPERO REGISTRATION NUMBER CRD42019136745.
Collapse
Affiliation(s)
- Jhalok Ronjan Talukdar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Matthew Cooper
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lyuba Lyutvyn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Blavatnik Institute, Harvard Medical School, Boston, MA, United States
| | - Rahim Ali
- Faculty of Law, Common Law Section, University of Ottawa, Ottawa, ON, Canada
| | - Rachel Berbrier
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Sabrina Janes
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Vanessa Ha
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Pauline B Darling
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Mike Xue
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Alexandro Chu
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Fariha Chowdhury
- Department of Rehabilitation Science(s), McMaster University, Hamilton, ON, Canada
| | - Hope E Harnack
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Louise Huang
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mikail Malik
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jacqui Powless
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Florence V Lavergne
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, ON, Canada
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Shelley Ehrlich
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - David Ja Jenkins
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - John L Sievenpiper
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, ON, Canada; Global Health Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Department of Pediatrics, McMaster University, Hamilton, ON, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada; Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon; Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada; Global Health Graduate Program, McMaster University, Hamilton, ON, Canada; Department of Pediatrics, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada.
| |
Collapse
|
6
|
Aljuraiban GS, Gibson R, Chan DS, Van Horn L, Chan Q. The Role of Diet in the Prevention of Hypertension and Management of Blood Pressure: An Umbrella Review of Meta-Analyses of Interventional and Observational Studies. Adv Nutr 2024; 15:100123. [PMID: 37783307 PMCID: PMC10831905 DOI: 10.1016/j.advnut.2023.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/12/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023] Open
Abstract
High blood pressure (BP) is a major pathological risk factor for the development of several cardiovascular diseases. Diet is a key modifier of BP, but the underlying relationships are not clearly demonstrated. This is an umbrella review of published meta-analyses to critically evaluate the wide range of dietary evidence from bioactive compounds to dietary patterns on BP and risk of hypertension. PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception until October 31, 2021, for relevant meta-analyses of randomized controlled trials or meta-analyses of observational studies. A total of 175 publications reporting 341 meta-analyses of randomized controlled trials (145 publications) and 70 meta-analyses of observational studies (30 publications) were included in the review. The methodological quality of the included publications was assessed using Assessment of Multiple Systematic Reviews 2 and the evidence quality of each selected meta-analysis was assessed using NutriGrade. This umbrella review supports recommended public health guidelines for prevention and control of hypertension. Dietary patterns including the Dietary Approaches to Stop Hypertension and the Mediterranean-type diets that further restrict sodium, and moderate alcohol intake are advised. To produce high-quality evidence and substantiate strong recommendations, future research should address areas where the low quality of evidence was observed (for example, intake of dietary fiber, fish, egg, meat, dairy products, fruit juice, and nuts) and emphasize focus on dietary factors not yet conclusively investigated.
Collapse
Affiliation(s)
- Ghadeer S Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Rachel Gibson
- Department of Nutritional Sciences, King's College London, London, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
| | - Doris Sm Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
| |
Collapse
|
7
|
Yamamoto N, Taito S, Miura T, Ariie T, Tomita Y, Ogihara H, Shiratsuchi D, Yorifuji T, Tsujimoto Y. Epidemiology and Reporting Characteristics of Systematic Reviews in Orthopedic Journals: A Meta-Epidemiological Study. J Clin Med 2023; 12:7031. [PMID: 38002645 PMCID: PMC10672058 DOI: 10.3390/jcm12227031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Systematic reviews (SRs) with complete reporting or rigorous methods can lead to less biased recommendations and decisions. A comprehensive analysis of the epidemiological and reporting characteristics of SRs in orthopedics is lacking. We evaluated 360 SRs, including 165 and 195 published in orthopedic journals in 2012 and 2022. According to the established reporting guidelines, we examined these SRs for key epidemiological characteristics, including focus areas, type of meta-analysis (MA), and reporting characteristics. Most SRs (71%) were therapy-related, with a significant proportion originating from authors in the USA, UK, and China. Pairwise MA was performed on half of the SRs. The proportion of protocol registrations improved by 2022 but remained low (33%). Despite a formal declaration of adherence to the reporting guidelines (68%), they were often not used and reported enough. Only 10% of the studies used full search strategies, including trial registries. Publication bias assessments, subgroup analyses, and sensitivity analyses were not even planned. The risk of bias assessment improved in 2022; however, the certainty of the evidence remained largely unassessed (8%). The use and reporting of standard methods in orthopedic SRs have remained suboptimal. Thus, authors, peer reviewers, journal editors, and readers should criticize the results more.
Collapse
Affiliation(s)
- Norio Yamamoto
- Department of Orthopedic Surgery, Hashimoto Hospital, Mitoyo 768-0103, Japan
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan;
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan; (S.T.); (T.M.); (T.A.); (H.O.)
| | - Shunsuke Taito
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan; (S.T.); (T.M.); (T.A.); (H.O.)
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima 734-8551, Japan
| | - Takanori Miura
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan; (S.T.); (T.M.); (T.A.); (H.O.)
- Department of Orthopedic Surgery, Akita Rosai Hospital, Odate 018-5604, Japan
| | - Takashi Ariie
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan; (S.T.); (T.M.); (T.A.); (H.O.)
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Okawa 831-8501, Japan
| | - Yosuke Tomita
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki 370-0033, Japan;
| | - Hirofumi Ogihara
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan; (S.T.); (T.M.); (T.A.); (H.O.)
- Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano City 381-2227, Japan
| | - Daijo Shiratsuchi
- Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan;
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan;
| | - Yasushi Tsujimoto
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan; (S.T.); (T.M.); (T.A.); (H.O.)
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto 606-8501, Japan
- Oku Medical Clinic, Osaka 573-0164, Japan
| |
Collapse
|
8
|
Talukdar JR, Steen JP, Goldenberg JZ, Zhang Q, Vernooij RWM, Ge L, Zeraatkar D, Bała MM, Ball GDC, Thabane L, Johnston BC. Saturated fat, the estimated absolute risk and certainty of risk for mortality and major cancer and cardiometabolic outcomes: an overview of systematic reviews. Syst Rev 2023; 12:179. [PMID: 37777760 PMCID: PMC10541715 DOI: 10.1186/s13643-023-02312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 08/08/2023] [Indexed: 10/02/2023] Open
Abstract
OBJECTIVE To assess the impact of reducing saturated fat or fatty foods, or replacing saturated fat with unsaturated fat, carbohydrate or protein, on the risk of mortality and major cancer and cardiometabolic outcomes in adults. METHODS We searched MEDLINE, EMBASE, CINAHL, and references of included studies for systematic reviews and meta-analyses (SRMAs) of randomized controlled trials (RCTs) and observational studies in adults published in the past 10 years. Eligible reviews investigated reducing saturated fat or fatty foods or replacing saturated fat with unsaturated fat, carbohydrate or protein, on the risk of cancer and cardiometabolic outcomes and assessed the certainty of evidence for each outcome using, for example, the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. We assessed the quality of SRMAs using a modified version of AMSTAR-2. Results were summarized as absolute estimates of effect together with the certainty of effects using a narrative synthesis approach. RESULTS We included 17 SRMAs (13 reviews of observational studies with follow-up 1 to 34 years; 4 reviews of RCTs with follow-up 1 to 17 years). The quality of two-thirds of the SRMAs was critically low to moderate; the main limitations included deficient reporting of study selection, absolute effect estimates, sources of funding, and a priori subgroups to explore heterogeneity. Our included reviews reported > 100 estimates of effect across 11 critically important cancer and cardiometabolic outcomes. High quality SRMAs consistently and predominantly reported low to very low certainty evidence that reducing or replacing saturated fat was associated with a very small risk reduction in cancer and cardiometabolic endpoints. The risk reductions where approximately divided, some being statistically significant and some being not statistically significant. However, based on 2 moderate to high quality reviews, we found moderate certainty evidence for a small but important effect that was statistically significant for two outcomes (total mortality events [20 fewer events per 1000 followed] and combined cardiovascular events [16 fewer per 1000 followed]). Conversely, 4 moderate to high quality reviews showed very small effects on total mortality, with 3 of these reviews showing non-statistically significant mortality effects. CONCLUSION Systematic reviews investigating the impact of SFA on mortality and major cancer and cardiometabolic outcomes almost universally suggest very small absolute changes in risk, and the data is based primarily on low and very low certainty evidence. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020172141.
Collapse
Affiliation(s)
- Jhalok Ronjan Talukdar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jeremy P Steen
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Joshua Z Goldenberg
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, USA
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Qian Zhang
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Long Ge
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Małgorzata M Bała
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
- Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, ON, Canada
| | - Bradley C Johnston
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, USA.
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA.
| |
Collapse
|
9
|
Rigutto-Farebrother J, Ahles S, Cade J, Murphy KJ, Plat J, Schwingshackl L, Roche HM, Shyam S, Lachat C, Minihane AM, Weaver C. Perspectives on the application of CONSORT guidelines to randomised controlled trials in nutrition. Eur J Nutr 2023:10.1007/s00394-023-03137-5. [PMID: 37099211 DOI: 10.1007/s00394-023-03137-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/21/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE Reporting guidelines facilitate quality and completeness in research reporting. The CONsolidated Standards Of Reporting Trials (CONSORT) statement is widely applied to dietary and nutrition trials but has no extension specific to nutrition. Evidence suggests poor reporting in nutrition research. The Federation of European Nutrition Societies led an initiative to make recommendations for a nutrition extension to the CONSORT statement towards a more robust reporting of the evidence base. METHODS An international working group was formed of nutrition researchers from 14 institutions in 12 different countries and on five continents. Using meetings over a period of one year, we interrogated the CONSORT statement specifically for its application to report nutrition trials. RESULTS We provide a total of 28 new nutrition-specific recommendations or emphasised recommendations for the reporting of the introduction (three), methods (twelve), results (five) and discussion (eight). We also added two additional recommendations that were not allocated under the standard CONSORT headings. CONCLUSION We identify a need to provide guidance in addition to CONSORT to improve the quality and consistency of the reporting and propose key considerations for further development of formal guidelines for the reporting of nutrition trials. Readers are encouraged to engage in this process, provide comments and conduct specific studies to inform further work on the development of reporting guidelines for nutrition trials.
Collapse
Affiliation(s)
- Jessica Rigutto-Farebrother
- Human Nutrition Laboratory, Institute for Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland.
- Laboratory for Nutrition and Metabolic Epigenetics, Institute for Food, Nutrition and Health, LFV E14.1, Schmelzbergstrasse 7, 8092, Zurich, Switzerland.
- Global Center for the Development of the Whole Child, University of Notre Dame, South Bend, USA.
| | - Sanne Ahles
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- BioActor BV, Maastricht, The Netherlands
| | - Janet Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Karen J Murphy
- Clinical and Health Sciences, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Jogchum Plat
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Helen M Roche
- Nutrigenomics Research Group, UCD Conway Institute, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Institute for Global Food Security, School of Biological Sciences, Queens University Belfast, Belfast, UK
| | - Sangeetha Shyam
- Centre for Translational Research, Institute for Research, Development, and Innovation (IRDI), International Medical University, Kuala Lumpur, Malaysia
- Departament de Bioquímica i Biotecnologia, Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Universitat Rovira i Virgili, Unitat de Nutrició Humana, Instituto de Salud Carlos III (ISCIII), Reus, Spain
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Anne-Marie Minihane
- Nutrition and Preventive Medicine, Norwich Medical School, University of East Anglia (UEA), Norwich, UK
- Norwich Institute of Healthy Ageing, UEA, Norwich, UK
| | - Connie Weaver
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, USA
| |
Collapse
|
10
|
Kamioka H, Origasa H, Tsutani K, Kitayuguchi J, Yoshizaki T, Shimada M, Wada Y, Takano-Ohmuro H. A Cross-Sectional Study Based on Forty Systematic Reviews of Foods with Function Claims (FFC) in Japan: Quality Assessment Using AMSTAR 2. Nutrients 2023; 15:2047. [PMID: 37432186 DOI: 10.3390/nu15092047] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/22/2023] [Accepted: 04/23/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The Foods with Function Claims (FFC) was introduced in Japan in April 2015 to make more products available that are labeled with health functions. The products' functionality of function claims must be explained by scientific evidence presented in systematic reviews (SRs), but the quality of recent SRs is unclear. This study assessed the quality of SRs in the FFC registered on the Consumer Affairs Agency (CAA) website in Japan. METHODS We searched the database from 1 April to 31 October 2022. Confidence in the methodological quality of each SR was evaluated by the AMSTAR 2 checklist. RESULTS Forty SRs were randomly extracted on the basis of the eligibility criteria and recruitment procedures. Overall confidence was rated as "high" (N = 0, 0%), "moderate" (N = 0, 0%), "low" (N = 2, 5%), or "critically low" (N = 38, 95%). The mean AMSTAR 2 score was 51.1% (SD 12.1%; range 19-73%). Among the 40 SRs, the number of critical domain deficiencies was 4 in 7.5% of SRs, 3 in 52.5% of SRs, 2 in 35% of SRs, and 1 in 5% of SRs. Registering the review's protocol and comprehensive search strategies were particularly common deficiencies. Additionally, the risk of bias (RoB) was insufficiently considered. CONCLUSION Overall, the methodological quality of the SRs based on the FFC, introduced eight years earlier, was very poor. This was especially true in the interpretation and discussion of critical domains, which had many deficiencies in terms of protocol registration, a comprehensive literature search strategy, and accounting for the RoB.
Collapse
Affiliation(s)
- Hiroharu Kamioka
- Faculty of Regional Environment Science, Tokyo University of Agriculture, 1-1-1 Sakuragaoka, Setagaya-ku, Tokyo 156-8502, Japan
| | - Hideki Origasa
- The Institute of Statistical Mathematics, 10-3 Midori-cho, Tachikawa, Tokyo 190-8562, Japan
| | - Kiichiro Tsutani
- The Institute of Seizon and Life Sciences, 4-5-1 Ginza, Chuo-ku, Tokyo 104-0061, Japan
| | - Jun Kitayuguchi
- Physical Education and Medicine Research Center Unnan, 328 Uji, Unnan City 699-1105, Japan
| | - Takahiro Yoshizaki
- Faculty of Food and Nutritional Sciences, Toyo University, 1-1-1 Izumino, Itakura Town 374-0193, Japan
| | - Mikiko Shimada
- Department of Nutrition, Faculty of Health Care, Kiryu University, 606-7 Asami, Midori City 379-2329, Japan
| | - Yasuyo Wada
- Department of Health Promotion, National Institute of Public Health, 2-3-6 Minami, Wako City 351-0197, Japan
| | - Hiromi Takano-Ohmuro
- Research Institute of Pharmaceutical Sciences, Musashino University, 1-1-20 Aramachi, Nishitokyo, Tokyo 202-8585, Japan
| |
Collapse
|
11
|
Xun Y, Guo Q, Ren M, Liu Y, Sun Y, Wu S, Lan H, Zhang J, Liu H, Wang J, Shi Q, Wang Q, Wang P, Chen Y, Shao R, Xu DR. Characteristics of the sources, evaluation, and grading of the certainty of evidence in systematic reviews in public health: A methodological study. Front Public Health 2023; 11:998588. [PMID: 37064677 PMCID: PMC10097925 DOI: 10.3389/fpubh.2023.998588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Objectives To systematically explore how the sources of evidence, types of primary studies, and tools used to assess the quality of the primary studies vary across systematic reviews (SRs) in public health. Methods We conducted a methodological survey of SRs in public health by searching the of literature in selected journals from electronic bibliographic databases. We selected a 10% random sample of the SRs that met the explicit inclusion criteria. Two researchers independently extracted data for analysis. Results We selected 301 SRs for analysis: 94 (31.2%) of these were pre-registered, and 211 (70.1%) declared to have followed published reporting standard. All SRs searched for evidence in electronic bibliographic databases, and more than half (n = 180, 60.0%) searched also the references of the included studies. The common types of primary studies included in the SRs were primarily cross-sectional studies (n = 132, 43.8%), cohort studies (n = 126, 41.9%), randomized controlled trials (RCTs, n = 89, 29.6%), quasi-experimental studies (n = 83, 27.6%), case-control studies (n = 58, 19.3%) qualitative studies (n = 38, 12.6%) and mixed-methods studies (n = 32, 10.6%). The most frequently used quality assessment tools were the Newcastle-Ottawa Scale (used for 50.0% of cohort studies and 55.6% of case-control studies), Cochrane Collaboration's Risk of Bias tool (50.7% of RCTs) and Critical Appraisal Skills Program (38.5% of qualitative studies). Only 20 (6.6%) of the SRs assessed the certainty of the body of evidence, of which 19 (95.0%) used the GRADE approach. More than 65% of the evidence in the SRs using GRADE was of low or very low certainty. Conclusions SRs should always assess the quality both at the individual study level and the body of evidence for outcomes, which will benefit patients, health care practitioners, and policymakers.
Collapse
Affiliation(s)
- Yangqin Xun
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Qiangqiang Guo
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Mengjuan Ren
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Yunlan Liu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Yajia Sun
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Shouyuan Wu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Hui Lan
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Juanjuan Zhang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Hui Liu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Jianjian Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qianling Shi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Qi Wang
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | - Ping Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- School of Public Health, Lanzhou University, Lanzhou, China
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Lanzhou University, An Affiliate of the Cochrane China Network, Lanzhou, China
- World Health Organization (WHO) Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Ruitai Shao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Non-communicable Diseases, World Health Organization (WHO), Geneva, Switzerland
| | - Dong Roman Xu
- SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China
| |
Collapse
|
12
|
Johnston BC, Zeraatkar D, Steen J, de Jauregui DRF, Zhu H, Sun M, Cooper M, Maraj M, Prokop-Dorner A, Reyes BC, Valli C, Storman D, Karam G, Zajac J, Ge L, Swierz MJ, Ghosh N, Vernooij RWM, Chang Y, Zhao Y, Thabane L, Guyatt GH, Alonso-Coello P, Hooper L, Bala MM. Saturated fat and human health: a protocol for a methodologically innovative systematic review and meta-analysis to inform public health nutrition guidelines. Syst Rev 2023; 12:39. [PMID: 36918997 PMCID: PMC10012519 DOI: 10.1186/s13643-023-02209-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/01/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND The health effects of dietary fats are a controversial issue on which experts and authoritative organizations have often disagreed. Care providers, guideline developers, policy-makers, and researchers use systematic reviews to advise patients and members of the public on optimal dietary habits, and to formulate public health recommendations and policies. Existing reviews, however, have serious limitations that impede optimal dietary fat recommendations, such as a lack of focus on outcomes important to people, substantial risk of bias (RoB) issues, ignoring absolute estimates of effects together with comprehensive assessments of the certainty of the estimates for all outcomes. OBJECTIVE We therefore propose a methodologically innovative systematic review using direct and indirect evidence on diet and food-based fats (i.e., reduction or replacement of saturated fat with monounsaturated or polyunsaturated fat, or carbohydrates or protein) and the risk of important health outcomes. METHODS We will collaborate with an experienced research librarian to search MEDLINE, EMBASE, CINAHL, and the Cochrane Database of Systematic Reviews (CDSR) for randomized clinical trials (RCTs) addressing saturated fat and our health outcomes of interest. In duplicate, we will screen, extract results from primary studies, assess their RoB, conduct de novo meta-analyses and/or network meta-analysis, assess the impact of missing outcome data on meta-analyses, present absolute effect estimates, and assess the certainty of evidence for each outcome using the GRADE contextualized approach. Our work will inform recommendations on saturated fat based on international standards for reporting systematic reviews and guidelines. CONCLUSION Our systematic review and meta-analysis will provide the most comprehensive and rigorous summary of the evidence addressing the relationship between saturated fat modification for people-important health outcomes. The evidence from this review will be used to inform public health nutrition guidelines. TRIAL REGISTRATION PROSPERO Registration: CRD42023387377 .
Collapse
Affiliation(s)
- Bradley C Johnston
- Department of Nutrition, College of Agriculture and Life Science, Texas A&M University, College Station, TX, USA. .,Department of Epidemiology and Biostatistics, School of Public Health, College Station, TX, USA.
| | - Dena Zeraatkar
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jeremy Steen
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Diego Rada Fernandez de Jauregui
- Preventive Medicine and Public Health Department, School of Pharmacy, University of the Basque Country/Euskal Herriko Unibertsitatea (UPV/EHU), Vitoria-Gasteiz, Spain.,Department of Nutrition, Texas A&M University, College Station, TX, USA
| | - Hongfei Zhu
- Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China.,Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Mingyao Sun
- Evidence Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China
| | - Matthew Cooper
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Malgorzata Maraj
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Prokop-Dorner
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Boris Castro Reyes
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Claudia Valli
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain.,Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Dawid Storman
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.,Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland.,Department of Adult Psychiatry, University Hospital, Krakow, Poland
| | - Giorgio Karam
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Joanna Zajac
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Jagiellonian University Medical College, Krakow, Poland
| | - Long Ge
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China.,Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Mateusz J Swierz
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.,Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Nirjhar Ghosh
- Department of Nutrition, Texas A&M University, College Station, TX, USA
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yaping Chang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Yunli Zhao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,The Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, China
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Faculty of Health Sciences, Hamilton, ON, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Malgorzata M Bala
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.,Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
13
|
Arnesen EK, Thorisdottir B, Bärebring L, Söderlund F, Nwaru BI, Spielau U, Dierkes J, Ramel A, Lamberg-Allardt C, Åkesson A. Nuts and seeds consumption and risk of cardiovascular disease, type 2 diabetes and their risk factors: a systematic review and meta-analysis. Food Nutr Res 2023; 67:8961. [PMID: 36816545 PMCID: PMC9930735 DOI: 10.29219/fnr.v67.8961] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
Objectives We aimed to systematically review studies and evaluate the strength of the evidence on nuts/seeds consumption and cardiometabolic diseases and their risk factors among adults. Methods A protocol was pre-registered in PROSPERO (CRD42021270554). We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Scopus up to September 20, 2021 for prospective cohort studies and ≥12-week randomized controlled trials (RCTs). Main outcomes were cardiovascular disease (CVD), coronary heart disease (CHD), stroke and type 2 diabetes (T2D), secondary total-/low density lipoprotein (LDL)-cholesterol, blood pressure and glycaemic markers. Data extraction and risk of bias (RoB) assessments (using RoB 2.0 and RoB-NObS) were performed in duplicate. Effect sizes were pooled using random-effects meta-analyses and expressed as relative risk (RR) or weighted mean differences with 95% confidence intervals (CI); heterogeneity quantified as I 2. One-stage dose-response analyses assessed the linear and non-linear associations with CVD, CHD, stroke and T2D. The strength of evidence was classified per the World Cancer Research Fund criteria. Results After screening 23,244 references, we included 42 papers from cohort studies (28 unique cohorts, 1,890,573 participants) and 18 RCTs (2,266 participants). In the cohorts, mainly populations with low consumption, high versus low total nuts/seeds consumption was inversely associated with total CVD (RR 0.81; 95% CI 0.75, 0.86; I 2 = 67%), CVD mortality (0.77; 0.72, 0.82; I 2 = 59.3%), CHD (0.82; 0.76, 0.89; I 2 = 64%), CHD mortality (0.75; 0.65, 0.87; I 2 = 66.9%) and non-fatal CHD (0.85; 0.75, 0.96; I 2 = 62.2%). According to the non-linear dose-response analyses, consumption of 30 g/day of total nuts/seeds was associated with RRs of similar magnitude. For stroke and T2D the summary RR for high versus low intake was 0.91 (95% CI 0.85, 0.97; I 2 = 24.8%) and 0.95 (0.75, 1.21; I 2 = 82.2%). Intake of nuts (median ~50 g/day) lowered total (-0.15 mmol/L; -0.22, -0.08; I 2 = 31.2%) and LDL-cholesterol (-0.13 mmol/L; -0.21, -0.05; I 2 = 68.6%), but not blood pressure. Findings on fasting glucose, HbA1c and insulin resistance were conflicting. The results were robust to sensitivity and subgroup analyses. We rated the associations between nuts/seeds and both CVD and CHD as probable. There was limited but suggestive evidence for no association with stroke. No conclusion could be made for T2D. Conclusion There is a probable relationship between consumption of nuts/seeds and lower risk of CVD, mostly driven by CHD, possibly in part through effects on blood lipids. More research on stroke and T2D may affect the conclusions. The evidence of specific nuts should be further investigated.
Collapse
Affiliation(s)
- Erik Kristoffer Arnesen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway,Erik Kristoffer Arnesen, Division of Clinical Nutrition, Institute of Basic Medical Science, University of Oslo, Box 1046 Blindern, NO-0317 Oslo, Norway.
| | | | - Linnea Bärebring
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Söderlund
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bright I. Nwaru
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ulrike Spielau
- Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway,Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jutta Dierkes
- Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway,Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway,Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Alfons Ramel
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | | | - Agneta Åkesson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
14
|
Pitre T, Jassal T, Park L, Coello PA, de Souza R, Zeraatkar D. Reporting and interpretation of effects in non-randomized nutritional and environmental epidemiology: a methods study. Ann Epidemiol 2023; 77:37-43. [PMID: 36375709 DOI: 10.1016/j.annepidem.2022.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE The presentation of absolute effects, in addition to relative effects, is critical to the optimal interpretation of effect estimates. Failure to present and interpret absolute effects may obscure the magnitude of the effect of an intervention or exposure and mislead evidence users. OBJECTIVE In this study, we estimate the proportion of systematic reviews and meta-analyses (SRMAs) addressing the health effects of nutritional and environmental exposures that report absolute effects. METHODS We searched MEDLINE and EMBASE from 2019 through 2021 for SRMAs addressing the health effects of nutritional and environmental exposures and patient-important health outcomes. We included a sample of 200 SRMAs. Pairs of reviewers, working independently and in duplicate, reviewed search records for eligibility and collected data from SRMAs. RESULTS More than two-thirds (153/200; 76.5%) of eligible systematic reviews reported on one or more dichotomous outcomes that could be translated to absolute effects. Only eight (8/153, 5.2%)5.2%), however, reported absolute effects. A similar proportion of reviews published in high-impact journals and in other journals reported absolute effects (4/131; 3.1% vs. 4/69; 5.9%). Among reviews that reported absolute effects, six reviews (6/8; 75%) reported absolute risk differences as fractions (e.g., 2 fewer cases per 1000 people) and two reviews (2/8; 25%) presented the number of cases prevented by modifying the exposure (e.g., 2000 cases prevented in United States annually). CONCLUSIONS Reviews addressing the effects of nutritional and environmental exposures on health outcomes rarely report absolute effects, which precludes effective interpretation of magnitudes of effects and their importance. We present guidance for review authors, editors, peer reviewers, and evidence users to calculate and interpret absolute effects.
Collapse
Affiliation(s)
- Tyler Pitre
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tanvir Jassal
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Louis Park
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Pablo Alonso Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain, Barcelona GRADE Centre, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Russell de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Dena Zeraatkar
- Department of Biomedical Informatics, Harvard Medical School, Cambridge, MA, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
15
|
Emmert-Fees KMF, Capacci S, Sassi F, Mazzocchi M, Laxy M. Estimating the impact of nutrition and physical activity policies with quasi-experimental methods and simulation modelling: an integrative review of methods, challenges and synergies. Eur J Public Health 2022; 32:iv84-iv91. [PMID: 36444112 PMCID: PMC9706116 DOI: 10.1093/eurpub/ckac051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The promotion of healthy lifestyles has high priority on the global public health agenda. Evidence on the real-world (cost-)effectiveness of policies addressing nutrition and physical activity is needed. To estimate short-term policy impacts, quasi-experimental methods using observational data are useful, while simulation models can estimate long-term impacts. We review the methods, challenges and potential synergies of both approaches for the evaluation of nutrition and physical activity policies. METHODS We performed an integrative review applying purposive literature sampling techniques to synthesize original articles, systematic reviews and lessons learned from public international workshops conducted within the European Union Policy Evaluation Network. RESULTS We highlight data requirements for policy evaluations, discuss the distinct assumptions of instrumental variable, difference-in-difference, and regression discontinuity designs and describe the necessary robustness and falsification analyses to test them. Further, we summarize the specific assumptions of comparative risk assessment and Markov state-transition simulation models, including their extension to microsimulation. We describe the advantages and limitations of these modelling approaches and discuss future directions, such as the adequate consideration of heterogeneous policy responses. Finally, we highlight how quasi-experimental and simulation modelling methods can be integrated into an evidence cycle for policy evaluation. CONCLUSIONS Assumptions of quasi-experimental and simulation modelling methods in policy evaluations should be credible, rigorously tested and transparently communicated. Both approaches can be applied synergistically within a coherent framework to compare policy implementation scenarios and improve the estimation of nutrition and physical activity policy impacts, including their distribution across population sub-groups.
Collapse
Affiliation(s)
- Karl M F Emmert-Fees
- Correspondence: Karl M.F. Emmert-Fees, Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany, Tel: +49 89 3187-43709, e-mail:
| | - Sara Capacci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Franco Sassi
- Centre for Health Economics and Policy Innovation (CHEPI), Imperial College Business School, London, UK
| | | | | |
Collapse
|
16
|
Zeraattalab-Motlagh S, Jayedi A, Shab-Bidar S. Mediterranean dietary pattern and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of prospective cohort studies. Eur J Nutr 2022; 61:1735-1748. [PMID: 35001218 DOI: 10.1007/s00394-021-02761-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/25/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Previous meta-analyses assessed the association of adherence to the Mediterranean dietary pattern (MedDiet) with the risk of type 2 diabetes (T2D). Since then, new large-scale cohort studies have been published. In addition, dose-response relation was not previously investigated and the certainty of evidence was not assessed. We aimed to explore the dose-response relationship between adherence to the MedDiet and the risk of T2D. METHODS We did a systematic search using PubMed, Scopus, and ISI Web of Science upto April 2021 for prospective cohort studies of the relationship between adherence to the MedDiet and the risk of T2D in the general population. The summary relative risks (RR) and 95%CI were estimated by applying a random-effects model. RESULTS Fourteen prospective cohort studies (410,303 participants and 41,466 cases) were included. There was an inverse association for the highest versus lowest category of adherence to the MedDiet (RR: 0.79, 95%CI 0.72, 0.88; I2 = 82%, n = 14; Risk difference: - 21 per 1000 person, 95%CI - 28, - 12; GRADE = moderate certainty), and for a 2-point increment in the MedDiet adherence score (RR: 0.86, 95%CI 0.82, 0.91; n = 13). The RR remained significant after controlling for important confounders and in almost all subgroups, especially subgroups defined by geographical region. We observed an inverse linear association between MedDiet adherence score and T2D incidence. CONCLUSION Adherence to the MedDiet was inversely related to T2D risk in a dose-response manner. Adherence to a Mediterranean-style diet may be a good advice for the primary prevention of T2D. REGISTRY AND REGISTRY NUMBER PROSPERO (CRD42021246589).
Collapse
Affiliation(s)
- Sheida Zeraattalab-Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), No 44, Hojjat-dost Alley, Naderi St., Keshavarz Blvd, Tehran, Iran
| | - Ahmad Jayedi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), No 44, Hojjat-dost Alley, Naderi St., Keshavarz Blvd, Tehran, Iran
- Social Determinant of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), No 44, Hojjat-dost Alley, Naderi St., Keshavarz Blvd, Tehran, Iran.
| |
Collapse
|
17
|
Storman D, Koperny M, Zając J, Polak M, Weglarz P, Bochenek-Cibor J, Swierz MJ, Staskiewicz W, Gorecka M, Skuza A, Wach AA, Kaluzinska K, Bała MM. Predictors of Higher Quality of Systematic Reviews Addressing Nutrition and Cancer Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010506. [PMID: 35010766 PMCID: PMC8744691 DOI: 10.3390/ijerph19010506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/15/2021] [Accepted: 12/26/2021] [Indexed: 02/04/2023]
Abstract
Systematic reviews/meta-analyses (SR/MAs) are considered a reliable source of information in healthcare. We aimed to explore the association of several characteristics of SR/MAs addressing nutrition in cancer prevention and their quality/risk of bias (using assessments from AMSTAR-2 and ROBIS tools). The analysis included 101 SR/MAs identified in a systematic survey. Associations of each specified characteristic (e.g., information about the protocol, publication year, reported use of GRADE, or other methods for assessing overall certainty of evidence) with the number of AMSTAR-2 not met (‘No’ responses) and the number of ROBIS items met (‘Probably Yes’ or “Yes’ responses) were examined. Poisson regression was used to identify predictors of the number of ‘No’ answers (indicating lower quality) for all AMSTAR-2 items and the number of ‘Yes’ or ‘Probably Yes’ answers (indicating higher quality/lower concern for bias) for all ROBIS items. Logistic regression was used to identify variables associated with at least one domain assessed as ‘low concern for bias’ in the ROBIS tool. In multivariable analysis, SR/MAs not reporting use of any quality/risk of bias assessment instrument for primary studies were associated with a higher number of ‘No’ answers for all AMSTAR-2 items (incidence rate ratio (IRR) 1.26, 95% confidence interval (CI) 1.09–1.45), and a lower number of ‘Yes’ or ‘Probably Yes’ answers for all ROBIS items (IRR 0.76, 95% CI 0.66–0.87). Providing information about the protocol and search for unpublished studies was associated with a lower number of ‘No’ answers (IRR 0.73, 95% CI 0.56–0.97 and IRR 0.75, 95% CI 0.59–0.95, respectively) and a higher number of ‘Yes’ or ‘Probably Yes’ answers (IRR 1.43, 95% CI 1.17–1.74 and IRR 1.28, 95% CI 1.07–1.52, respectively). Not using at least one quality/risk of bias assessment tool for primary studies within an SR/MA was associated with lower odds that a study would be assessed as ‘low concern for bias’ in at least one ROBIS domain (odds ratio 0.061, 95% CI 0.007–0.527). Adherence to methodological standards in the development of SR/MAs was associated with a higher overall quality of SR/MAs addressing nutrition for cancer prevention.
Collapse
Affiliation(s)
- Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland; (D.S.); (J.Z.); (P.W.); (M.J.S.)
| | - Magdalena Koperny
- Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Jagiellonian University Medical College, 31-034 Krakow, Poland;
| | - Joanna Zając
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland; (D.S.); (J.Z.); (P.W.); (M.J.S.)
| | - Maciej Polak
- Department of Epidemiology and Population Studies, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-034 Krakow, Poland;
| | - Paulina Weglarz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland; (D.S.); (J.Z.); (P.W.); (M.J.S.)
| | | | - Mateusz J. Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland; (D.S.); (J.Z.); (P.W.); (M.J.S.)
| | - Wojciech Staskiewicz
- Students’ Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, 31-034 Krakow, Poland; (W.S.); (M.G.); (A.S.); (A.A.W.); (K.K.)
| | - Magdalena Gorecka
- Students’ Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, 31-034 Krakow, Poland; (W.S.); (M.G.); (A.S.); (A.A.W.); (K.K.)
| | - Anna Skuza
- Students’ Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, 31-034 Krakow, Poland; (W.S.); (M.G.); (A.S.); (A.A.W.); (K.K.)
| | - Adam A. Wach
- Students’ Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, 31-034 Krakow, Poland; (W.S.); (M.G.); (A.S.); (A.A.W.); (K.K.)
| | - Klaudia Kaluzinska
- Students’ Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, 31-034 Krakow, Poland; (W.S.); (M.G.); (A.S.); (A.A.W.); (K.K.)
| | - Małgorzata M. Bała
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland; (D.S.); (J.Z.); (P.W.); (M.J.S.)
- Correspondence:
| |
Collapse
|
18
|
Zajac JF, Storman D, Swierz MJ, Koperny M, Weglarz P, Staskiewicz W, Gorecka M, Skuza A, Wach A, Kaluzinska K, Bochenek-Cibor J, Johnston BC, Bala MM. Are systematic reviews addressing nutrition for cancer prevention trustworthy? A systematic survey of quality and risk of bias. Nutr Rev 2021; 80:1558-1567. [PMID: 34921318 PMCID: PMC9086792 DOI: 10.1093/nutrit/nuab093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Context The last 30 years have yielded a vast number of systematic reviews and/or meta-analyses addressing the link between nutrition and cancer risk. Objective The aim of this survey was to assess overall quality and potential for risk of bias in systematic reviews and meta-analyses (SRMAs) that examined the role of nutrition in cancer prevention. Data Sources MEDLINE, Embase, and the Cochrane Library databases were searched (last search performed November 2018). Study Selection Studies identified as SRMAs that investigated a nutritional or dietary intervention or exposure for cancer prevention in the general population or in people at risk of cancer and in which primary studies had a comparison group were eligible for inclusion. Screening, data extraction, and quality assessment were conducted independently by 2 reviewers. Data Extraction Altogether, 101 studies were randomly selected for analysis. The methodological quality and risk of bias were evaluated using the AMSTAR-2 and ROBIS tools, respectively. Results Most SRMAs included observational studies. Less than 10% of SRMAs reported a study protocol, and only 51% of SRMAs assessed the risk of bias in primary studies. Most studies conducted subgroup analyses, but only a few reported tests of interaction or specified subgroups of interest a priori. Overall, according to AMSTAR-2, only 1% of SRMAs were of high quality, while 97% were of critically low quality. Only 3% had a low risk of bias, according to ROBIS. Conclusions This systematic survey revealed substantial limitations with respect to quality and risk of bias of SRMAs. SRMAs examining nutrition and cancer prevention cannot be considered trustworthy, and results should be interpreted with caution. Peer reviewers as well as users of SRMAs should be advised to use the AMSTAR-2 and/or ROBIS instruments to help to determine the overall quality and risk of bias of SRMAs. Systematic Review Registration PROSPERO registration number CRD42019121116.
Collapse
Affiliation(s)
- Joanna F Zajac
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz J Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Koperny
- Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Jagiellonian University Medical College, Krakow, Poland
| | - Paulina Weglarz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Staskiewicz
- Students' Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Gorecka
- Students' Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Skuza
- Students' Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Adam Wach
- Students' Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Klaudia Kaluzinska
- Students' Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | | | - Bradley C Johnston
- Department of Nutrition and the Department of Epidemiology and Biostatistics, Texas A&M University, College Station, Texas, USA; and with the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
19
|
Zeraatkar D, Kohut A, Bhasin A, Morassut RE, Churchill I, Gupta A, Lawson D, Miroshnychenko A, Sirotich E, Aryal K, Azab M, Beyene J, de Souza RJ. Assessments of risk of bias in systematic reviews of observational nutritional epidemiologic studies are often not appropriate or comprehensive: a methodological study. BMJ Nutr Prev Health 2021; 4:487-500. [PMID: 35028518 PMCID: PMC8718856 DOI: 10.1136/bmjnph-2021-000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND An essential component of systematic reviews is the assessment of risk of bias. To date, there has been no investigation of how reviews of non-randomised studies of nutritional exposures (called 'nutritional epidemiologic studies') assess risk of bias. OBJECTIVE To describe methods for the assessment of risk of bias in reviews of nutritional epidemiologic studies. METHODS We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (Jan 2018-Aug 2019) and sampled 150 systematic reviews of nutritional epidemiologic studies. RESULTS Most reviews (n=131/150; 87.3%) attempted to assess risk of bias. Commonly used tools neglected to address all important sources of bias, such as selective reporting (n=25/28; 89.3%), and frequently included constructs unrelated to risk of bias, such as reporting (n=14/28; 50.0%). Most reviews (n=66/101; 65.3%) did not incorporate risk of bias in the synthesis. While more than half of reviews considered biases due to confounding and misclassification of the exposure in their interpretation of findings, other biases, such as selective reporting, were rarely considered (n=1/150; 0.7%). CONCLUSION Reviews of nutritional epidemiologic studies have important limitations in their assessment of risk of bias.
Collapse
Affiliation(s)
- Dena Zeraatkar
- Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alana Kohut
- McMaster University, Hamilton, Ontario, Canada
| | - Arrti Bhasin
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rita E Morassut
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Isabella Churchill
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Gupta
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daeria Lawson
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anna Miroshnychenko
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Emily Sirotich
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Komal Aryal
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maria Azab
- McMaster University, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| |
Collapse
|
20
|
Swierz MJ, Storman D, Zajac J, Koperny M, Weglarz P, Staskiewicz W, Gorecka M, Skuza A, Wach A, Kaluzinska K, Bochenek-Cibor J, Johnston BC, Bala MM. Similarities, reliability and gaps in assessing the quality of conduct of systematic reviews using AMSTAR-2 and ROBIS: systematic survey of nutrition reviews. BMC Med Res Methodol 2021; 21:261. [PMID: 34837960 PMCID: PMC8627612 DOI: 10.1186/s12874-021-01457-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AMSTAR-2 ('A Measurement Tool to Assess Systematic Reviews, version 2') and ROBIS ('Risk of Bias in Systematic Reviews') are independent instruments used to assess the quality of conduct of systematic reviews/meta-analyses (SR/MAs). The degree of overlap in methodological constructs together with the reliability and any methodological gaps have not been systematically assessed and summarized in the field of nutrition. METHODS We performed a systematic survey of MEDLINE, EMBASE, and the Cochrane Library for SR/MAs published between January 2010 and November 2018 that examined the effects of any nutritional intervention/exposure for cancer prevention. We followed a systematic review approach including two independent reviewers at each step of the process. For AMSTAR-2 (16 items) and ROBIS (21 items), we assessed the similarities, the inter-rater reliability (IRR) and any methodological limitations of the instruments. Our protocol for the survey was registered in PROSPERO (CRD42019121116). RESULTS We found 4 similar domain constructs based on 11 comparisons from a total of 12 AMSTAR-2 and 14 ROBIS items. Ten comparisons were considered fully overlapping. Based on Gwet's agreement coefficients, six comparisons provided almost perfect (> 0.8), three substantial (> 0.6), and one a moderate level of agreement (> 0.4). While there is considerable overlap in constructs, AMSTAR-2 uniquely addresses explaining the selection of study designs for inclusion, reporting on excluded studies with justification, sources of funding of primary studies, and reviewers' conflict of interest. By contrast, ROBIS uniquely addresses appropriateness and restrictions within eligibility criteria, reducing risk of error in risk of bias (RoB) assessments, completeness of data extracted for analyses, the inclusion of all necessary studies for analyses, and adherence to predefined analysis plan. CONCLUSIONS Among the questions on AMSTAR-2 and ROBIS, 70.3% (26/37 items) address the same or similar methodological constructs. While the IRR of these constructs was moderate to perfect, there are unique methodological constructs that each instrument independently addresses. Notably, both instruments do not address the reporting of absolute estimates of effect or the overall certainty of the evidence, items that are crucial for users' wishing to interpret the importance of SR/MA results.
Collapse
Affiliation(s)
- Mateusz J Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland
| | - Joanna Zajac
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland
| | - Magdalena Koperny
- Chair of Epidemiology and Preventive Medicine, Department of Epidemiology Jagiellonian University Medical College , Kopernika 7 Street 31-034, Krakow, Poland
| | - Paulina Weglarz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland
| | - Wojciech Staskiewicz
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Gorecka
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Skuza
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Adam Wach
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Klaudia Kaluzinska
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | | | - Bradley C Johnston
- Departments of Nutrition, Epidemiology and Biostatistics, Texas A&M University, College Station, College Station, TX, USA.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland.
| |
Collapse
|
21
|
Kanukula R, McKenzie JE, Bero L, Dai Z, McDonald S, Kroeger CM, Korevaar E, Page MJ. Methods used to select results to include in meta-analyses of nutrition research: a meta-research study. J Clin Epidemiol 2021; 142:171-183. [PMID: 34780979 DOI: 10.1016/j.jclinepi.2021.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate how often review authors encounter multiple results from included studies that are eligible for inclusion in a particular meta-analysis, and how often methods to select results are specified. METHODS MEDLINE and Epistemonikos were searched (January 2018 - June 2019) to identify systematic reviews with meta-analysis of the association between food/diet and health-related outcomes. A random sample of these reviews was selected, and for the first presented ('index') meta-analysis, rules used to select effect estimates to include in this meta-analysis were extracted from the reviews and their protocols. All effect estimates from the primary studies that were eligible for inclusion in the index meta-analyses were extracted (e.g. when a study report presented effect estimates for blood pressure at 3 weeks and 6 weeks, both unadjusted and adjusted for covariates, and all were eligible for inclusion in a meta-analysis of the effect of red meat consumption on blood pressure, we extracted all estimates and classified the study as having "multiplicity of results"). RESULTS Forty-two systematic reviews with 325 studies (104 randomized, 221 non-randomized) were included; 14 reviews had a protocol. In 29% of review protocols and 69% of reviews, authors specified at least one decision rule to select effect estimates when multiple were available. In 68% of studies included in the index meta-analyses, there was at least one type of multiplicity of results. CONCLUSIONS Authors of systematic reviews of nutrition studies should anticipate encountering multiplicity of results in the included primary studies. Specification of methods to handle multiplicity when designing reviews is therefore recommended.
Collapse
Affiliation(s)
- Raju Kanukula
- School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Lisa Bero
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, 13080 E. 19th Ave, Aurora, CO 80045, United States
| | - Zhaoli Dai
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, NSW 2113, Australia; Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, D17, The Hub, 6th Floor, Camperdown, NSW, 2006, Australia
| | - Sally McDonald
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, D17, The Hub, 6th Floor, Camperdown, NSW, 2006, Australia
| | - Cynthia M Kroeger
- Charles Perkins Centre, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, D17, The Hub, 6th Floor, Camperdown, NSW, 2006, Australia
| | - Elizabeth Korevaar
- School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Matthew J Page
- School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia.
| |
Collapse
|
22
|
Kelly SE, Greene-Finestone LS, Yetley EA, Benkhedda K, Brooks SPJ, Wells GA, MacFarlane AJ. NUQUEST-NUtrition QUality Evaluation Strengthening Tools: development of tools for the evaluation of risk of bias in nutrition studies. Am J Clin Nutr 2021; 115:256-271. [PMID: 34605544 PMCID: PMC8755056 DOI: 10.1093/ajcn/nqab335] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Dietary exposure assessments are a critical issue in evaluating human nutrition studies; however, nutrition-specific criteria are not consistently included in existing bias assessment tools. OBJECTIVES Our objective was to develop a set of risk of bias (RoB) tools that integrated nutrition-specific criteria into validated generic assessment tools to address RoB issues, including those specific to dietary exposure assessment. METHODS The Nutrition QUality Evaluation Strengthening Tools (NUQUEST) development and validation process included 8 steps. The first steps identified 1) a development strategy; 2) generic assessment tools with demonstrated validity; and 3) nutrition-specific appraisal issues. This was followed by 4) generation of nutrition-specific items and 5) development of guidance to aid users of NUQUEST. The final steps used established ratings of selected studies and feedback from independent raters to 6) assess reliability and validity; 7) assess formatting and usability; and 8) finalize NUQUEST. RESULTS NUQUEST is based on the Scottish Intercollegiate Guidelines Network checklists for randomized controlled trials, cohort studies, and case-control studies. Using a purposive sample of 45 studies representing the 3 study designs, interrater reliability was high (Cohen's κ: 0.73; 95% CI: 0.52, 0.93) across all tools and at least moderate for individual tools (range: 0.57-1.00). The use of a worksheet improved usability and consistency of overall interrater agreement across all study designs (40% without worksheet, 80%-100% with worksheet). When compared to published ratings, NUQUEST ratings for evaluated studies demonstrated high concurrent validity (93% perfect or near-perfect agreement). Where there was disagreement, the nutrition-specific component was a contributing factor in discerning exposure methodological issues. CONCLUSIONS NUQUEST integrates nutrition-specific criteria with generic criteria from assessment tools with demonstrated reliability and validity. NUQUEST represents a consistent and transparent approach for evaluating RoB issues related to dietary exposure assessment commonly encountered in human nutrition studies.
Collapse
Affiliation(s)
- Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Karima Benkhedda
- Bureau of Nutritional Sciences, Health Canada, Ottawa, Ontario, Canada
| | - Stephen P J Brooks
- Bureau of Nutritional Sciences, Health Canada, Ottawa, Ontario, Canada,Department of Biology, Carleton University, Ottawa, Ontario, Canada
| | - George A Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | |
Collapse
|
23
|
Chen Z, Ahmed M, Ha V, Jefferson K, Malik V, Ribeiro PAB, Zuchinali P, Drouin-Chartier JP. Dairy Product Consumption and Cardiovascular Health: a Systematic Review and Meta-Analysis of Prospective Cohort Studies. Adv Nutr 2021; 13:S2161-8313(22)00071-0. [PMID: 34550320 PMCID: PMC8970833 DOI: 10.1093/advances/nmab118] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The association between dairy product consumption and cardiovascular health remains highly debated. We quantitatively synthesized prospective cohort evidence on the associations between dairy consumption and risk of hypertension (HTN), coronary heart disease (CHD) and stroke. We systematically searched PubMed, Embase, and Web of Science through August 1st, 2020 to retrieve prospective cohort studies that reported on dairy consumption and risk of HTN, CHD or stroke. We used random-effects models to calculate the pooled relative risk (RR) and 95% confidence interval (CI) for the highest vs the lowest category of intake and for 1 serving/day increase in consumption. We rated the quality of evidence using NutriGrade. Fifty-five studies were included. Total dairy consumption was associated with a lower risk of HTN (RR for highest vs lowest level of intake: 0.91, 95% CI: 0.86-0.95, I2 = 73.5%; RR for 1 serving/day increase: 0.96, 95% CI: 0.94-0.97, I2 = 66.5%), CHD (highest vs lowest level of intake: 0.96, 95% CI: 0.92-1.00, I2 = 46.6%; 1 serving/day increase: 0.98, 95% CI: 0.95-1.00, I2 = 56.7%), and stroke (highest vs lowest level of intake: 0.90, 95% CI: 0.85-0.96, I2 = 60.8%; 1 serving/day increase: 0.96, 95% CI: 0.93-0.99, I2 = 74.7%). Despite moderate to considerable heterogeneity, these associations remained consistent across multiple subgroups. Evidence on the relationship between total dairy and risk of HTN and CHD were of moderate quality and of low quality for stroke. Low-fat dairy consumption was associated with lower risk of HTN and stroke, and high-fat dairy with a lower risk of stroke. Milk, cheese, or yogurt consumption showed inconsistent associations with the cardiovascular outcomes in high vs. low intake and dose-response meta-analyses. Total dairy consumption was associated with a modestly lower risk of hypertension, CHD and stroke. Moderate to considerable heterogeneity was observed in the estimates and the overall quality of the evidence was low to moderate.
Collapse
Affiliation(s)
- Zhangling Chen
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mavra Ahmed
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada,Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada
| | - Vanessa Ha
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Vasanti Malik
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Paula A B Ribeiro
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, QC, Canada,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Priccila Zuchinali
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | | |
Collapse
|
24
|
Tobias DK, Wittenbecher C, Hu FB. Grading nutrition evidence: where to go from here? Am J Clin Nutr 2021; 113:1385-1387. [PMID: 33963733 PMCID: PMC8168365 DOI: 10.1093/ajcn/nqab124] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Deirdre K Tobias
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Clemens Wittenbecher
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Frank B Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|