[EQ] Application of Systematic Review Methodology to the Field of Nutrition

Nutritional Research Series:
Advancing the Role of Evidence-based Reviews in Nutrition Research and Applications

Volume 1: Application of Systematic Review Methodology to the Field of Nutrition

 

Agency for Healthcare Research and Quality

U.S. Department of Health and Human Services - AHRQ Publication No. 09-0025 January 2009

 

Available online as PDF file [36p.] at: http://www.ahrq.gov/downloads/pub/evidence/pdf/nutrition/nutrtp1.pdf

 

“…..Systematic reviews represent a rigorous and transparent approach of synthesizing scientific evidence that minimizes bias. They evolved within the medical community to support development of clinical and public health practice guidelines, set research agendas and formulate scientific consensus statements. The use of systematic reviews for nutrition related topics is more recent. Systematic reviews provide independently-conducted comprehensive and objective assessments of available information addressing precise questions. This approach to summarizing available data is a useful tool for identifying the state of science including knowledge gaps and associated research needs, supporting development of science-based recommendations and guidelines, and serving as the foundation for updates as new data emerge.

 

Our objective is to describe the steps for performing systematic reviews and highlight areas unique to the discipline of nutrition important to consider in data assessment. Steps involved in generating systematic reviews include identifying staffing and planning for outside expert input, forming a research team, developing an analytic framework, developing and refining research questions, defining eligibility criteria, identifying search terms, screening abstracts according to eligibility criteria, retrieving articles for evaluation, constructing evidence and summary tables, assessing methodological quality and applicability, and synthesizing results including performing meta-analysis, if appropriate.

 

Unique and at times challenging, nutrition related considerations include baseline nutrient exposure, nutrient status, bioequivalence of bioactive compounds, bioavailability, multiple and interrelated biological functions, undefined nature of some interventions, and uncertainties in intake assessment. Systematic reviews are a valuable and independent component to decision making processes by groups responsible for developing science-based recommendations and policies….”

 

 

 

Contents

Evidence Report

Chapter 1. Introduction

Examples of recent systematic reviews of nutrition related topics

Chapter 2. Systematic Review Methodology

Identify staffing

Form multidisciplinary research team

Plan for outside inputs

Develop analytic framework

Develop and refine research questions

Define eligibility criteria

Identify search terms

Perform literature search

Evaluate search results

Construct evidence and summary tables, and extract data

Assess methodological quality and applicability of studies

Perform meta-analysis, as appropriate

Synthesize results

Chapter 3. Discussion

Unique Considerations When Conducting Nutrition-Related Systematic Strengths and Limitations of Systematic Review Approach for Nutrition Reviews

Baseline Exposure

Nutrient Status

Bioequivalence of Different Chemical Forms of Nutrients

Bioavailability of Nutrients

Multiple and Interrelated Biological Functions of a Nutrient

Undefined Nature of Nutrient Intervention

Uncertainties in Assessing Dose Response Relationships

Applications

Chapter 4. Conclusion

References

 

Volume 2: Issues and Challenges in Conducting Systematic Reviews to Support Development of Nutrient Reference Values:
Workshop Summary (March 2009).

PDF [41p.] at: http://www.ahrq.gov/downloads/pub/evidence/pdf/nutrition/nutrtp2.pdf

“…..Nutrient reference values have significant public health and policy implications. Given the importance of defining reliable nutrient reference values, there is a need for an explicit, objective, and transparent process to set these values. The Tufts Medical Center Evidence-based Practice Center assembled a group of nutrition experts from academic institutions and federal government agencies, led participants in discussions, conducted exercises in formulating questions and evidence review criteria that would be amenable to systematic reviews of the scientific literature, performed a literature search on the questions to identify potentially relevant publications, and identified challenges and limitations of applying this method to support the development of nutrient reference values, using vitamin A as an example.

The workgroup concluded that the systematic review approach could be productively used to inform the development of reference values. Challenges identified in this exercise include prioritizing and defining research questions when the volume of literature is large, relying on intermediate (surrogate) outcomes when few or no studies directly linked nutrient intake with clinical outcomes are available, and determining reliable nutrient biomarkers. Ultimately, an objective, unbiased systematic review of a defined question could be useful; not only in helping to set nutrient reference values, but also for increasing the transparency of the decision making process.

Volume 3: Reporting of Systematic Reviews of Micronutrients and Health: A Critical Appraisal (March 2009).

            PDF [48p.] at: http://www.ahrq.gov/downloads/pub/evidence/pdf/nutrition/nutrtp3.pdf

.

Background: The quality of nutrition-related systematic reviews (SR) is an unstudied but important factor affecting their usefulness.

Objective: To evaluate reporting quality of published SRs and identify areas for improvement.

Design: Descriptive and exploratory analyses of reporting quality (7 nutrition items and 28 SR reporting items) of all English-language SRs published through July 2007 linking micronutrients and health outcomes in humans. Factors that may to be associated with the reporting quality were also evaluated.

 

 

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[EQ] Methods for the development of NICE public health guidance

Methods for the development of NICE public health guidance

National Institute for Health and Clinical Excellence, London

(second edition) April 2009

 

Available online PDF [282p.] at: http://www.nice.org.uk/media/2FB/53/PHMethodsManual110509.pdf

 

“……..NICE produces guidance in four areas:

- public health – guidance for the promotion and protection of good health and the prevention of disease

- health technologies – guidance on the use of new and existing health technologies (including drugs, medical devices, diagnostic techniques and surgical procedures)

- interventional procedures – guidance on the efficacy and safety of surgical, endoscopic and endovascular procedures and allied techniques

- clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions.

 

This manual describes the methods used by the Centre for Public Health Excellence (CPHE) in NICE to develop public health guidance

NICE’s methods and processes for developing public health guidance are based on a clear set of values and principles. The range of activities and topics covered

is inclusive.

 

It is based on a conceptual framework for public health (see appendix A). This comprises four vectors – population, environment, society and organisations – linked to human behaviour. They explain the patterns of potentially preventable diseases. Social differences in the population are linked to patterns of mortality and morbidity. These differences manifest themselves in a number of key areas including:

- conditions and diseases such as cardiovascular disease, cancer, obesity, diabetes, vaccine-preventable infections

- behaviours such as smoking, drug or alcohol misuse, sexual activity, physical activity

- other factors affecting health such as environment, work, housing and transport

- accidents and injuries

- child and maternal health, mental health, oral health.

In any of these areas, public health activities may be direct (for example, providing contraceptive services or smoking cessation services) or indirect (for example, creating safe open spaces for physical activity as part of general work to upgrade the environment). Traditional public health issues (such as ensuring the health of pregnant and breastfeeding women) and other issues associated with the wider determinants of health are all covered.

In summary, NICE public health guidance considers a variety of approaches, from health promotion and public education campaigns, through uptake of immunisation and screening to activities such as community development. ……”

Contents

1 Introduction

1.1 NICE guidance

1.2 Equality and social value judgements

1.3 Who is this manual for?

1.4 Framework for public health guidance

1.5 Types of knowledge and evidence

1.6 Stakeholders

1.7 Quality assurance principles

1.8 References and further reading

2 Topic selection and scoping the guidance

3 Determining the evidence for review and consideration

3.1 Introduction

3.2 Types of evidence

3.3 Types of review and types of research question

3.4 Planning reviews

3.5 Colloquial evidence

3.6 Equality and diversity

3.7 References and further reading

4 Identifying the evidence

4.1 Introduction

4.2 Phase one: constructing the search protocol

4.3 Phase two: developing the search strategy

4.4 Phase three: gathering the evidence, conducting searches and documenting the process

4.5 Equality and diversity

4.6 References

5 Reviewing the scientific evidence

5.1 Introduction

5.2 Selecting relevant evidence

5.3 Assessing the quality of the evidence

5.4 Extracting, synthesising and presenting the evidence

5.5 Deriving evidence statements

5.6 Assessing applicability

5.7 Published guidance

5.8 Equality and diversity

5.9 References and further reading

6 Incorporating health economics

6.1 Introduction

6.2 Reviewing economic evaluations

6.3 Prioritising areas for further economic analysis

6.4 Economic evidence and guidance recommendations

6.5 References and further reading

7 Developing recommendations

7.1 Introduction

7.2 Considering the evidence and other issues

7.3 Format and wording of recommendations

7.4 Revisions following fieldwork and stakeholder consultation

7.5 Considerations

7.6 Equality and diversity

7.7 Prioritising recommendations for implementation

7.8 Formulating research recommendations

7.9 Equality and diversity

7.10 Further reading

8 Testing the recommendations: fieldwork

8.1 Introduction

8.2 Aim of fieldwork

8.3 Guiding principles

8.4 Fieldwork commissioning

8.5 Approaches to fieldwork

8.6 Ethical approval

8.7 Quality standards for fieldwork methods

8.8 Fieldwork analysis

8.9 Fieldwork report

8.10 Using fieldwork findings to finalise recommendations

8.11 Equality and diversity

8.12 References and further reading

Appendix A Conceptual framework for the work of the Centre for Public Health Excellence (CPHE)

Appendix B Electronic resources

Appendix C Example of audit information to accompany search strategies

Appendix D Glossary of study designs

Appendix E Algorithm for classifying quantitative (experimental and observational) study designs

Appendix F Quality appraisal checklist – quantitative intervention studies

Appendix G Quality appraisal checklist – quantitative studies reporting correlations and associations

Appendix H Quality appraisal checklist – qualitative studies

Appendix I Quality appraisal checklist – economic evaluations

Appendix J Process for using review-level material in exceptional circumstances

Appendix K Evidence tables

Appendix L NICE review format

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMS Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
------------------------------------------------------------------------------------
PAHO/WHO Website

Follow us on Twitter: http://twitter.com/eqpaho

Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

 

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.