scholarly journals What Contributes to the Variation of Dairy Recommendations in Global Food-Based Dietary Guidelines

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1264-1264
Author(s):  
Zhaoli Dai ◽  
Cynthia Kroeger ◽  
Sally Mcdonald ◽  
Lisa Bero
Keyword(s):  
Systematic Review ◽  
Health Equity ◽  
Guideline Development ◽  
Evidence Base ◽  
Dietary Guidelines ◽  
Dietary Recommendations ◽  
Systematic Review Methods ◽  
Dairy Consumption ◽  
Evidence Quality ◽  
Global Food

Abstract Objectives Dairy consumption remains controversial due to uncertainty about its health impacts and effects on food sustainability. There are variations in dairy recommendations in global food-based dietary guidelines (FBDGs). Yet, how methods used to develop recommendations contribute to such variation is unknown. In this study, we assessed this dietary context in dairy recommendations. Methods We search the FBDG database at the Food and Agricultural Organization website in 2019 to identify dietary guidelines published since 2009. Eligible guidelines needed to include dietary recommendations and describe the guideline development processes. Protocols for this review were registered (CRD42019125258; CRD42019126452) and published previously. Two reviewers independently reviewed the guidelines and extracted information on dairy recommendations. Systematic review methods, quality of evidence assessment, evidence underpinning the recommendations, and information on health equity were evaluated. We used descriptive statistics to summarize the findings. Results We included 26 eligible FBDGs, including the Dietary Guidelines for Americans 2020–2025. Serving sizes of dairy recommendations varied, ranging from 1 ser/d (11.5%) to 3–5 ser/d (3.9%), with 27% of the guidelines recommending 2 ser/d and another 27% having no or unclear recommendations. The majority of the guidelines (n = 19, 73%) endorsed low-fat or skimmed fat dairy, while 7 (27%) did not emphasize fat contents. All guidelines recommended dairy as a dietary source for calcium (n = 16, 61.5%) and/or vitamin D (n = 10, 38.5%). Only 8 guidelines (31%) recommended dairy alternatives, among which 4 (18%) recommended soy products. Systematic review methods and evidence quality assessment were implemented in 5 guidelines (19%). Only 12 guidelines (46%) considered health equity to address cultural/regional aspects to formulate dietary recommendations. Conclusions Most dietary guidelines recommend reduced-fat dairy consumption, but only 31% recommend plant-based protein as dairy alternatives, despite lactose intolerance and food sustainability as global concerns. Methodological rigor in the evidence base and health equity considerations remain a challenge in dietary guideline development. Funding Sources The Australian National Health and Medical Research Council.

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

2020 ◽  
Vol 23 (16) ◽  
pp. 2879-2885
Author(s):  
Zhaoli Dai ◽  
Cynthia M Kroeger ◽  
Mark Lawrence ◽  
Gyorgy Scrinis ◽  
Lisa Bero
Keyword(s):  
Food Intake ◽  
Methodological Quality ◽  
Guideline Development ◽  
Evidence Base ◽  
Dietary Guidelines ◽  
Evidence Based ◽  
Processed Food ◽  
Dietary Recommendations ◽  
Dietary Guideline ◽  
Development Methods

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

scholarly journals Methodological quality of public health guideline recommendations on vitamin D and calcium : a systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031840 ◽  
Author(s):  
Zhaoli Dai ◽  
Cynthia M Kroeger ◽  
Sally McDonald ◽  
Matthew J Page ◽  
Joanne E McKenzie ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Vitamin D ◽  
Bone Health ◽  
Methodological Quality ◽  
Guideline Development ◽  
Grey Literature ◽  
Dietary Guidelines ◽  
Published Data

IntroductionCurrent recommendations for vitamin D and calcium in dietary guidelines and bone health guidelines vary significantly among countries and professional organisations. It is unknown whether the methods used to develop these recommendations followed a rigourous process and how the differences in methods used may affect the recommended intakes of vitamin D and calcium. The objectives of this study are (1) collate and compare recommendations for vitamin D and calcium across guidelines, (2) appraise methodological quality of the guideline recommendations and (3) identify methodological factors that may affect the recommended intakes for vitamin D and calcium. This study will make a significant contribution to enhancing the methodological rigour in public health guidelines for vitamin D and calcium recommendations.Methods and analysesWe will conduct a systematic review to evaluate vitamin D and calcium recommendations for osteoporosis prevention in generally healthy middle-aged and older adults. Methodological assessment will be performed for each guideline against those outlined in the 2014 WHO handbook for guideline development. A systematic search strategy will be applied to locate food-based dietary guidelines and bone health guidelines indexed in various electronic databases, guideline repositories and grey literature from 1 January 2009 to 28 February 2019. Descriptive statistics will be used to summarise the data on intake recommendation and on proportion of guidelines consistent with the WHO criteria. Logistic regression, if feasible, will be used to assess the relationships between the methodological factors and the recommendation intakes.Ethics and disseminationEthics approval is not required as we will only extract published data or information from the published guidelines. Results of this review will be disseminated through conference presentations and peer-reviewed publications.PROSPERO registration numberCRD42019126452

scholarly journals Yogurt, cultured fermented milk, and health: a systematic review

2020 ◽  
Author(s):  
Dennis A Savaiano ◽  
Robert W Hutkins
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
English Language ◽  
Dairy Product ◽  
Quality Criteria ◽  
Fermented Milk ◽  
Dietary Guidelines ◽  
Milk Products ◽  
Dairy Consumption ◽  
Fermented Milk Products

Abstract Consumption of yogurt and other fermented products is associated with improved health outcomes. Although dairy consumption is included in most dietary guidelines, there have been few specific recommendations for yogurt and cultured dairy products. A qualitative systematic review was conducted to determine the effect of consumption of fermented milk products on gastrointestinal and cardiovascular health, cancer risk, weight management, diabetes and metabolic health, and bone density using PRISMA guidelines. English language papers in PubMed were searched, with no date restrictions. In total, 1057 abstracts were screened, of which 602 were excluded owing to lack of appropriate controls, potential biases, and experimental design issues. The remaining 455 papers were independently reviewed by both authors and 108 studies were included in the final review. The authors met regularly to concur, through consensus, on relevance, methods, findings, quality, and conclusions. The included studies were published between 1979 and 2017. From the 108 included studies, 76 reported a favorable outcome of fermented milks on health and 67 of these were considered to be positive or neutral quality according to the Academy of Nutrition and Dietetics’ Quality Criteria Checklist. Of the 32 remaining studies, the study outcomes were either not significant (28) or unfavorable (4), and most studies (18) were of neutral quality. A causal relationship exists between lactose digestion and tolerance and yogurt consumption, and consistent associations exist between fermented milk consumption and reduced risk of breast and colorectal cancer and type 2 diabetes, improved weight maintenance, and improved cardiovascular, bone, and gastrointestinal health. Further, an association exists between prostate cancer occurrence and dairy product consumption in general, with no difference between fermented and unfermented products. This article argues that yogurt and other fermented milk products provide favorable health outcomes beyond the milk from which these products are made and that consumption of these products should be encouraged as part of national dietary guidelines. Systematic review registration:  PROSPERO registration no. CRD42017068953.

Evidence Collection and Evaluation for the Development of Dietary Guidelines and Public Policy on Nutrition

2019 ◽  
Vol 39 (1) ◽  
pp. 227-247 ◽  
Author(s):  
Dena Zeraatkar ◽  
Bradley C. Johnston ◽  
Gordon Guyatt
Keyword(s):  
Public Policy ◽  
Conflicts Of Interest ◽  
Guideline Development ◽  
Policy Decision ◽  
Evidence Base ◽  
Dietary Guidelines ◽  
International Standards ◽  
Systematic Review Methodology ◽  
Assessment Development ◽  
Evidence Collection

Dietary guidelines and recommendations, usually developed by government bodies or large authoritative organizations, have major downstream effects on public policy. A growing body of evidence supports the notion that there are serious deficiencies in the methods used to develop dietary guidelines. Such deficiencies include the failure to access or conduct comprehensive systematic reviews, a lack of systematic or rigorous evaluation of the quality of the evidence, a failure to acknowledge the limitations of the evidence base underlying recommendations, and insufficiently stringent management of conflicts of interest. These issues may be addressed by adhering to international standards for guideline development, including adopting systematic review methodology and using rigorous systems to evaluate the certainty of the evidence and to move from evidence to recommendations, of which the GRADE approach (Grading of Recommendations Assessment,Development and Evaluation) is the most rigorous and fully developed. Improving the methods by which dietary guidelines are produced has considerable potential to substantially improve public policy decision-making.

Development of a Range of Plausible Noncancer Toxicity Values for 2,3,7,8-Tetrachlorodibenzo-p-Dioxin Based on Effects on Sperm Count: Application of Systematic Review Methods and Quantitative Integration of Dose Response Using Meta-Regression

2020 ◽  
Author(s):  
Daniele S Wikoff ◽  
Jonathan D Urban ◽  
Caroline Ring ◽  
Janice Britt ◽  
Seneca Fitch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Dose Response ◽  
Animal Studies ◽  
Sperm Count ◽  
Human Health Risk ◽  
Evidence Base ◽  
Risk Of Bias ◽  
Systematic Review Methods ◽  
Meta Regression ◽  
Tetrachlorodibenzo P Dioxin

Abstract Regulatory agencies have derived noncancer toxicity values for 2,3,7,8-tetrachlorodibenzo-p-dioxin based on reduced sperm counts relying on single studies from a large body of evidence. Techniques such as meta-regression allow for greater use of the available data while simultaneously providing important information regarding the uncertainty associated with the underlying evidence base when conducting risk assessments. The objective herein was to apply systematic review methods and meta-regression to characterize the dose-response relationship of gestational exposure and epididymal sperm count. Twenty-three publications (20 animal studies consisting of 29 separate rat experimental data sets, and 3 epidemiology studies) met inclusion criteria. Risk of bias evaluation was performed to critically appraise study validity. Low to very low confidence precluded use of available epidemiological data as candidate studies for dose-response due to inconsistencies across the evidence base, high risk of bias, and general lack of biological coherence, including lack of clinical relevance and dose-response concordance. Experimental animal studies, which were found to have higher confidence following the structured assessment of confidence (eg, controlled exposure, biological consistency), were used as the basis of a meta-regression. Multiple models were fit; points of departure were identified and converted to human equivalent doses. The resulting reference dose estimates ranged from approximately 4 to 70 pg/kg/day, depending on model, benchmark response level, and study validity integration approach. This range of reference doses can be used either qualitatively or quantitatively to enhance understanding of human health risk estimates for dioxin-like compounds.

scholarly journals Recommended dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids: a systematic review

2012 ◽  
Vol 107 (S2) ◽  
pp. S8-S22 ◽  
Author(s):  
Javier Aranceta ◽  
Carmen Pérez-Rodrigo
Keyword(s):  
Systematic Review ◽  
Fatty Acids ◽  
Grey Literature ◽  
Relevant Literature ◽  
Dietary Guidelines ◽  
Background Information ◽  
Fat Intake ◽  
Dietary Recommendations ◽  
Dietary Reference Intakes ◽  
Cholesterol Intake

Dietary fat and its effects on health and disease has attracted interest for research and Public Health. Since the 1980s many bodies and organizations have published recommendations regarding fat intake. In this paper different sets of recommendations are analyzed following a systematic review process to examine dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids. A literature search was conducted in relevant literature databases along a search for suitable grey literature reports. Documents were included if they reported information on either recommended intake levels or dietary reference values or nutritional objectives or dietary guidelines regarding fat and/or fatty acids and/or cholesterol intake or if reported background information on the process followed to produce the recommendations. There is no standard approach for deriving nutrient recommendations. Recommendations vary between countries regarding the levels of intake advised, the process followed to set the recommendations. Recommendations on fat intake share similar figures regarding total fat intake, saturated fats andtransfats. Many sets do not include a recommendation about cholesterol intake. Most recent documents provide advice regarding specificn-3 fatty acids. Despite efforts to develop evidence based nutrient recommendations and dietary guidelines that may contribute to enhance health, there are still many gaps in research. It would be desirable that all bodies concerned remain transparent about the development of dietary recommendations. In order to achieve this, the type of evidence selected to base the recommendations should be specified and ranked. Regular updates of such recommendations should be planned.

scholarly journals Dairy Foods, Obesity, and Metabolic Health: The Role of the Food Matrix Compared with Single Nutrients

2019 ◽  
Vol 10 (5) ◽  
pp. 917S-923S ◽  
Author(s):  
Dariush Mozaffarian
Keyword(s):  
Weight Gain ◽  
Saturated Fat ◽  
Dietary Guidelines ◽  
Dietary Recommendations ◽  
Cvd Risk ◽  
Dairy Foods ◽  
Dairy Consumption ◽  
Reduced Fat ◽  
Total Fat ◽  
Fermented Dairy

ABSTRACT In the 20th century, scientific and geopolitical events led to the concept of food as a delivery system for calories and specific isolated nutrients. As a result, conventional dietary guidelines have focused on individual nutrients to maintain health and prevent disease. For dairy foods, this has led to general dietary recommendations to consume 2–3 daily servings of reduced-fat dairy foods, without regard to type (e.g., yogurt, cheese, milk), largely based on theorized benefits of isolated nutrients for bone health (e.g., calcium, vitamin D) and theorized harms of isolated nutrients for cardiovascular diseases (CVDs) and obesity (e.g., total fat, saturated fat, total calories). However, advances in nutrition science have demonstrated that foods represent complex matrices of nutrients, minerals, bioactives, food structures, and other factors (e.g., phoshopholipids, prebiotics, probiotics) with correspondingly complex effects on health and disease. The present evidence suggests that whole-fat dairy foods do not cause weight gain, that overall dairy consumption increases lean body mass and reduces body fat, that yogurt consumption and probiotics reduce weight gain, that fermented dairy consumption including cheese is linked to lower CVD risk, and that yogurt, cheese, and even dairy fat may protect against type 2 diabetes. Based on the current science, dairy consumption is part of a healthy diet, without strong evidence to favor reduced-fat products; while intakes of probiotic-containing unsweetened and fermented dairy products such as yogurt and cheese appear especially beneficial.

scholarly journals The availability of global guidance for the promotion of women’s, newborns’, children’s and adolescents’ health and nutrition in conflicts

2020 ◽  
Vol 5 (Suppl 1) ◽  
pp. e002060
Author(s):  
Samira Aboubaker ◽  
Egmond Samir Evers ◽  
Loulou Kobeissi ◽  
Lauren Francis ◽  
Robinah Najjemba ◽  
...  
Keyword(s):  
Adolescent Health ◽  
English Language ◽  
Guideline Development ◽  
Newborn Care ◽  
Evidence Base ◽  
Communicable Diseases ◽  
Key Informants ◽  
Humanitarian Settings ◽  
Health And Nutrition ◽  
Guidance Documents

BackgroundSignificant global gains in sexual, reproductive, maternal, newborn, child and adolescent health and nutrition (SRMNCAH&N) will be difficult unless conflict settings are adequately addressed. We aimed to determine the amount, scope and quality of publically available guidance documents, to characterise the process by which agencies develop their guidance and to identify gaps in guidance on SRMNCAH&N promotion in conflicts.MethodsWe identified guidance documents published between 2008 and 2018 through English-language Internet sites of humanitarian response organisations, reviewed them for their scope and assessed their quality with the AGREE II (Appraisal of Guidelines for REsearch and Evaluation II) tool. Additionally, we interviewed 22 key informants on guidance development, dissemination processes, perceived guidance gaps and applicability.FindingsWe identified 105 conflict-relevant guidance documents from 75 organisations. Of these, nine were specific to conflicts, others were applicable also to other humanitarian settings. Fifteen documents were technical normative guidelines, others were operational guides (67), descriptive documents (21) or advice on legal, human rights or ethics questions (2). Nutrition was the most addressed health topic, followed by communicable diseases and violence. The documents rated high quality in their ‘scope and purpose’ and ‘clarity of presentation’ and low for ‘rigour of development’ and ‘editorial independence’. Key informants reported end user need as the primary driver for guideline development and WHO technical guidelines as their main evidence base. Insufficient local contextualisation, lack of inter-agency coordination and lack of systematic implementation were considered problems in guideline development. Several guidance gaps were noted, including abortion care, newborn care, early child development, mental health, adolescent health beyond sexual and reproductive health and non-communicable diseases.InterpretationOrganisations are motivated and actively producing guidance for SRMNCAH&N promotion in humanitarian settings, but few documents address conflicts specifically and there are important guidance gaps. Improved inter-organisation collaboration for guidance on SRMNCAH&N promotion in conflicts and other humanitarian settings is needed.

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