W7 - Critical Appraisal - Development of Nutrition Recommendations & Guidelines

Question 1

Why is critical appraisal important?

Answer 1

To be able to translate scientific evidence to practise.

Question 2

Give some examples of conflicting messages in nutrition

Answer 2

Fats give you heart diseases

Meat give you cancer

Carbs are bad for you

Question 3

What are the common goals for nutrient reference standards

Answer 3

To meet physiological needs

Min risk of adverse effects

⬇️ risk of chronic diseases

Question 4

UK has dietary reference values produced by who?

Answer 4

Public health England

Scientific advisory committee on nutrition

Question 5

What comes under the DRV

Answer 5

EAR

RNI

LRNI

Safe intake

Question 6

EAR

Answer 6

Estimated avg req

Question 7

RNI

Answer 7

Ref nutrient intake

Question 8

LRNI

Answer 8

Lower reference nutrient intake

Question 9

What do nutrient recommendations focus on?

Answer 9

A single nutrient

i.e macro or micronutrients

Question 10

What do dietary guidelines refer to?

Answer 10

Foods + dietary patterns

Question 11

What do clinical practise guidelines do?

Answer 11

Personalise guidelines to the ind + translate the evidence base for the management of clinical conditions.

Question 12

What regulates the health claims in marketing on the packaging of food products in Europe & the UK?

Answer 12

European Food Safety Authority

Question 13

What came out in 2006

Answer 13

Regulations came out to ensure that any nutrition or health claim on food labels needs to be backed up by scientific evidence.

Question 14

What are the 2 broad study designs used commonly in nutrition studies?

Answer 14

Experimental

Observational

Question 15

What are case control studies good for in nutrition?

Answer 15

The impact of a specific nutrient or food intake/item/dietary pattern on the risk of developing a diseases between groups of people.

Question 16

Observational studies

Answer 16

Association, not causation

Limited to responders, data collected/questions

Rely on self-report

Question 17

Intervention studies (treatment vs control)

Answer 17

Not always possible/ethical

Limited time effect

Limited to group characteristics

Controlled env (lab)

Question 18

Advantages to prospective cohort studies

Answer 18

Large sample

Long time-frame

Multiple measures at once

Cheaper + more feasible than RCT

Question 19

Disadvantages to prospective cohort studies

Answer 19

Accuracy of data

Assumptions rather than certainty

Uncontrolled setting

Question 20

What do evidence-based guidelines typically feature?

Answer 20

Explicit methodology

Systematic review of the evidence

Graded recommendations linked directly to the supporting evidence

State explicitly when recommendations are based on opinion.

Question 21

What are the steps usually involved in guideline development

Answer 21

Specification of the topic + guideline development methodology

Systematic review of the evidence

Consideration of expert opinion

Public policy considerations

Drafting of the document

Peer review

Question 22

What happens to supporting evidence?

Answer 22

Undergoes critical appraisal, incl, an assessment of the mag of the effect on outcomes observed in studies.

Question 23

As well as health effects, guidelines can have secondary effects in other domains of daily life

Give examples

Answer 23

Family budgets

Shopping patterns

Question 24

As well as health effects & secondary effects what can dietary guidelines also do?

Answer 24

Alter corporate dynamics w/in the commercial market place

i.e

Food industry

Restaurants

Retailing

Advertising

Question 25

Why is comprehensiveness important?

Answer 25

To ensure all evidence is considered, avoiding any bias.

Question 26

Why is critical appraisal carried out?

Answer 26

To examine strengths + weaknesses of the study designs so that judgement about the evidence can be linked to quality.

Question 27

What influences where an ind will fall in the bell curve surrounding the mean?

Answer 27

Variety of effect modifiers

i.e risk factors, past medical history, lifestyle…

Question 28

Limitations of evidence-based practise guidelines

Answer 28

Guidelines could be slightly wrong due to errors stemming from limitations in the science, I,e lack of data.

Recommendations that don’t give guidance on individualisation or that reduced complex decisions into simplistic algorithms may result in more harm than good.