Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 4K1, Canada; email:
Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada; email:
Annu Rev Nutr. 2019 Aug 21;39:227-247. doi: 10.1146/annurev-nutr-082018-124610.
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.
膳食指南和建议通常由政府机构或大型权威组织制定，对公共政策有重大的后续影响。越来越多的证据支持这样一种观点，即制定膳食指南所使用的方法存在严重缺陷。这些缺陷包括未能获取或进行全面的系统评价，缺乏对证据质量的系统或严格评估，未能承认建议所依据的证据基础的局限性，以及对利益冲突的管理不够严格。通过遵守指南制定的国际标准，可以解决这些问题，包括采用系统评价方法和使用严格的系统来评估证据的确定性，并从证据到建议，其中 GRADE 方法（推荐评估、制定和评价分级）是最严格和最完善的。改进膳食指南制定方法有很大潜力可以大大改善公共政策决策。
