Navigating nutrition evidence for individualised care
Diet is key to the maintenance of health and crucial in the prevention and management of many diseases. Modified nutrient intake may become essential to prevent deficiency, optimise development and health, or manage symptoms and disease progression. A new Position Paper (Hickson et al 2024) from the Academy of Nutrition Sciences (ANS) provides a state-of-the-art summary of how evidence-based practice, with a particular emphasis on research evaluation, is used to inform nutrition interventions for individuals.
Developed in collaboration with registered professionals working in the UK, Canada and the USA, the paper examines available frameworks for appraising quality and certainty of nutrition research evidence, the development of nutrition guidelines to support evidence implementation in practice, and the influence of other sources of nutrition information as well as misinformation. It provides a valuable resource for students of nutrition and dietetics as well as qualified professionals.
Of major importance to evidence-based nutrition and dietetic practice is the ability to critically appraise the quality and certainty of research evidence in terms of: (i) whether an appropriate study design has been used to answer the clinical question; (ii) the methodological quality of the study (i.e. specific aspects of the methods); and (iii) the overall quality and certainty of the evidence as a basis for deriving recommendations. The Paper provides examples of critical appraisal tools for use with different study designs, including tools to assess the risk of bias within studies.
Ten consensus recommendations are made, addressed to three specific audiences:
i. Nutrition and dietetic professionals, and their professional bodies;
ii. Researchers - those funding, commissioning or undertaking research aimed at delivering evidence-based practice (e.g. grant funding bodies, guideline developers, researchers etc);
iii. Disseminators - those disseminating nutrition information to patients and the public (people in the media, journalists, policy makers, politicians, other healthcare professionals, etc).
An evidence-based approach to delivery of individualised nutrition advice is crucial to ensure an intervention is efficacious and most likely to be acceptable, effective and safe. The Academy advises that the highest levels of evidence are sometimes not possible to achieve due to the nature of human nutrition and diet research. Therefore, it recommends that the concept of using the entirety of the best available evidence should be applied in prescribing nutrition interventions for individuals by nutrition and dietetic professionals.
One of the recommendations addressed to the research community and those seeking to conduct research in nutrition is that a greater understanding of the most robust research designs for use in nutritional interventions aimed at individuals is required. The development of a hierarchy of evidence specifically for nutrition studies for individualised care is needed, which reflects the concepts of study quality, best available evidence and individualisation.
Challenges identified
The ANS Position Paper also considers major challenges in applying research evidence to individuals Perhaps the most obvious of these is that, in addition to the increasing quantity and quality of robustly performed research studies, there is an abundance of conflicting information and misinformation that has to be navigated from diverse sources, including non-qualified practitioners, social media influencers and celebrities, the proliferation of fad diets and health products, and the tendency to use sensational headlines to attract more clicks, views and sales.
Accompanying editorials
The ANS Position Paper (Hickson et al 2024) is accompanied by an editorial published in Nutrition Bulletin, Journal of Human Nutrition and Dietetics, and Nutrition and Dietetics that summarises the challenges identified and the recommendations made. The Position Paper builds on previous Position Papers from the Academy of Nutrition Sciences that focussed on how dietary recommendations are formulated for populations for prevention of non-communicable diseases (Williams et al., 2021) and evidence used to support health claims for specific foods (Ashwell et al., 2022). Accompanying editorials focus on specific aspects of these Position Papers. See below for more information.
Previous Position Papers
ANS Position Paper: Evidence for Dietary Recommendations
The first Position Paper, published in December 2020 in the British Journal of Nutrition, focused on the nature of the evidence base underpinning dietary recommendations and the systematic processes used by expert panels to ensure that rigour, relevance and consistency are brought to their conclusions. Click here for an overview
In addition to the full paper, there were accompanying editorials in Nutrition Bulletin and the Journal of Human Nutrition and Dietetics, which highlight the Academy’s recommendations. The Position Paper also addresses some of the challenges inherent in studying diet-disease relationships and lessons learned over the past 45 years of evidence-based policy making in dietary prevention of non-communicable diseases, such as cancers and cardiovascular diseases. One such challenge concerns the investigation of the biological mechanisms underlying diet-disease relationships through experimental studies. A recent publication by one of the Position Paper’s authors, discusses this in detail and it is also explored in a blog.
ANS Position Paper: Evidence for Health Claims
The second Position Paper on use of nutrition evidence, published in the British Journal of Nutrition in November 2022, focuses on the Nutrition and Health Claims Regulation and use of evidence to support health claims for foods. Click here for an overview . A blog discussing why health professionals need to know about the processes in place to regulate the use of such claims is available and accompanying editorials appeared in Nutrition Bulletin and the Journal of Human Nutrition and Dietetics. These editorials summarise the recommendations and highlight the implications of the Regulation for nutrition and dietetic professionals.
References
Position Papers from the Academy of Nutrition Sciences
Ashwell, M., Hickson, M., Stanner, S., Prentice, A. & Williams, C. M. (2022) Nature of the evidence base and strengths, challenges and recommendations in the area of nutrition and health claims: a Position Paper from the Academy of Nutrition Sciences. British Journal of Nutrition 130(2):221-238. https://doi.org/10.1017/S0007114522003300
Hickson, M., Papoutsakis, C., Madden A., Smith M.A. & Whelan K. (2024) Nature of the evidence base and approaches to guide nutrition interventions for individuals: a position paper from the Academy of Nutrition Sciences. British Journal of Nutrition https://doi.org/10.1017/S0007114524000291
Williams, C. M., Ashwell, M., Prentice, A., Hickson, M., Stanner, S. (2021) Nature of the evidence base and frameworks underpinning dietary recommendations for prevention of non-communicable diseases: a position paper from the Academy of Nutrition Sciences. Br J Nutr, 126 , 1076-1090 https://doi.org/10.1017/S0007114520005000
Associated editorials
Buttriss J, Hickson M, Whelan K, Williams C (2024a) Navigating the complexity of applying nutrition evidence to individualised care: Summary of an Academy of Nutrition Sciences Position Paper. Nutrition Bulletin https://doi.org/10.1111/nbu.12660
Buttriss J, Hickson M, Whelan K, Williams C (2024b) Navigating the complexity of applying nutrition evidence to individualised care: Summary of an Academy of Nutrition Sciences Position Paper. Journal of Human Nutrition and Dietetics https://doi.org/10.1111/jhn.13288
Buttriss J, Hickson M, Whelan K, Williams C (2024c) Navigating the complexity of applying nutrition evidence to individualised care: Summary of an Academy of Nutrition Sciences Position Paper. Nutrition and Dietetics https://doi.org/10.1111/1747-0080.12867
Stanner S, Ashwell M, Williams CM (2022a) Why do health professionals need to know about the nutrition and health claims regulation? Summary of an Academy of Nutrition Sciences Position Paper. Nutrition Bulletin 48 (1) 1-5. https://doi.org/10.1111/nbu.12598
Stanner S, Ashwell M, Williams CM (2022b) Why do health professionals need to know about the nutrition and health claims regulation? Summary of an Academy of Nutrition Sciences Position Paper. Journal Human Nutrition and Dietetics 36 (1), 12-16. https://doi.org/10.1111/jhn.13118
Williams C.M., Buttriss J.L., Whelan K. (2021a) Synthesising nutrition science into dietary guidelines for populations amidst the challenge of fake news: Summary of an Academy of Nutrition Sciences position paper. Nutrition Bulletin 46 (1) 2-7 https://doi.org/10.1111/nbu.12480
Williams C.M., Buttriss J.L., Whelan K. (2021b) Synthesising nutrition science into dietary guidelines for populations amidst the challenge of fake news: Summary of an Academy of Nutrition Sciences position paper. Journal of Human Nutrition and Dietetics 34 (3), 467-71 https://doi.org/10.1111/jhn.12863
Dr Judy Buttriss
Academy of Nutrition Sciences, Chair of Trustees