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Scope and quality of Cochrane reviews of nutrition interventions: a cross-sectional study

View Article: PubMed Central - PubMed

ABSTRACT

Background: All countries face significant challenges from complex manifestations of malnutrition, which affects one in three people globally. Systematic reviews provide ready-to-use syntheses of quality-appraised evidence to inform decision-making for actions. To enhance the utility and quality of future Cochrane nutrition evidence, we described the scope and quality of all nutrition systematic reviews in the Cochrane Database of Systematic Reviews (CDSR).

Methods: We screened all active CDSR records (31 July 2015) to identify reviews and protocols using pre-specified eligibility criteria and definitions. Duplicate, independent data extraction included criteria for inclusion of studies in completed reviews (PICOS). We assessed methodological quality (AMSTAR), use of GRADE, mapped reviews against 2013 Global Burden of Disease data, and categorised the paradigm (medical, lifestyle and socio-ecological) of the review question. We analysed our results using descriptive statistics.

Results: We screened 8484 records, and included 470 (8%) completed reviews (in 45 Cochrane Review Groups (CRGs)) and 169 (7%) protocols (in 41 CRGs) published by 47 of 53 CRGs with reviews. Most completed reviews were produced by the Pregnancy and Childbirth (n = 73), Neonatal (n = 64), Metabolic and Endocrine Disorders (n = 33), Developmental, Psychosocial and Learning Problems (n = 26), Kidney and Transplant (n = 18) and Heart (n = 18) CRGs. Only 27% (n = 129) of reviews had searches for new studies in 2013 or thereafter. Supplementation/supplement interventions were most common (50%; n = 235; majority with micronutrients; 73%, n = 173), followed by food interventions (20%; n = 95). All reviews included randomised controlled trials; about 5% included other designs; 25% used GRADE; the median AMSTAR score was 9 (interquartile range: 7 to 10), 51% were high (AMSTAR 9-11) and 49% moderate (AMSTAR 5-8) quality. More than 80% framed questions using a medical paradigm. For top causes of years-of-life-lost, most reviews addressed preterm birth, diabetes and ischaemic heart disease; for leading risk factors for disability-adjusted-life-years, most targeted childhood undernutrition and high body mass index.

Conclusions: Nutrition reviews comprised 8% of active CDSR records, were widely distributed across nearly all CRGs and reflected the double nutrition burden. This analysis presents a comprehensive description of the scope and quality of Cochrane nutrition reviews, and identifies gaps for future activities to support actions to address the nutrition burden, in line with the current nutrition agenda and impetus.

No MeSH data available.


Graphic representation of the three paradigms (medical, lifestyle and socio-ecological) that conceptualize how the relationship between food and health is viewed and how the causes of nutrition problems are framed [12], along with the broad categories of nutrition interventions (nutrition-specific, nutrition-sensitive) and the enabling environment for nutrition improvement to support these interventions [2, 13]
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Fig1: Graphic representation of the three paradigms (medical, lifestyle and socio-ecological) that conceptualize how the relationship between food and health is viewed and how the causes of nutrition problems are framed [12], along with the broad categories of nutrition interventions (nutrition-specific, nutrition-sensitive) and the enabling environment for nutrition improvement to support these interventions [2, 13]

Mentions: Since approaches to assessing interventions are closely linked to putative causal pathways, the perspectives adopted by researchers play an important role in evaluating cause-effect relationships. Lawrence has identified three paradigms (medical, lifestyle and socio-ecological) within which the relationship between food and health can be viewed, and which specifically influence how the causes of nutrition problems are framed [12]. The medical paradigm incorporates a linear view of single or multiple nutrient deficiencies and their impacts on health, without considering context or other components or factors affecting these relationships. The lifestyle paradigm goes wider, considering multi-functional, non-linear relationships between food, dietary patterns and other factors, such as behaviour. Broadest of all is the socio-ecological paradigm, which views the relationships between nutrition and health within social and ecological settings, with consideration of food and other relevant systems. We have graphically represented these three paradigms in Fig. 1, and overlaid the broad categories of actions that are likely relevant to each paradigm, namely nutrition- specific interventions, nutrition-sensitive interventions and an enabling environment for nutrition improvement [2, 13]. Nutrition-specific interventions address the immediate causes of undernutrition, such as inadequate dietary intake, and some of the underlying causes like feeding practices and access to food. Nutrition-sensitive interventions would address some of the underlying and basic causes of malnutrition by incorporating nutrition goals and actions throughout a wide range of sectors. They can also serve as delivery platforms for nutrition-specific interventions [13].Fig. 1


Scope and quality of Cochrane reviews of nutrition interventions: a cross-sectional study
Graphic representation of the three paradigms (medical, lifestyle and socio-ecological) that conceptualize how the relationship between food and health is viewed and how the causes of nutrition problems are framed [12], along with the broad categories of nutrition interventions (nutrition-specific, nutrition-sensitive) and the enabling environment for nutrition improvement to support these interventions [2, 13]
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5384134&req=5

Fig1: Graphic representation of the three paradigms (medical, lifestyle and socio-ecological) that conceptualize how the relationship between food and health is viewed and how the causes of nutrition problems are framed [12], along with the broad categories of nutrition interventions (nutrition-specific, nutrition-sensitive) and the enabling environment for nutrition improvement to support these interventions [2, 13]
Mentions: Since approaches to assessing interventions are closely linked to putative causal pathways, the perspectives adopted by researchers play an important role in evaluating cause-effect relationships. Lawrence has identified three paradigms (medical, lifestyle and socio-ecological) within which the relationship between food and health can be viewed, and which specifically influence how the causes of nutrition problems are framed [12]. The medical paradigm incorporates a linear view of single or multiple nutrient deficiencies and their impacts on health, without considering context or other components or factors affecting these relationships. The lifestyle paradigm goes wider, considering multi-functional, non-linear relationships between food, dietary patterns and other factors, such as behaviour. Broadest of all is the socio-ecological paradigm, which views the relationships between nutrition and health within social and ecological settings, with consideration of food and other relevant systems. We have graphically represented these three paradigms in Fig. 1, and overlaid the broad categories of actions that are likely relevant to each paradigm, namely nutrition- specific interventions, nutrition-sensitive interventions and an enabling environment for nutrition improvement [2, 13]. Nutrition-specific interventions address the immediate causes of undernutrition, such as inadequate dietary intake, and some of the underlying causes like feeding practices and access to food. Nutrition-sensitive interventions would address some of the underlying and basic causes of malnutrition by incorporating nutrition goals and actions throughout a wide range of sectors. They can also serve as delivery platforms for nutrition-specific interventions [13].Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: All countries face significant challenges from complex manifestations of malnutrition, which affects one in three people globally. Systematic reviews provide ready-to-use syntheses of quality-appraised evidence to inform decision-making for actions. To enhance the utility and quality of future Cochrane nutrition evidence, we described the scope and quality of all nutrition systematic reviews in the Cochrane Database of Systematic Reviews (CDSR).

Methods: We screened all active CDSR records (31 July 2015) to identify reviews and protocols using pre-specified eligibility criteria and definitions. Duplicate, independent data extraction included criteria for inclusion of studies in completed reviews (PICOS). We assessed methodological quality (AMSTAR), use of GRADE, mapped reviews against 2013 Global Burden of Disease data, and categorised the paradigm (medical, lifestyle and socio-ecological) of the review question. We analysed our results using descriptive statistics.

Results: We screened 8484 records, and included 470 (8%) completed reviews (in 45 Cochrane Review Groups (CRGs)) and 169 (7%) protocols (in 41 CRGs) published by 47 of 53 CRGs with reviews. Most completed reviews were produced by the Pregnancy and Childbirth (n = 73), Neonatal (n = 64), Metabolic and Endocrine Disorders (n = 33), Developmental, Psychosocial and Learning Problems (n = 26), Kidney and Transplant (n = 18) and Heart (n = 18) CRGs. Only 27% (n = 129) of reviews had searches for new studies in 2013 or thereafter. Supplementation/supplement interventions were most common (50%; n = 235; majority with micronutrients; 73%, n = 173), followed by food interventions (20%; n = 95). All reviews included randomised controlled trials; about 5% included other designs; 25% used GRADE; the median AMSTAR score was 9 (interquartile range: 7 to 10), 51% were high (AMSTAR 9-11) and 49% moderate (AMSTAR 5-8) quality. More than 80% framed questions using a medical paradigm. For top causes of years-of-life-lost, most reviews addressed preterm birth, diabetes and ischaemic heart disease; for leading risk factors for disability-adjusted-life-years, most targeted childhood undernutrition and high body mass index.

Conclusions: Nutrition reviews comprised 8% of active CDSR records, were widely distributed across nearly all CRGs and reflected the double nutrition burden. This analysis presents a comprehensive description of the scope and quality of Cochrane nutrition reviews, and identifies gaps for future activities to support actions to address the nutrition burden, in line with the current nutrition agenda and impetus.

No MeSH data available.