Challenges and lessons from systematic literature reviews for the Australian dietary guidelines
In 2009-10 the Dietitians Association of Australia conducted a series of systematic reviews for the National Health and Medical Research Council to generate evidence statements to inform the revision of the Dietary Guidelines for Australians. In total 202 body of evidence statements were constructed and assigned a grading detailing the certainty with which each could be used to inform policy. This paper describes some of the challenges and insights gained from the process, specifically related to: study type, study quality assessment, the lack of quantified data, diet exposure, definition of a healthy population, generalisability and applicability, and resource allocation. It is clear that there is still a need for further refinement of the methods for evaluating evidence for nutrition policy, but the current dietary guidelines are now much more robustly evidence informed than ever before.
Available from: Peter Williams
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ABSTRACT: There have been no comprehensive reviews of the relation of breakfast cereal consumption to nutrition and health. This systematic review of all articles on breakfast cereals to October 2013 in the Scopus and Medline databases identified 232 articles with outcomes related to nutrient intake, weight, diabetes, cardiovascular disease, hypertension, digestive health, dental and mental health, and cognition. Sufficient evidence was available to develop 21 summary evidence statements, ranked from A (can be trusted to guide practice) to D (weak and must be applied with caution). Breakfast cereal consumption is associated with diets higher in vitamins and minerals and lower in fat (grade B) but is not associated with increased intakes of total energy or sodium (grade C) or risk of dental caries (grade B). Most studies on the nutritional impact are cross-sectional, with very few intervention studies, so breakfast cereal consumption may be a marker of an overall healthy lifestyle. Oat-, barley-, or psyllium-based cereals can help lower cholesterol concentrations (grade A), and high-fiber, wheat-based cereals can improve bowel function (grade A). Regular breakfast cereal consumption is associated with a lower body mass index and less risk of being overweight or obese (grade B). Presweetened breakfast cereals do not increase the risk of overweight and obesity in children (grade C). Whole-grain or high-fiber breakfast cereals are associated with a lower risk of diabetes (grade B) and cardiovascular disease (grade C). There is emerging evidence of associations with feelings of greater well-being and a lower risk of hypertension (grade D), but more research is required.
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