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Clin Nutr. 2015 Dec;34(6):1043-51. doi: 10.1016/j.clnu.2015.07.008. Epub 2015 Jul 16.

Standard operating procedures for ESPEN guidelines and consensus papers.

Author information

Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany. Electronic address:
Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Tel Aviv University, Petah Tikva, Israel. Electronic address:
Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany. Electronic address:
Department of Medical, Surgical and Health Sciences, University of Trieste, Italy. Electronic address:
Department of Clinical Nutrition and Metabolism, Uppsala University, Uppsala University Hospital, Uppsala, Sweden; Department of Geriatric Medicine, Uppsala University Hospital, Uppsala, Sweden. Electronic address:
Department of Gastroenterology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. Electronic address:


The ESPEN Guideline standard operating procedures (SOP) is based on the methodology provided by the Association of Scientific Medical Societies of Germany (AWMF), the Scottish Intercollegiate Guidelines Network (SIGN), and the Centre for Evidence-based Medicine at the University of Oxford. The SOP is valid and obligatory for all future ESPEN-sponsored guideline projects aiming to generate high-quality guidelines on a regular basis. The SOP aims to facilitate the preparation of guideline projects, to streamline the consensus process, to ensure quality and transparency, and to facilitate the dissemination and publication of ESPEN guidelines. To achieve this goal, the ESPEN Guidelines Editorial board (GEB) has been established headed by two chairmen. The GEB will support and supervise the guideline processes and is responsible for the strategic planning of ESPEN guideline activities. Key elements of the SOP are the generation of well-built clinical questions according to the PICO system, a systemic literature search, a classification of the selected literature according to the SIGN evidence levels providing an evidence table, and a clear and straight-forward consensus procedure consisting of online voting's and a consensus conference. Only experts who meet the obligation to disclosure any potential conflict of interests and who are not employed by the Industry can participate in the guideline process. All recommendations will be graded according to the SIGN grading and novel outcome models besides biomedical endpoints. This approach will further extent the leadership of ESPEN in creating up-to-date and suitable for implementation guidelines and in sharing knowledge on malnutrition and clinical nutrition.


Clinical nutrition; Evidence level; Guideline; Position paper; Recommendation grading; Standard operating procedure

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