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Proc Nutr Soc. 2018 Nov;77(4):432-444. doi: 10.1017/S0029665118000125. Epub 2018 Apr 30.

Generating the evidence for risk reduction: a contribution to the future of food-based dietary guidelines.

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Department of Epidemiology,German Institute of Human Nutrition Potsdam-Rehbruecke,Arthur-Scheunert-Allee 114-116, 14558 Nuthetal,Germany.
Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf,D-40225 Düsseldorf,Germany.
Department of Public Health and Surveillance,Scientific Institute of Public Health,Rue Juliette Wytsmanstraat 14, 1050 Brussels,Belgium.
Department of Nutritional Sciences,University of Vienna,Althanstraße 14, UZA II, 1090 Vienna,Austria.
German Nutrition Society,Godesberger Allee 18, 53175 Bonn,Germany.


A major advantage of analyses on the food group level is that the results are better interpretable compared with nutrients or complex dietary patterns. Such results are also easier to transfer into recommendations on primary prevention of non-communicable diseases. As a consequence, food-based dietary guidelines (FBDG) are now the preferred approach to guide the population regarding their dietary habits. However, such guidelines should be based on a high grade of evidence as requested in many other areas of public health practice. The most straightforward approach to generate evidence is meta-analysing published data based on a careful definition of the research question. Explicit definitions of study questions should include participants, interventions/exposure, comparisons, outcomes and study design. Such type of meta-analyses should not only focus on categorical comparisons, but also on linear and non-linear dose-response associations. Risk of bias of the individual studies of the meta-analysis should be assessed, rated and the overall credibility of the results scored (e.g. using NutriGrade). Tools such as a measurement tool to assess systematic reviews or ROBIS are available to evaluate the methodological quality/risk of bias of meta-analyses. To further evaluate the complete picture of evidence, we propose conducting network meta-analyses (NMA) of intervention trials, mostly on intermediate disease markers. To rank food groups according to their impact, disability-adjusted life years can be used for the various clinical outcomes and the overall results can be compared across the food groups. For future FBDG, we recommend to implement evidence from pairwise and NMA and to quantify the health impact of diet-disease relationships.


DALY disability-adjusted life years; FBDG food-based dietary guidelines; FG fasting glucose; GBD global burden of disease; HDL-C HDL-cholesterol; LDL-C LDL-cholesterol; NMA network meta-analysis; PAF population-attributable fractions; RCT randomised controlled trials; SBP systolic blood pressure; SSB sugar-sweetened beverages; T2D type 2 diabetes; TC total cholesterol; Evidence; Food-based dietary guidelines; Meta-analysis

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