Researchers Push for GRADE Methodology to Improve Nutrition Practices

In a bid to enhance the reliability of nutrition guidelines, Bradley C. Johnston and his team at EvidenceBasedNutrition.org are advocating for the adoption of the GRADE methodology. This approach aims to standardize how nutrition evidence is assessed and applied, addressing a pressing need for consistency in both clinical and public health settings.

The Challenge of Inconsistent Nutrition Advice

The nutrition field is currently grappling with inconsistent evidence assessment, leading to fluctuating public and clinical advice. A prominent example of this is the shift in dietary recommendations regarding fat intake, which began in the United States in the 1960s and continued until 2015. During this period, guidelines failed to differentiate between saturated and unsaturated fats. As a result, despite a growing body of evidence that challenged previous recommendations, much of the public health advice remained unchanged. The lack of clarity regarding the certainty of evidence and strength of recommendations contributed to the proliferation of low-fat products that often replaced healthy fats with refined carbohydrates.

Johnston’s recent literature review highlights a significant gap in the nutrition field. It found no studies examining dietitians’ competencies in interpreting the magnitude of health outcomes or the certainty of evidence. This deficiency hinders informed decision-making in clinical practice and public health.

Implementing GRADE as a Standard

Johnston has become an advocate for training health professionals in evidence-based practice using the GRADE methodology. This framework, endorsed by over a hundred organizations globally, including the American Academy of Nutrition and Dietetics and WHO, provides a structured approach to evaluating evidence quality and making recommendations.

Johnston and his colleagues argue that standardization allows for better comparisons among various interventions, whether they involve dietary changes, physical activity, or medications. They recently applied GRADE methods to formulate clinical guideline recommendations for managing pediatric obesity, focusing on nutrition, physical activity, and pharmacological interventions.

Nutrition research presents unique challenges, as many clinical questions lack randomized controlled trials (RCTs), and existing studies often do not employ genuine placebos. Johnston acknowledges these hurdles but asserts that GRADE can still uphold rigorous scientific standards when nutrition experts collaborate with researchers in methodology.

Moreover, GRADE allows authors to “rate up” the certainty of evidence in cases where observational studies indicate significant effects. For instance, recent studies on bariatric surgery for adolescents with severe obesity have reported large positive effects on weight loss and related health outcomes. These findings have been rated with moderate certainty in obesity management guidelines.

Educational Initiatives for Nutrition Professionals

Beyond addressing current issues, Johnston is also focused on the future of nutrition education. He stresses the necessity of standardized training for nutrition students and professionals, advocating for consistent competency requirements across educational programs. Such training would empower dietitians to become leaders in their field, promoting informed decision-making among clients.

The series of articles known as the Nutrition Users’ Guides represents a collaborative effort to provide structured guidance on evaluating nutrition literature. Each article includes worksheets that help practitioners assess study methodologies, interpret results, and apply findings to specific patient or population contexts.

As Johnston explains, the implementation of GRADE methods in literature reviews enhances transparency. By clearly detailing how conclusions about evidence certainty are reached, the process invites scrutiny and fosters dialogue among professionals.

Through research, education, and advocacy, Johnston and his team aim to transform how nutrition professionals engage with research evidence. Their efforts will not only improve the quality of nutrition practice and policy but also empower health professionals and their clients to make informed choices based on reliable evidence.