Nutrition guidelines vary widely in methodological quality: an overview of reviews

J Clin Epidemiol. 2018 Dec;104:62-72. doi: 10.1016/j.jclinepi.2018.08.018. Epub 2018 Aug 29.


Objectives: To identify, describe, and map contemporary nutrition guidelines (NGs) from reviews that used the Appraisal of Guidelines, Research and Evaluation (AGREE) tool.

Study design and setting: We performed an overview of reviews that systematically assessed the quality of NGs using the AGREE tool. We searched MEDLINE and EMBASE from inception to February 2018. Two authors independently selected and assessed reviews and extracted data.

Results: We included nine evaluations with a total of 67 NGs. The higher median AGREE scores were for the domains "scope and purpose" (80%, Q1-Q3: 59-89%) and "clarity and presentation" (69%, Q1-Q3: 53-89%), while the lower were for "rigor of development" (58%, Q1-Q3: 31-84%), "editorial independence" (53%, Q1-Q3: 19-79%), "stakeholder involvement" (50%, Q1-Q3: 28-72%), and "applicability" (22%, Q1-Q3: 11-50%). The median AGREE overall rating was 5 (Q1-Q3: 4-6), and most were recommended for use (75%; 30/40). Twenty-nine NGs (43.3%; 29/67) scored ≥60% in three or more domains, including "rigor of development" domain. The methodological quality of NGs did not improve over time.

Conclusion: The methodological quality of NGs varies widely, but there is general need for improvement in most AGREE domains. NG developers could incorporate available tools to ensure the development of high-quality NGs.

Keywords: AGREE tool; Guidelines; Methodological quality; Nutrition; Overview.

Publication types

  • Review

MeSH terms

  • Humans
  • Nutrition Policy / trends*
  • Program Evaluation
  • Research Design / standards*
  • Review Literature as Topic