Use of GRADE in evidence syntheses published in high-impact-factor nutrition journals: A methodological survey

J Clin Epidemiol. 2021 Jul;135:54-69. doi: 10.1016/j.jclinepi.2021.02.010. Epub 2021 Feb 12.


Objective: To identify and describe the use of the GRADE approach for rating the certainty of evidence in nutrition systematic reviews (SRs).

Study design and setting: We systematically searched for SRs using GRADE that were published between 2015 and 2019 in the 10 "nutrition" journals with the highest impact factor according to the JCR 2018.

Results: Out of 800 SRs, 55 SRs of randomized control trials (RCTs) and/or nonrandomized studies (NRSs) used GRADE. Forty-seven SRs (5.9%) rated the outcome specific certainty of evidence (n = 36 in 2018/2019). We identified a total of 465 certainty of evidence outcome ratings (n = 335 RCT ratings), ranging from very-low (28.8%) to low (41%), moderate (26.5%), and high (3.7%). Very-low and high certainty of evidence ratings accounted for 61.4% and 0.8% of ratings in SRs of NRSs, compared to 16.1% and 4.8% in SRs of RCTs. Certainty of evidence was downgraded mostly for risk of bias (37.8%) and imprecision (33%) in SRs of RCTs and for imprecision (32.7%), risk of bias (29.4%) and inconsistency (29%) in SRs of NRSs.

Conclusion: Our study suggests a need for directing more attention toward strengthening acceptance of GRADE as well as building knowledge of the GRADE methodology in nutrition evidence synthesis.

Keywords: GRADE; certainty of evidence; dietetics; nutrition; systematic reviews.

MeSH terms

  • Clinical Trials as Topic / methods
  • GRADE Approach / methods*
  • GRADE Approach / statistics & numerical data
  • Humans
  • Journal Impact Factor*
  • Nutritional Sciences / methods*
  • Periodicals as Topic / statistics & numerical data*
  • Systematic Reviews as Topic / methods*