In Cochrane nutrition reviews assessment of dietary adherence varied considerably

Lukas Schwingshackl; Julia Stadelmaier; Roberta Lay; Ursula Griebler; Karina Karolina De Santis; Hajo Zeeb; Christina Kien; Mia Reimer; Julian Eble; Peter von Philipsborn; Ansgar Gerhardus; Erik von Elm; Joerg J Meerpohl; Eva Kiesswetter

doi:10.1016/j.jclinepi.2023.03.016

In Cochrane nutrition reviews assessment of dietary adherence varied considerably

J Clin Epidemiol. 2023 Jun:158:1-9. doi: 10.1016/j.jclinepi.2023.03.016. Epub 2023 Mar 23.

Affiliations

¹ Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: lukas.schwingshackl@uniklinik-freiburg.de.
² Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
³ Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria.
⁴ Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
⁵ Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, and Pettenkofer School of Public Health, Munich, Germany.
⁶ Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany.
⁷ Cochrane Switzerland, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
⁸ Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany.

PMID: 36965600
DOI: 10.1016/j.jclinepi.2023.03.016

Abstract

Objectives: Our aim was to investigate if and how Cochrane nutrition reviews assess dietary adherence to a specific dietary regimen.

Study design and setting: Cochrane nutrition reviews fulfilling the following criteria were included: systematic review of randomized controlled trials including adults and investigating the effect of caloric restriction, dietary pattern, foods, nutrients, supplements, or other nutrition-related-interventions. Extensive data extraction and descriptive statistics were conducted.

Results: Overall, 226 Cochrane reviews were included. Most reviews mentioned dietary adherence in the main text (n = 174), predominantly in the Methods and Results. Dietary adherence was assessed in 76 reviews and defined in 19. It was included in the risk of bias (RoB) assessment in 20 reviews with nine using a newly created RoB domain for dietary adherence, and considered as outcome in 37 reviews. Seventy-five reviews addressed degree of adherence and five treatment effects considering the degree of adherence.

Conclusion: Dietary adherence was reported in a heterogeneous manner in Cochrane nutrition reviews. Due to its high importance, we suggest that systematic reviews report the assessment and degree of dietary adherence measured in primary studies. Dietary adherence can further be examined as outcome, evaluated within the RoB (deviations from intended interventions) and included in sensitivity analyses.

Keywords: Cochrane review; Dietary adherence; Dietary intervention; Nutrition; Randomized controlled trial; Risk of bias; Systematic review.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Bias
Diet*
Humans
Randomized Controlled Trials as Topic
Risk Assessment
Systematic Reviews as Topic