Issues related to the conduct of systematic reviews: a focus on the nutrition field. Key Steps in Conducting Systematic Reviews for Underpinning Clinical Practice Guidelines: Methodology of the European Association of Urology. Quality control of the nutritional component of the Growth Failure in Children with Renal Diseases Study. Systematic reviews incorporating evidence from nonrandomized study designs: reasons for caution when estimating health effects Epidemiology and Reporting Characteristics of Systematic Reviews of Biomedical Research: A Cross-Sectional Study Patient satisfaction is rated higher by radiation oncology outpatients receiving nutrition intervention compared with usual care. Perspectives on the School Nutrition Dietary Assessment Study from the Child and Adolescent Trial for Cardiovascular Health. A Prospective Study of Diet Quality and Mental Health in Adolescents Dual computer monitors to increase efficiency of conducting systematic reviews. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Systematic Reviews of Animal Studies; Missing Link in Translational Research? Nutrition education intervention for college female athletes. Influence of a nutritional intervention on dietary intake and quality of life in cancer patients: a randomized controlled trial. Behavioral variables and education are predictors of dietary change in the Women's Health Trial: Feasibility Study in Minority Populations. Organisation of a proposed Cochrane Diet and Nutrition Field A novel school-based intervention to improve nutrition knowledge in children: cluster randomised controlled trial The quality of reporting might not reflect the quality of the study: implications for undertaking and appraising a systematic review
Systematic review s ( SRs ) are an increasingly popular evidence -based tool and are often used to answer complex research questions across many different research domains . Early SR methodology was advanced by social scientists , and the term meta- analysis was coined by a social scientist who also conducted research in psychology . SRs have recently become popular in healthcare and are likely to be beneficial in any field . The aim of this report is to highlight issues in SR conduct with a focus on the field of nutrition and to make recommendations on improving SR conduct in this area . Development of the research question is probably the most important step in conducting an SR . The 4 main components of an answerable question are 1 ) the patient , population , or problem ; 2 ) the intervention , independent variable , or exposure ; 3 ) the comparators ; and 4 ) the dependent variables or outcomes of interest . The question will be used to determine the optimal methods for conducting the SR . SRs often include study design s beyond r and omized trials and do not always include a meta- analysis of the results . Other topics explored include underst and ing and interpreting discordant review s and the importance of reporting tools [ eg , QUality Of Reporting Of Meta-analyses ( QUOROM Statement ) or CONsoli date d St and ards Of Reporting of Trials ( CONSORT Statement ) ] . Recommendations are then provided , such as developing a capacity-building program , search ing the primary literature for research gaps , and extending reporting tools such as the QUOROM Statement to the field of nutrition CONTEXT The findings of systematic review s ( SRs ) and meta-analyses ( MAs ) are used for clinical decision making . The European Association of Urology has committed increasing re sources into the development of high quality clinical guidelines based on such SRs and MAs . OBJECTIVE In this paper , we have summarised the process of conducting SRs for underpinning clinical practice guidelines under the auspices of the European Association of Urology Guidelines Office . EVIDENCE ACQUISITION The process involves explicit methods and the findings should be reproducible . When conducting a SR , the essential first step is to formulate a clear and answerable research question . An extensive literature search lays the foundation for evidence synthesis . Data are extracted independently by two review ers and any disagreements are resolved by discussion or arbitration by a third review er . EVIDENCE SYNTHESIS In SRs , data for particular outcomes in individual r and omised controlled trials may be combined statistically in a meta- analysis to increase power when the studies are similar enough . Biases in studies included in a SR/MA can lead to either an over estimation or an under estimation of true intervention effect size , result ing in heterogeneity in outcome between studies . A number of different tools are available such as Cochrane Risk of Bias assessment tool for r and omised controlled trials . In circumstances where there is too much heterogeneity , or when a review has included nonr and omised comparative studies , it is more appropriate to conduct a narrative synthesis . The GRADE tool for assessing quality of evidence strives to be a structured and transparent system , which can be applied to all evidence , regardless of quality . A SR not only identifies , evaluates , and summarises the best available evidence , but also the gaps to be targeted by future studies . CONCLUSIONS SRs and MAs are integral in developing sound clinical practice guidelines and recommendations . PATIENT SUMMARY Clinical practice guidelines should be evidence based , and systematic review s and meta-analyses are essential in their production . We have discussed the key steps of conducting systematic review s and meta-analyses in this paper Quality control procedures are critically important in a clinical trial in which dietitians in geographically separated units perform collaborative nutritional intervention and data collection during a period of several years . Typically , the quality control measures developed within the nutritional component of a clinical trial encompass the following areas of activity : 1 . Uniform collection and coding procedures for dietary intake records 2 . Collection of accurate and reliable anthropometric measurements 3 . Nutritional assessment , intervention , and counseling of patients 4 . Assessment of patient compliance with  dietary intervention  Accordingly , the functions of the core nutritional unit of a multicenter clinical trial are as follows : 1 . To ensure the collection of uniform , accurate nutrient and anthropometric data in participating centers using st and ardized procedures 2 . To provide consistent nutritional education to ensure st and ardized counseling of the patient , the primary caretaker , or both The major objective of the nutritional component of this clinical trial is to identify changes in nutriture and appetite as evidence d by food consumption records , appetite assessment , and anthropometric measurements , and to intervene as study guidelines permit . From December 1984 to June 1989 , the core Systematic review s that include nonr and omized studies ( NRS ) face a number of logistical challenges . However , the greatest threat to the validity of such review s arises from the differing susceptibility of r and omized controlled trials ( RCTs ) and NRS to selection bias . Groups compared in NRS are unlikely to be balanced because of the reasons leading study participants to adopt different health behaviours or to be treated differentially . Research ers can try to minimize the susceptibility of NRS to selection bias both at the design stage , for example , by matching participants on key prognostic factors , and during data analysis , for example , by regression modelling . However , because of logistical difficulties in matching , imperfect knowledge about the relationships between prognostic factors and between prognostic factors and outcome , and measurement limitations , it is inevitable that estimates of effect size derived from NRS will be confounded to some extent . Research ers , review ers and users of evidence alike need to be aware of the consequences of residual confounding . In poor quality RCTs , selection bias tends to favour the new treatment being evaluated . Selection bias need not necessarily lead to systematic bias in favour of one treatment but , even if it acts in an unpredictable way , it will still give rise to additional , nonstatistical uncertainty bias around the estimate of effect size . Systematic review s of NRS studies run the risk of compounding these biases . Nutritional choices and uptake of health education about nutrition are very likely to be associated with potential confounding factors . Therefore , pooled estimates of the effects of nutritional exposures and their confidence intervals are likely to be misleading ; review ers need to take into account both systematic and uncertainty bias Background Systematic review s ( SRs ) can help decision makers interpret the deluge of published biomedical literature . However , a SR may be of limited use if the methods used to conduct the SR are flawed , and reporting of the SR is incomplete . To our knowledge , since 2004 there has been no cross-sectional study of the prevalence , focus , and completeness of reporting of SRs across different specialties . Therefore , the aim of our study was to investigate the epidemiological and reporting characteristics of a more recent cross-section of SRs . Methods and Findings We search ed MEDLINE to identify potentially eligible SRs indexed during the month of February 2014 . Citations were screened using prespecified eligibility criteria . Epidemiological and reporting characteristics of a r and om sample of 300 SRs were extracted by one review er , with a 10 % sample extracted in duplicate . We compared characteristics of Cochrane versus non-Cochrane review s , and the 2014 sample of SRs versus a 2004 sample of SRs . We identified 682 SRs , suggesting that more than 8,000 SRs are being indexed in MEDLINE annually , corresponding to a 3-fold increase over the last decade . The majority of SRs addressed a therapeutic question and were conducted by authors based in China , the UK , or the US ; they included a median of 15 studies involving 2,072 participants .  Meta- analysis was performed in 63 % of SRs , mostly using st and ard pairwise methods . Study risk of bias/ quality assessment was performed in 70 % of SRs but was rarely incorporated into the analysis ( 16 % ) . Few SRs ( 7 % ) search ed sources of unpublished data , and the risk of publication bias was considered in less than half of SRs . Reporting quality was highly variable ; at least a third of SRs did not report use of a SR protocol , eligibility criteria relating to publication status , years of coverage of the search , a full Boolean search logic for at least one data base , methods for data extraction , methods for study risk of bias assessment , a primary outcome , an abstract conclusion that incorporated study limitations , or the funding source of the SR . Cochrane SRs , which accounted for 15 % of the sample , had more complete reporting than all other types of SRs . Reporting has generally improved since 2004 , but remains suboptimal for many characteristics . Conclusions An increasing number of SRs are being published , and many are poorly conducted and reported . Strategies are needed to help reduce this avoidable waste in research BACKGROUND Satisfaction with services has been considered vital for the provision of quality health care , however , there are few published papers utilizing patient satisfaction with nutrition services as a measurable outcome . METHOD A r and omized , controlled trial investigating the impact of nutrition intervention ( NI ) vs. usual care ( UC ) in 54 ambulatory oncology patients receiving radiotherapy to the gastrointestinal or head and neck area demonstrated beneficial impacts in terms of body weight , nutritional status , quality of life and bowel health . This study reports the changes in patient satisfaction that were associated with these improved outcomes for patients receiving NI compared with UC . The patient satisfaction with clinical nutrition services question naire was used to measure overall satisfaction and satisfaction with four components of nutrition services 12 weeks after patients commenced radiotherapy . RESULTS Patients receiving NI rated satisfaction higher for staff interpersonal skills ( P < 0.001 ) , perceived health benefits ( P = 0.008 ) , staff presentation skills ( P = 0.044 ) and for overall patient satisfaction with nutrition services ( P = 0.002 ) . There were no significant differences between those patients receiving NI or UC for the nutrition supplements factor ( P = 0.191 ) . CONCLUSIONS These data suggest that patients receiving NI perceive nutrition as being beneficial and of higher importance to their health than those receiving UC . This may lead to increased compliance with the nutrition prescription and help explain the better outcomes observed in the NI group compared with the UC group . Patient satisfaction with nutrition services should be conducted regularly to act as a quality -control measure and target areas for improvement The School Nutrition Dietary Assessment Study provides current data on the nutritional quality and adequacy of the National School Lunch Program ( NSLP ) and the School Breakfast Program ( SBP ) as well as on the dietary intakes of students participating in these programs . The study demonstrates that the NSLP and SBP meals and children 's total diets do not conform to the recommendations of the US Department of Agriculture and the National Research Council and confirms the need to improve the nutritional quality of the nation 's school meal program and student 's overall dietary intakes . In this regard , the Child and Adolescent Trial for Cardiovascular Health ( CATCH ) is the first collaborative , school-based field trial that tests the effectiveness of a multi-level intervention design ed to reduce the fat , saturated fat , and sodium content of school meals and student 's diets . This commentary highlights the findings and questions raised by the School Nutrition Dietary Assessment Study and presents an overview of CATCH , including the implication s and significant questions that can be addressed by this intervention study Objectives A number of cross-sectional and prospect i ve studies have now been published demonstrating inverse relationships between diet quality and the common mental disorders in adults . However , there are no existing prospect i ve studies of this association in adolescents , the onset period of most disorders , limiting inferences regarding possible causal relationships . Methods In this study , 3040 Australian adolescents , aged 11–18 years at baseline , were measured in 2005–6 and 2007–8 . Information on diet and mental health was collected by self-report and anthropometric data by trained research ers . Results There were cross-sectional , dose response relationships identified between measures of both healthy ( positive ) and unhealthy ( inverse ) diets and scores on the emotional subscale of the Pediatric Quality of Life Inventory ( PedsQL ) , where higher scores mean better mental health , before and after adjustments for age , gender , socio-economic status , dieting behaviours , body mass index and physical activity . Higher healthy diet scores at baseline also predicted higher PedsQL scores at follow-up , while higher unhealthy diet scores at baseline predicted lower PedsQL scores at follow-up . Improvements in diet quality were mirrored by improvements in mental health over the follow-up period , while deteriorating diet quality was associated with poorer psychological functioning . Finally , results did not support the reverse causality hypothesis . Conclusion This study highlights the importance of diet in adolescence and its potential role in modifying mental health over the life course . Given that the majority of common mental health problems first manifest in adolescence , intervention studies are now required to test the effectiveness of preventing the common mental disorders through dietary modification OBJECTIVE Systematic review s ( SRs ) are the cornerstone of evidence -based medicine . In this study , we evaluated the effectiveness of using two computer screens on the efficiency of conducting SRs . STUDY DESIGN AND SETTING A cohort of review ers before and after using dual monitors were compared with a  control group that did not use dual monitors .  The outcomes were time spent for abstract screening , full-text screening and data extraction , and inter-rater agreement . We adopted multivariate difference-in-differences linear regression models . RESULTS A total of 60 SRs conducted by 54 review ers were included in this analysis . We found a significant reduction of 23.81 minutes per article in data extraction in the intervention group relative to the control group ( 95 % confidence interval : -46.03 , -1.58 , P = 0.04 ) , which was a 36.85 % reduction in time . There was no significant difference in time spent on abstract screening , full-text screening , or inter-rater agreement between the two groups . CONCLUSION Using dual monitors when conducting SRs is associated with significant reduction of time spent on data extraction . No significant difference was observed on time spent on abstract screening or full-text screening . Using dual monitors is one strategy that may improve the efficiency of conducting SRs H istorically , nutrition principles and recommendations for diabetes and related complications have been based on scientific evidence and diabetes knowledge when available and , when evidence was not available , on clinical experience and expert consensus . Often it has been difficult to discern the level of evidence used to construct the nutrition principles and recommendations . Furthermore , in clinical practice , many nutrition recommendations that have no scientific supporting evidence have been and are still being given to individuals with diabetes . To address these problems and to incorporate the research done in the past 8 years , this 2002 technical review provides principles and recommendations classified according to the level of evidence available . It review s the evidence from r and omized , controlled trials ; cohort and case-controlled studies ; and observational studies , which can also provide valuable evidence ( 1,2 ) , and takes into account the number of studies that have provided consistent outcomes of support . In this review , nutrition principles are grade d into four categories based on the available evidence : those with strong supporting evidence , those with some supporting evidence , those with limited supporting evidence and those based on expert consensus . Evidence -based nutrition recommendations attempt to translate research data and clinical ly applicable evidence into nutrition care . However , the best available evidence must still be moderated by individual circumstances and preferences . The goal of evidence -based recommendations is to improve the quality of clinical judgments and facilitate costeffective care by increasing the awareness of clinicians and patients with diabetes of the evidence supporting nutrition services and the strength of that evidence , both in quality and quantity . Before 1994 , the American Diabetes Association ’s ( ADA ’s ) nutrition principles and recommendations attempted to define an “ ideal ” nutrition prescription that would apply to everyone with diabetes ( 3–5 ) . Although individualization was a major principle of all recommendations , it was usually done within defined limits for recommended energy intake and macronutrient composition . The 1994 nutrition recommendations shifted this focus to one that emphasized effects of  nutrition therapy  on metabolic control ( 6,7 ) . The nutrition prescription is determined considering treatment goals and lifestyle changes the diabetic patient is willing and able to make , rather than predetermined energy levels and percentages of carbohydrate , protein , and fat . The goal of nutrition intervention is to assist and facilitate individual lifestyle and behavior changes that will lead to improved metabolic control . This focus continues with the 2002 nutrition principles and recommendations . Medical nutrition therapy ( MNT ) is an integral component of diabetes management ( 8,9 ) and diabetes sel fmanagement education ( 10 ) . ( Medical nutrition therapy is the preferred term and should replace other terms , such as diet , diet therapy , and dietary management .  ) MNT for diabetes includes the process and the system by which nutrition care is provided for diabetic individuals and the specific lifestyle recommendations for that care . However , recommendations should not only be based on scientific evidence but should also take into consideration lifestyle changes the ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● Background The method ological quality of animal studies is an important factor hampering the translation of results from animal studies to a clinical setting . Systematic review s of animal studies may provide a suitable method to assess and thereby improve their method ological quality . Objectives The aims of this study were : 1 ) to evaluate the risk of bias assessment in animal-based systematic review s , and 2 ) to study the internal validity of the primary animal studies included in these systematic review s. Data Sources We systematic ally search ed Pubmed and Embase for SRs of pre clinical animal studies published between 2005 and 2012 . Results A total of 91 systematic review s met our inclusion criteria . The risk of bias was assessed in 48 ( 52.7 % ) of these 91 systematic review s. Thirty-three ( 36.3 % ) SRs provided sufficient information to evaluate the internal validity of the included studies . Of the evaluated primary studies , 24.6 % was r and omized , 14.6 % reported blinding of the investigator/caretaker , 23.9 % blinded the outcome assessment , and 23.1 % reported drop-outs . Conclusions To improve the translation of animal data to clinical practice , systematic review s of animal studies are worthwhile , but the internal validity of primary animal studies needs to be improved . Furthermore , risk of bias should be assessed by systematic review s of animal studies to provide insight into the reliability of the available evidence OBJECTIVE To evaluate the efficacy of a nutrition education intervention for college female athletes to improve nutrition knowledge , build self-efficacy with respect to making healthful dietary choices , and improve dietary intake . DESIGN A pretest-posttest control group design was implemented . PARTICIPANTS A women 's soccer team ( n = 15 ) and a women 's swim team ( n = 15 ) were r and omly assigned to experimental and control groups , respectively . INTERVENTION The intervention focused on nutrition knowledge , self-efficacy in making healthful dietary choices , and dietary practice s to demonstrate treatment effect . MAIN OUTCOME MEASURES Dependent variables were nutrition knowledge , self-efficacy , and dietary practice s. Independent variables were group assignment . ANALYSES The Mann-Whitney U test was used to analyze the results between groups , and the Fisher exact probability test was used to detect differences between groups in the number of positive dietary changes . RESULTS Treatment participants significantly improved nutrition knowledge , self-efficacy ( P < .05 ) , and the overall number of positive dietary changes ( P < .03 ) . CONCLUSIONS This study reduces the paucity of nutrition education intervention research among athletes and demonstrates the ability to increase not only nutrition knowledge , which is typically reported , but also self-efficacy and improvement in overall positive dietary changes during an 8-week intervention OBJECTIVE Weight loss is common in patients with malignant tumors and it can adversely affect quality of life and survival . The aim of the present study was to investigate the effects of a nutritional intervention in cancer patients in an outpatient setting . METHODS Cancer out patients ( N = 58 ) who were classified as undernourished or at high risk for undernutrition by the Nutritional Risk Screening 2002 tool were r and omized into two groups . One group ( n = 30 ) received st and ardized individual nutritional therapy , including counseling by a dietitian , food fortification , and oral nutritional supplements if required . The second group ( n = 28 ) received st and ard care . The nutritional intervention lasted 3 mo . Dietary intake ( 3-d dietary record ) , nutritional status ( body weight ) , physical functioning ( performance status , h and -grip strength ) and quality of life ( European Organization for Research and Treatment of Cancer Quality of Life Question naire version 3.0 ) were assessed at baseline and after 6 wk and 3 mo . An additional follow-up assessment was carried out 3 mo post-intervention . RESULTS Nutritional intervention led to a significantly higher average energy and protein intake in the nutritional therapy group ( + 379 kcal ; 95 % confidence interval [ CI ] , 117 - 642 ; P = 0.007 , respectively ; + 10.4 g ; 95 % CI , 2.3 - 18.5 ; P = 0.016 ) . However , the increased dietary intake was not associated with improvements in nutritional status , physical functioning , or quality of life . CONCLUSIONS Individual nutritional counseling significantly and positively influenced energy and protein intake , but did not improve nutritional or physical outcome or quality of life . These results indicate that nutritional therapy alone is of limited efficacy in cancer patients whose nutritional status has already deteriorated BACKGROUND Reducing the intakes of fats and increasing consumption of fruits and vegetables are an important goal for improving population health . Analyzing the effects of nutrition education programs on subjects ' dietary intakes incorporating factors such as habit persistence in diets , unhealthy eating habits , perceptions of health risks , participation motivation , and expectancies can yield useful insights . METHODS A Food Frequency Question naire ( FFQ ) was used to measure intakes at baseline , 6 and 12 months , by 318 and 548 postmenopausal women in , respectively , the Control and Intervention groups of the Women 's Health Trial : Feasibility Study in Minority Population s ( WHTFSMP ) . Information on background , behavioral , and anthropometric variables was collected . The Intervention group met in classes led by nutritionists . Dynamic r and om effects models were estimated for the two groups using the data at baseline , 6 and 12 months on the intakes of carbohydrate , saturated , monounsaturated , and polyunsaturated fats , fiber , beta-carotene , ascorbic acid , and calcium . RESULTS The nutrition education program lowered the intakes of fats while increasing fiber , beta-carotene , and ascorbic acid intakes especially in subjects scoring high on indices reflecting concerns about health , desirability of change , and participation motivation . In addition , subjects '  education was a predictor of dietary intakes in the Intervention group . CONCLUSIONS Nutrition education can be an effective tool for improving diets , but behavioral characteristics deserve greater attention in helping to design the most effective approaches for various target groups The Cochrane Collaboration helps people make well-informed decisions about health care by preparing , maintaining and promoting the accessibility of systematic review s of the effects of healthcare interventions . In all , 51 Cochrane Review Groups are responsible for preparing and maintaining the review s. Most of these Review Groups are problem-based . However , there are a number of areas or dimensions of health care , such as the setting of care ( eg primary care ) or the type of patient/consumer ( eg older persons ) , that can not be usefully conceptualised as ‘ health problems ’ . In order to reflect the interests of these dimensions , or ‘ fields ’ , of health care more effectively , the Cochrane Collaboration created another type of entity : Cochrane Fields or Networks . The core functions of these Fields are described . It is proposed that a new Cochrane Subfield for Diet and Nutrition should be set up to attract a cadre of new review ers in order to ensure the proper representation of diet and nutrition expertise in the relevant Collaborative Review Groups . The method ological pitfalls of the use of nonr and omised studies will be a key issue for the new Subfield , since the focus of the Cochrane Collaboration 's programme of search ing data bases , journals and conference proceedings has been on the identification of reports of r and omised controlled trials ( RCTs ) . Some of these sources will be need to be search ed again for non- RCT studies . The financial considerations of establishing of a Cochrane Subfield for Diet and Nutrition are discussed Background Improving nutrition knowledge among children may help them to make healthier food choices . The aim of this study was to assess the effectiveness and acceptability of a novel educational intervention to increase nutrition knowledge among primary school children . Methods We developed a card game ' Top Grub ' and a ' healthy eating ' curriculum for use in primary schools . Thirty-eight state primary schools comprising 2519 children in years 5 and 6 ( aged 9 - 11 years ) were recruited in a pragmatic cluster r and omised controlled trial . The main outcome measures were change in nutrition knowledge scores , attitudes to healthy eating and acceptability of the intervention by children and teachers . Results Twelve intervention and 13 control schools ( comprising 1133 children ) completed the trial . The main reason for non-completion was time pressure of the school curriculum . Mean total nutrition knowledge score increased by 1.1 in intervention ( baseline to follow-up : 28.3 to 29.2 ) and 0.3 in control schools ( 27.3 to 27.6 ) . Total nutrition knowledge score at follow-up , adjusted for baseline score , deprivation , and school size , was higher in intervention than in control schools ( mean difference = 1.1 ; 95 % CI : 0.05 to 2.16 ; p = 0.042 ) . At follow-up , more children in the intervention schools said they ' are currently eating a healthy diet ' ( 39.6 % ) or ' would try to eat a healthy diet ' ( 35.7 % ) than in control schools ( 34.4 % and 31.7 % respectively ; chi-square test p < 0.001 ) . Most children ( 75.5 % ) enjoyed playing the game and teachers considered it a useful re source . Conclusions The ' Top Grub ' card game facilitated the enjoyable delivery of nutrition education in a sample of UK primary school age children . Further studies should determine whether improvements in nutrition knowledge are sustained and lead to changes in dietary behaviour Abstract The systematic review has become an increasingly popular method of synthesizing findings on a topic in order to inform clinical practice , commissioning of care , and future research . A central component of the systematic review is an assessment of study quality or risk of bias , i.e. an assessment of how near to the ‘ truth ’ the findings of the study are . While undertaking a recent systematic review , it became apparent that the outcomes of the quality appraisal process were somewhat different across systematic review s where the same r and omized controlled trials had been included . The quality of the report writing of the r and omized controlled trials included was identified as one possible reason for this discrepancy . This had implication s upon the conclusions drawn by the review . It is suggested that reasonable attempts to contact study authors should be made in order to inform the quality appraisal process while undertaking systematic review s of r and omized controlled trials and that the presence or absence of this process should be considered by research consumers when appraising the quality of a systematic review . This process enables a full assessment of study quality rather than simply an assessment of the quality of report writing
The reporting quality of SRs has improved 3 y after publication of SR reporting st and ards , but the reporting of nutrition variables has not .
Improved adherence to consensus methods and reporting st and ards should improve the utility of nutrition SRs
BACKGROUND The quality of nutrition-related systematic review s ( SRs ) is an unstudied but important factor affecting their usefulness .
OBJECTIVES The objectives were to evaluate the reporting quality of published SRs and to identify areas of improvement .