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Limitations of observational evidence: implications for evidence-based dietary recommendations - PubMed

️Wed Jan 01 2014

Review

Limitations of observational evidence: implications for evidence-based dietary recommendations

Kevin C Maki et al. Adv Nutr. 2014.

Abstract

Data from randomized controlled trials (RCTs) provide the strongest evidence for establishing relations between exposures, including dietary exposures, and health outcomes. However, not all diet and health outcome relations can be practically or ethically evaluated by using RCTs; therefore, many dietary recommendations are supported by evidence primarily from observational data, particularly those from prospective cohort studies. Although such evidence is of critical importance, limitations are often underappreciated by nutrition scientists and policymakers. This editorial review is intended to 1) highlight some of these limitations of observational evidence for diet-disease relations, including imprecise exposure quantification, collinearity among dietary exposures, displacement/substitution effects, healthy/unhealthy consumer bias, residual confounding, and effect modification; and 2) advocate for greater caution in the communication of dietary recommendations for which RCT evidence of clinical event reduction after dietary intervention is not available.

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Conflict of interest statement

Author disclosures: K. C. Maki, T. M. Rains, and P. M. Kris-Etherton have received research funding support and/or consulting fees from The Beef Checkoff. J. L. Slavin, no conflicts of interest.

Figures

**FIGURE 1**
Hierarchy of research evidence. Reproduced with permission from University of Illinois at Chicago (5).

Comment in

Comment on "Limitations of observational evidence: implications for evidence-based dietary recommendations".
Ankarfeldt MZ. Ankarfeldt MZ. Adv Nutr. 2014 May 14;5(3):293. doi: 10.3945/an.114.005777. Print 2014 May. Adv Nutr. 2014. PMID: 24829477 Free PMC article. No abstract available.
Comment on "Limitations of observational evidence: implications for evidence-based dietary recommendations". Reply to Ankarfeldt.
Maki KC, Slavin JL, Rains TM, Kris-Etherton PM. Maki KC, et al. Adv Nutr. 2014 May 14;5(3):293-4. doi: 10.3945/an.114.005892. Print 2014 May. Adv Nutr. 2014. PMID: 24829478 Free PMC article. No abstract available.

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Limitations of observational evidence: implications for evidence-based dietary recommendations - PubMed