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Meta-analysis is not enough: The critical role of pathophysiology in determining optimal care in clinical nutrition.

Authors :
Soeters P
Bozzetti F
Cynober L
Elia M
Shenkin A
Sobotka L
Source :
Clinical nutrition (Edinburgh, Scotland) [Clin Nutr] 2016 Jun; Vol. 35 (3), pp. 748-57. Date of Electronic Publication: 2015 Sep 05.
Publication Year :
2016

Abstract

Evidence based medicine has preferably been based on prospective randomized controlled trials (PRCT's) and subsequent meta-analyses in many fields including nutrition and metabolism. These meta-analyses often yield convincing, contradictory or no proof of effectiveness. Consequently recommendations and guidelines of varying validity and quality have been published, often failing to convince the medical, insurance and government worlds to support nutritional care. Causes for lack of adequate proof of effectiveness are manifold. Many studies and meta-analyses lacked pathophysiological depth in design and interpretation. Study populations were not homogenous and endpoints not always clearly defined. Patients were included not at nutritional risk, unlikely to benefit from nutritional intervention. Others received nutrients in excess of requirements or tolerance due to organ failure. To include all available studies in a meta-analysis, study quality and homogeneity were only assessed on the basis of formal study design and outcome rather than on patient characteristics. Consequently, some studies showed benefit but included patients suffering harm, other studies were negative but contained patients that benefited. Recommendations did not always emphasize these shortcomings, confusing the medical and nutritional community and creating the impression that nutritional support is not beneficial. Strong reliance on meta-analyses and guidelines shifts the focus of education from studying clinical and nutritional physiology to memorizing guidelines. To prevent or improve malnutrition more physiological knowledge should be acquired to personalize nutritional practices and to more correctly value and evaluate the evidence. This also applies to the design and interpretation of PRCT's and meta-analyses.<br /> (Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Details

Language :
English
ISSN :
1532-1983
Volume :
35
Issue :
3
Database :
MEDLINE
Journal :
Clinical nutrition (Edinburgh, Scotland)
Publication Type :
Academic Journal
Accession number :
26615913
Full Text :
https://doi.org/10.1016/j.clnu.2015.08.008