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Totality of evidence needed for nutrition recommendations

Nature Reviews Endocrinology volume 10, page 310 (2014)Cite this article

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We thank Pi-Sunyer and colleagues (We stand by our guidelines. Nat. Rev. Endocrinol. 10, doi:10.1038/nrendo.2013.272-c1)1 for responding to our criticism of the 2013 guidelines for the management of overweight and obesity that were produced by these authors on behalf of the American Heart Association (AHA), the American College of Cardiology (ACC) and The Obesity Society (TOS) (Have new guidelines overlooked the role of diet composition? Nat. Rev. Endocrinol. 10, 132–133; 2014).2 Our disagreement is about how to assess the evidence evaluating the importance of diet composition for weight control. Whereas Pi-Sunyer et al. stand by their use of the Institute of Medicine (IOM) methodology—which recognizes only long-term randomized controlled trials (RCTs) with high retention rates as evidence for consideration—we maintain that this approach is far too narrow for nutrition studies. If the IOM criteria were the only measure of the validity of scientific evidence, we would need RCTs to assess the efficacy and safety of the parachute before its use could be endorsed.

We think it necessary to distinguish between the evidence required to establish effects of diet composition on body weight and that required for synthetic pharmaceutical compounds. To establish a causal link between diet composition and obesity, one first needs to include evidence from animal, experimental, mechanistic, observational and interventional studies, and look at the totality of evidence, as recommended by the FDA.3 The approach used by Pi-Sunyer et al. might to some extent be acceptable for drug trials that aim to assess the efficacy and safety of new molecules; however, using the same methodology in research that examines the role of naturally occurring foods and/or nutrients essentially eliminates the majority of all scientific studies in the area.

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References

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Acknowledgements

A.A. is supported by the OPUS Center, which is funded by a grant from the Nordea Foundation.

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Authors and Affiliations

  1. Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Nørre Alle 51, Copenhagen N, DK-2200, Denmark

    Arne Astrup

  2. Charles Perkins Centre and School of Molecular Bioscience, University of Sydney, Biochemistry Building, G08, Sydney, 2006, NSW, Australia

    Jennie Brand-Miller

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Correspondence to Arne Astrup.

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Competing interests

A.A. has conducted research funded by meat and dairy organizations, and currently acts as consultant for the following companies with interests in the food marketing sector: Gerson Lehrman Group (ad hoc consultant for clients); Global Dairy Platform; Jenny Craig; McCain Foods; and McDonald's. J.B.-M. is the co-author of books about the glycemic index (GI) of foods, manages a GI testing service at the University of Sydney, and is the President of the Glycemic Index Foundation, a not-for-profit health promotion charity that educates consumers and health professionals about the benefits of a healthy low-GI diet.

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Astrup, A., Brand-Miller, J. Totality of evidence needed for nutrition recommendations. Nat Rev Endocrinol 10, 310 (2014). https://doi.org/10.1038/nrendo.2013.271-c2

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