DLM-SF: Systematic Review and Guideline Methods (2023)
Guideline Development Process
The Saturated Fat Evidence-Based Nutrition Practice Guideline was developed using Academy methods1 and GRADE’s Evidence-to-Decision (EtD) framework.2 Panel members completed EtD frameworks to draft recommendations. The EtD framework guided panel members to consider the following factors: importance of the topic, supporting evidence, the balance of benefits and harms, evidence certainty, importance of affected outcomes, resource use, equity, client values, and acceptability and feasibility of stakeholders when developing draft recommendations. The research methodology synthesized results from each completed EtD framework. The panel met via webinar to review, revise, and vote on recommendation statements and supporting text. Final recommendation statements were approved unanimously by panel members. All recommendations were developed with the expectation that they will be individualized by healthcare professionals to meet the needs and values of patients, clients, and the public. Furthermore, these recommendations are a tool for shared decision-making between healthcare professionals and patients or clients and do not replace clinical judgement. The focus of this guideline is on saturated fat intake and reduced risk and management of CVD and reduction of CVD risk factors. The topics addressed include:
- Amount of saturated fat intake
- Replacement nutrients for saturated fat
- Sources of saturated fat intake
Grading of Recommendation Statements
Recommendation statements are graded with a number (1 or 2) and a letter (A-D). The number in the recommendation rating refers to the strength of the recommendation. The letter refers to the strength of evidence from the supporting systematic review (HIGH-A, MODERATE-B, LOW-C, or VERY LOW-D). Typically, higher certainty evidence results in strong recommendations and lower certainty evidence results in weak recommendations. Additional information can be found on the Grade Recommendation Rating and Rating page in the EAL.
This EBNPG and its supporting systematic review were developed and conducted by six RDNs and one patient advocate. Four volunteer panel members with practice and/or research expertise in cardiovascular health were selected by the Academy Council on Research’s Workgroup Selection Subcommittee, which is composed of Academy members. Academy staff served as the systematic review and guideline methodologists. The full panel participated in each step of the systematic review and recommendation development process. The patient advocate participated in the development of the scope of the guideline and screening process. Unfortunately, the patient advocate was unable to continue participation in guideline development beyond the screening process due to health issues.
The Saturated Fat EBNPG went through external stakeholder review. Four nutrition and dietetic practitioners were provided with a one-page practitioner guide, and were asked to incorporate the recommendations into their daily practice, and obtain feedback from colleagues, patients and clients. After the two-week period, the participants provided feedback in a focus group.
The Saturated Fat EBNPG underwent peer review. External reviewers working in the field of cardiovascular health were recruited to conduct a detailed review of all recommendations and supporting information. The Appraisal of Guidelines for Research Evaluation II (AGREE II) tool was provided as an assessment tool for the rigor of EBNPG development, and reviewers were also invited to give feedback on the content of the recommendations and supporting information. As stated above, feedback was also obtained from practicing RDNs during a focus group.
Guideline methodologists coordinated review comments and revision of the final EBNPG document. All recommendation statement revisions were approved by panel members.
Academy EBNPGs are considered for update every five years. At that point, a scoping review is conducted to determine whether substantial literature on the topic has been published since the last systematic review. The Academy’s Council on Research, informed by the research team, determines whether this EBNPG requires modification to none, some, or all recommendation statements.
Monitoring, Evaluating and Auditing Guideline Implementation
Healthcare professionals are encouraged to monitor and evaluate the effectiveness of EBNPG. The Academy offers members the opportunity to document outcomes in their online platform, Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII),4 and/or join the Nutrition Research Network,5 for inclusion in research studies such as those that evaluate the effectiveness of EBNPG.
To evaluate the effectiveness of EBNPGs, RDNs and other healthcare professionals are encouraged to utilize strategies promoted within the field of implementation science.6 Those strategies include but are not limited to:
- Assessment of the guideline (clarity, quality, acceptability, complexity, sustainability).
- Prioritize implementation of 1-2 recommendations based on assessment of the guideline.
- Form an implementation team.
- Develop an implementation plan with identification of barriers and strategies.
- Develop an evaluation plan
- Identify measurable implementation, as well as health outcomes
- Utilize Nutrition Research Network resources
- Utilize the Academy’s ANDHII data collection platform.
Additional information on the implementation of science and strategies can be found in the Academy's Guideline Implementation Manual.
- Papoutsakis C, Moloney L, Sinley RC, Acosta A, Handu D, Steiber AL. Academy of Nutrition and Dietetics Methodology for Developing Evidence-Based Nutrition Practice Guidelines. J Acad Nutr Diet. 2017;117(5):794-804.
- Moberg J, Oxman AD, Rosenbaum S, et al. The GRADE Evidence to Decision (EtD) framework for health system and public health decisions. Health Res Policy Syst. 2018;16(1):45.
- Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010;182(18):E839-842.
- Murphy WJ, Yadrick MM, Steiber AL, et al. Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII): A Pilot Study on the Documentation of the Nutrition Care Process and the Usability of ANDHII by Registered Dietitian Nutritionists. J Acad Nutr Diet. 2018;118(10):1966-1974.
- Academy of Nutrition and Dietetics. Nutrition Research Network. https://www.eatrightpro.org/research/projects-tools-and-initiatives/nutrition-research-network. Published 2018. Accessed March 31, 2022
- Murofushi K, Badaracco C, County C, et al. Implementation Science in Evidence-based Nutrition Practice: Considerations for the Registered Dietitian Nutritionist.J Acad Nutr Diet. 2021;121(7):1392-1400..
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