Commonalities among Dietary Recommendations from 2010 to 2021 Clinical Practice Guidelines: A Meta-Epidemiological Study from the American College of Lifestyle Medicine

Probably not a substantial claim: may not pass S3 (load-bearing).

9% of included clinical practice guidelines focused on autoimmune diseases.

“autoimmune diseases (9%)”

Probably not a substantial claim: may not pass S3 (load-bearing).

After initial screening excluded 2109 publications, 323 full-text reports were assessed for eligibility.

“After initial screening excluded 2109 publications, 323 full-text reports were found and assessed for eligibility.”

May combine two claims.

The included clinical practice guidelines were published between 2010 and 2021, with 77% published after 2014.

“The included CPGs were published between 2010 and 2021 (77% published after 2014).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The initial and updated database searches identified 2381 unique publications, and other searches identified 57 additional unique publications.

“The initial and updated database searches identified 2381 unique publications, and other searches identified 57 additional unique publications.”

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Most guidelines (83%) came from major medical professional societies, 12% from governments, and 5% from large health stakeholder associations.

“Most of the guidelines (83%) came from major medical professional societies, with 12% coming from governments and 5% from large health stakeholder associations.”

Probably not a substantial claim: may not pass S3 (load-bearing).

32% of included guidelines were written for adults and children or adolescents.

“Guidelines written for adults and children or adolescents (32%) were also included”

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64% of included guidelines were written for adults aged 18 years or older, and 4% for seniors aged 55 years or older.

“This review focused on guidelines written for adults, which included those aged ≥18 y (64% of the included guidelines) and seniors aged ≥55 y (4%).”

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22% of the included guidelines were original documents, 63% were updates to previous guidelines, and the original/update status was unclear for the remaining 15%.

“Other results indicated that 22% of the included guidelines were original documents, 63% were updates to previous guidelines, and the original/update status was unclear for the remaining 15%.”

May combine two claims.

Nearly all included CPGs (91%) recommended a specific dietary pattern, and 33 dietary patterns were specified altogether (Table 4).

“Nearly all included CPGs (91%) recommended a specific dietary pattern, and 33 dietary patterns were specified altogether (Table 4).”

• AssumptionRests on an assumption: Dietary recommendations from CPGs for different health outcomes and populations are sufficiently comparable to be pooled and compared.

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More than 20% of the CPGs also encouraged intake of legumes/pulses (47%), any nuts and seeds (44%), low-fat dairy (38%), any fish/seafood (36%), lean meat (26%), and oily or fatty fish (23%).

“More than 20% of the CPGs also encouraged intake of legumes/pulses (47%), any nuts and seeds (44%), low-fat dairy (38%), any fish/seafood (36%), lean meat (26%), and oily or fatty fish (23%).”

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CPGs specifying methods reported formal consensus through Delphi [35] or Glaser-like [36] techniques (19%), informal consensus (31%), or a voting system (18%).

“CPGs specifying methods reported formal consensus through Delphi [35] or Glaser-like [36] techniques (19%), informal consensus (that is, no mention of specific or recognized techniques, or insufficient detail; 31%), or a voting system (18%).”

• cites [35] Barrett, 2020, What are Delphi studies?, Evid. Based Nurs. sourceNot checked yet

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• cites [36] Fink, 1984, Consensus methods: characteristics and guidelines for use, Am. J. Public Health. sourceNot checked yet

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Two guidelines for Japanese populations with diabetes (type 1 and/or type 2) recommended fruit intake be limited to ≤1 unit of fructose (fruit) [38] or 1 unit (80 kcal)/d, given that fruits currently on markets often contain a large amount of sugar because of selective breeding [46].

“Two guidelines for Japanese populations with diabetes (type 1 and/or type 2) recommended fruit intake be limited to ≤1 unit of fructose (fruit) [38] or 1 unit (80 kcal)/d, given that fruits currently on markets often contain a large amount of sugar because of selective breeding [46].”

• cites [38] Araki, 2020, Japanese clinical practice guideline for diabetes 2019, Diabetol. Int. sourceNot checked yet

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• cites [46] Tajima, 2015, Evidence-based practice guideline for the treatment for diabetes in Japan 2013, Diabetol. Int. sourceNot checked yet

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Another 5 dietary patterns recommended by 10%-15% of the included guidelines were low-fat or lipid monitoring (14%), low-sodium (13%), high-fiber (12%), plant-based (12%), and vegetarian diets (10%).

“Another 5 dietary patterns recommended by 10%–15% of the included guidelines were low-fat or lipid monitoring (14%), low-sodium (13%), high-fiber (12%), plant-based (12%), and vegetarian diets (10%).”

May combine two claims.

The most frequently recommended dietary patterns were Mediterranean (33% of guidelines), DASH (26%), and a "healthy diet" (24%) or similarly named pattern.

“The most frequently recommended dietary patterns were Mediterranean (33% of guidelines), Dietary Approaches to Stop Hypertension (DASH; 26%), and a “healthy diet” (24%) or similarly named pattern (for example, balanced diet, healthful eating plan, and healthy eating pattern).”

• AssumptionRests on an assumption: Dietary recommendations from CPGs for different health outcomes and populations are sufficiently comparable to be pooled and compared.

May combine two claims.

Although 38% of the guidelines recommended a single dietary pattern, 53% recommended multiple dietary patterns.

“Although 38% of the guidelines recommended a single dietary pattern, 53% recommended multiple dietary patterns.”

May combine two claims.

The CPGs commonly lacked a clear statement that views of the funding body had not influenced the guideline content (77% not reporting), where 40% of the CPGs provided no statement at all about funding or support.

“The CPGs commonly lacked a clear statement that views of the funding body had not influenced the guideline content (77% not reporting), where 40% of the CPGs provided no statement at all about funding or support.”

May combine two claims.

In particular, 3 guidelines for populations with CVD and 1 guideline for overweight/obesity recommended low-to-moderate intake of dairy, fish, and poultry [33,43] (one of these stipulated fish intake ≥2 times/wk [33]) or specified ≤2 servings/d [44] or <6 oz/d [45] of meat, poultry, and fish.

“In particular, 3 guidelines for populations with CVD and 1 guideline for overweight/obesity recommended low-to-moderate intake of dairy, fish, and poultry [33,43] (one of these stipulated fish intake ≥2 times/wk [33]) or specified ≤2 servings/d [44] or <6 oz/d [45] of meat, poultry, and fish.”

• cites [33] El-Deeb, 2015, Oman Heart Association guidelines for the management of hypertension: practical recommendations from the Oman Heart Association (OHA), High Blood Press, Cardiovasc. Prev.Not checked yet

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• cites [43] 2020Not checked yet

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• cites [44] Ibrahim, 2014, The Egyptian hypertension society: Egyptian hypertension guidelines, Egypt, Heart JNot checked yet

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Of the 8 criteria reviewed, 76% of the CPGs provided details on ≥6 criteria, whereas 8% of the CPGs provided details on 2 or fewer criteria.

“Of the 8 criteria reviewed, 76% of the CPGs provided details on ≥6 criteria, whereas 8% of the CPGs provided details on 2 or fewer criteria.”

May combine two claims.

Although most CPGs (86%) clearly reported competing interests, half gave no details regarding whether or how attempts were made to reduce the effect of competing interests in guideline development.

“Although most CPGs (86%) clearly reported competing interests, half gave no details regarding whether or how attempts were made to reduce the effect of competing interests in guideline development.”

The quote only partly states this claim.

14% of included guidelines did not disclose competing interests of guideline development group members.

“No | 11 | 14”

Probably not a substantial claim: may not pass S3 (load-bearing).

The definitions of Mediterranean-style and DASH diets varied somewhat.

“The definitions of Mediterranean-style and DASH diets varied somewhat, but 1 guideline summarized Mediterranean diets as being rich in vegetables, whole grains, and olive oil and DASH diets as rich in fruit, vegetables, and low-fat dairy, whereas being low in saturated fat, total fat, cholesterol, red meat, salt, sweets, and sugar-containing beverages [37].”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

One guideline summarized Mediterranean diets as being rich in vegetables, whole grains, and olive oil and DASH diets as rich in fruit, vegetables, and low-fat dairy, whereas being low in saturated fat, total fat, cholesterol, red meat, salt, sweets, and sugar-containing beverages [37].

“The definitions of Mediterranean-style and DASH diets varied somewhat, but 1 guideline summarized Mediterranean diets as being rich in vegetables, whole grains, and olive oil and DASH diets as rich in fruit, vegetables, and low-fat dairy, whereas being low in saturated fat, total fat, cholesterol, red meat, salt, sweets, and sugar-containing beverages [37].”

• cites [37] Garvey, 2016, Reviewers of the AACEOCPG. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity, Endocr. Pract. sourceNot checked yet

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The processes used to form recommendations from gathered evidence also varied, but one-third of the guidelines (32%) failed to report sufficient details for this criterion.

“The processes used to form recommendations from gathered evidence also varied, but one-third of the guidelines (32%) failed to report sufficient details for this criterion.”

May combine two claims.

These guidelines discouraged consumption of insoluble fiber from sources such as beans, nuts, and grains [47] or whole grains [48], and they discouraged intake of foods with high oligosaccharide content (for example, legumes, chickpeas, and lentils [49]).

“These guidelines discouraged consumption of insoluble fiber from sources such as beans, nuts, and grains [47] or whole grains [48], and they discouraged intake of foods with high oligosaccharide content (for example, legumes, chickpeas, and lentils [49]).”

• cites [47] Pietrzak, 2018, Guidelines on the management of irritable bowel syndrome: in memory of Professor Witold Bartnik, Prz. Gastroenterol.Not checked yet

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• cites [48] Lacy, 2021, ACG clinical guideline: management of irritable bowel syndrome, Am. J. Gastroenterol. sourceNot checked yet

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• cites [49] Song, 2018, Clinical practice guidelines for irritable bowel syndrome in Korea, 2017 revised edition, J. Neurogastroenterol. Motil. sourceNot checked yet

  Not checked in the free run.

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Macronutrient components mentioned in >20% recommendations included fiber (73% of the CPGs), SFAs (46%), dietary cholesterol (37%), unsaturated FAs (MUFA and/or PUFA; 29%), trans-fats (24%), and ω-3 FAs (23%).

“Macronutrient components mentioned in >20% recommendations included fiber (73% of the CPGs), SFAs (46%), dietary cholesterol (37%), unsaturated FAs (MUFA and/or PUFA; 29%), trans-fats (24%), and ω-3 FAs (23%).”

May combine two claims.

Intake of any fish/seafood was encouraged by 49% of these CPGs, whereas 40% recommended intake of oily or fatty fish specifically.

“Intake of any fish/seafood was encouraged by 49% of these CPGs, whereas 40% recommended intake of oily or fatty fish specifically.”

May combine two claims.

As with the overall study findings, few CPGs discouraged intake of any food groups, but those most frequently discouraged were red meat (37%), processed meat (31% of these CPGs), refined grains (23%), and fatty meat (20%).

“As with the overall study findings, few CPGs discouraged intake of any food groups, but those most frequently discouraged were red meat (37%), processed meat (31% of these CPGs), refined grains (23%), and fatty meat (20%).”

May combine two claims.

The remaining CPG addressed populations with IBD and recommended diets rich in fruit, vegetables, and ω-3 FAs, and low in ω-6 FAs.

“The remaining CPG addressed populations with IBD and recommended diets rich in fruit, vegetables, and ω-3 FAs, and low in ω-6 FAs.”

May combine two claims.

A total of 12 CPGs focused on populations with diabetes, such that all 12 addressed populations with T2D, and 8 also addressed those with type 1 diabetes.

“A total of 12 CPGs focused on populations with diabetes, such that all 12 addressed populations with T2D, and 8 also addressed those with type 1 diabetes.”

May combine two claims.

Dietary patterns that were recommended by ≥25% of these CPGs were healthy (42%), Mediterranean (42%), DASH (25%), and plant-based diet (25%).

“Dietary patterns that were recommended by ≥25% of these CPGs were healthy (42%), Mediterranean (42%), DASH (25%), and plant-based diet (25%).”

May combine two claims.

Just 3 food groups and no food components were mentioned by >1 of these CPGs. Recommendations were to include/increase vegetables (57% of the CPGs), fruit (43%), and whole grains (29%).

“Just 3 food groups and no food components were mentioned by >1 of these CPGs. Recommendations were to include/increase vegetables (57% of the CPGs), fruit (43%), and whole grains (29%).”

May combine two claims.

Nearly half (46%) recommended vegetable or plant oils be included/increased in the diet, and 26% encouraged intake of soy protein or soy products.

“Nearly half (46%) recommended vegetable or plant oils be included/increased in the diet, and 26% encouraged intake of soy protein or soy products.”

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Nearly all reviewed CPGs mentioned ≥1 macronutrient (91%) in their dietary or nutrition recommendations, where the most (78%) mentioned lipids, and more than half mentioned carbohydrates (59%) or protein (54%).

“Nearly all reviewed CPGs mentioned ≥1 macronutrient (91%) in their dietary or nutrition recommendations, where the most (78%) mentioned lipids, and more than half mentioned carbohydrates (59%) or protein (54%).”

May combine two claims.

There was strong consensus among these CPGs regarding food groups to include or increase in the diet. Most guidelines encouraged intake of fruit (89% of the CPGs), vegetables (89%), whole grains (80%), any nuts and seeds (66%), legumes/pulses (60%), and low-fat dairy (60%).

“There was strong consensus among these CPGs regarding food groups to include or increase in the diet (Supplemental Figure 3). Most guidelines encouraged intake of fruit (89% of the CPGs), vegetables (89%), whole grains (80%), any nuts and seeds (66%), legumes/pulses (60%), and low-fat dairy (60%).”

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Altogether, 11 of the CPGs included in this study were written for populations with digestive conditions including chronic constipation (n = 2), chronic gastritis (n = 1), colonic diverticular disease (n = 1), diarrhea in cancer patients (n = 1), or IBS (n = 6).

“Altogether, 11 of the CPGs included in this study were written for populations with digestive conditions including chronic constipation (n = 2), chronic gastritis (n = 1), colonic diverticular disease (n = 1), diarrhea in cancer patients (n = 1), or IBS (n = 6).”

May combine two claims.

Similarly, few food component recommendations were made for those with digestive conditions. Food components mentioned by >1 CPG were alcohol (27% discouraged), water (18% encouraged), and salt or sodium (9% allowed; 9% discouraged).

“Similarly, few food component recommendations were made for those with digestive conditions. Food components mentioned by >1 CPG were alcohol (27% discouraged), water (18% encouraged), and salt or sodium (9% allowed; 9% discouraged).”

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Most CPGs included in this meta-epidemiologic study (96%) focused on populations with conditions related to a single major health outcome of interest, but 3 CPGs focused on 2 or more chronic diseases.

“Most CPGs included in this meta-epidemiologic study (96%) focused on populations with conditions related to a single major health outcome of interest (general health promotion, autoimmune diseases, cancers, CVD, digestive conditions, T2D, and weight-related conditions), but 3 CPGs focused on 2 or more chronic diseases (Supplemental Table 1) [[30], [31], [32]].”

• cites [30] Grundy, 2019, AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, CirculationNot checked yet

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• cites [31] Cosentino, 2020, Eur. Heart J. sourceNot checked yet

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• cites [32] Wolfram, 2015, Evidence-based guideline of the German Nutrition Society: fat intake and prevention of selected nutrition-related diseases, Ann. Nutr. Metab. sourceNot checked yet

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May combine two claims.

Beyond alcohol and SSBs, few CPGs made recommendations for beverages. Although water consumption was encouraged by 6% of the CPGs and discouraged by none, the opposite was true for caffeine (0% encouraged; 6% discouraged).

“Beyond alcohol and SSBs, few CPGs made recommendations for beverages. Although water consumption was encouraged by 6% of the CPGs and discouraged by none, the opposite was true for caffeine (0% encouraged; 6% discouraged).”

May combine two claims.

Food components mentioned by >1 CPG were alcohol (60% discouraged) and SSBs (40% discouraged).

“Food components mentioned by >1 CPG were alcohol (60% discouraged) and SSBs (40% discouraged).”

May combine two claims.

One CPG addressing IBD, Crohn disease, and ulcerative colitis recommended a low-FODMAP diet and specified a high-protein diet for those with active IBD or Crohn disease.

“One CPG addressing IBD, Crohn disease, and ulcerative colitis recommended a low-FODMAP diet and specified a high-protein diet for those with active IBD or Crohn disease.”

May combine two claims.

Intake of vegetable/plant oils (in general or as specified) was encouraged by 35% of the guidelines, with many specifying types of oils such as olive (17%), canola (3%), or nontropical vegetable/plant oils (4%). Another 5% specified to avoid or limit tropical plant oils (for example, palm oil and coconut oil).

“Intake of vegetable/plant oils (in general or as specified) was encouraged by 35% of the guidelines, with many specifying types of oils such as olive (17%), canola (3%), or nontropical vegetable/plant oils (4%). Another 5% specified to avoid or limit tropical plant oils (for example, palm oil and coconut oil).”

May combine two claims.

Guidelines widely discouraged intake of multiple food components. More than half discouraged alcohol (62%) and salt or sodium (56%) intake, and more than one-third discouraged SSBs (36%) and sweets or added sugar (36%).

“Guidelines widely discouraged intake of multiple food components. More than half discouraged alcohol (62%) and salt or sodium (56%) intake, and more than one-third discouraged SSBs (36%) and sweets or added sugar (36%).”

May combine two claims.

Two other categories with mixed recommendations were fruit juice (4% encouraged; 6% discouraged) and wine or red wine (3% encouraged; 3% discouraged).

“Two other categories with mixed recommendations were fruit juice (4% encouraged; 6% discouraged) and wine or red wine (3% encouraged; 3% discouraged).”

May combine two claims.

Food components encouraged by ≥2 of these CPGs were vegetable/plant oils (33%) and soy protein or soy products (17%).

“Food components encouraged by ≥2 of these CPGs were vegetable/plant oils (33%) and soy protein or soy products (17%) (Supplemental Figure 6).”

May combine two claims.

Five CPGs for populations with celiac disease [[52], [53], [54], [55], [56]] recommended complete avoidance of gluten, but gluten was not mentioned by any other CPG.

“Five CPGs for populations with celiac disease [[52], [53], [54], [55], [56]] recommended complete avoidance of gluten, but gluten was not mentioned by any other CPG.”

• cites [52] Al-Toma, 2019, European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders, U. Eur. Gastroenterol. J. sourceNot checked yet

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• cites [53] Sood, 2019, Diet and inflammatory bowel disease: the Asian Working Group guidelines, Indian J. Gastroenterol. sourceNot checked yet

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• cites [54] Remes-Troche, 2018, Clinical guidelines on the diagnosis and treatment of celiac disease in Mexico, Rev. Gastroenterol. Mex (Engl Ed).Not checked yet

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May combine two claims.

Intake of 2 other food groups was discouraged by >10% of reviewed CPGs, and these were refined grains (19%) and fatty meat (for example, high-fat meats, fatty cuts of meat, meat fat, or organ meats; 12%).

“Intake of 2 other food groups was discouraged by >10% of reviewed CPGs, and these were refined grains (19%) and fatty meat (for example, high-fat meats, fatty cuts of meat, meat fat, or organ meats; 12%).”

May combine two claims.

Three of these CPGs (60%) encouraged intake of fruit, vegetables, and whole grains, whereas 2 of these same CPGs (40%) encouraged intake of any poultry and any fish/seafood.

“Three of these CPGs (60%) encouraged intake of fruit, vegetables, and whole grains, whereas 2 of these same CPGs (40%) encouraged intake of any poultry and any fish/seafood.”

May combine two claims.

Similar to the aforementioned reporting, there was strong consensus to include/increase intake of vegetables (92%), and at least half also encouraged intake of legumes/pulses (75%), fruit (67%), whole grains (67%), any fish/seafood (50%), and any nuts and seeds (50%).

“Similar to the aforementioned reporting, there was strong consensus to include/increase intake of vegetables (92%), and at least half also encouraged intake of legumes/pulses (75%), fruit (67%), whole grains (67%), any fish/seafood (50%), and any nuts and seeds (50%).”

May combine two claims.

Twenty of these guidelines (65%) encouraged intake, and 1 guideline (3%) discouraged intake, of nontropical vegetable/plant oils, which are high in unsaturated FAs.

“Twenty of these guidelines (65%) encouraged intake, and 1 guideline (3%) discouraged intake, of nontropical vegetable/plant oils, which are high in unsaturated FAs.”

May combine two claims.

Recommendations encouraging intake of food components were scarce, but 2 components were mentioned by >10% of the reviewed CPGs.

“Recommendations encouraging intake of food components were scarce, but 2 components were mentioned by >10% of the reviewed CPGs.”

May combine two claims.

Of these 35 CPGs, 66% recommended multiple dietary patterns to support the health of individuals with cardiovascular conditions, and 4 specific dietary patterns were mentioned by >25% of the CPGs. These were Mediterranean (46% of these CPGs), DASH (43%), low-sodium (26%), and healthy (26%) dietary patterns.

“Of these 35 CPGs, 66% recommended multiple dietary patterns to support the health of individuals with cardiovascular conditions, and 4 specific dietary patterns were mentioned by >25% of the CPGs. These were Mediterranean (46% of these CPGs), DASH (43%), low-sodium (26%), and healthy (26%) dietary patterns.”

May combine two claims.

Two of the CPGs were directed at diabetes management in chronic kidney disease or kidney transplant patients, and 2 offered guidelines for individuals with prediabetes.

“Two of the CPGs were directed at diabetes management in chronic kidney disease or kidney transplant patients, and 2 offered guidelines for individuals with prediabetes.”

May combine two claims.

Five CPGs were aimed at populations with celiac disease and recommended gluten-free dietary patterns, where 1 additionally recommended high-fiber diets.

“Five CPGs were aimed at populations with celiac disease and recommended gluten-free dietary patterns, where 1 additionally recommended high-fiber diets.”

May combine two claims.

Each recommended multiple dietary patterns including Mediterranean-style (100% of these CPGs), low-carbohydrate (75%), reduced-calorie (75%), DASH (50%), high-protein (50%), and vegetarian diets (50%), among others (each recommended by just 1 CPG).

“Each recommended multiple dietary patterns including Mediterranean-style (100% of these CPGs), low-carbohydrate (75%), reduced-calorie (75%), DASH (50%), high-protein (50%), and vegetarian diets (50%), among others (each recommended by just 1 CPG).”

May combine two claims.

The most commonly discouraged food groups were processed meat (42%), red meat (25%), and refined grains (25%).

“The most commonly discouraged food groups were processed meat (42%), red meat (25%), and refined grains (25%) (Supplemental Figure 5).”

May combine two claims.

Some food groups had mixed recommendations with the percentage of CPGs encouraging or discouraging intake differing ≤5%. These included any dairy (5% encouraged; 9% discouraged), eggs (4% encouraged; 3% discouraged), any meat (3% encouraged; 5% discouraged), and any grains (5% encouraged; 1% discouraged, for populations with IBS [47]).

“Some food groups had mixed recommendations with the percentage of CPGs encouraging or discouraging intake differing ≤5%. These included any dairy (5% encouraged; 9% discouraged), eggs (4% encouraged; 3% discouraged), any meat (3% encouraged; 5% discouraged), and any grains (5% encouraged; 1% discouraged, for populations with IBS [47]).”

• cites [47] Pietrzak, 2018, Guidelines on the management of irritable bowel syndrome: in memory of Professor Witold Bartnik, Prz. Gastroenterol.Not checked yet

  Not checked in the free run.

May combine two claims.

All 12 of these CPGs recommended ≥1 dietary pattern, and 50% recommended >1 pattern to support the health of individuals with diabetes.

“All 12 of these CPGs recommended ≥1 dietary pattern, and 50% recommended >1 pattern to support the health of individuals with diabetes.”

May combine two claims.

Although few of the reviewed CPGs made explicit recommendations to exclude/decrease/limit any food groups, >20% recommended excluding red meat (32%) and processed meat (27%).

“Although few of the reviewed CPGs made explicit recommendations to exclude/decrease/limit any food groups, >20% recommended excluding red meat (32%) and processed meat (27%).”

May combine two claims.

Unsurprisingly, most CPGs discouraged populations with diabetes from consuming salt or sodium (83%), sweets or added sugar (67%), alcohol (58%), and SSBs (58%). One quarter of the CPGs also discouraged intake of processed foods (25%).

“Unsurprisingly, most CPGs discouraged populations with diabetes from consuming salt or sodium (83%), sweets or added sugar (67%), alcohol (58%), and SSBs (58%). One quarter of the CPGs also discouraged intake of processed foods (25%) (Supplemental Figure 5).”

May combine two claims.

All 5 CPGs discouraged intake of red meat, and 4 (80%) discouraged intake of processed meat for populations with colorectal or lung cancer and cancer survivors.

“All 5 CPGs discouraged intake of red meat, and 4 (80%) discouraged intake of processed meat for populations with colorectal or lung cancer and cancer survivors.”

May combine two claims.

Intake of protein from plant or vegetable sources was encouraged by the 18% of CPGs, whereas recommendations for animal sources of protein were mixed (5% encouraged; 4% discouraged).

“Intake of protein from plant or vegetable sources was encouraged by the 18% of CPGs, whereas recommendations for animal sources of protein were mixed (5% encouraged; 4% discouraged).”

May combine two claims.

Dietary patterns recommended by these CPGs included a low-fat diet (n = 1), a low-carbohydrate diet (n = 1), and the USDA MyPlate recommendations (n = 1).

“Dietary patterns recommended by these CPGs included a low-fat diet (n = 1), a low-carbohydrate diet (n = 1), and the USDA MyPlate recommendations (n = 1).”

May combine two claims.

The 2 other CPGs did not specify dietary patterns, but 1 recommended diets rich in fruit and nonstarchy vegetables and low in red and processed meat, whereas the other recommended diets high in vegetables, fruit, and whole grains and low in saturated fats, red meats, and alcohol.

“The 2 other CPGs did not specify dietary patterns, but 1 recommended diets rich in fruit and nonstarchy vegetables and low in red and processed meat, whereas the other recommended diets high in vegetables, fruit, and whole grains and low in saturated fats, red meats, and alcohol.”

May combine two claims.

Six of the CPGs (55%) made food group recommendations, and just 3 food groups were mentioned by >1 CPG. These included fruit (27% encouraged), vegetables (27% encouraged), and legumes/pulses (9% encouraged; 18% discouraged, for populations with IBS [47,49]).

“Six of the CPGs (55%) made food group recommendations, and just 3 food groups were mentioned by >1 CPG. These included fruit (27% encouraged), vegetables (27% encouraged), and legumes/pulses (9% encouraged; 18% discouraged, for populations with IBS [47,49]).”

• cites [47] Pietrzak, 2018, Guidelines on the management of irritable bowel syndrome: in memory of Professor Witold Bartnik, Prz. Gastroenterol.Not checked yet

  Not checked in the free run.

• cites [49] Song, 2018, Clinical practice guidelines for irritable bowel syndrome in Korea, 2017 revised edition, J. Neurogastroenterol. Motil. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The reviewed guidelines primarily focused on major chronic diseases with only 1 guideline aimed at general health promotion in older adults.

“The reviewed guidelines primarily focused on major chronic diseases with only 1 guideline aimed at general health promotion in older adults.”

Classified as probably not a substantial claim.

Our review included the most recently revised CPGs published in peer-reviewed journals or stakeholder websites since 2010.

“Accordingly, the global FBDG review included all FAO repository guidelines that spanned from 1986 to 2017; however, our review included the most recently revised CPGs published in peer-reviewed journals or stakeholder websites since 2010.”

May combine two claims.

Food groups encouraged by >1 CPG were fruit (75% of these CPGs), low-fat dairy (75%), vegetables (75%), lean meat (50%), and legumes/pulses (50%).

“Food groups encouraged by >1 CPG were fruit (75% of these CPGs), low-fat dairy (75%), vegetables (75%), lean meat (50%), and legumes/pulses (50%).”

May combine two claims.

Recommendations for all other major food groups and components were more varied, but approximately one-third encouraged intake of low-fat dairy, fish/seafood, lean meats, and nontropical vegetable oils, whereas nearly one-third discouraged intake of red and processed meats, SSBs, and sweets or added sugars.

“Recommendations for all other major food groups and components were more varied, but approximately one-third encouraged intake of low-fat dairy, fish/seafood, lean meats, and nontropical vegetable oils, whereas nearly one-third discouraged intake of red and processed meats, SSBs, and sweets or added sugars.”

May combine two claims.

Dietary patterns were mentioned in nearly all reviewed guidelines, with more than half recommending multiple dietary patterns.

“Dietary patterns were mentioned in nearly all reviewed guidelines, with more than half recommending multiple dietary patterns.”

May combine two claims.

For instance, similar to the overall trends, 50% or more of the guidelines on CVD and diabetes encouraged intake of vegetables, fruit, and whole grains; however, most of these guidelines further promoted legumes/pulses, and approximately half encouraged intake of any nuts/seeds and any fish/seafood.

“For instance, similar to the overall trends, 50% or more of the guidelines on CVD and diabetes encouraged intake of vegetables, fruit, and whole grains; however, most of these guidelines further promoted legumes/pulses, and approximately half encouraged intake of any nuts/seeds and any fish/seafood.”

May combine two claims.

No food components were encouraged by >1 CPG, but 3 CPGs (75%) discouraged intake of alcohol, SSBs, and sweets or added sugar, whereas 2 (50%) discouraged intake of salt or sodium.

“No food components were encouraged by >1 CPG, but 3 CPGs (75%) discouraged intake of alcohol, SSBs, and sweets or added sugar, whereas 2 (50%) discouraged intake of salt or sodium.”

May combine two claims.

Although the guidelines for CVD and diabetes were aligned in recommending limited intake of alcohol and salt/sodium, CVD guidelines more often encouraged low-fat dairy intake, whereas most diabetes guidelines emphasized limited intake of sweets or added sugars and SSBs.

“Although the guidelines for CVD and diabetes were aligned in recommending limited intake of alcohol and salt/sodium, CVD guidelines more often encouraged low-fat dairy intake, whereas most diabetes guidelines emphasized limited intake of sweets or added sugars and SSBs.”

May combine two claims.

Overall, the guidelines were aligned on recommendations to consume vegetables and fruit and to limit intake of alcohol.

“Overall, the guidelines were aligned on recommendations to consume vegetables and fruit and to limit intake of alcohol.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

It recommended a balanced diet aligned with the DGA and Nordic Nutritional Recommendations with <10% of energy from SFAs and 20%-30% of energy from MUFAs and PUFAs.

“It recommended a balanced diet aligned with the DGA and Nordic Nutritional Recommendations with <10% of energy from SFAs and 20%–30% of energy from MUFAs and PUFAs.”

Probably not a substantial claim: may not pass S3 (load-bearing).

One diabetes guideline from Japan recommended limited intake of fruit owing to higher sugar content from selective breeding.

“As noted previously, 1 diabetes guideline from Japan recommended limited intake of fruit owing to higher sugar content from selective breeding [46], and another Japanese guideline for CVD prevention recommended a low-salt Japanese dietary pattern (that is, lean meats, reduced butter and other animal fats, and consumption of soy, fish, vegetables, seaweed, mushrooms, fruit, and unpolished grains) [”

• cites [46] Tajima, 2015, Evidence-based practice guideline for the treatment for diabetes in Japan 2013, Diabetol. Int. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Most guidelines supported intake of whole grains and limited salt or sodium, and many encouraged intake of legumes/pulses and any nuts and seeds.

“Most guidelines supported intake of whole grains and limited salt or sodium, and many encouraged intake of legumes/pulses and any nuts and seeds.”

May combine two claims.

These were Mediterranean, DASH, plant-based, vegetarian, and vegan dietary patterns.

“These were Mediterranean, DASH, plant-based, vegetarian, and vegan dietary patterns.”

May combine two claims.

Guideline recommendations were primarily based on systematic reviews, and recommendation language was largely decided by consensus or voting processes.

“Guideline recommendations were primarily based on systematic reviews, and recommendation language was largely decided by consensus or voting processes.”

May combine two claims.

Guidelines on CVD, diabetes, and various digestive conditions were most prevalent with few guidelines focused on populations with cancers or weight-related conditions.

“Guidelines on CVD, diabetes, and various digestive conditions were most prevalent with few guidelines focused on populations with cancers or weight-related conditions.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Our review included only guidelines published in English, resulting in representation from 18 individual countries (mostly in North America or Europe) plus regional guidelines for Asian, Australian, European, or global populations.

“Our review included only guidelines published in English, resulting in representation from 18 individual countries (mostly in North America or Europe) plus regional guidelines for Asian, Australian, European, or global populations.”

May combine two claims.

Our informal quality assessment identified transparent reporting of guideline development processes and competing interests but less transparency for how competing interests were managed and how guideline development was funded.

“Our informal quality assessment identified transparent reporting of guideline development processes and competing interests but less transparency for how competing interests were managed and how guideline development was funded.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The bulk of CPGs included in this study were from North America and Europe.

“Although the bulk of CPGs included in this study were from North America and Europe, the inclusion of guidelines from various countries and regions around the globe increases the generalizability of our findings, which suggest clear consensus that fruit, vegetables, and whole grains are essential dietary components supporting human health, whereas intake of alcohol and salt or sodium should be li”

Classified as probably not a substantial claim.

Few included guidelines were written expressly to address patients' dietary or nutritional needs.

“This was unsurprising because few included guidelines were written expressly to address patients’ dietary or nutritional needs.”

May combine two claims.

Serving sizes and frequency of intake were rarely outlined in food group or component recommendations, thus quantity or proportion of these items encouraged in the diet was not always clear.

“Serving sizes and frequency of intake were also rarely outlined in food group or component recommendations, thus quantity or proportion of these items encouraged in the diet was not always clear.”

Classified as probably not a substantial claim. May combine two claims.

Several guidelines offered clear descriptions of dietary patterns, but some mentioned only the name of a pattern without further details.

“Although several guidelines offered clear descriptions of dietary patterns, some mentioned only the name of a pattern without further details.”

Classified as probably not a substantial claim.

This large meta-epidemiologic study captured dietary recommendations from the most current versions of CPGs published in the last decade.

“This large meta-epidemiologic study captured dietary recommendations from the most current versions of CPGs published in the last decade.”

Probably not a substantial claim: may not pass S3 (load-bearing).

National food-based dietary guidelines are globally aligned in much of their guidance.

“Recent evidence suggests that these national FBDGs are globally aligned in much of their guidance [4].”

• cites [4] Herforth, 2019, A global review of food-based dietary guidelines, Adv. Nutr. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The study adapted relevant portions of the AGREE II instrument to extract data on methodologic and reporting quality in the reviewed clinical practice guidelines.

“We adapted relevant portions of the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) [28] to extract data on methodologic and reporting quality in the reviewed CPGs.”

• cites [28] Hoffmann-Eßer, 2017, Guideline appraisal with AGREE II: systematic review of the current evidence on how users handle the 2 overall assessments, PLOS ONE sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

A study protocol was published on PROSPERO before data extraction.

“Before data extraction, a study protocol was published on the International Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/prospero; PROSPERO 2021 CRD42021226281).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Results are reported according to meta-epidemiologic study guidelines, which include an adapted PRISMA statement.

“Results are reported according to the said guidelines [22], which include an adapted PRISMA statement [26].”

• cites [22] Murad, 2017, Guidelines for reporting meta-epidemiological methodology research, Evid. Based Med. sourceNot checked yet

  Not checked in the free run.

• cites [26] Moher, 2009, PRISMA Group, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, PLOS Med sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two independent investigators screened all titles and abstracts and assessed full-text articles for eligibility.

“Two independent investigators screened all titles and abstracts in Rayyan and assessed full-text articles for study eligibility criteria presented in Table 1.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The meta-epidemiologic study used a systematic review approach following the National Academy of Medicine's Standards for Systematic Reviews.

“This meta-epidemiologic study used a systematic review approach following the National Academy of Medicine’s Standards for Systematic Reviews [25].”

• cites [25] 2011Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

In the United States, high-quality diets are associated with a significantly lower risk of all-cause mortality and major chronic diseases.

“in the United States, high-quality diets are associated with a significantly lower risk of all-cause mortality and major chronic diseases [2].”

• cites [2] Schwingshackl, 2018, Diet quality as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension Score, and Health Outcomes: an updated systematic review and meta-analysis of cohort studies, J. Acad. Nutr. Diet. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Adherence to food-based dietary guidelines is associated with better quality of life, mental health, healthy weight maintenance, lower risk of major chronic diseases, and lower all-cause mortality.

“adherence to FBDGs has been associated with desirable outcomes in multiple domains such as a better quality of life [5,6] and mental health [7], healthy weight maintenance, and lower risk of major chronic diseases [for example, CVD, type 2 diabetes (T2D), multiple cancers [2,[8], [9], [10]]] and all-cause mortality [2,9,11].”

• cites [5] Govindaraju, 2018, Dietary patterns and quality of life in older adults: a systematic review, Nutrients sourceNot checked yet

  Not checked in the free run.

• cites [6] Evers, 2022, Adherence to dietary guidelines is associated with better physical and mental quality of life: results from a cross-sectional survey among 728 Dutch MS patients, Nutr. Neurosci. sourceNot checked yet

  Not checked in the free run.

• cites [7] Lassale, 2019, Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies, Mol. Psychiatry. sourceNot checked yet

  Not checked in the free run.

• cites [2] Schwingshackl, 2018, Diet quality as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension Score, and Health Outcomes: an updated systematic review and meta-analysis of cohort studies, J. Acad. Nutr. Diet. sourceNot checked yet

  Not checked in the free run.

• cites [9] Voortman, 2017, Adherence to the 2015 Dutch dietary guidelines and risk of non-communicable diseases and mortality in the Rotterdam Study, Eur. J. Epidemiol. sourceNot checked yet

  Not checked in the free run.

• cites [11] Ewers, 2021, Non-adherence to established dietary guidelines associated with increased mortality: the Copenhagen General Population Study, Eur. J. Prev. Cardiol. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

A suboptimal diet is responsible for more deaths globally than any other risk factor, such as tobacco smoking.

“A suboptimal diet is responsible for more deaths globally than any other risk factors, such as tobacco smoking.”

• cites [1] Afshin, 2019, Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, Lancet sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

More than half of diet-related deaths in 195 countries were attributed to nonoptimal intake of whole grains, fruit, and sodium.

“According to a 2019 systematic analysis of dietary risks in 195 countries, more than half of these diet-related deaths were attributed to nonoptimal intake of whole grains, fruit, and sodium [1].”

• cites [1] Afshin, 2019, Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, Lancet sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All data were extracted by one investigator and checked by a second.

“All data were extracted by 1 investigator and checked by a second.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A risk-of-bias assessment was not completed because bias was not pertinent to the review's research question, as per meta-epidemiologic study guidelines by Murad and Wang.

“However, a risk-of-bias assessment was not completed because bias was not pertinent to this review’s research question, as per the meta-epidemiologic study guidelines by Murad and Wang [22].”

• cites [22] Murad, 2017, Guidelines for reporting meta-epidemiological methodology research, Evid. Based Med. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Risk of bias in the development of the guidelines was not assessed.

“risk of bias in the development of the guidelines was not a primary focus of this study so was not assessed.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Methodologic and reporting quality was not assumed to be high among the guidelines, so key features of quality were assessed using criteria adapted from AGREE II.

“methodologic and reporting quality was not assumed to be high among the guidelines, so key features of quality deemed relevant by the investigators were assessed using criteria adapted from the AGREE II [28] appraisal tool for guidelines”

• cites [28] Hoffmann-Eßer, 2017, Guideline appraisal with AGREE II: systematic review of the current evidence on how users handle the 2 overall assessments, PLOS ONE sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The FBDG review reported that 27% of the guidelines supported fish consumption.

“The FBDG review also reported that one-third of the guidelines recommended lean meat or meat with fat removed, 27% supported fish consumption, and 23% recommended limiting or moderating meat consumption.”

• cites [4] Herforth, 2019, A global review of food-based dietary guidelines, Adv. Nutr. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The FBDG review reported that 23% of the guidelines recommended limiting or moderating meat consumption.

“The FBDG review also reported that one-third of the guidelines recommended lean meat or meat with fat removed, 27% supported fish consumption, and 23% recommended limiting or moderating meat consumption.”

• cites [4] Herforth, 2019, A global review of food-based dietary guidelines, Adv. Nutr. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A recent global review of 90 food-based dietary guidelines (FBDGs) found a high level of consistency in recommendations to consume abundant fruit and vegetables, to include legumes in the diet, and to limit sugar and salt.

“Similar to our findings, a recent global review of 90 FBDGs found a high level of consistency in recommendations to consume abundant fruit and vegetables, to include legumes in the diet, and to limit sugar and salt [4].”

• cites [4] Herforth, 2019, A global review of food-based dietary guidelines, Adv. Nutr. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

From these findings, we feel confident that the reviewed CPG recommendations are generally trustworthy and sufficiently evidence based.

“From these findings, we feel confident that the reviewed CPG recommendations are generally trustworthy and sufficiently evidence based.”

• AssumptionRests on an assumption: The informal quality assessment used in this study adequately captures the quality and trustworthiness of the included guidelines.

Probably not a substantial claim: may not pass S3 (load-bearing).

The FBDG review reported that one-third of the guidelines recommended lean meat or meat with fat removed.

“The FBDG review also reported that one-third of the guidelines recommended lean meat or meat with fat removed, 27% supported fish consumption, and 23% recommended limiting or moderating meat consumption.”

• cites [4] Herforth, 2019, A global review of food-based dietary guidelines, Adv. Nutr. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The FBDG review reported high consistency in recommendations to include animal-sourced foods.

“In contrast to this study, the review of FBDGs reported high consistency in recommendations to include starchy staples (mentioned in just 2 CPGs in our review) and animal-sourced foods (as 1 of the 4 or 5 recommended food groups) but to avoid excessive intake of fats/oils (as indicated by small proportions on food guide graphics such as food pyramids).”

• cites [4] Herforth, 2019, A global review of food-based dietary guidelines, Adv. Nutr. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The FBDG review reported high consistency in recommendations to avoid excessive intake of fats/oils.

“In contrast to this study, the review of FBDGs reported high consistency in recommendations to include starchy staples (mentioned in just 2 CPGs in our review) and animal-sourced foods (as 1 of the 4 or 5 recommended food groups) but to avoid excessive intake of fats/oils (as indicated by small proportions on food guide graphics such as food pyramids).”

• cites [4] Herforth, 2019, A global review of food-based dietary guidelines, Adv. Nutr. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The global FBDG review included all FAO repository guidelines that spanned from 1986 to 2017.

“Accordingly, the global FBDG review included all FAO repository guidelines that spanned from 1986 to 2017; however, our review included the most recently revised CPGs published in peer-reviewed journals or stakeholder websites since 2010.”

• cites [4] Herforth, 2019, A global review of food-based dietary guidelines, Adv. Nutr. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

CPGs targeting specific medical conditions (that is, more restricted populations) may be less subject to these differences.

“CPGs targeting specific medical conditions (that is, more restricted populations) may be less subject to these differences.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Evidence-based recommendations for dietary practices can become outdated if not regularly updated.

“Furthermore, with the rapid advancement of nutrition science over recent decades, evidence-based recommendations for dietary practices can become outdated if not regularly updated.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study conducted an informal quality assessment of the included guidelines.

“Our informal quality assessment identified transparent reporting of guideline development processes and competing interests but less transparency for how competing interests were managed and how guideline development was funded.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The FBDG review reported high consistency in recommendations to include starchy staples.

“In contrast to this study, the review of FBDGs reported high consistency in recommendations to include starchy staples (mentioned in just 2 CPGs in our review) and animal-sourced foods (as 1 of the 4 or 5 recommended food groups) but to avoid excessive intake of fats/oils (as indicated by small proportions on food guide graphics such as food pyramids).”

• cites [4] Herforth, 2019, A global review of food-based dietary guidelines, Adv. Nutr. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The FBDG review found recommendations for dairy, red meat, fats and oils, and nuts were more variable across guidelines and were often unclear as to whether these foods should be included with moderation or limited in the diet.

“Similar to our review, the FBDG review found recommendations for dairy, red meat, fats and oils, and nuts were more variable across guidelines and were often unclear as to whether these foods should be included with moderation or limited in the diet.”

• cites [4] Herforth, 2019, A global review of food-based dietary guidelines, Adv. Nutr. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

National FBDGs for general populations are expected to vary between countries owing to differences in agriculture, culture, economics, and food production.

“Finally, national FBDGs for general populations are expected to vary between countries owing to differences in agriculture, culture, economics, and food production [57].”

• cites [57] Dwyer, 2012, Dietary standards and guidelines: similarities and differences among countriesNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The FBDG study reviewed relevant information provided in English on the FAO site by 90 countries.

“The FBDG study reviewed relevant information provided in English on the FAO site by 90 countries [4].”

• cites [4] Herforth, 2019, A global review of food-based dietary guidelines, Adv. Nutr. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Both global FBDGs and CPGs for adults with major chronic diseases reviewed in this study show clear consensus support for consuming fruit, vegetables, legumes/pulses, and whole grains while limiting intake of salt or sodium.

“Despite these differences, both global FBDGs and CPGs for adults with major chronic diseases reviewed in this study show clear consensus support for consuming fruit, vegetables, legumes/pulses, and whole grains while limiting intake of salt or sodium.”

Classified as probably not a substantial claim.

Comparing recommendations across guidelines with inconsistent details necessitated a simplified approach to categorize intake as positive (include/increase) or negative (exclude/decrease/limit).

“Comparing recommendations across guidelines with inconsistent details also necessitated a simplified approach to categorize intake as positive (include/increase) or negative (exclude/decrease/limit).”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

The public discourse around nutrition is increasingly noisy and confusing as various experts and pseudo-experts populate the internet with information of varying quality.

“The public discourse around nutrition is increasingly noisy and confusing as various experts and pseudo-experts populate the internet with information of varying quality [19].”

• cites [19] Spiteri Cornish, 2015, The impact of consumer confusion on nutrition literacy and subsequent dietary behavior, Psychol. Market. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Current evidence suggests these extreme macronutrient diets may propagate divergence from dietary reference intakes and dietary guidelines and may increase cardiovascular disease risk factors.

“Research on these diets is still emerging, but current evidence suggests these extreme macronutrient diets may propagate divergence from dietary reference intakes [61] and dietary guidelines [62] and may increase cardiovascular disease risk factors [[63], [64], [65]].”

• cites [61] Karlsen, 2021, Theoretical intakes of modern-day paleo diets: comparison to U.S. dietary reference intakes, Curr. Dev. Nutr. sourceNot checked yet

  Not checked in the free run.

• cites [62] Churuangsuk, 2020, Carbohydrate knowledge, dietary guideline awareness, motivations and beliefs underlying low-carbohydrate dietary behaviours, Sci. Rep. sourceNot checked yet

  Not checked in the free run.

• cites [63], [64], [65]Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Many patients have nutrition questions related to these conditions, and they look to their medical providers for guidance.

“Many patients have nutrition questions related to these conditions, and they look to their medical providers for guidance [20].”

• cites [20] Adams, 2010, Nutrition in medicine: nutrition education for medical students and residents, Nutr. Clin. Pract. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

These findings support both the ACLM's dietary position statement and its recent expert consensus statement that the most effective dietary intervention for achieving T2D remission is whole, plant-based foods with minimal consumption of meat and other animal products.

“These findings support both the ACLM’s dietary position statement [23] and its recent expert consensus statement that the most effective dietary intervention for achieving T2D remission is whole, plant-based foods with minimal consumption of meat and other animal products [60].”

• cites [23] 2018Not checked yet

  Not checked in the free run.

• cites [60] Rosenfeld, 2022, Dietary interventions to treat type 2 diabetes in adults with a goal of remission: an expert consensus statement from the American College of Lifestyle Medicine, Am. J. Lifestyle Med. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable).

The identification of consensus among guidelines can provide clarity for health care practitioners and policymakers.

“The identification of consensus among guidelines can provide clarity for health care practitioners and policymakers.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In the United States, the rising prevalence of overweight/obesity and associated chronic conditions constitute a growing public health threat, and the need to address these conditions is urgent.

“In the United States, the rising prevalence of overweight/obesity and associated chronic conditions constitute a growing public health threat, and the need to address these conditions is urgent [59].”

• cites [59] Hales, 2020, Prevalence of obesity and severe obesity among adults: United States, 2017-2018, NCHS Data BriefNot checked yet

  Not checked in the free run.

May combine two claims.

The reviewed guidelines aimed at preventing, managing, or treating major chronic diseases were closely aligned in their dietary recommendations for daily intake of plant sources of food (especially fruit, vegetables, and whole grains), with limited consumption of alcohol and salt or sodium.

“The reviewed guidelines aimed at preventing, managing, or treating major chronic diseases were closely aligned in their dietary recommendations for daily intake of plant sources of food (especially fruit, vegetables, and whole grains), with limited consumption of alcohol and salt or sodium.”

Classified as probably not a substantial claim.

This study focused on summarizing recommended content rather than quantities of intake.

“With these limitations, this study focused on summarizing recommended content rather than quantities of intake.”

May combine two claims.

The dissemination of public health recommendations on diet as part of medical treatment can be hampered by providers' lack of familiarity with nutrition guidelines or lack of confidence in delivering nutrition advice in patient encounters.

“However, the dissemination of public health recommendations on diet as part of medical treatment can be hampered by providers’ lack of familiarity with nutrition guidelines or lack of confidence in delivering nutrition advice in patient encounters [21].”

• cites [21] Crowley, 2019, Nutrition in medical education: a systematic review, Lancet Planet. Health. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Our findings suggest clear consensus that intake of alcohol and salt or sodium should be limited.

“Although the bulk of CPGs included in this study were from North America and Europe, the inclusion of guidelines from various countries and regions around the globe increases the generalizability of our findings, which suggest clear consensus that fruit, vegetables, and whole grains are essential dietary components supporting human health, whereas intake of alcohol and salt or sodium should be li”