Meta-analysis is not enough: The critical role of pathophysiology in determining optimal care in clinical nutrition
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.
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The frequent simultaneous presence of undernutrition and inflammation confounds the value of serum albumin as an indicator of adequate nutrition intake or uptake in a sizeable subgroup of individuals despite a significant population-level correlation.
“These observations confound the value of serum albumin as an indicator of adequate nutrition intake or uptake in a sizeable subgroup of individuals despite a significant correlation in the population as a whole.108”
From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [108]
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Self-citationImmunonutrition and Supplementation: Pathways, Promise, and Pessimism
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Reckefuß, N., & Kampa, U. (2017) · Aktuelle Ernährungsmedizin · doi:10.1055/s-0043-119650 · Cited by 2 · see citing works
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Nutritional support in geriatric patients: the ESPEN new recommended guidelines
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Analiza metodologiei cercetării utilizate în literatura din domeniul nutriţiei
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- Authors
- Soeters, P., Bozzetti, F., Cynober, L., Elia, M., Shenkin, A., & Sobotka, L.
- Affiliations
- Maastricht University Medical Centre (NL)
- University of Milan (IT)
- Hôpital Cochin (FR)
- University of Liverpool (GB)
- Charles University (CZ)
- Corresponding author
- Soeters, Peter
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2016-06
- Volume
- 35
- Issue
- 3
- Pages
- 748-757
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W1264721759
- Cited by
- 40
- References
- 73
- Citations by year
- 2024: 1 · 2023: 5 · 2022: 7 · 2021: 4 · 2020: 8 · 2019: 5 · 2018: 2 · 2017: 6 · 2016: 1 · 2015: 1
- FWCI
- 0.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Keywords
- pathophysiology, nutritional support, malnutrition, evidence-based medicine, meta-analysis limitations, randomized controlled trials, nutritional risk, personalized nutrition, nutritional physiology, clinical guidelines
- MeSH terms
- Diet, Healthy, Animals, Dietetics, Energy Metabolism, Humans, Meta-Analysis as Topic, Reproducibility of Results, Biomarkers, Randomized Controlled Trials as Topic, Practice Guidelines as Topic, Nutritional Support, Patient Selection, Evidence-Based Medicine, Biomedical Research, Malnutrition, Nutritional Sciences
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