An evaluation of the recommendations for primary nutrition research addressing noncommunicable disease using the EPICOT+ framework: A cross-sectional descriptive meta-research study of Cochrane nutrition systematic reviews

Plain Language Summary

Noncommunicable diseases (NCDs), or chronic diseases, are a global health problem. NCDs include heart disease, cancer, chronic respiratory disease, and diabetes. Many of the factors associated with the development of NCDs are related to nutrition. In a database of Cochrane nutrition systematic reviews (SRs) (n = 692) we identified 150 SRs, focusing on four types of NCDs (cardiovascular diseases, e.g., heart attacks and stroke, cancer, chronic respiratory disease, e.g., asthma and diabetes), and their nutrition-related risk factors (obesity, unhealthy diets). We analyzed certain sections of these SRs to see whether the authors included certain items from the EPICOT+ framework. This framework is used for creating or finding the best practice evidence-based research. This includes reference to the evidence, population, intervention, comparison, outcome, date of search, study design, duration of follow-up, and burden of disease in their recommendations and search methods.

We found that almost all SRs reported the literature search date (98.7%), the intervention(s) that need to be examined (94.7%), the study design(s) that would work best (89.3%), and the outcome(s) that need to be measured (86%) in future studies. Fewer authors described how long study participants should be followed up for (52%), the intervention(s) against which the intervention of interest needs to be compared to in future studies (30%) and the burden of disease or condition being addressed (8%). We also analyzed what the authors recommended. Most SRs recommended more studies on whether the specific foods or food groups, diets or dietary patterns, micronutrient or complementary supplements, nutrition education techniques, and policies or programs work for a variety of clinical and patient-relevant outcomes. Many authors recommended large, randomized studies, with better quality and reporting, and following study participants for long periods of time.

Our findings show that research recommendations reported by authors of Cochrane nutrition SRs largely followed the EPICOT+ framework. For example, items that could be improved were the comparison and the time frame items. Our summary of their recommendations could help with planning of future studies by showing where important gaps in the current nutrition evidence are.