Limitations of observational evidence: Implications for evidence-based dietary recommendations

Kevin C. Maki, Joanne L. Slavin, Tia M. Rains, Penny M. Kris-Etherton

Research output: Contribution to journalReview article

49 Scopus citations

Abstract

Data from randomized controlled trials (RCTs) provide the strongest evidence for establishing relations between exposures, including dietary exposures, and health outcomes. However, not all diet and health outcome relations can be practically or ethically evaluated by using RCTs; therefore, many dietary recommendations are supported by evidence primarily from observational data, particularly those from prospective cohort studies. Although such evidence is of critical importance, limitations are often underappreciated by nutrition scientists and policymakers. This editorial review is intended to 1) highlight some of these limitations of observational evidence for diet-disease relations, including imprecise exposure quantification, collinearity among dietary exposures, displacement/substitution effects, healthy/unhealthy consumer bias, residual confounding, and effect modification; and 2) advocate for greater caution in the communication of dietary recommendations for which RCT evidence of clinical event reduction after dietary intervention is not available.

Original languageEnglish (US)
Pages (from-to)7-15
Number of pages9
JournalAdvances in Nutrition
Volume5
Issue number1
DOIs
StatePublished - Jan 1 2014

    Fingerprint

All Science Journal Classification (ASJC) codes

  • Food Science
  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

@article{8ddd3a295c3c4f568dc19a181e49a6ac,
title = "Limitations of observational evidence: Implications for evidence-based dietary recommendations",
abstract = "Data from randomized controlled trials (RCTs) provide the strongest evidence for establishing relations between exposures, including dietary exposures, and health outcomes. However, not all diet and health outcome relations can be practically or ethically evaluated by using RCTs; therefore, many dietary recommendations are supported by evidence primarily from observational data, particularly those from prospective cohort studies. Although such evidence is of critical importance, limitations are often underappreciated by nutrition scientists and policymakers. This editorial review is intended to 1) highlight some of these limitations of observational evidence for diet-disease relations, including imprecise exposure quantification, collinearity among dietary exposures, displacement/substitution effects, healthy/unhealthy consumer bias, residual confounding, and effect modification; and 2) advocate for greater caution in the communication of dietary recommendations for which RCT evidence of clinical event reduction after dietary intervention is not available.",
author = "Maki, {Kevin C.} and Slavin, {Joanne L.} and Rains, {Tia M.} and Kris-Etherton, {Penny M.}",
year = "2014",
month = jan
day = "1",
doi = "10.3945/an.113.004929",
language = "English (US)",
volume = "5",
pages = "7--15",
journal = "Advances in nutrition (Bethesda, Md.)",
issn = "2161-8313",
publisher = "American Society for Nutrition",
number = "1",

}