TY - JOUR
T1 - Vitamin D recommendations in clinical guidelines
T2 - A systematic review, quality evaluation and analysis of potential predictors
AU - Fraile Navarro, David
AU - López García-Franco, Alberto
AU - Niño de Guzmán, Ena
AU - Rabassa, Montserrat
AU - Zamanillo Campos, Rocío
AU - Pardo-Hernández, Héctor
AU - Ricci-Cabello, Ignacio
AU - Canelo-Aybar, Carlos
AU - Meneses-Echavez, Jose F.
AU - Yepes-Nuñez, Juan José
AU - Kuindersma, Jesse
AU - Gich Saladich, Ignasi
AU - Alonso-Coello, Pablo
N1 - Funding Information:
We want to acknowledge Saskia Cheyne for English language correction and proof‐reading. Pablo Alonso‐Coello was supported by a Miguel Servet investigator contract from the Instituto de Salud Carlos III (CPII15/0034). Montserrat Rabassa is funded by a Sara Borrell post‐doctoral contract (CD16/00157) from the Carlos III Institute of Health and the European Social Fund (ESF).
Publisher Copyright:
© 2021 John Wiley & Sons Ltd
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/11
Y1 - 2021/11
N2 - Background: Vitamin D has been widely promoted for bone health through supplementation and fortification of the general adult population. However, there is growing evidence that does not support these strategies. Our aim is to review the quality and recommendations on vitamin D nutritional and clinical practice guidelines and to explore predictive factors for their direction and strength. Methods: We searched three databases and two guideline repositories from 2010 onwards. We performed a descriptive analysis, a quality appraisal using AGREE II scores (Appraisal of Guidelines Research and Evaluation) and a bivariate analysis evaluating the association between direction and strength of recommendations, AGREE II domains’ scores and pre-specified characteristics. Results: We included 34 guidelines, 44.1% recommended, 26.5% suggested and 29.4% did not recommend vitamin D supplementation. Guidelines that scored higher for “editorial independence” and “overall quality score” were less likely to recommend or suggest vitamin D supplementation (median 68.8 vs 35.4; P =.001 and 58.3 vs 37.5; P =.02). Guidance produced by government organisations and those that reported source of funding were associated with higher AGREE II scores. Unclear role of source of funding was associated with recommending or suggesting vitamin D supplementation (P =.034). Editorial independence was an independent predictor for recommending or suggesting vitamin D supplementation (OR 1.09; CI95% 1.02 to 1.16; P =.006). Conclusions: Policymakers, clinicians and patients should be aware that lower quality guidelines and those reporting conflicts of interest are more likely to promote vitamin D supplementation. Guideline organisations should improve the quality of their recommendations’ development and the management of conflicts of interest. Users and editors should be aware of these findings when using and appraising guidelines.
AB - Background: Vitamin D has been widely promoted for bone health through supplementation and fortification of the general adult population. However, there is growing evidence that does not support these strategies. Our aim is to review the quality and recommendations on vitamin D nutritional and clinical practice guidelines and to explore predictive factors for their direction and strength. Methods: We searched three databases and two guideline repositories from 2010 onwards. We performed a descriptive analysis, a quality appraisal using AGREE II scores (Appraisal of Guidelines Research and Evaluation) and a bivariate analysis evaluating the association between direction and strength of recommendations, AGREE II domains’ scores and pre-specified characteristics. Results: We included 34 guidelines, 44.1% recommended, 26.5% suggested and 29.4% did not recommend vitamin D supplementation. Guidelines that scored higher for “editorial independence” and “overall quality score” were less likely to recommend or suggest vitamin D supplementation (median 68.8 vs 35.4; P =.001 and 58.3 vs 37.5; P =.02). Guidance produced by government organisations and those that reported source of funding were associated with higher AGREE II scores. Unclear role of source of funding was associated with recommending or suggesting vitamin D supplementation (P =.034). Editorial independence was an independent predictor for recommending or suggesting vitamin D supplementation (OR 1.09; CI95% 1.02 to 1.16; P =.006). Conclusions: Policymakers, clinicians and patients should be aware that lower quality guidelines and those reporting conflicts of interest are more likely to promote vitamin D supplementation. Guideline organisations should improve the quality of their recommendations’ development and the management of conflicts of interest. Users and editors should be aware of these findings when using and appraising guidelines.
KW - guidelines
KW - primary care
KW - public health
KW - quality appraisal
KW - Vitamin D
UR - http://www.scopus.com/inward/record.url?scp=85115064455&partnerID=8YFLogxK
U2 - 10.1111/ijcp.14805
DO - 10.1111/ijcp.14805
M3 - Review Article
C2 - 34486779
AN - SCOPUS:85115064455
SN - 1368-5031
VL - 75
JO - International Journal of Clinical Practice
JF - International Journal of Clinical Practice
IS - 11
M1 - e14805
ER -