section two


completes a food frequency questionnaire accurately and can’t design an arm of a trial in which no one eats. While feeding stud- ies on metabolic wards can control for these issues, that environ- ment doesn’t represent real-life conditions. Tis challenge is the reason many researchers believe nutrition science is one of the most complex aspects of health care. Development of guidelines and recommendations from


seemingly conflicting research can lead to controversy if evidence is not evaluated in consistent ways; however, standardization of the methodology used to review and evaluate the literature— including clear identification of the population studied, as certain groups may have been excluded from the research—informs rec- ommendations and provides a schema for indicating how strong the evidence is. As Waleed Alhazzani, MD, MSc, associate profes- sor in the Division of Critical Care at McMaster University and an expert in clinical practice guideline development emphatically states, “any guideline or recommendation is only as credible as its methodology.” In the accompanying interviews, guidelines experts Alison Steiber, PhD, RDN, and Bram Rochwerg, MD, point out factors that practitioners should consider in applying guidelines when evidence is inconclusive.


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