National guidelines on nutrient reference values for the healthy adult population and for pregnant or lactating women are based on heterogeneous sources of evidence: review of guidelines

Abstract

Abstract Many countries provide dietary guidelines for health practitioners and/or the general population. However, there is no general, international guideline serving as a template for national dietary guidelines, and there is little to no consensus regarding reference values for different nutrients. The present review compared 27 national dietary guidelines for healthy adults as well as for pregnant and/or breastfeeding women, and analysed their quality and the evidence behind their recommendations. The guidelines were evaluated for their quality using the instrument Agree II, and found to be heterogeneous (overall quality score 14%–100%) and often insufficient (quality score < 50%) due to missing information about their methodology and sources of evidence. We analysed the evidence (number of studies, study types and publication years) of reference values of a number of nutrients using the five guidelines that provided the highest scores in the Agree II assessment. The reference values varied among guidelines, were rarely based on up-to-date meta-analyses, and were often based on insufficiently reported evidence (22/27 guidelines with quality score < 50%). We recommend systematic reviews of high quality studies to formulate future guidelines, and to use guidelines on how to write guidelines.