Vitamin D recommendations in clinical guidelines: A systematic review, quality evaluation and analysis of potential predictors
Por:
Navarro, DF, Garcia-Franco, AL, de Guzman, EN, Rabassa, M, Campos, RZ, Pardo-Hernandez, H, Ricci-Cabello, I, Canelo-Aybar, C, Meneses-Echavez, JF, Yepes-Nunez, JJ, Kuindersma, J, Saladich, IG, Alonso-Coello, P
Publicada:
1 nov 2021
Ahead of Print:
1 sep 2021
Resumen:
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.
Filiaciones:
Navarro, DF:
Hlth Ctr Dr Mendiguchia Carriche, Serv Madrileno Salud, Madrid, Spain
Primary Care, Serv Madrileno Salud, Madrid, Spain
Macquarie Univ, Australian Inst Hlth Innovat, Level 6 75 Talavera Rd, Sydney, NSW 2109, Australia
Garcia-Franco, AL:
Hlth Ctr Dr Mendiguchia Carriche, Serv Madrileno Salud, Madrid, Spain
Primary Care, Serv Madrileno Salud, Madrid, Spain
de Guzman, EN:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, Barcelona, Spain
Rabassa, M:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, Barcelona, Spain
Campos, RZ:
Hlth Res Inst Balearic Isl IdISBa, Balearic Islands, Spain
Valencian Int Univ VIU, Dept Hlth, Valencia, Spain
Balearic Isl Hlth Serv, Primary Care Res Unit Mallorca, Balearic Islands, Spain
Pardo-Hernandez, H:
St Pau Biomed Res Inst IIB St Pau, Barcelona, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
Ricci-Cabello, I:
Hlth Res Inst Balearic Isl IdISBa, Balearic Islands, Spain
Balearic Isl Hlth Serv, Primary Care Res Unit Mallorca, Balearic Islands, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
Canelo-Aybar, C:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, Barcelona, Spain
Meneses-Echavez, JF:
Norwegian Inst Publ Hlth, Oslo, Norway
Univ Santo Tomas, Fac Cultura Fis Deporte & Recreac, Bogota, Colombia
Yepes-Nunez, JJ:
Univ Andes, Sch Med, Bogota, Colombia
Fdn Santa Fe Bogota Univ Hosp, Internal Med Sect, Pulmonol Serv, Bogota, Colombia
Kuindersma, J:
Univ Groningen, Biomed Sci, Groningen, Netherlands
Saladich, IG:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, Barcelona, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
Univ Autonoma Barcelona UAB, Bellaterra, Spain
Alonso-Coello, P:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, Barcelona, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
Open Access
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