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Title: Systematic review to support the development of nutrient reference intake values: challenges and solutions

Author
item CHUNG, MEI - Tufts University
item BALK, ETHAN - Tufts University
item IP, STANLEY - Tufts University
item LEE, JOUNGHEE - Tufts University
item TERASAWA, TERUHIKO - Tufts University
item RAMAN, GOWRI - Tufts University
item TRIKALINOS, THOMAS - Tufts University
item LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item LAU, JOSEPH - Tufts University

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/3/2010
Publication Date: 8/11/2010
Citation: Chung, M., Balk, E.M., Ip, S., Lee, J., Terasawa, T., Raman, G., Trikalinos, T., Lichtenstein, A.H., Lau, J. 2010. Systematic review to support the development of nutrient reference intake values: challenges and solutions. American Journal of Clinical Nutrition. 92(2):273-276.

Interpretive Summary: The Institute of Medicine (IOM) issues the Dietary Reference Intake (DRI) values for US and Canadian populations. Due to renewed interest in the effect of vitamin D and calcium on a wide range of health outcomes, the DRI values for these nutrients are currently being reassessed. To facilitate this process, a workshop was sponsored by the IOM and World Health Organization (WHO) to determine the best logistical approach for the reassessment. Both suggested that incorporating systematic reviews into the process would facilitate summarizing the large amount of data and enhancing the transparency of the deliberations. At the request of the US and Canadian governments, the Tufts University Evidence-based Practice Center (EPC) performed a systematic review of vitamin D and calcium. This was the first time that an independent systematic review has been commissioned to coincide with an ongoing DRI process. This paper highlights the major challenges encountered, along with their solutions. These include the need to prioritize and clearly formulate key questions, select outcomes of interest, document limitations of existing literature for establishing DRI values, and establish tailored quality assessment tools to assist decision making.

Technical Abstract: Workshops sponsored by the Institute of Medicine (IOM) and the World Health Organization (WHO) suggested that incorporating systematic reviews into the process of updating nutrient reference values would enhance the transparency of the process. The IOM issues the Dietary Reference Intake values (DRIs) for US and Canadian populations. At the request of the US and Canadian governments, sponsors of the ongoing review of the 1997 DRIs for vitamin D and calcium, the Tufts University Evidence-based Practice Center (EPC) performed a systematic review to be made available to the current DRI Committee early in its deliberative process. This was the first time that an independent systematic review has been commissioned to coincide with an ongoing DRI process. This paper describes the approach and methodology used for the systematic review and highlights the major challenges encountered, along with their solutions. These include the need to prioritize and clearly formulate key questions, select outcomes of interest, document limitations of existing literature for establishing nutrient reference values, and establish tailored quality assessment tools to assist decision making. The experiences described in this paper can serve as basis for future advances in methodology when integrating systematic review into development of future nutrient reference values.