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August 12, 2019

Improving the Quality of Dietary Research

Author Affiliations
  • 1New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
  • 2Metabolism and Body Composition Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana
JAMA. 2019;322(16):1549-1550. doi:10.1001/jama.2019.11169

Compared with pharmaceutical research, studies evaluating diet or dietary interventions for chronic diseases like obesity (to be distinguished from micronutrient deficiency syndromes like scurvy or rickets) have far greater challenges in terms of consistency, quality control, confounding, and interpretation. For instance, a placebo for an active drug can be easily prepared, but dietary assignment can rarely be truly masked. Moreover, diet is highly heterogeneous, with myriad interacting and potentially confounding factors. If an intervention increases intake from one food category, participants may well eat less from other food categories.

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    3 Comments for this article
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    Don't Forget Enteral Nutrition
    Carlo Pedrolli, M.D. | S. Chiara Hospital, Clinical Nutrition Unit , Trento, Itali
    I read with much interest this paper.

    I would suggest to add a proposal to improve quality of dietary research.

    We have thousands of patients fed by enteral nutrition in which the variability of nutrients is very little; in a way there are many patients in whom we know exactly how many calories we give, how many proteins, how many carbohydrates, how much fiber and how many micronutrients we give as nutritional intake and it is possible to calculate exactly how much they eat in a day.

    I think we use this information too infrequently in research
    and I would advise to do it to enhance the quality of dietary research; do you agree?
    CONFLICT OF INTEREST: None Reported
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    Don't Ignore Empiric Science
    William Wilson, Family Physician | Acute Rehabilitation and Nursing Home practice
    I agree with the conclusions of this excellent article. We need to improve our approach for performing academic research in the field of nutrition, and the suggestions in this article make sense. I also believe it's essential to pay attention to empirical or observational science. After all, we don't want to spend a lot of time studying sideways falling balls. The obvious empirical-based observation in nutrition science is the uncontroversial fact that our modern diet of highly processed food is highly toxic to virtually everyone when consumed over time. The standard American diet is both neurotoxic and harmful to all aspects of human physiology. As a primary care physician, to me, it makes little sense to waste time and money studying this obvious truth. A much more thoughtful and productive approach would be to focus on issues such as the role of calories in obesity, the role of various micronutrients in common chronic medical problems, and determining the ideal balance of micronutrient elements for optimal health and preventing common chronic diseases. Different popular diets such as low carbohydrate diets, high protein diets such as the Atkin's diet, the Zone Diet, intermittent fasting, the Paleo diet, ketogenic diets, and other popular dietary variations should be compared head to head to determine the best nutritional advice to give to our patients.
    CONFLICT OF INTEREST: None Reported
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    Question
    Eric Reines, MD | Element Care PACE
    Is this a preamble to undoing the work of the Scientific Report of the 2015 Dietary Guidelines Advisory Committee? While this article is true as far as it goes, it does not acknowledge robust evidence already in place.
    CONFLICT OF INTEREST: None Reported
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