Quality Appraisal of Nutritional Guidelines to Prevent, Diagnose, and Treat Malnutrition in All Its Forms during Pregnancy

Abstract

This work aimed to identify clinical practice guidelines (CPGs) that include recommendations for the prevention, diagnosis, and treatment of women’s malnutrition during pregnancy and to evaluate the quality of these guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. We conducted a literature review using PubMed and different websites from January 2009 to February 2021. The quality of the CPGs was independently assessed by reviewers using the AGREE II instrument, which defines guidelines scoring >70% in the overall assessment as “high quality”. The analysis included 43 guidelines. Among the main findings, we identified that only half of the CPGs (51.1%) obtained a final “high quality” evaluation. AGREE II results varied widely across domains and categories. The two domains that obtained the highest scores were scope and purpose with 88.3% (range 39 to 100%) and clarity of presentation with 87.2% (range 25 to 100%). Among the “high quality” CPGs, the best scores were achieved by the three guidelines published by the National Institute of Health and Care Excellence (NICE) and the World Health Organization (WHO). Due to the importance of maternal nutrition in pregnancy, it is essential to join forces to improve the quality of the guidelines, especially in CPGs that do not meet the reference standards for quality.

Quality appraisal of clinical practice guidelines for the management of Dysphagia after acute stroke

“…The AGREE II manual does not offer any advice on how to explain the scores. In accordance with previous studies ( 15 , 16 ), if a CPG scored above 70% on six domains, it was classified as ‘high quality’; if a CPG scored above 70% on three to five domains, it was classified as ‘moderate quality’; and if a CPG scored less than 70% on ≥ two domains, it was classified as ‘low quality’.…”

“…Our results were largely similar to the results of CPG quality appraisal in different clinical topics ( 43–45 ), indicating that the problems in CPG development have some commonality. The CPG development group should pay more attention to improving the methodological quality according to the AGREE II instrument, and each item should be refined as much as possible ( 16 , 42 ).…”

A scoping review and critical evaluation of the methodological quality of clinical practice guidelines on nutrition in the preconception

“…AGREE II provides elements that allow for developing and implementing initiatives to improve healthcare quality. We recommend this instrument that guideline developers, clinicians, researchers, and policymakers consider and utilize the AGREE II tool, as it is a comprehensive and user-friendly instrument that can be adapted to specific populations, injuries, or diseases ( 39 ).…”