NUQUEST—NUtrition QUality Evaluation Strengthening Tools: development of tools for the evaluation of risk of bias in nutrition studies. Issue 1 (4th October 2021)

• Record Type: Journal Article
• Authors: Kelly, Shannon E; Greene-Finestone, Linda S; Yetley, Elizabeth A; Benkhedda, Karima; Brooks, Stephen P J; Wells, George A; MacFarlane, Amanda J
• Is Part Of: American journal of clinical nutrition. Volume 115:Issue 1(2022)
• Page Start: 256
• Page End: 271
• Publication Date: 2021-10-04
• Subjects: quality assessment instrument -- nutrition -- randomized controlled trial -- cohort study -- case-control study -- risk of bias tool; Diet therapy -- Periodicals; Nutrition -- Periodicals; Dietetics -- Periodicals; 613.205
• DOI: 10.1093/ajcn/nqab335
• Languages: English
• ISSNs: 0002-9165

Abstract

ABSTRACT: Background: Dietary exposure assessments are a critical issue in evaluating human nutrition studies; however, nutrition-specific criteria are not consistently included in existing bias assessment tools. Objectives: Our objective was to develop a set of risk of bias (RoB) tools that integrated nutrition-specific criteria into validated generic assessment tools to address RoB issues, including those specific to dietary exposure assessment. Methods: The Nutrition QUality Evaluation Strengthening Tools (NUQUEST) development and validation process included 8 steps. The first steps identified 1 ) a development strategy; 2 ) generic assessment tools with demonstrated validity; and 3 ) nutrition-specific appraisal issues. This was followed by 4 ) generation of nutrition-specific items and 5 ) development of guidance to aid users of NUQUEST. The final steps used established ratings of selected studies and feedback from independent raters to 6 ) assess reliability and validity; 7 ) assess formatting and usability; and 8 ) finalize NUQUEST. Results: NUQUEST is based on the Scottish Intercollegiate Guidelines Network checklists for randomized controlled trials, cohort studies, and case-control studies. Using a purposive sample of 45 studies representing the 3 study designs, interrater reliability was high (Cohen's κ: 0.73; 95% CI: 0.52, 0.93) across all tools and at least moderate for individual tools (range: 0.57–1.00). The use of a worksheet improved usability and consistency of overall interrater agreement across all study designs (40% without worksheet, 80%–100% with worksheet). When compared to published ratings, NUQUEST ratings for evaluated studies demonstrated high concurrent validity (93% perfect or near-perfect agreement). Where there was disagreement, the nutrition-specific component was a contributing factor in discerning exposure methodological issues. Conclusions: NUQUEST integrates nutrition-specific criteria with generic criteria from assessment tools with demonstrated reliability and validity. NUQUEST represents a consistent and transparent approach for evaluating RoB issues related to dietary exposure assessment commonly encountered in human nutrition studies.