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Food-based dietary guidelines in Spain: an assessment of their methodological quality

European Journal of Clinical Nutrition volume 76, pages 350–359 (2022)Cite this article

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Abstract

Background & objectives

Food-based dietary guidelines (FBDGs) have been developed to promote healthy diets and prevent chronic diseases. However, the methodological quality of Spanish FBDGs has not been systematically assessed yet. The objective of this review is to identify and assess the methodological quality of Spanish FBDGs, as well as to describe their food guides and key recommendations.

Methods

We conducted a systematic search to identify Spanish FBDGs targeted at the general population using multiple sources. Two authors independently screened the references, extracted data, and assessed the quality of the FBDGs using the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Recommendation Excellence (AGREE-REX) instruments. We performed a descriptive analysis of the FBDGs.

Results

We included 19 FBDGs, published between 2007 and 2019. The median scores for each AGREE II domain were: “scope and purpose” 44% (Q1–Q3: 33–61%); “Stakeholder involvement” 31% (11–44%), “rigor of development” 3% (1–14%); “clarity of presentation” 42% (33–47%), “applicability” 0% (0–6%); and “editorial independence” 0% (0–8%). Six FBDGs (32%; 6/19) were categorized as “recommended with modifications”, and the rest (68%; 13/19) as “not recommended”. None of the FBDGs scored ≥60% in three or more domains, including the “rigor of development” domain. FBDGs indexed in literature databases scored significantly higher in overall rating than those not indexed (P = 0.023). The majority of FBDGs (74%; 14/19) used the pyramid as a food guide representation with a larger number of food levels (3–7 levels). The majority of FBDGs recommended a daily intake of cereals and grains, vegetables, fruits, olive oil and dairy products; a weekly intake of vegetable and animal proteins; and the occasional and limited intake of other food groups (e.g., ultraprocessed foods).

Conclusions

Overall, the methodological quality of FBDGs is poor showing that only 32% of FBDGs are “recommended for use with modifications”. Our results highlight the need to revise, systematize and improve FBDG development processes in Spain.

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Acknowledgements

We would like to thank Ivan Solà for his support in reviewing the search strategy and collecting some full-text documents for screening. We would like to thank all the individuals involved in the development of Spanish FBDGs, who provided additional information about their references for eligibility.

Funding

MR is funded by a Sara Borrell (CD16/00157) post-doctoral contract from the Carlos III Institute of Health and the European Social Fund (ESF).

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Authors and Affiliations

  1. Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain

    Montserrat Rabassa, Yolanda Hernández Ponce, Sònica Garcia-Ribera & Pablo Alonso-Coello

  2. Department of Nutrition, Texas A&M University, College Station, TX, USA

    Bradley C. Johnston

  3. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Bradley C. Johnston

  4. Agència de Salut Pública de Catalunya, Departament de Salut. Generalitat de Catalunya, Barcelona, Spain

    Gemma Salvador Castell & Maria Manera

  5. Department of Physiology, Faculty of Medicine; Spanish Society of Community Nutrition (SENC), University of the Basque Country (UPV/EHU), Biscay, Spain

    Carmen Pérez Rodrigo

  6. University of Navarra, Department of Food Science and Physiology; University of Las Palmas de Gran Canaria (ULPGC), Department of Preventive Medicine and Public Health. University of the Basque Country (UPV/EHU), Department of Physiology, Faculty of Medicine; CIBER-OBN-Instituto de Salud Carlos III, Madrid, Spain

    Javier Aranceta-Bartrina

  7. Department of Preventive Medicine & Public Health, CIBER-OBN-Instituto de Salud Carlos III, University of Navarra, Madrid, Spain

    Miguel Ángel Martínez-González

  8. CIBER-ESP-Instituto de Salud Carlos III, Madrid, Spain

    Pablo Alonso-Coello

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  1. Montserrat Rabassa
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  2. Yolanda Hernández Ponce
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Contributions

MR envisioned and designed the study; MR drafted the protocol, which was reviewed and approved by all authors. MR designed and executed the search strategy. MR and SG-R screened references for eligibility, which were reviewed by SC-G, MM, M-G, MA, MR, and YHP extracted data from eligible FBDGs, which was reviewed by SG-R, MR, and YHP assessed the methodological quality of FBDGs. MR performed the statistical analysis. MR drafted the paper, which was critically reviewed and approved by all authors.

Corresponding author

Correspondence to Montserrat Rabassa.

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Competing interests

PAC and BCJ are members of the GRADE Working Group. For a separate research project, BCJ received funds from Texas A&M AgriLife Research to support investigator-initiated research related to saturated and polyunsaturated fats. Support from Texas A&M AgriLife institutional funds are from interest and investment earnings, not a sponsoring organization, industry, or company.

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Rabassa, M., Hernández Ponce, Y., Garcia-Ribera, S. et al. Food-based dietary guidelines in Spain: an assessment of their methodological quality. Eur J Clin Nutr 76, 350–359 (2022). https://doi.org/10.1038/s41430-021-00972-9

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