Standards of Nutritional Care for Patients with Cystic Fibrosis: A Methodological Primer and AGREE II Analysis of Guidelines
Maria G. Grammatikopoulou,
Tonia Vassilakou,
Dimitrios G. Goulis,
Xenophon Theodoridis,
Meletios P. Nigdelis,
Arianna Petalidou,
Konstantinos Gkiouras,
Dimitrios Poulimeneas,
Olga Alexatou,
Kyriaki Tsiroukidou,
Georgios Marakis,
Zoe Daniil,
Dimitrios P. Bogdanos
Affiliations
Maria G. Grammatikopoulou
Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, 57400 Thessaloniki, Greece
Tonia Vassilakou
Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 11521 Athens, Greece
Dimitrios G. Goulis
Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece
Xenophon Theodoridis
Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
Meletios P. Nigdelis
Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece
Arianna Petalidou
Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
Konstantinos Gkiouras
Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
Dimitrios Poulimeneas
Department of Nutrition & Dietetics, Harokopio University, 17676 Athens, Greece
Olga Alexatou
Department of Nutrition & Dietetics, Harokopio University, 17676 Athens, Greece
Kyriaki Tsiroukidou
3rd Department of Pediatrics, Hippokration General Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
Georgios Marakis
Nutrition and Food Standards Unit, Risk Assessment and Nutrition Directorate, Hellenic Food Authority, 11526 Athens, Greece
Zoe Daniil
Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
Dimitrios P. Bogdanos
Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
Although many Clinical Practice Guidelines (CPGs) have been published for the care of patients with Cystic Fibrosis (CF), including a variety of nutrition recommendations, the quality of these CPGs has never been evaluated. The aim of this study was to compare, review, and critically appraise CPGs for the nutritional management of CF, throughout the lifespan. We searched PubMed, Guidelines International Network (GIN), ECRI Institute, and Guidelines Central for CPGs, with information on the nutritional management of CF. Retrieved CPGs were appraised by three independent reviewers, using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument and checklist. A total of 22 CPGs (seven solely nutrition oriented), by 14 different publishers, were retrieved. The Thoracic Society of Australia and New Zealand CPGs scored the highest overall quality (94.4%), while the Paediatric Gastroenterology Society/Dietitians Association of Australia CPGs had the lowest score (27.8%). Great variation in AGREE II domain-specific scores was observed in all CPGs, suggesting the existence of different strengths and weaknesses. Despite the availability of several CPGs, many appear outdated, lacking rigor, transparency, applicability, and efficiency, while incorporating bias. Considering that CPGs adherence is associated with better outcomes and the need for improving life expectancy in patients with CF, the development of CPGs of better quality is deemed necessary.
