This review by Hemingway et al BMJ 20th Feb 2010 pp 410 ( Ten steps towards improving prognosis research)is to my mind of paramount importance for nutritionists. They strongly criticise the science of prognosis in clinical medicine.They describe low quality,low impact prognosis research in clinical medicine which is then inflated by the Media.
Are we in nutrition any better?
The authors define prognosis research as the study of the relationship between
occurrences of outcomes and predictors in defined populations of people with disease.
Observational research evaluating three broad questions.
1. Causes of disease progression
2. Prediction of risk in individuals
3. And individual response to treatment
They site instances where multiple papers have been written which have failed to answer quite simple prognostic questions.
They identify 10 areas where specific actions would make studies more reliable.
The goals should be
1. Identification of single biomarkers that independent association with outcome.
2. Development of multivariable risk prediction models that predict an individual’s outcome.
3. Identification of biomarkers that predict response to treatment
The translation of emerging putative prognostic biomarkers from the laboratory to the bedside(or table ).
This is a science that Nutrition could look at with advantage.
We have good logic for
1. 5 pieces of fruit and vegetable a day
2. Low salt intake
3. Plenty of fibre in the diet.
4. Being overweight
Have we evidence that changing our life styles to accommodate to these dietary challenges makes any difference to health or life expectation? Are these recommendations applicable to all age groups and physical states e.g. growth, pregnancy.
Good prognostic studies might be helpful.
Hemingway et al 2010 Ten steps towards improving prognosis research BMJ vol 340 pp 410-413
- Martin Eastwood