The criteria used in evidence-based medicine provide a poor fit for decisions concerning nutrient intake recommendations. For many nutrient-disease relationships, level 1 evidence cannot be ethically obtained. The challenge is to design an approach that will allow responsible development of national policy in the absence of randomized clinical trials. A decision strategy based not on proving benefit but on estimating harm is proposed. We note that not changing a recommendation is itself a recommendation
An alternative view on evidence-based nutrition
Robert P. Heaney, MD, is John A. Creighton University professor at Creighton University, Omaha, Nebraska. He has had a lifelong career devoted to nutritional physiology and is the winner of the McCollum Award of the American Society for Clinical Nutrition and the Atwater Award of the Agricultural Research Service (US Department of Agriculture). He is an honorary member of the American Dietetic Association.
Connie M. Weaver, PhD, is distinguished professor and head of the Department of Foods and Nutrition, Purdue University, West Lafayette, Indiana. She is a member of the Institute of Medicine and a past president of the American Society of Nutrition.
Jeffrey Blumberg, PhD, is a professor of Nutrition Science and Policy at Tufts University, Boston, Massachusetts, and a fellow of the American Society for Nutrition. He has served on the Surgeon General's Workshop on Health Promotion and Aging, Food and Drug Administration Food Advisory Committee, and World Health Organization Expert Consultation on the Development of Nutrition Guidelines for the Elderly.
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No reprints will be available.
Correspondence: Robert P. Heaney, MD, Creighton University, 601 N 30th St, Suite 4841, Omaha, NE 68131 (firstname.lastname@example.org).