Differing methodological quality but identical recommendations? - Assessment of methodological quality and content analysis of Clinical Practice Guidelines and Food-based Dietary Guidelines in early childhood allergy prevention

ObjectiveRecommendations on early childhood allergy prevention (ECAP) are found in clinical practice guidelines (CPG) and food-based dietary guidelines (FBDG). This study aims to compare the methodological quality and the content of recommendations in CPGs and FBDGs for ECAP. Study Design and SettingWe assessed methodological quality of a sample of 36 guidelines (23 CPGs, 13 FBDGs), retrieved through extensive searching, with the Appraisal of Guidelines for Research and Evaluation tool (AGREE) II. On a subset of recommendations, we performed an in-depth analysis by type of intervention for direction of and strength of recommendation and level of evidence. Descriptive analysis was conducted with SPSS 27. ResultsCPGs scored higher than FBDGs in most AGREE domains (3, 4, 5 and 6). The 36 guidelines contain 280 recommendations on ECAP, with 68 addressing the introduction of complementary foods and allergenic foods. We found only slight differences between those recommendations in CPGs and FBDGs. ConclusionFBDGs on ECAP are of lower quality than CPGs. This does not affect their recommendations on the introduction of complementary foods and allergenic foods but may compromise their trustworthiness. What is new?- Methodological quality of guidelines on ECAP is low, especially in FBDGs - Recommendations on introduction of complementary feeding rarely vary - Recommendations on introduction of potential allergenic foods show slight variation - More attention is needed on the slight differences and the underlying evidence