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A suggestion for quality assessment in systematic reviews of observational studies in nutritional epidemiology
Jong-Myon Bae
Epidemiol Health. 2016;38:e2016014.   Published online April 26, 2016
DOI: https://doi.org/10.4178/epih.e2016014
  • 20,624 View
  • 248 Download
  • 53 Web of Science
  • 58 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
It is important to control the quality level of the observational studies in conducting meta-analyses. The Newcastle-Ottawa Scale (NOS) is a representative tool used for this purpose. We investigated the relationship between high-quality (HQ) defined using NOS and the results of subgroup analysis according to study design.
METHODS
We selected systematic review studies with meta-analysis which performed a quality evaluation on observational studies of diet and cancer by NOS. HQ determinations and the distribution of study designs were examined. Subgroup analyses according to quality level as defined by the NOS were also extracted. Equivalence was evaluated based on the summary effect size (sES) and 95% confidence intervals computed in the subgroup analysis.
RESULTS
The meta-analysis results of the HQ and cohort groups were identical. The overall sES, which was obtained by combining the sES when equivalence was observed between the cohort and case-control groups, also showed equivalence.
CONCLUSIONS
The results of this study suggest that it is more reasonable to control for quality level by performing subgroup analysis according to study design rather than by using HQ based on the NOS quality assessment tool.
Summary
Korean summary
관찰연구에 대한 메타분석을 수행할 때, 선정된 논문들의 질적 수준을 통제하기 위해 개발된 Newcastle-Ottawa Scale (NOS)는 평가 항목의 속성상 환자-대조군연구보다는 코호트 연구에서 High quality (HQ) 판정이 될 가능성이 높다. 이에, 식이와 암의 관련성을 연구한 관찰연구에 대한 메타분석에 있어 대부분의 코호트 연구를 HQ로 판정하였기에, HQ 군과 Cohort 군의 메타분석 결과는 동일하였다. 코호트군과 환자-대조군 간의 summary effect size (sES)가 동질성을 보일 경우 이를 합친 Overall sES 또한 동질성을 보였다. 이에, 식이역학에 특화된 질적평가도구가 개발되기 까지는 NOS를 적용하기 보다는 연구설계별로 하부군 분석을 하는 것을 권한다.

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Methods
Comparison of methods of extracting information for meta-analysis of observational studies in nutritional epidemiology
Jong-Myon Bae
Epidemiol Health. 2016;38:e2016003.   Published online January 11, 2016
DOI: https://doi.org/10.4178/epih.e2016003
  • 18,001 View
  • 252 Download
  • 10 Web of Science
  • 8 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
A common method for conducting a quantitative systematic review (QSR) for observational studies related to nutritional epidemiology is the “highest versus lowest intake” method (HLM), in which only the information concerning the effect size (ES) of the highest category of a food item is collected on the basis of its lowest category. However, in the interval collapsing method (ICM), a method suggested to enable a maximum utilization of all available information, the ES information is collected by collapsing all categories into a single category. This study aimed to compare the ES and summary effect size (SES) between the HLM and ICM.
METHODS
A QSR for evaluating the citrus fruit intake and risk of pancreatic cancer and calculating the SES by using the HLM was selected. The ES and SES were estimated by performing a meta-analysis using the fixedeffect model. The directionality and statistical significance of the ES and SES were used as criteria for determining the concordance between the HLM and ICM outcomes.
RESULTS
No significant differences were observed in the directionality of SES extracted by using the HLM or ICM. The application of the ICM, which uses a broader information base, yielded more-consistent ES and SES, and narrower confidence intervals than the HLM.
CONCLUSIONS
The ICM is advantageous over the HLM owing to its higher statistical accuracy in extracting information for QSR on nutritional epidemiology. The application of the ICM should hence be recommended for future studies.
Summary
Korean summary
영양역학과 관련하여 관찰연구 결과를 체계적 고찰을 할 때, 통상적으로 섭취가 가장 낮은 군을 기준으로 하여 가장 높은 군의 effect size (ES) 정보를 추출하는 Highest versus Lowest Method (HLM)을 적용한다. 그러나 주어진 정보를 최대한 활용한다는 점에서 구간의 정보들을 통합한 ES 정보로 메타분석에 적용하는 Interval Collapse Method (ICM)법이 제안되었다. HLM에 비하여 더 많은 정보를 활용한 ICM 적용을 한 결과, ES 뿐만 아니라 SES에서도 일치성을 보이면서 표준오차가 작아지는 현상을 확인하였다. 영양역학의 메타분석을 위해 추출하는 방법 중 정보를 보다 더 많이 활용하는 ICM이 HLM에 비하여 통계적 정확성의 이득을 더 갖기 때문에, 향후 적극 활성화할 필요가 있다.

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