Scanning for New Evidence on the Nutrient Content of Human Milk A Process Model for Determining Age-Specific Nutrient Requirements (2020) / Chapter Skim
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2 Methodological Approach to Evidence Scanning
2 Methodological Approach to Evidence Scanning
Pages 9-16
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identify new evidence on existing DRI nutrients in human milk that could inform future DRI reviews. APPROACH The committee approached its task by designing a literature search strategy with the objective of identifying articles on nutrients to provide information for updating the USDA SR Database and to inform future DRI reviews.
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. The experts were asked to develop their presentations in response to the following objectives for the evidence scan: • Identify current evidence on the nutrient content and volume of human milk; • Develop a literature search strategy for the evidence scan; and • Identify a methodological strategy for assessing the results of the literature search.
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TABLE 2-1 Prespecified Criteria for Assessing the Relevance of Identified Evidence: Key Question 1: Nutrient Composition of Human Milk Component Criteria Populations Human Include • Adult women (≥ 18 years of age) with generally healthy, full-term, singleton infants living in a high-income or upper middle-income countrya • Generally healthy, full-term infants living in a high-incomeb or upper middle-income countryc during the study Exclude • Infants older than 12 months of age at the time of study enrollment • Infants with low birth weight or premature birth • Women taking nutritional supplementsd or galactagoguese Exposures Milk (e.g., lactation, breastfeeding)
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. g The committee chose to exclude data regarding milk produced in the first week postpartum to avoid data that may represent the colostral phase of milk production.
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with generally healthy, full-term, singleton infants living in a high-incomea or upper middle-incomeb country during the study Exclude • Infants older than 6 months at the time of study enrollment • Infants 0–5.9 months not exclusively breastfed • Women taking nutritional supplements or galactogoguesc Exposures Volume of milk (e.g., lactation, breastfeeding) consumed by infant Exclude • Colostrumd Comparators Not relevant for this evidence scan Outcomes Not relevant for this evidence scan Study Designs Include • Publications from 1980e or more recent • Randomized controlled trials • Observational prospective cohort studies and case-control studies • Cross-sectional studies Exclude • Case studies, mechanistic studies • Studies with no primary data including systematic reviews, narrative reviews, editorials, conference abstracts, theses, and commentaries • Studies presenting data obtained using methods not considered adequate o Population size, milk collection procedures, and analytical methods not considered adequate (see Appendix B)
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The search process is shown in Figure 2-1. Syntax and Language Terms The National Academies' research staff compiled a literature search strategy based on the committee's prespecified criteria for nutrient composition and milk volume (see Tables 2-1 and 2-2, respectively)
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Studies on milk volume were examined for the methods used to measure milk volume and for infants 0–5.9 months exclusively breastfeeding. Each article was examined by two committee members: one as a primary data extractor and one as a secondary validator who verified extracted data; conflicts were resolved by discussion between the data abstractor and the validator, which confirmed that the study was truly eligible for inclusion.
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2009. Opportunities and challenges in conducting systematic reviews to support the development of nutrient reference values: Vitamin A as an example.
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