Methods used to select results to include in meta-analyses of nutrition research: a meta-research study

Raju Kanukula, Joanne E. McKenzie, Lisa Bero, Zhaoli Dai, Sally McDonald, Cynthia M. Kroeger, Elizabeth Korevaar, Matthew J. Page

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Objectives: To investigate how often review authors encounter multiple results from included studies that are eligible for inclusion in a particular meta-analysis, and how often methods to select results are specified.

Methods: MEDLINE and Epistemonikos were searched (January 2018 - June 2019) to identify systematic reviews with meta-analysis of the association between food/diet and health-related outcomes. A random sample of these reviews was selected, and for the first presented ('index') meta-analysis, rules used to select effect estimates to include in this meta-analysis were extracted from the reviews and their protocols. All effect estimates from the primary studies that were eligible for inclusion in the index meta-analyses were extracted (e.g. when a study report presented effect estimates for blood pressure at 3 weeks and 6 weeks, both unadjusted and adjusted for covariates, and all were eligible for inclusion in a meta-analysis of the effect of red meat consumption on blood pressure, we extracted all estimates and classified the study as having "multiplicity of results").

Results: Forty-two systematic reviews with 325 studies (104 randomized, 221 non-randomized) were included; 14 reviews had a protocol. In 29% of review protocols and 69% of reviews, authors specified at least one decision rule to select effect estimates when multiple were available. In 68% of studies included in the index meta-analyses, there was at least one type of multiplicity of results.

Conclusions: Authors of systematic reviews of nutrition studies should anticipate encountering multiplicity of results in the included primary studies. Specification of methods to handle multiplicity when designing reviews is therefore recommended.

Original languageEnglish
Pages (from-to)171-183
Number of pages13
JournalJournal of Clinical Epidemiology
Early online date12 Nov 2021
Publication statusPublished - Feb 2022

Bibliographical note

Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • Nutrition
  • Meta-analysis
  • Systematic review
  • Multiplicity
  • Eligibility criteria
  • Decision rule


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