How reliable are randomised controlled trials for studying the relationship between diet and disease? A narrative review.
Large numbers of randomised controlled trials (RCT) have been carried out in order to investigate diet-disease relationships. This article examines eight sets of studies and compares the findings with those from epidemiological studies (cohort studies in seven of the cases). The studies cover the role of dietary factors in blood pressure, body weight, cancer and heart disease. In some cases, the findings from the two types of study are consistent, whereas in other cases the findings appear to be in conflict. A critical evaluation of this evidence suggests factors that may account for conflicting findings. Very often RCT recruit subjects with a history of the disease under study (or at high risk of it) and have a follow-up of only a few weeks or months. Cohort studies, in contrast, typically recruit healthy subjects and have a follow-up of 5-15 years. Owing to these differences, findings from RCT are not necessarily more reliable than those from well-designed prospective cohort studies. We cannot assume that the results of RCT can be freely applied beyond the specific features of the studies.
Centre for Science,Athabasca University,Athabasca,AB,Canada,T9S 3A3.
Norman J
NJ
Temple
D002318:Cardiovascular Diseases / Q000178:diet therapy / Q000517:prevention & control; D004032:Diet; D005247:Feeding Behavior; D006801:Humans; D009369:Neoplasms / Q000178:diet therapy / Q000517:prevention & control; D009765:Obesity / Q000178:diet therapy / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic / Q000379:methods*
BP blood pressure; Cohort studies; DASH Dietary Approaches to Stop Hypertension; Diet–disease research; Nutrition methods; RCT randomised controlled trial; Randomised controlled trials; SSB sugar-sweetened beverages