Guidelines, guidelines, guidelines: what are we to do with all of these North American guidelines?

Over the past decade, clinical guidelines for nutrition therapy in the critically ill have been developed by different North American societies. To avoid target audience confusion and uncertainty, there is a need to undergo a review of the content of these guidelines. In this review, the authors compared the grading systems, the levels of evidence used, and the content of North American nutrition clinical guidelines. The 3 clinical guidelines that met their search criteria and hence were included in the comparison are the Canadian Clinical Practice Guidelines, the American Dietetics Association's evidence-based guideline for critical illness, and the Society of Critical Care Medicine and American Society of Parenteral and Enteral Nutrition's joint guideline. Through their comparison, the authors have shown that although there are several topics where there is a similar direction of recommendation across the 3 societies/organizations, there are stark contrasts among many of the recommendations. These major differences can be attributed to the admission of different populations, lower levels of evidence or expert opinion into the guideline production process, lack of clarity in the link between the evidence and the recommendation, and lack of uniformity in the reporting of levels of evidence and grades of recommendation. The authors have identified the need for the North American nutrition organizations to harmonize the development of future nutrition guidelines in a timely way, so that they remain current and up-to-date. Furthermore, guideline users need to be aware of the dissimilarities in these guidelines before applying the recommendations to their daily practice.

Direct diet quantification indicates low intakes of (n-3) fatty acids in children 4 to 8 years old.

Estimates of essential fatty acid intakes, including (n-3) PUFA, are available in pediatric populations based on limited indirect approaches. Furthermore, recommended intakes for short- and long-chain (LC) (n-3) PUFA have emerged for this population. This study provides direct quantification of fatty acid intakes in children aged 4-8 y. Identical portions of all food and natural health products consumed over 3 d were collected. Duplicate samples were analyzed for energy, macronutrients, and fatty acids, including alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) by high performance capillary GLC. The results for 41 children [25 females, 16 males; 5.8 +/- 0.2 y (mean age +/- SEM)] showed daily energy intakes of 5879 +/- 211 kJ (mean +/- SEM) and (n-3) PUFA intakes in mg/d as follows: ALA, 1161 +/- 108; EPA, 38.4 +/- 9.3; DPA, 26.3 +/- 3.9; and DHA, 54.1 +/- 11.4. Based on the Dietary Reference Intakes from the Institute of Medicine, 61% of the children met the adequate intake for ALA and 22% met the suggested adequate intake for DHA+EPA (10% of the adequate intake for ALA). These intakes were also compared with the recent Australia/New Zealand recommendations for children, where only 51% met the recommended intake for EPA+DPA+DHA. These results demonstrate a moderate shortfall in ALA intake in Canadian children and a nutrient gap for the LC (n-3) PUFA, including DHA, when comparing intakes for this population to suggested and recommended intakes.