grade

The GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) is a method of assessing the certainty in evidence (also known as quality of evidence or confidence in effect estimates) and the strength of recommendations in health care. It provides a structured and transparent evaluation of the importance of outcomes of alternative management strategies, acknowledgment of patients and the public values and preferences, and comprehensive criteria for downgrading and upgrading certainty in evidence. It has important implications for those summarizing evidence for systematic reviews, health technology assessments, and clinical practice guidelines as well as other decision makers.However, when used to summarize evidence from nutritional science, dietary, lifestyle and environmental exposure the use of the GRADE approach has been criticized. That is because the GRADE system only allows for randomized controlled trials (RCT) to be rated as high evidence and rates all observational studies as low evidence because of their potential of confounding. This dismisses the strength of observational studies when it comes to long-term effects of dietary and lifestyle factors and does not reflect the key limitations that RCTs have when it comes to long-term effects. One example of a slowly progressing disease that should preferably be studied with observational studies but not RCTs is atherosclerosis.

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