Feeding on Networks: A Disservice to Everyone

Numerous researchers have pointed out the alarming prevalence of poorly conducted studies and implausible results in nutrition research. Unless there is a fundamental reform of our research methods, we will continue to drift further away from good scientific practice until we lose all respect. John Ioannidis said:The Challenge of Redesigning Nutritional Epidemiological Research,

“Nutrition research may have negatively impacted public perceptions of the science. The resources of some of these studies could have been better spent on clearly manageable threats to health, such as smoking, lack of exercise, air pollution, or climate change. Furthermore, the perpetuated epidemiological model of nutrition is likely to undermine public health nutrition. Unfounded beliefs that justify eating more if ‘quality food’ is consumed confuse the public and distract from the agenda of preventing and treating obesity.”

If researchers do not approach the issue critically, media outlets and social media influencers will continue to use studies to gain attention rather than inform the public of the need to interpret this information with caution. These concerns have good basis.

Nutrition online

A systematic review It was published Public Health Nutrition We aimed to summarize the level of quality and accuracy [1] for nutrition-related information on websites, such as healthy eating, nutrients, dietary supplements, food-related health outcomes, and dietary patterns. Additionally, the review aimed to determine whether there were differences in these two factors across websites, social networks, or publishers.

The final analysis included 64 studies published between 1996 and 2021.

• There was an increasing trend in the number of publications on the subject; while there was 1 publication in 1996, it increased to 11 publications in 2020 (the year with the most publications).
• Most studies did not focus on information published in a specific region; those that did, generally assessed information published in high-income countries.
• The most studied topics were disease management (26.6%), general nutrition (23.4%) and maternal-child nutrition (15.6%).
• While the number of shares on social media and websites varied between 4 and 2,770, each post was shared on average 165.7 times.
• Studies were classified as at risk of bias. [2]

Most studies were rated as neutral (51.6%) or negative (28.1%), primarily due to the potential risk of bias in sample selection. Importantly, some studies did not use or report methods to measure result reliability.

Quality

Study quality was assessed in forty-one studies using three different methods [3]

• 48.8% of studies were classified as weak – “the final conclusion of the study was cautious or negative.” The absence of references in the source material was the primary factor contributing to this rating.
• Social media posts were rated “bad” 62.5% of the time, compared to websites, which were 47.1% more often.
• The proportion of topics on weight loss and supplements that were rated as “poor” in quality was higher.
• A higher proportion of “good” ratings were seen for topics related to child and maternal nutrition; “positive outcomes or outcomes that do not raise concerns.”

Precision

Precision Forty-seven studies were analysed to assess accuracy when compared with authoritative guidelines, academic literature or scoring systems.

• 48.9% of studies were classified as weak
• While social media and websites are each about 50% worse off, YouTube is even worse off.
• Topics related to weight loss and supplements were rated more likely to be “poor” in accuracy.
• Some topics received low scores despite being assessed by only one study (e.g., immune function and sports nutrition).

Quality and Accuracy

Finally, both quality and accuracy were analyzed in 27 articles.

• Government and commercial websites received mixed scores, with some studies rating them high and others rating them low.
• The most positive in terms of both quality and accuracy were institutions and academic institutions.
• Interestingly, Wikipedia was analyzed in two studies: One study rated it high for quality and accuracy, while the other rated it medium.

While the review had some important limitations, such as excluding studies that did not provide specific data sought and ignoring readability (a factor that makes it easier to read) in search terms, the authors concluded that poor quality and inaccurate nutrition information is widespread on websites and social networks. This is increasingly a concern as social media becomes an increasingly important source of nutrition information. The authors suggest that accredited experts and nutritionists should publish and promote high-quality content, while social networks and online platforms should exercise stricter control over the information shared on their sites.

I am skeptical that accredited professionals alone can solve this problem. We have all come across profiles of professionals with often impressive credentials who use scientific jargon and claim to base their practices on evidence. Yet these individuals selectively present biased studies. Pointing out errors or writing critical articles about such professionals may not change the views of their followers. Those who support these professionals are likely to continue to believe in their credibility while dismissing dissenting opinions.

Who watches the watchdog?

Imagine two online sources that publish different information on a particular topic, both run by respected professionals. Which one provides high-quality information? You might say that it provides the best evidence, and I would agree. However, simply “reading” the best evidence is not enough; correct interpretation is vital. More importantly, can one of these perspectives be ignored simply because it disagrees with the prevailing consensus?

I don’t have the answers to these questions, but I believe there is no “definitive solution” to the problem; there are currently no gold standard guidelines. Fortunately, some authors have investigated this issue and suggested measures to address it.

A review It is a study that aims to identify interventions to manage the excess of both true and false information in Health Policy, which makes the search for reliable sources difficult. [4] The authors recommend four interventions.

The interventions were categorized into four levels of prevention as follows:

• Primitive: Interventions focused on building resilient communities and health systems that are resistant to misinformation. These are the cornerstones of transparency, encouraging dialogue, and providing access to high-quality scientific information, all of which rebuild and maintain trust in government, science, and health professionals.
• Priority: Broad strategies to reduce susceptibility to misinformation through education and training programs to improve digital health literacy and identify common manipulative techniques (e.g., emotionally provocative content)
• Secondary: Identify and address certain false or misleading claims and take action to prevent them.
• Tertiary: This phase focuses on reducing the negative impacts of information epidemics on public health, including fact-checking, partnerships with the media sector to prevent inaccuracies or exaggerations in reporting, and platform-based interventions to prevent the spread of harmful misinformation through content moderation and platform regulation.

While many of these interventions appear promising on paper, their real-world effectiveness remains uncertain.

We have a long way to go, and we continue to face many challenges around misinformation. If I had to sum it all up in one piece of advice, it would be this: Be mindful of the content you consume, the profiles you follow, and especially the information shared by people you trust. Often, your critical sense is less alert when it comes from someone who shares your views. In times of widespread misinformation, questioning and skepticism are good ways to avoid being misled.

[1] Quality included reliability of information, balance and impartiality, references, and transparency. Accuracy was the actual accuracy of the information, typically compared with scientific literature or recognized guidelines.

[2] The authors used an adapted version Nutrition and Dietetics Academy Quality Criteria Checklist including relevance and validation questions. The authors adopted three questions: Is the review question clear and appropriate? Is the search strategy comprehensive and well-defined? Are the processes of abstraction, synthesis, and analysis defined and consistently applied? To be classified as positive, all three questions must have positive answers; otherwise, the rating will be neutral or negative.

[3] Criteria also include those developed by the authors. DISTINGUISH“a brief survey that provides users with a valid and reliable way to assess the quality of written information about treatment options for a health problem,” and JAMA Criteriauses four basic standards to evaluate websites: authorship, attribution, description, and currency.

[4] While I am generally wary of narrative reviews because of the potential for bias and the tendency to tell a story, I believe this study offers exciting ideas that can contribute to developing a more effective model for health information management.

Sources: Quality and accuracy of online nutrition information: a systematic review of content analysis studies. Public Health Nutrition. DOI: 10.1017/S1368980023000873

Beyond misinformation: Developing a public health prevention framework for managing information ecosystems.Lancet Public Health. DOI: 10.1016/S2468-2667(24)00031-8

The Challenge of Redesigning Nutritional Epidemiological Research. JAMA. DOI: 10.1001/jama.2018.11025.