Manual of Clinical Nutrition Management III- 1 Copyright © 2013 Compass Group, Inc.
CLINICAL NUTRITION MANAGEMENT
A REFERENCE GUIDE
INTRODUCTION
The material in this section:
provides the dietitian with relevant evidence-based information to consider in the development of
the nutrition care plan
forms the basis for the development of disease- or condition-specific nutrition interventions and
protocols as required by the organization
As part of Morrison Management Specialists’ strategic plan to support and assimilate evidence-based
research into clinical practice, the Manual of Clinical Nutrition Management integrates the Academy of
Nutrition and Dietetic’s (AND or Academy) recommendations and conclusion-grading statements established
as part of the Academy’s Evidence Analysis Library and evidence-based analysis process. The Academy’s
Evidence Analysis Library (www.andevidencelibrary.com) is an online library that includes a synthesis of the
best, most relevant research on important dietetic practice questions. The library’s resources include
conclusion statements that provide a concise summary of the research on a given question. The Academy has
assigned grades, ranging from Grade I (good/strong) to Grade V (insufficient evidence), to evidence and
conclusion statements. These grades, which are based on the quality and extent of the research, are a tool for
practitioners to use when determining the certainty of information.
The Academy’s grades are integrated throughout the Manual to assist the dietitian in interpreting the
strength and relevance of evidence on a particular topic. The criteria and characteristics of the five grades are
described in Table III-1.
Table III-1: Conclusion Grading Characteristicsa^
Grade I
Good/strong
Quality of studies is strong and free from design flaws, bias, and
execution problems. Uses large number of subjects; outcomes
directly related to question; statistical difference is large and
meaningful; can be generalized to population of interest.
Grade II
Fair
Quality of studies is strong, however, with minor methodological
concerns; inconsistency among results of studies, or studies
evaluated have weaker design; doubts about adequate sample size;
doubts about statistical significance; minor doubts about
generalizability to population of interest.
Grade III
Limited/weak
Studies of weak design; inconclusive findings due to design flaws, bias,
or execution problems; inconsistency among results that cannot be
explained; inadequate sample size; serious doubts about
generalizability to population of interest.
Grade IV
Expert opinion only
No studies available; conclusion based on usual practice, expert
consensus, clinical experience, opinion, or extrapolation from the
research.
Grade V
Insufficient evidence
No evidence pertains to the question being addressed.aThe grading system is based on the grading system from: Greer N, Mosser G, Logan G, Halaas GW. A practical approach to evidence
grading. Jt Comm J Qual Improv. 2000;26:700-712. In September 2004, the Academy’s Research Committee modified the grading system
to this current version.
When necessary, the practitioner can use grading information to assist in clinical decision-making as
described in Table III-2.