Development of WHO nutrition guidelines
The development of global guidelines is one of WHO’s core functions. A rigorous process ensures that WHO guidelines are developed using best practices and making appropriate use of available evidence.
Process for developing nutrition guidelines at WHO
1. Once the need for a guideline on a particular topic has been established, the scope of the guideline is defined, which determines what will and will not be included in the guideline. Scoping of the guideline includes consideration of the areas of practice or policy to which the guideline will apply, and relevant interventions, individuals and/or populations, and important outcomes.
2. The key questions that the guideline needs to address are developed in PICO format (population, intervention, comparator and outcome) and the priority health outcomes that the recommendations intend to influence are identified and prioritized. The questions and outcomes will guide gathering and synthesis of evidence in the form of systematic reviews of the literature.
3. The scope, key questions and prioritized health outcomes are submitted to the GRC for approval.
4. Systematic reviews of the literature are conducted to bring together the available evidence and are frequently commissioned from WHO collaborating centres or other groups with expertise in systematic review methodology.
5. The evidence is reviewed by NUGAG and the quality assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Recommendations are formulated based on the evidence and strength of each recommendation is determined. Several factors are considered in determining the strength, including quality of the evidence, values and preferences, balance of benefits and harms, resource implications, priority of the problem, equity and human rights, acceptability and feasibility.
6. The guideline document is drafted and is reviewed by the external review group. Comments from the general public on the draft guideline are also solicited through a public consultation.
Publishing and updating
7. The finalized guideline is submitted to the GRC for review.
8. The GRC-approved guideline is released.
9. Activities targeting the dissemination, implementation and/or adaption, and evaluation of the guideline are carried out.
10. Plans for updating the guideline are initiated.
Important groups and activities in the nutrition guideline development process
WHO Steering Committee for Nutrition Guideline Development
The WHO Steering Committee for Nutrition Guideline Development was established in 2009 and includes representatives from all departments of WHO with an interest in the provision of scientific advice on nutrition. The Steering Committee oversees and guides the development of nutrition guidelines. It also provides overall supervision of the guideline development process.
Guideline development group
The guideline development group –entitled the WHO Nutrition Guidance Expert Advisory Group (NUGAG)– provides input on the scope of the guideline, key research questions underpinning the recommendations and priority health outcomes; and interprets and evaluates the evidence used to inform development of recommendations.
The NUGAG consists of two subgroups, the NUGAG Subgroup on Diet and Health and the NUGAG Subgroup on Nutrition actions; both include experts from various WHO expert advisory panels and those identified through open calls for specialists. NUGAG members include subject-matter experts (e.g. in nutrition, epidemiology, paediatrics and physiology); experts in programme evaluation, GRADE and related methodologies; and representatives of potential stakeholders (e.g. programme managers, policy advisers and other health professionals involved in the health-care process). Representatives of commercial organizations are not invited to participate because the inclusion of such individuals is considered to be inappropriate for membership of any WHO guideline group due to actual, potential and perceived conflicts of interest.
The external review group
The external review group is established by the WHO Secretariat and generally consists of subject-matter experts , including representatives of public institutions that are members of the WHO Global Network of Institutions for Scientific Advice on Nutrition, and other stakeholders. The external review group may be asked to participate in/contribute to different stages of the guideline development process including review of the scope of the guideline early in the development process and review of the draft guideline prior to finalizing it.
The need for a balanced gender mix and representation from all WHO regions is considered when forming both the NUGAG and external review group.
WHO Guidelines Review Committee (GRC)
All WHO guidelines are approved by the WHO Guidelines Review Committee (GRC) which includes both representatives from the WHO Secretariat and qualified individuals outside of the organization. The GRC ensures that WHO guidelines are of a high methodological quality and are developed through a transparent, evidence-based decision-making process.
The GRC reviews every WHO guideline twice during its development – once after the scope of the guideline has been defined at the initial planning stage, and again after the recommendations have been developed and the guideline has been finalized. The GRC is guided by the standards and procedures outlined in the WHO handbook for guideline development.
The public is invited to provide comments on the draft guideline before it is finalized, via public consultation. Comments from the public may also be collected on the scope, key questions and priority outcomes before this information is submitted to the GRC for approval.
Management of conflicts of interest
All external experts participating in the WHO guideline development process are asked to declare any relevant interests prior to participation. All declarations are reviewed by the WHO Secretariat in consultation with the WHO Legal Office in order to determine eligibility to participate in the guideline development process. Similarly, declaration of interest forms also collected from all those who submit comments during public consultations.