Table 4.

Main methodological differences between the GRADE Evidence to Decisions framework [60], and approaches taken by the 3rd World Cancer Research Fund/ American Institute for Cancer Research Expert report [8], and the USDA Dietary Guidelines for Americans 2015–2020 [7]

Macro-level	Micro-level	GRADE		3rd WCRF/AICR Reporta		USDA DGA 2015–2020b
		Y/N/U	Explanation	Y/N/U	Explanation	Y/N/U	Explanation
Conflict of interest from committee members	Intellectual and financial conflicts	Y	Should be reported	N	Not reported	U	Per Federal Advisory Committee Act rules, Advisory Committee members were thoroughly vetted for conflicts of interest before they were appointed to their positions and were required to submit a financial disclosure form annually
EtDs framework	Problem	Y	Problem priority definition?	U	N/A	U	N/A
	Benefit and harms	Y	How substantial are beneficial/harmful effects?	U	N/A	N	N/A
	Certainty of evidence	Y	see Table 2	Y	see Table 2	Y	see Table 2
	Values	Y	How much people value the main outcomes?	N	N/A	N	N/A
	Balance of effects	Y	Balance between desirable and undesirable effects?	N	Panel has sometimes not made recommendations despite strong evidence; because of potentially adverse effects (dairy and prostate cancer) on one cancer despite evidence of protection for another (e.g., dairy and colorectal cancer)	N	N/A
	Resources required	Y	How large are the costs?	N	N/A	N	N/A
	Cost effectiveness	Y	Cost effectiveness of the intervention?	N	N/A	N	N/A
	Equity	Y	Impact on health equity?	N	N/A	N	N/A
	Acceptability	Y	Option acceptable to key stakeholders?	N	N/A	N	N/A
	Feasibility	Y	Implementation feasible?	U	Sometimes not feasible	N	N/A
Recommendation	Strength of recommendation	Y	Strong, weak (conditional, discretional, or qualified)	Y	Recommendations were made only when the CUP Panels judged the evidence sufficiently strong (when exposure was convincingly/probably or causally linked to cancer risk)	U	The grades used for conclusion statements also fall into one of four categories (as the certainty of evidence evaluation): strong, moderate, limited, and grade not assignable

CUP continuous update project, EtDs Evidence to Decisions, N no, N/A not applicable, U unclear, Y yes

^aWorld Cancer Research Fund/American Institute for Cancer Research report is the most comprehensive global research project on diet, and physical activity and cancer risk or survival [8]

^bThe United States Department of Agriculture’s Dietary Guidelines for Americans 2015–2020 are the most comprehensive guidance for healthy eating in the US and worldwide [7]