Protocol for update of food-based dietary guidelines for Czechia

Background: Current Czech national food based dietary guidelines are outdated and do not reflect the most recent scientific evidence, nor considerations of sustainability and equity. Building on the Nordic Nutrition Recommendations 2023 (NNR), this project aims to develop updated, evidence based food based dietary guidelines (FBDGs) for the Czech Republic. Objectives: To systematically update the evidence on associations between major food groups and health outcomes, integrate environmental and equity dimensions, and formulate clear, feasible, and context specific recommendations through a structured consensus process. Methods: For each food group, a PICO framework will be defined. Existing systematic reviews from NNR provide the evidence base. Systematic update searches will cover the period from the NNR search cut-off until the present. Dual independent screening is performed, with artificial intelligence used as a secondary reviewer. Risk of bias will be assessed with RoB 2 (randomized trials), ROBINS I (non randomized interventions), ROBINS E/RoB NObs (observational exposure studies), and AMSTAR-2/ROBIS (systematic reviews). Certainty of evidence is graded with GRADE, complemented by NutriGrade where relevant. Parallel assessments summarize environmental impacts and equity/feasibility aspects. For each topic, concise evidence briefs will be prepared. Draft recommendation statements will be evaluated in a two-round modified Delphi process against five criteria (evidence consistency, clarity, feasibility and acceptability, equity, environmental impact). Consensus will be defined as a median score of 7 to 9 with less than one third of ratings under 6. Discussion and dissemination: The project will deliver transparently developed, evidence based, and implementable food based dietary guidelines for the Czech Republic. Outputs will include final recommendations for the public and practice, a technical background report, and a record of comments and their resolution. All materials will be made openly available and presented to stakeholders, including public consultation groups.