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      Why context matters when changing the diet: A narrative review of placebo, nocebo, and psychosocial context effects and implications for outcome research and nutrition counselling

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          Abstract

          Placebo (PE) and nocebo effects (NE) have been subjects of systematic research in medicine and psychotherapy for many decades to distinguish between the (specific) pharmacological effect of medication and the (unspecific) effect of the context. Despite this significant research, the awareness, operationalisation, and reflection of the multiplicity of PE, NE, and psychosocial context effects (PSCE) is currently limited when researching outcomes of diet changes in studies without randomisation and placebo control. This neglection is critical as it could systematically influence outcomes by moderating and mediating them and thus reducing the validity and evidence base of these studies. Therefore, we performed a (non-systematic) narrative review (NR) on the following objectives: (1) present a concise overview about the relevance of PE, NE, and PSCE in medicine and nutrition research; (2) review the current state of research on reflecting context effects when studying diet changes; (3) provide useful theoretical foundations via consideration and integration of micro- and macro context effects; (4) operationalise as hypotheses the potential PE, NE, and PSCE which are specific for researching diet changes; and (5) derive their impact for future research as well as for nutrition counselling. The electronic search in this NR for objective (2) identified N = 5 publications and for objective (4) we found N = 61 articles retrieved in the first round of search, additional references were identified by a manual and snowball search among the cited references resulting finally in N = 37. This NR offers a synoptical basis to foster awareness and operationalisation of a variety of PE, NE, and PSCE. Interdisciplinary research teams should monitor these factors using, e.g., qualitative, mixed-method studies, process evaluation, item bank approaches, moderator and mediator analysis that might reveal substantially new insights, and outcomes of relevance to science and nutrition counselling. Nevertheless, the present NR has several limitations, especially as it is non-systematic, because it is a very heterogeneous field of research, in which the topic we are investigating is usually regarded as marginal and subordinate. Therefore, future research should conduct systematic reviews and particularly theory-based primary studies (experimental research) on hypotheses of PE, NE, and PSCE in outcome research in diet changes.

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          The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.

          In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
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                Author and article information

                Contributors
                Journal
                Front Nutr
                Front Nutr
                Front. Nutr.
                Frontiers in Nutrition
                Frontiers Media S.A.
                2296-861X
                28 October 2022
                2022
                : 9
                : 937065
                Affiliations
                [1] 1Department of Medicine, Faculty of Health, Integrated Curriculum for Anthroposophic Medicine (ICURAM) and Institute of Integrative Medicine, Witten/Herdecke University , Witten, Germany
                [2] 2Research Methods in Health Sciences, University of Education , Freiburg, Germany
                [3] 3Department of Psychosomatic Medicine, Gemeinschaftskrankenhaus Herdecke , Herdecke, Germany
                [4] 4Department of Medicine, Faculty of Health, Witten/Herdecke University , Witten, Germany
                [5] 5Department of Psychology and Psychotherapy, Faculty of Health, Witten/Herdecke University , Witten, Germany
                Author notes

                Edited by: Nina Cecilie Øverby, University of Agder, Norway

                Reviewed by: Jeanette Mary Andrade, University of Florida, United States; Naomi Kakoschke, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Australia

                *Correspondence: Melanie Neumann, melanie.neumann@ 123456uni-wh.de

                These authors have contributed equally to this work and share first authorship

                This article was submitted to Nutrition Methodology, a section of the journal Frontiers in Nutrition

                Article
                10.3389/fnut.2022.937065
                9650541
                36386910
                58bdf0de-850a-443e-bf21-43336870da12
                Copyright © 2022 Neumann, Wirtz, Lutz, Ernesti and Edelhäuser.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 05 May 2022
                : 11 October 2022
                Page count
                Figures: 4, Tables: 1, Equations: 0, References: 180, Pages: 18, Words: 13332
                Funding
                Funded by: Software AG – Stiftung , doi 10.13039/501100014542;
                Funded by: Karl und Veronica Carstens-Stiftung , doi 10.13039/501100006709;
                Categories
                Nutrition
                Review

                placebo effect,nocebo effect,psychosocial context effects,diet change,nutrition research,nutrition counselling/therapy,narrative review

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