Chapter One:

Introduction to Nutritional
Epidemiology

Mr.Abdiwali Abdirashiid Aroush

Lecturer at Eelo University (EU)
 Definitions

Health: A state of complete physical, mental and social

well-being and not merely the absence of disease or
infirmity (WHO,1948)

Disease: A physiological or psychological dysfunction

Illness: A subjective state of not being well

Sickness: A state of social dysfunction

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 Definitions…

Public health

The science & art of

Preventing disease,
prolonging life,
promoting health & efficiency
through organized community effort (Winslow,
1920)

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 Definitions…
Epidemiology

It is the study of frequency, distribution, and

determinants of diseases and other health-related
conditions in a human population
and
the application of this study to the prevention of
disease and promotion of health.

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 Components of the definition

1.Study: Systematic collection, analysis and

interpretation of data.

Epidemiology involves collection, analysis and

interpretation of health related data.

Epidemiology is a science

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 Components…

2. Frequency: the number of times an event

occurs.

Epidemiology studies the number of times a

disease occurs.

It answers the question How many?

Epidemiology is a quantitative science

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 Components…

3. Distribution: Distribution of an event by person,

place and time.

Epidemiology studies distribution of diseases

It answers the question who, where and when?

Epidemiology describes health events

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 Components…

4. Determinants: Factors the presence/absence of

which affect the occurrence and level of an event

Epidemiology studies what determines health

events
It answers the question how and why?

Epidemiology analyzes health events.

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 Components…

5. Diseases & other health related events

Epidemiology is not only the study of diseases

The focus of Epidemiology are not only patients

It studies all health related conditions

Epidemiology is a broader science

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 Components…

6. Human population

Epidemiology diagnoses and treats

communities/populations

Clinical medicine diagnoses and treats patients

Epidemiology is a basic science of public health

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 Components…

7. Application

Epidemiological studies have direct and practical

applications for prevention of diseases &
promotion of health.

Epidemiology is a science and practice

Epidemiology is an applied science

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 History of Epidemiology

1. Hippocrates (460BC): Environment & human

behaviors affects health
2. John Graunt (1662): Quantified births, deaths
and diseases
3. Lind (1747): Scurvy could be treated with fresh
fruit

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 History…

4. William Farr (1839): Established application of vital

statistics for the evaluation of health problems
5. John Snow (1854): tested a hypothesis on the origin
of epidemic of cholera
6. Bradford Hill (1937): Suggested criteria for
establishing causation

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 Scope of Epidemiology
Originally, Epidemiology was concerned with
investigation & management of epidemics of
communicable diseases

Lately, Epidemiology was extended to endemic

communicable diseases and non-communicable
infectious diseases

Recently, Epidemiology can be applied to all

diseases and other health related events.
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 Epidemic
• Epidemic: a widespread occurrence of an
infectious disease in a community at a
particular time.
"a flu epidemic"

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 Purpose/use of Epidemiology

The ultimate purpose of Epidemiology is

prevention of diseases and promotion of health

1. Elucidation of natural history of diseases

2.Description of health status of population
3. Establishing determinants of diseases
4. Evaluation of intervention effectiveness

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 Types of Epidemiology
Two major categories of Epidemiology

1.Descriptive Epidemiology

Defines frequency and distribution of diseases

and other health related events

Answers the four major questions: how many,

who, where, and when?

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 Types…

2. Analytic Epidemiology

Analyses determinants of health problems

Answers two other major questions: how? and

why?

Generally, Epidemiology answers six major

questions: how many, who, where, when, how and
why?
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 Basic Epidemiological assumptions

1.Human diseases doesn’t occur at random or by

chance

2. Human diseases have causal and preventive

factors

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 Basic features of Epidemiology
1. Studies are conducted on human population
2. It examines patterns of events in people
3. Can establish cause-effect relationship
4. It is an advancing science

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 Functions of Epidemiology
• Public Health Surveillance
• Investigation
• Data Analysis
• Intervention
• Evaluation
• Communication
• Management and Teamwork
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 Natural History of Disease
• Natural history of disease refers to the
progression of a disease process in an
individual over time, in the absence of
treatment.
• Watching with out intervention.

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Definition of Nutrition By WHO
• Nutrition is the intake of food, considered in relation
to the body’s dietary needs. Good nutrition – an
adequate, well balanced diet combined with regular
physical activity – is a cornerstone of good health.
Poor nutrition can lead to reduced immunity,
increased susceptibility to disease, impaired physical
and mental development, and reduced productivity.
 Scale Up Nutrition (SUN Program)

61 countries are leading a global Movement to

end Malnutrition in all its forms.
 Nutritional epidemiology
 Nutritional epidemiology is a relatively new field of medical
research  that studies the relationship between nutrition and

health .
Nutritional Epidemiology: The study of
the nutritional determinants of disease in
human populations.
the field of Epidemiology , nutrition can be
defined as:
The way in which the human body reacts with diet
The extent to which the diet influences levels of health
 NUTRITIONAL EPIDEMIOLOGY

• Many questions about diet and disease remain

unresolved.
• Nutritional epidemiology will enable us to understand
the relationship between diet and health as well as diet
and disease
Nutritional epidemiology has contributed to
understanding the etiology of many diseases.

 Low intake of fruits and vegetables has been shown to be

related to increased risk of cardiovascular disease.

 Replacing saturated and trans fats with unsaturated fats can

play an important role in the prevention of coronary heart
disease and type 2 diabetes.

 Many diseases—as cataracts and neural-tube defects—that

were not thought to be nutritionally related have been found
to have important dietary determinants.
 What are neural tube defects?
 in pregnant women folic acid deficiency can result
birth defects such as neural tube defects
 Neural tube defects are birth defects of the brain,
spine, or spinal cord. They happen in the first month
of pregnancy. The two most common neural tube
defects are spina bifida and anencephaly. In spina
bifida, the fetal spinal column doesn't close
completely. There is usually nerve damage that
causes at least some paralysis of the legs. In
anencephaly, most of the brain and skull do not
develop. Babies with anencephaly are usually either
stillborn or die shortly after birth.
Spina bifida
Nutritional epidemiology has contributed to
understanding the etiology of many diseases.

 In the early 1990s, epidemiological studies established that

women could substantially reduce their risk of bearing a
child with a neural tube birth defect by increasing their
intake of the B vitamin folic acid.

 Medical organizations in many nations have recommended

increased intakes of folic acid for women of childbearing
potential

 Government agencies in several countries are planning to

fortify staple foods with folic acid.
 Goals of nutritional epidemiology
I. Monitoring food consumption, nutrient intake and nutritional
status of a population.

II. Generating new hypotheses about diet and disease, to:

a) produce evidence that supports or refutes existing
hypotheses
b) assess the strength of diet-disease associations.

III.Contributing to prevention of disease and improvement of

public health.
 Advantages of Nutritional Epidemiology
• Its direct relevance to human health.
 Epidemiologists study real life.
 The results of their work can be translated into specific
recommendations for changes in nutrient intakes or food
consumption patterns.
 Disadvantages of Nutritional Epidemiology

1. The potential for many kinds of bias.

– Bias is defined as systematic error, resulting in over- or
underestimation of the strength of association between exposure and
outcome.

2. Difficulty in determining whether observed associations are

causal.
• If the association between a factor and a disease is not causal,
 Disadvantages of Nutritional Epidemiology

– For example,
• even though drinking of alcohol is associated with lung cancer risk,
efforts to discourage alcohol consumption would not be likely to reduce
the lung cancer death rate,
• because the relationship is not causal.
• Instead, it reflects the association of both alcohol intake and lung cancer
with a third factor which is cigarette smoking.
 Modern nutritional
epidemiology
Major diseases throughout the world
• Heart disease
• Cancer
• Osteoporosis
• Cataracts
• Stroke
• Diabetes
• Neural tube defects
 Characteristics of modern nutrition-
related diseases

1. Multiple determinants (factors) (multicausation)

diet, genetic, psychosocial, levels of physical activity;

2. Long latent periods

3. Not readily reversible

4. May result from excessive and/or insufficient intake

of dietary factors
 Difficulties facing nutritional epidemiology

Extremely complex nature of diet

• To understand this complexity, it is helpful to compare diet with another exposure such as cigarette smoking.
 Example of Complexity
• An epidemiologist who is studying tobacco can obtain useful
information simply by asking people, "Do you smoke?"
• By collecting a few additional pieces of information such as:-
– number of cigarettes smoked per day,
– types or brands of cigarettes smoked,
– age at which the person began (or stopped) smoking
• the researcher can obtain a clear, reasonably accurate picture of an
individual's smoking history.
• In contrast, one cannot learn much by asking people, "Do you
eat?"
• In contrast, everyone eats and everyone is exposed, to varying
degrees, to most dietary factors.
 Example of Complexity
• Eating patterns often evolve slowly over periods of years and
people may not remember when their habits changed.

• The foods that people eat consist of complex mixtures of

compounds.

• People who eat more of one type of food must eat less of other
types of foods, thus creating a complex set of inter- correlations
among dietary components.
 Example of Complexity

• Eating habits may be correlated with other factors that influence

disease risk, such as ethnic background, socioeconomic status and
tobacco use.

• Even the method of preparation of foods may be important.

– For example,
– boiled coffee may raise blood cholesterol levels;
– filtered coffee does not raise blood cholesterol because filtering removes
the components that may have cholesterol-raising effects.
Thank you!

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