Nutritional Epidemiology

(Introduction)

BY
NATASHA AMJAD
0verview

 Nutritional epidemiology is a sub discipline of epidemiology and provides specific knowledge

to nutritional science.
 It provides data about the diet-disease relationships that is transformed by Public Health
Nutrition into the practice of prevention.
 The specific contributions of nutritional epidemiology include
 dietary assessment
 description of nutritional exposure
 statistical modelling of the diet-disease relationship
Examples

 In an example from the late nineteenth century, the unusual occurrence of beri-beri among
sailors largely on polished rice led Takaki to hypothesize that some factor was lacking in
their diet; the addition of milk and vegetables to their rations effectively eliminated this
disease.
 Decades later a deficiency of thiamine was found to be primarily responsible for this
syndrome
Cont…

 Typically, deficiency syndromes occur with high frequency among those with very low
intake and rarely or never occur among those not so exposed.
 In addition, these deficiency diseases often have short latent periods; symptoms are
usually manifested within months of starting a deficient diet and can typically be reversed
within days or weeks.
 Hence, research has moved rapidly from observations to experiments in both animals and
humans.
Cont….

 The relationships between diet and the occurrence of the major diseases are of both
scientific and practical importance to public health nutritionists.
 Although epidemiologic efforts originally concentrated primarily on infectious diseases,
during the last 30 years attention has largely shifted to the etiology of chronic diseases.
 Thus contemporary epidemiologists are accustomed to the study of diseases with low
frequencies, long latency periods, and multiple causes. For example, hypertension,
hypercholesterolemia, and cigarette smoking have been identified as major determinants
of coronary heart disease;
 this knowledge has contributed to a major decline in this cause of death during recent
years.
Limitations

 Although epidemiology is logically equipped to address the dietary causes of

disease, the complex nature of diet poses an unusually difficult challenge to this
discipline.
 Cigarette smoking is more typical of exposures studied by epidemiologists:
subjects or their spouses can report whether or not they smoke cigarettes with a
high degree of accuracy.
 Furthermore, individuals can readily provide quantitative information on the
number of cigarettes they smoke per day, their usual brand of cigarettes, the age
at which they started smoking, and changes in their pattern of use.
 Diet, in contrast, represents an unusually complex set of exposures that are strongly intercorrelated.
 With few exceptions, all individuals arc exposed to hypothesized causal factors; everyone eats fat,
fiber, and vitamin A, for instance.
 Thus, exposures cannot be characterized as present or absent; rather they are continuous variables,
often with a rather limited range of variation.
 Furthermore, individuals rarely make clear changes in their diet at identifiable points in time; more
typically, eating patterns evolve over periods of years.
 Finally, individuals are generally not aware of the content of the foods that they cat; therefore, the
consumption of nutrients is usually determined indirectly based on the reported use of foods or on
the level of biochemical measurements.
Cont…

 So The most serious limitation to research in nutritional epidemiology has been the lack
of practical methods to measure diet.
 The diets of persons within one country are too homogeneous
 to detect relationships with disease