2014 2 MHS Exposure Outcome

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EXPOSUREandOUTCOME

M.K. EPIDEMIOLOGI GIZIDept. Gizi Masyarakat, FEMAIPB

2014


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Basic Question in Analytic Epidemiology

Are exposure and disease linked?

Exposure Outcome

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Exposure = cause, agent, paparan

pajanan

Exposure in Nutritional Epidemiology:

Diet (national, household, individual) Biochemical status Anthropometry

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1. Dose2. Intensity

3. Duration

4. Comulative exposure

Aspect of exposure:


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1. Personal interviews2. Self administered questionnaires

3. Diaries

4. Observation5. Routine record

6. Physical/chemical measurement on the

environment7. Physical/chemical measurement on the

person

Exposure assessment:


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Outcome = disease, effect, dampak

Outcomein Nutritional Epidemiology :

Death

Morbidity

Physiological measures

Biochemical markers

Anthropometry

Performances

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World Health Organization:

a state of complete physical, mental,[and] social well-being and not merely

the absence of disease or infirmity

Health Status?


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1. Fase Rentanproses etiologi

2. Fase Presimtomatikperubahan patologi(ireversibel)

3. Fase Kliniktanda/gejala terdeteksi

4. Fase Terminalakibat penyakit

Natural history of disease

(Rothman, Mausner, Kramer 1980an):


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Issues to consider

Etiology (cause) of nutrition related-diseaseis often difficult to determine

Many exposures cause more than oneoutcome

Outcomes may be due to a multipleexposures or continual exposure overtime

Causes may differ by individual

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Stage of Nutrition Deficientcy

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No Depletion Stages

1 Dietary inadequacy

2 Dec. level in reserve tissue store

3 Dec. level in body fluids4 Dec. functional level in tissues

5 Dec. activity of nutrient-dependent

enzyme for some protein6 Functional change

7 Clinical symptomps

8 Anatomical signs


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Direct Methods of

Nutritional Assessment

ABCD methods

Anthropometric methods

Biochemical, laboratory methods

Clinical methods Dietary assessment methods

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Scale of Data

1. Nominal: These data do not represent anamount or quantity (e.g., Marital Status, Sex)

2. Ordinal: These data represent an ordered series

of relationship (e.g., level of education)

3. Interval: These data is measured on an intervalscale having equal units but an arbitrary zero

point. (e.g.: Temperature, IQ)

4. Interval Ratio: Variable such as weight for whichwe can compare meaningfully one weight

versus another (say, 100 Kg is twice 50 Kg)30/09/2014


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Relation E-O

Exposures: causes, risk factors,independent variables

Outcomes: effects, diseases,

injuries, disabilities, deaths,dependent variables

Statistical association versus

biological causation: cause-effectrelationship

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Association vs Causation

Association- implies that exposure might cause disease

exposures associated with a difference in

disease risk are often called risk factors

Causation - implies that there is a true

mechanism that leads from exposure to

disease

Finding an association does not make it causal

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Bradford Hills Criteria forCausal Inference (1971):

1. Consistency of findings

2. Strength of association

3. Dose-response effect (biological gradient)4. Temporal sequence

5. Biological plausibility

6. Coherence with established facts7. Specificity of association

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Exposure Disease

Linear Models:

Additional Factors30/09/2014


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Web Model:

There is nosingle cause

Causes of disease are interacting Illustrates the interconnection of

possible causes

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Web of Causation - CHD

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2014 2 MHS Exposure Outcome

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