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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
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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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