Transcript Food Guide Pyramid

Faculty of Applied Medical Sciences
Department of Nursing
Nutrition (NUTN 204)
AHMAD ALBALAWI
SENIOR SPECIALIST IN NUTRITION
Lecturer
My Webpage and Email
Ahmad albalawi: Department of Clinical
Nutrition
• Webpage
– http://www.ut.edu.sa/ar/web/u014451/courses
• Contact email
– [email protected]
Outlines
•
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Definition of nutrition
Importance of nutrition to health
Overview of types of nutrients
Nutrition Care Process
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What is Nutrition?
• the science of foods and the nutrients and
non-nutrients in food and the body’s
mechanism of using these nutrients including
ingestion, digestion, absorption, transport,
metabolism, interaction, storage and excretion
• a broader definition includes the social,
societal/economic, cultural, psychological, and
environmental implications of food and eating
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What is Nutrition?
• In hospitals, nutrition may refer to the food
requirements of patients, including
nutritional solutions delivered via an IV
(intravenous) or IG (intragastric) tube
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What is Nutrition?
“the science of food, the nutrients and the
substances therein, their action, interaction,
and balance in relation to health and disease,
and the process by which the organism
ingests, absorbs, transport, utilizes, and
excretes food substances”
(The Council on Food and Nutrition of the American Medical Association)
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What is Nutrition?
• Nutritional science studies how the body breaks food
down (catabolism) and repairs and creates cells and
tissue (anabolism)
catabolism and anabolism = metabolism
• Also examines how the body responds to food. In other
words
• Nutritional science investigates the metabolic and
physiological responses of the body to diet
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IMPORTANCE OF NUTRITION TO HEALTH
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Nutrition…
• more focused on the steps of biochemical
sequences through which substances inside
us and other living organisms are
transformed from one form to another metabolism and metabolic pathways
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Nutrition…
• involves identifying how certain diseases,
conditions or problems may be caused by
dietary factors
– poor diet (malnutrition)
– food allergies
– metabolic diseases
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OVERVIEW OF TYPES OF
NUTRIENTS
•Macronutrients (organic):
•Carbohydrates
•Protein
•fat
•Micronutrients
•Vitamins ( organic)
•Minerals (inorganic)
•Water
Hint: organic compounds contain carbon with carbonhydrogen bonds, while inorganic may contain carbon and
other metal elements but with no carbon-hydrogen bonds
(Difference Between. Info, 2014)
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Nutrition Care Process
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• Nutrition Assessment: Registered Nutritionists (RN) and Dieticians
(RD) collect documents regarding the patient such as nutritionrelated history, anthropometric measurements, biochemical results
and client history
• Diagnosis: Nutrition assessment will provide data to RD that guides
them to select the appropriate nutrition diagnosis ( for example,
naming the specific problem)
• Intervention: Intervention will be directed by RD to the root of the
cause of the nutrition-related disease or problem and aimed at
reducing the symptoms of and signs of the diagnosis
• Monitoring/Evaluation: The final step of the process is monitoring
and evaluation, which the RD sees whether the patient/ client has
achieved or is in-progress towards the planned goals
(Eat Right Academy of Nutrition and Dietetics, 2014)
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Question
• Define Nutrition?
1. It only focuses on metabolic reactions in the body
2. It only focuses on the metabolism of certain diseases
in the body
3. It focuses on metabolic reactions, how food
substances work in the body, and diseases that are
related to diet
4. Non of the above
• Everyone please answer the question by writing
the number of the choice you see correct above
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References
• Willett, WC. Overview and perspective in
human nutrition. Asia Pac J Clin Nutr
2008;17(S1): 1-4.
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Faculty of Applied Medical Sciences
Department of Nursing
Nutrition (NUTN 204)
Nutritional Health Assessment
AHMAD ALBALAWI., MASTER OF NUTRITION
Lecturer
Outlines
• Historical information
• Food Intake Data
• Anthropometric Data
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Ideal body weight
Body Mass Index
Computation of BMI
BMI Classification
Skin-fold Measurements
Waist to Hip Ratio
Mid Upper Arm Circumference (MUAC)
Stadiometer
Desirable body weight
• Implementing Nutrition Care
– Energy Requirement
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Historical Information
• Historical Information
– information about a person’s history with respect
to health status, socioeconomic status, drug use,
and diet
– reflects a person’s medical record and may reveal
a disease that interferes with the person’s ability
to eat or the body’s use of nutrients
– Also reflects person’s family history of major
diseases
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Historical Information
• 1930 to 1959, nutritional assessment was used in designed
surveys to describe the nutritional status of populations on
a national basis
• During 1950s, the importance of nutritional assessment
had been noticed, and awareness had been increased
among physicians and surgeons regarding the relationship
between nutritional status and well-being
• In 1970s, the assessment of the nutritional status of
hospitalized patients have been developed for those who
live in developing regions
(Sando and Okada, 1998)
Food Intake Data
• examines a person’s intake of foods,
beverages, and supplements may reveal either
a surplus or inadequacy of nutrients or energy
– How is it done?
• Record the foods the person has eaten over a period of
24 hours (24-hour recall), 3 days or a week
• Ask what food the person typically eats and how much
each
• Days in the record must be typical of the person’s diet
• Determine the nutrition consumed (based from food
composition
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Food Intake Data
• Obesity in saudi arabia:
– Prevalence of overweight in Saudi Arabia is around 36%
(17232 subjects)
– Prevalence of obesity is 35.5% (17232 subjects)
(Alnozha et al, 2010)
• According to Al-rethaiaa, Fahmy and Al-shwaiyat , 2010,
students in Saudi are 21.8% overweight and 15.7% obese.
• The study included 357 participants who were studying at
Alqassim University
Anthropometric Data
Anthropometric Data
• Reveals nutrition problem by taking height weight
and comparing the person’s measurements with
standards specific for gender and age or with
previous measures
• Taken periodically to reveal patterns
• May reveal problems such as growth failure in
children, wasting or swelling of body tissues and
obesity
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Ideal body weight
• Indicates a person’s body composition has a
good balance of lean body mass and fat tissue
• importance: it is used to major whether or not a
person is at risk of nutritional-related diseases
such as heart and cardiovascular diseases
(National Heart, Lung and Blood Institute)
Body Mass Index
The weight in kilograms (kg) divided by the
square of the height in meters (describes
relative weight for height)
BMI = weight (kg) ÷ height (m2)
Computation of BMI
Joe is 5 feet 10 inches tall and weighs 172 lb.
Step 1 Convert weight into kg
– 172 lb ÷ 2.2 lb/kg = 78.18  78.2 kg
Step 2 Convert height into meters
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5’10” = 70” (5’ x 12 (constant)” = 60” + 10” =70”)
70” x 2.54 (constant) cm/in =177.8 cm
177.8 cm ÷ 100 cm = 1.8 m
1.8 m2 = 3.24  3.2 m (1.8 x 1.8 = 3.24)
Step 3 Calculate BMI
– 78.2 ÷ 3.2 = 24.43
BMI Classification
Classification
BMI
Underweight
<18.5
Normal
18.5 – 24.9
Overweight
25.0 – 29.9
Obesity
≥30.0
Skin-fold Measurements
Facts:
1. Half of total body fat is directly under the
skin
2. Skin-fold measurement is not used to
assess or monitor weight status
3. Multiple sites should be measured
Percent Body Fat
Classification
Appearance
Men
Women
Very Low Fat
Skinny
7-10
14-17
Low Fat
Thin
10-13
17-20
Average
Normal
13-17
20-27
Above Normal
Plump
17-25
27-31
Very High
Fat
>25
>31
Waist to Hip Ratio
• Abdominal ratio
• To measure body fat distribution and adiposity
• Formula: Waist/ hip circumference
• Waist is measured
at the narrowest
point under the
last rib
• Hip is measured at
the widest point
of the buttock
Waist-to-Hip Ratio
• Guide in evaluating health risk
Waist to Hip Ratio
• Formula:
Waist circumference (cm)
Hip circumference (cm)
• For men more than 102cm of the waist circumference is
considered obese
• For women more than 88cm of the waist circumference is
considered obese
• > 1 in men = obesity
• > 0.85 in women =obesity
Mid Upper Arm Circumference (MUAC)
• It evaluate fat stores
• It measures the arm, muscle mass, subcutaneous fat and bone
• It estimates wasting of an individual
Steps:
• Use a measuring tape
• Allow the subject to sit and hang his arm on the side
• Mark the midpoint
• Place the tape around the mid upper arm
• Measure 3 times (nearest cm)
• Average the 3 measurements
Mid Upper Arm Circumference (Children 1- 5)
MUAC
Level of nutrition
> 14
Normal
12.5 - 14
Mild / moderate
malnutrition
< 12.5
Severe malnutrition
Mid Upper Arm Circumference (Adults)
MUAC
Level of nutrition
Male: > 23
Normal
< 23
Malnourish
Female: > 22
Normal
< 22
Malnourish
Stadiometer
Height
• A linear measurement
• Indication of past or chronic nutritional
status
How to obtain correct height
measurement?
• Infantometer for infants
How to obtain correct height
measurement?
• Stadiometer for children and adults
How to obtain correct height measurement?
Infants:
How to obtain correct height measurement?
Children and adults:
How to obtain correct height
measurement?
Knee Height
• To estimate stature of
the patients whose
standing height cannot
be taken accurately
• Bent the knee to a 90
degree angle
How to obtain correct height
measurement?
Knee Height
• Measure by using a tape measure, from the knee cap
to the tibia
• Make at least 2 readings
• Get the knee height in cm
• Formula
Men: 64.19 – (0.04 x age in years) + (2.02 x knee height in cm)
Women: 84.88 – (0.24 x age in years) + (1.83 x knee height in cm)
Desirable body weight
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Desirable Body Weight (Infants)
Based on birth weight and age
• First 6 months:
DBW = Birth weight (gm) + (age in mo. X 600)
• 7 months – 1 year:
DBW = Birth weight (gm) + (age in mo. X 500)
Desirable Body Weight (Infants)
Based on age
•
DBW (k) = (age in mo./2) + 3
Desirable Body Weight (Children)
•
DBW (k) = (age in years x 2) + 8
Desirable Body Weight
(Teens & Adults)
Tannhauser’s / Broca Index
Method:
• DBW (k) = height (cm) – 100
Desirable Body Weight (DBW) for
Teens & Adults
BMI derived formula
Formula:
• Men: DBW (k) = height in meters² x 22
• Women: DBW (k) = height in meters2 x 20.8
IBW and ABW:
http://www.manuelsweb.com/IBW.htm
Desirable Body Weight
(Amputees)
Formula:
• Compute DBW
• Adjust DBW according to type of amputation
Adjusted DBW = DBW (DBW x % total wt. amputated)
Desirable Body Weight
(Amputees)
Body part % of total body weight
Hand
Forearm and hand
Entire arm
Foot
Below knee amputation
Above knee amputation
Entire leg
0.3
2.6
6.2
1.7
7.0
11.0
18.6
Implementing Nutrition Care
Energy Requirement
• Total Energy Requirement (TER):
– For muscular and metabolic activities of the
body which requires energy
– Energy – comes from oxidation of food
– Measured in kilocalories / kilojoules
– Consider: age, sex, physical activity and health
condition
– TER is rounded off to the nearest 50 kcal
Total Energy Requirement (Infants)
• 1 – 6 months
TER (kcal /day) = 120 kcals
K DBW
• 7 months – 1 year
TER (kcal /day) = 110 kcals
K DBW
Total Energy Requirement (Children)
• Narins and Weil
TER = 1000 + (100 x age in years)
• Calorie Needs for age & DBW
TER = DBW (k) x calorie allowance accdg to age
Age Suggested kcal / k DBW /day
1 – 3 105
4 – 6 90
7 – 9 75
10 - 12 65 (boys); 55 (girls)
Total Energy Requirement (Adolescents)
• TER = DBW (k) x calorie allowance based on age
Age Suggested kcal / k DBW /day
13 – 15 55 (boys); 45 (girls)
16 – 19 45 (boys); 40 (girls)
Average
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Total Energy Requirement (Adults)
• Energy Allowance Based on Activity Level
TEA = DBW (k) x Physical Activity
Activity level
Bed rest (hospital patients)
27.5
Sedentary (mostly sitting)
30.0
Light (Tailor, Nurse, Physician, Jeepney driver)
35.0
Moderate (Carpenter, Painter, Heavy housework)
40.0
Very active (swimming, lumberman)
45.0
Question
• Calculate your BMI
• Calculate your desirable body weight by using
Tannhauser’s / Broca method
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references
• Cobiac, L, Dreosti, I & Baghurst, K 1998, Recommended Dietary intakes - is
it time for a change? Comm Dept Health & Fam Serv, Canberra
•
Food and Nutrition Board 2003, Dietary reference intakes. Applications in
dietary assessment, National Academy of Science.
http://books.nap.edu/catalog/9956.html (accessed on 8/1/07)
•
National Health and Medical Research Council, Department of Health and
Ageing & Ministry of Health, 2006, Nutrient reference
• values for Australia and New Zealand: Executive Summary, National Health
and Medical Research Council, Canberra
• Institute of Medicine, 2006, Dietary Reference Intakes. The essential guide
to nutrient requirements, National Academy Press Washington DC. (ref QP
141.D54 2006)
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Thank you
Food Guides
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Outlines
• Food Guide Pyramids and the Saudi food and
nutritional Palm
• food exchange list
• Food labels
• Food handling and preparation
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Food Guide
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Adequacy
Balance
kCalorie (energy) control
Nutrient Density
Moderation
Variety
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• adequacy (dietary): providing all the essential nutrients, fiber, and
energy in amounts sufficient to maintain health
• balance (dietary): providing foods in proportion to each other and in
proportion to the body’s needs
• kcalorie (energy) control: management of food energy intake
• nutrient density: a measure of the nutrients a food provides relative to
the energy it provides. The more nutrients and the fewer kcalories, the
higher the nutrient density
– empty-kcalorie foods: a popular term used to denote foods that contribute
energy but lack protein, vitamins, and minerals; potato chips, candy, and
colas
• moderation (dietary): providing enough but not too much of a
substance
• variety (dietary): eating a wide selection of foods within and among
the major food
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FOOD GUIDES
Include:
•Nutritional requirements that are based on:
•Food pyramid and the Saudi food palm
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Food Guide Pyramid
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Food Guide Pyramid
• Suggests a range of daily servings from each
major food group to address under-nutrition
and over-nutrition
• Emphasis on:
1. Variety
2. Balance
3. Moderation
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Food Guide Pyramid
1. Variety: no single food supplies all 40+
necessary nutrients in amounts needed
– Helps mitigate the natural toxins and food
contaminants by diluting the impact a single
food has on overall intake
– Ensures adequate intake while minimizing the
likelihood of imbalances
2. Balance
3. Moderation
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Question
• What is the recommended serving amount of
carbohydrates per day according to Food
Pyramid?
– 4 servings per day
– 5 servings per day
– 6 servings per day
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Exchange food list
Exchange food list
• Diet-planning tools that organize foods by
their proportions of carbohydrate, fat, and
protein.
• Foods on any single list can be used
interchangeably
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percentage Standards of
macronutrients for adults
• Protein 20%
• Fat 20%
• Carbohydrates 60%
– Protein gives 4 calories per gram
– Fat gives 9 calories per gram
– Carbohydrates gives 4 calories per gram
Case study
• Khalid is a regular man (Hieght175cm, weight
82kg) . He wants to keep his weight in a
normal range. How many grams of Protein, fat
and carbohydrates does he need daily if his
calories needs are 2000 Kcal?
calculation
• Protein(20%) :
– 20/100 *2000= 400/4=100g
• Fat (20%)
– 20/100*2000=400/9=44.4g
• CHO(60%):
– 60/100*2000=1,200/4=300g
Carbs
(g)
Protein (g)
Fat (g)
Calories
starch
15
3
0-1
80
fruit
15
-
-
60
Fat- free
12
8
0-3
90
Reduced
12
8
5
120
Whole
12
8
8
150
Other
carbohydrates
15
Varies
Varies
Varies
No starchy
carbohydrates
5
2
-
25
Very lean
-
7
0-1
35
Lean
-
7
3
55
Medium –fat
-
7
5
75
High-fat
-
7
8
100
Fat group
-
5
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Groups
Carbs group
milk
Meat
No.
exe
Carbohydrates
(g)
Protein
(g)
Fat
(g)
Calories
(g)
Milk (low fat)
3
36
24
15
360
Fruits
4
60
-
-
240
Starch
12
120
36
12
960
Vegetables
5
25
10
-
125
Meat (lean)
3
-
35
15
225
Fat
3
-
-
15
135
241
105
57
2045
Total
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Food Exchange List
Food Exchange Calculator
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Food Labels
What do we get from labels?
1. Nutrient content of the food or
beverage
2. Ingredients used
3. Serving size
4. Calories from each nutrient
•
•
Information which is in grams (g),
milligrams (mg), or percentages (%)
Food labels are calculated based on
adult needs
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Food Handling and Preparation
1.
2.
3.
4.
4 Guidelines in Food Safety
Clean — Wash hands and surfaces often
Separate — Don't cross-contaminate
Cook — Cook to proper temperatures
Chill — Refrigerate promptly
For more information:
http://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/getanswers/food-safety-fact-sheets/safe-food-handling/basics-forhandling-food-safely
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Food Handling and Preparation
•
Preparation
–
–
–
–
Always wash hands with warm water and soap for 20
seconds before and after handling food.
Don't cross-contaminate. Keep raw meat, poultry, fish,
and their juices away from other food. After cutting
raw meats, wash cutting board, utensils, and
countertops with hot, soapy water.
Cutting boards, utensils, and countertops can be
sanitized by using a solution of 1 tablespoon of
unscented, liquid chlorine bleach in 1 gallon of water.
Marinate meat and poultry in a covered dish in the
refrigerator.
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Food Handling and Preparation
• Serving
– Hot food should be held at 140 °F or warmer.
– Cold food should be held at 40 °F or colder.
– Perishable food should not be left out more
than 2 hours at room temperature (1 hour
when the temperature is above 90 °F).
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Food Handling and Preparation
What are the problems that can result from improper food
handling and preparation?
Food-borne Diseases
1. Campylobacter
2. E. coli
4 most common causes of
food-borne diseases
3. Salmonella
4. Norovirus
5. Botulism
6. Listeria
7. Mad-cow disease
8. Ptomaine poisoning
9. Staphylococcus
10. Trichinosis
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References
• Fight Bac! [homepage on internet]. Canadian Partnership
for Consumer Food Safety Education. [Cited 2012 Oct
23]. Available from:
http://www.canfightbac.org/cpcfse/en/
• Government of Canada. Healthy Canadians: Food Safety
and You [Homepage on Internet]. 2010 [cited 2012 Oct
12]. Available from:
http://www.healthycanadians.gc.ca/init/sfh-msaeng.php
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Thank You!
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Research in Nutrition
Ahmad Albalawi
Learning Objectives
• At the end of the lectures on nutrition research, you should
be:
•
Familiar with the types of research used in nutrition
•
Aware of how to make basic interpretations of
epidemiological findings
•
Aware of the factors that limit the ability of research to
identify the relationship between diet and disease
• Able to make decisions about the strength of evidence in
nutritional science
Outlines
• Types of research used in nutrition
• Laboratories studies
– Advantages and limitations
• Nutritional epidemiology
– Advantages and limitations
• Level of evidence in nutrition
• Conclusion
Nutrition Research
Laboratory Studies
e.g. animal studies
e.g. in vitro studies
Epidemiology
Experimental Studies
Observational Studies
Descriptive Studies
e.g. National Surveys
Clinical trials
(Human intervention trials)
Ecological Studies
e.g. cross-cultural correlations
e.g. migrant studies
Community Trials
Analytical Studies
e.g. cohort
e.g. case control
Laboratory Studies
• e.g. animal and in vitro studies
• advantages:
• allow tight control
• useful for giving ideas about what to study
further or for deducing mechanisms of action
• animal studies useful for establishing levels
of safety
• main limitation:
• limited relevance to humans
Nutritional Epidemiology
• Epidemiology = study of the nutritional determinants of
disease (and other health outcomes) in human populations
Observational Studies
• descriptive studies (e.g.
National surveys)
• ecological studies (e.g. crosscultural correlations, migrant studies)
• case-control studies
• cohort studies
Experimental Studies
• clinical trails
• community trials
Summary of Epidemiological Studies
Descriptive
e.g population survey
Ecological
compare different geographical regions or
the same region over time (per capita
consumption)
Case-control
compare people with disease (cases)
versus people without the disease (controls)
Cohort
follow healthy people over time
Nested CaseControl
case-control study within an existing cohort
Trials
researchers intervene at the individual or
community level
Jargon Busters
Exposure
Variable believed to be associated with an
outcome e.g. poor fibre intake
Outcome
Health condition, physiological effect,
disease etc.
e.g. colon cancer
Correlation
Relationship between variables
Positive – increase exposure, increase outcome
Negative – increase exposure, decrease outcome
Nutritional Epidemiology
Strengths:
• diet-disease relationship often observed at
the level of free-living populations
• can identify associations between exposure
and outcomes
• results can be used to calculate direct
estimates of risk
Nutritional Epidemiology
Limitations:
• cannot prove cause and effect
• limited control - potential for many kinds of
bias
• ‘real life’ relevance encourages misuse and
over-interpretation of data
• very effective at discerning strong
associations between exposure and outcome
but less effective in discerning weaker
associations (diet and disease associations are often
weak)
Strength of Evidence
WEAK
STRONGER
in vitro
descriptive
animal
ecological
case-study
case-control
cohort
intervention trials
Conclusion
• There are different types of studies that are
considered in nutrition and dietetics
• Only human relevant studies are
considered for nutritional interventions
• Animal and lab researches are useful for
studying mechanisms and reactions of
substances
• Animal studies are less reliable because of
their riskiness
References
• Keli, SO .et al. Fish consumption and risk of stroke. The Zutphen study.
Stroke, 1994;23:328-332.
• Langseth, L. Nutritional Epidemiology: Possibilities and Limitations. ILSI,
1996.
• Lopez-Carrillo, L. et al. Chilli pepper consumption and gastric cancer in
Mexico: a case-control study. American Journal of Epidemiology,
1994;139:263-274.
• Martinez, ME. et al. Intake of supplemental and total fibre and risk of
colorectal adenoma recurrence in the wheat bran fiber trial. Cancer
Epidemiology, Biomarkers & Prevention. 2002;11: 906-914.
Do you have any questions?