EXPOSURE and OUTCOME

M.K. EPIDEMIOLOGI GIZI

Dept. Gizi Masyarakat, FEMA IPB
2014

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. Dose
2. Intensity
3. Duration
4. Comulative exposure
Aspect of exposure:
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1. Personal interviews
2. Self administered questionnaires
3. Diaries
4. Observation
5. Routine record
6. Physical/chemical measurement on the
environment
7. Physical/chemical measurement on the
person
Exposure assessment:
Outcome = disease, effect, dampak
Outcome in 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 Rentan proses etiologi
2. Fase Presimtomatik perubahan patologi
(ireversibel)
3. Fase Klinik tanda/gejala terdeteksi
4. Fase Terminal akibat penyakit
Natural history of disease
(Rothman, Mausner, Kramer 1980an):
Issues to consider
Etiology (cause) of nutrition related-disease
is often difficult to determine
Many exposures cause more than one
outcome
Outcomes may be due to a multiple
exposures or continual exposure over
time
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 fluids
4 Dec. functional level in tissues
5 Dec. activity of nutrient-dependent
enzyme for some protein
6 Functional change
7 Clinical symptomps
8 Anatomical signs
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 an
amount 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 interval
scale having equal units but an arbitrary zero
point. (e.g.: Temperature, IQ)

4. Interval Ratio: Variable such as weight for which
we can compare meaningfully one weight
versus another (say, 100 Kg is twice 50 Kg) 30/09/2014
Relation E-O
Exposures: causes, risk factors,
independent variables
Outcomes: effects, diseases,
injuries, disabilities, deaths,
dependent variables
Statistical association versus
biological causation: cause-effect
relationship
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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 for
Causal 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 facts
7. Specificity of association
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Exposure Disease
Linear Models:
Additional Factors
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Web Model:
There is no single cause
Causes of disease are interacting
Illustrates the interconnection of
possible causes
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Web of Causation - CHD
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