Diyet ile Besin Alımının Biyokimyasal Göstergeleri
Özet
Beslenme biyobelirteçleri, diyet doğrulama çalışmalarında referans araçlar, diyet alım belirteçleri, besin ögesi durumunun entegre belirteçleri ve diyet müdahale çalışmalarında bağlılık belirteçleri olarak faydalı uygulamalara sahip olabilir. Diyet doğrulama çalışmalarında referans değerler olarak beslenme biyobelirteçlerinin kullanımı kullanışlıdır çünkü biyokimyasal belirteçler ve raporlama yöntemlerindeki hataların genellikle bağımsız olduğu varsayılabilir. Geri kazanım biyobelirteçleri, besinlerin mutlak alımları hakkında bilgi sağlayan ve alım dışındaki belirleyicilerden önemli ölçüde etkilenmeyen beslenme biyobelirteçlerinin bir alt sınıfıdır. Diyet doğrulama çalışmalarında geri kazanım biyobelirteçlerinin kullanılması, dolaylı olarak da olsa, diğer yöntemlerin doğruluğu hakkında değerli bilgiler sağlayabilir. Bununla birlikte, epidemiyolojik çalışmalarda mutlak alımlar nadiren ilgilenilmekte ve bunların çok pahalı ve külfetli olan çift işaretli su kullanılarak enerji alımına göre ayarlanması gerekmektedir.
Ayrıca, geri kazanım biyobelirteçleri şu anda yalnızca azot, potasyum, sodyum ve enerji alımı için mevcuttur ve bu nedenle diyetin yalnızca sınırlı yönleri hakkında bilgi sağlamaktadır.
Kandaki veya diğer dokulardaki besin konsantrasyonlarının biyokimyasal ölçümlerinin kullanılması, bir dizi besin alımının yararlı bir değerlendirmesini sağlayabilir. Hastalık sonuçlarına ilişkin çalışmalarda diyet alımlarının ölçütü olarak rapor edilen besin tüketimine veya biyokimyasal belirteçlere dayalı yöntemlerin tercih edilip edilemeyeceği besinden besine farklılık gösterir. Biyobelirteçlerin kullanımı, eksik besin bileşimi verileri veya besin içeriğindeki büyük besin içi varyasyon nedeniyle diyet alımlarının raporlanmasına dayalı yöntemlerle zayıf ölçülen besinler için özellikle önemlidir. D vitamini veya likopen durumunda olduğu gibi, diyet alımları, sağlık sonuçları üzerindeki etkilere aracılık eden besin ögesi durumunun yalnızca zayıf ön göstergeleri ise, sağlık sonuçlarıyla ilişkileri saptamak için besin ögesi durumunun entegre biyobelirteçlerinin kullanılması tercih edilebilir. Epidemiyolojik çalışmalarda bir biyobelirtecin diyet alımının yararlı bir belirteci olması için çeşitli kriterlerin karşılanması gerekir, bunlar: alım duyarlılığı, zaman entegrasyonu, analitik doğruluk, spesifik şehir ve biyobelirteç konsantrasyonlarının diğer ilgili belirleyicilerini kontrol etme yeteneğidir.
Bir biyobelirteç alıma duyarlı olsa bile, yalnızca çok kısa süreli alımı yansıtıyorsa, yani zaman entegrasyonu zayıfsa, epidemiyolojik çalışmalarda yararlı olmayacaktır. Biyobelirteçlerin uzun vadeli tekrarlanabilirliğine ilişkin veriler (bkz. Tablo 8-1), bu belirtecin kullanışlılığına karar vermek için kritik öneme sahiptir. Bir biyobelirtecin uzun vadeli tekrarlanabilirliğinin yüksek olması da yeterli değildir, çünkü bu, diyet alımları için iyi bir zaman entegrasyonundan ziyade nispeten sabit olan biyobelirteç konsantrasyonlarının diğer belirleyicilerini yansıtabilmektedir. Biyobelirteçler “objektif” ölçüler olarak görülse de, besin biyobelirteçleri ve sağlık sonuçları çalışmaları, hem diyetle alınan alımlarla ilişkili faktörler hem de besinlerin emilimi veya metabolizması ile ilişkili faktörler tarafından karıştırılabilir. İnflamasyon, hiperinsülinemi veya karsinogenez gibi hastalıkların etiyolojisinde yer alan süreçler, hastalığın teşhisinden çok önce biyobelirteç konsantrasyonlarını etkileyebilir ve bu nedenle kontrolü zor olan kafa karışıklığına neden olabilir. Belirli bir besinin alımını tahmin etmek için bir yöntemin seçimi bu nedenle besin bazında dikkatli bir şekilde yapılmalıdır ve uygulamasına dikkat edilmelidir. Toplam yağ veya karbonhidrat alımı gibi birçok önemli besin için alıma ilişkin spesifik bir biyokimyasal gösterge mevcut değildir. Ek olarak, göstergenin kişi içi varyasyon konsantrasyonu, güçlü homeostatik mekanizmalar veya diyet dışındaki güçlü belirleyicilerin varlığı, biyobelirteçleri uzun vadeli diyet alımının zayıf bir ölçüsü haline getirebilir. Spesifik yağ asitleri, folat ve karotenoidler gibi bazı diyet faktörleri için biyobelirteçler ve rapor edilen diyet alımı yararlı tamamlayıcı bilgiler sağlayabilir. Son olarak, selenyum ve D vitamini de dahil olmak üzere çeşitli besinler için biyokimyasal göstergeler, bu besinler için diyet alım değerlendirme yöntemlerinin sınırlamaları nedeniyle tercih edilen yöntem olacaktır. Rastgele hata ve yanlılığı en aza indirmek için numune toplama, saklama ve analize dikkat etmek çok önemlidir. Ek olarak, standartlaştırılmış yöntemlerin raporlanması biyobelirteçlerin epidemiyolojik çalışmalarında kullanılan, replikasyona izin vermek ve yaşamı etkileyen potansiyel hatalara ilişkin sezgi sağlamak için önemlidir (Gallo ve ark., 2011). Analitik yöntemler geliştikçe ve diyet alımının ölçütü olarak daha fazla biyokimyasal gösterge doğrulandıkça, bunların beslenme epidemiyolojisindeki kullanımlarının artması muhtemeldir.
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