Total Enerji Alımının Epidemiyolojik Analizlerde Kullanımı
Özet
Vaka ve kontrol grubu arasındaki vücut büyüklüğü, fiziksel aktivite ve metabolik verimlilikteki farklılıklardan kaynaklanan toplam enerji alımındaki varyasyonun bir sonucu olarak, belirli besin ögelerinin alımı ile hastalık riski arasında bir ilişki bulunuyorsa, bu ilişkinin primer olarak diyetten kaynaklandığı varsayılamaz. Bu nedenle, diyet ve hastalık ilişkisini değerlendiren epidemiyolojik çalışmalar, toplam enerji alımından bağımsız olarak, temel olarak diyetin besin bileşiminin etkilerine yönelik olmalıdır. Bunun için, total enerji alımının karıştırıcı faktör olarak analize dahil edildiği besin ögesi yoğunluğu metodu veya besin ögesi alımı için toplam enerji alımına göre düzeltme yapılan regresyon modelleri kullanılabilir.
Epidemiyolojik çalışmalarda enerjiye göre düzeltilmiş besin ögesi alımını kullanmanın temel mantığı, bireylerin veya toplumların besin ögesi alımında yapılacak değişikliklerin, toplam besin alımını artırmak veya azaltmak yerine, esas olarak diyet bileşimini değiştirerek yapılması gerektiğidir. Bununla birlikte, ikincil bir fayda olarak, enerji için düzeltme yapılması, ölçüm hatasını azaltabilir. Çünkü besin ögesi ve toplam besin alımlarındaki hatalar yüksek oranda ilişkili olma eğilimindedir ve dolayısıyla enerji alımı için düzeltme yapılması ile bu iki hata kısmen birbirini etkisiz kılar.
Epidemiyolojik çalışmalarda enerji alımı verilerinin manipülasyonu ve yorumlanmasına ilişkin tehlikeler vurgulanmış olsa da, bu faktörler, aynı zamanda, toplam enerji alımı ölçümünün elde edilmesinin önemini de vurgulamaktadır. Örneğin, koroner kalp hastalığı ile ilgili bir çalışmada uygulanan anket vasıtasıyla, yalnızca doymuş yağ alımı hakkında bilgi elde edilmişse, diyetin yüksek doymuş yağ bileşimi gerçekten koroner hastalığa neden oluyor olsa bile, ters bir ilişki bulunması veya hiç bir ilişkinin bulunmaması da mümkündür. Çünkü vakaların enerji alımı kontrollerden daha az olabilir. Böyle bir bulgu, ancak toplam enerji alımının tahminine yönelik bir denklem mevcut olması durumunda, uygun şekilde yorumlanabilir.
Diyetsel faktörler ve hastalık arasındaki ilişki karmaşıktır. Dikkatle toplanmış alım ölçümlerinde bile, yanıltıcı sonuçlardan kaçınmak için çeşitli analitik yaklaşımların biyolojik etkilerinin dikkate alınması gerekir.
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