Araştırmaların Gelecekteki Yönü
Özet
Yeni nesil büyük prospektif çalışmalar artık kanser, koroner kalp hastalığı ve diğer birçok sonuç değişkenleriyle ilgili olarak beslenme hakkında muazzam bir yeni veri kapsamı sunmaktadır. Önümüzdeki yıllarda, çalışmalarda daha uzun süreli takipler yapılabilecektir. Asya ve Meksika'daki kohort çalışmalarıyla beraber incelenebilecek diyet maruziyetlerinin aralığını genişletecek daha da geniş bir veri kapsamı mevcut olacaktır. Bununla birlikte, Güney Amerika, Doğu Avrupa ve Afrika'da yapılacak çalışmalara ihtiyaç vardır. Ayrıca, çocukluk ve ergenlik döneminde diyetle ilgili veriler sınırlı olduğu için bu gruplarda beslenmenin uzun vadeli sağlık üzerindeki etkilerine ilişkin çalışmaların da yapılması gerekmektedir.
Otomatik 24 saatlik hatırlatma yöntemleri ve “omiklere” dayalı biyobelirteçler de dahil olmak üzere, beslenme durumunun değerlendirilmesine yönelik birçok yeni yaklaşım araştırılmaktadır. Bu yaklaşımların mevcut olarak kullanılan beslenme durumunun değerlendirilmesi yaklaşımlarına getirdikleri katma değeri belirlemek için dikkatli geçerlik çalışmalarıyla incelenmesi gerekmektedir. Geçerlik çalışmaları büyük kohort çalışmaları kapsamında gerçekleştirilebilecek olursa, ölçüm hatası zayıflıklarından daha az etkilenecek şekilde ilişkilerin nicel tahminlerini sağlayacaktır. Beslenme ve hastalık ilişkileri genel anlamda daha iyi anlaşıldıkça; bu konudaki çalışmalar ayrıca doz-cevap, zamansal ilişkiler ve diğer diyetle ilgili ve diyet dışı faktörlerle etkileşimler hakkında gelişmiş tahminler yapılabilmesini olanaklı kılacaktır. Kohort çalışmalarından elde edilen birincil verilerin aynı havuzda toplanması, incelenebilecek diyet değişkenlerinin kapsamını daha da genişletecek ve nadir kanserler vb. diğer sonuç değişkenleriyle olan ilişkilerin tahmin edilmesinde daha yüksek hassasiyet getirecektir.
Premorbid sonuç değişkenlerinin ve doku hasarı belirteçlerinin kullanılması, klinik hastalık çalışmalarından elde edilen bulguların ikna ediciliğini artırarak ilgili patofizyolojinin daha iyi anlaşılmasını sağlayabilir. Moleküler patolojideki gelişmeler, daha önce homojen olduğu düşünülen, ancak şimdi çok ayrıntılı olarak sınıflandırılabilen hastalıkları incelemek için birçok yeni fırsatlar yaratmaktadır. Beslenme ile ilişkili faktörlerin hastalık sınıflarıyla olan ilişkilerinde farklılıkların olması durumu yeni ilişkilerin belirlenebilmesini ve ilişkilerin nedensellik boyutunda incelenebilme potansiyelini sunacaktır. Yüksek genetik hastalık riski taşıyan bireylerin DNA analizi kullanılarak belirlenmesi, hastalığın etiyolojik olarak anlaşılmasına ve önlenmesine büyük katkı sağlayabilecek genetik faktörler ve beslenme arasındaki etkileşimleri incelemek için yeni fırsatlar yaratmaktadır.
Tekrarlı ölçümler sayesinde beslenme, genetik polimorfizmler dahil moleküler olarak karakterize edilen sonuç değişkenleri hakkında toplanabilecek verilerin kapsamının büyük ölçüde genişlemesi hem yeni büyük fırsatlar sağlayacak hem de analitik zorluklar getirecektir. Bu durum da hem biyolojik hem de istatistiksel konuların aynı anda daha fazla beraber dikkate alınmasını gerektirecektir.
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