EXPLORING THE ROLE OF DIET IN MODIFYING THE EFFECT OF KNOWN DISEASE DETERMINANTS - APPLICATION TO RISK-FACTORS OF LIVER-CIRRHOSIS

Citation
G. Corrao et al., EXPLORING THE ROLE OF DIET IN MODIFYING THE EFFECT OF KNOWN DISEASE DETERMINANTS - APPLICATION TO RISK-FACTORS OF LIVER-CIRRHOSIS, American journal of epidemiology, 142(11), 1995, pp. 1136-1146
Citations number
67
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Public, Environmental & Occupation Heath
ISSN journal
0002-9262
Volume
142
Issue
11
Year of publication
1995
Pages
1136 - 1146
Database
ISI
SICI code
0002-9262(1995)142:11<1136:ETRODI>2.0.ZU;2-K
Abstract
The analysis of the combined effects of nutritional factors with other putative disease determinants in log-linear or logistic models is met hodologically complicated by the strong multicollinearity between nutr itional factors, resulting in poor precision in estimating the paramet ers. Furthermore, the generally used multiplicative structure is not a lways the most appropriate for describing the resulting joint effect o f two or more factors on the disease risk. The authors addressed such problems in a case-control study assessing the interactions between al cohol intake, chronic hepatitis C virus (HCV) infection, and nutrient intake on the risk of liver cirrhosis. During the period from November 1989 to May 1990, 282 patients admitted to the medical departments of the hospitals of the Province of L'Aquila (central Italy) were enroll ed: 115 cirrhotic patients aged 24-82 years (78 of whom were males) ho spitalized because of liver decompensation, and 167 control patients a ged 25-84 years (100 of whom were males) admitted to the same hospital s for acute diseases unrelated to alcohol intake, infection with hepat otropic viruses, and nutrition. No dose-effect relation was found betw een the intake of any nutrient and the risk of cirrhosis using classic al methods, The analysis of principal components showed, however, that a pattern of higher lipid but lower protein and carbohydrate intakes was significantly associated with the risk of cirrhosis. The Breslow a nd Storer parametric family of relative risk functions showed that a m ultiplicative structure was the most adequate to describe the joint ef fect of nutritional pattern with alcohol intake and/or chronic HCV inf ection, whereas an additive structure best described the joint effect of chronic HCV infection and alcohol intake. In conclusion, the analys is of principal components and the Breslow and Storer family are usefu l tools to explore the role of diet on disease risk when precise patho genic knowledge is not available. As an original finding, the authors suggest that a higher lipid intake, combined with lower protein and ca rbohydrate intakes, modifies multiplicatively the risk of cirrhosis as sociated with alcohol intake and/or chronic HCV infection.