Introduction to Epidemiology (401076)

Added on - 03 May 2020

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Running head: CRITICAL ANALYSISCritical AnalysisName of the StudentName of the UniversityAuthor note
2CRITICAL ANALYSISPaper Selected: Reflux-Inducing Dietary Factors and Risk of Adenocarcinoma of theEsophagus and Gastric CardiaOverview of the PaperIssues addressed in the paperOver the last decades, the reported cases of adenocarcinoma of the esophagusamounts to about less than 10% of all the esophageal cancers in the Western population(Zhang, Jin, &Shen,2012). Reflux is the common risk factor associated with the esophagealadenocarcinoma and gastric cardia cancer (Pohl et al., 2013). Moreover, the long termsufferers with severe reflux symptoms, the risk of developing esophageal cancer increases40-fold (Zhang, Jin, &Shen, 2012; Pohl et al., 2013). The reflux disease common among theWestern populations is chronic gastroesophageal reflux (GER) (Zhang, Jin, &Shen, 2012).Western suffers from reflux at least once per week. In Sweden, there is an annual increase of1.5% of the reflux disease over the tenure of 24 years (Stefanidis et al., 2010). Therefore,identification of the factors responsible for the development of the reflux disease is importantfor the individuals who are suffering from the discomfort of reflux like heartburn (Kahrilas etal., 2012). Moreover, identification of the disease causing factors will also help towards thedevelopment towards esophageal cancer prevention steps. There are multiple foods, whichare known to relax the lower esophageal sphincter (LES) and thus promoting reflux. Thesereflux promoting food includes dietary fat, mints, chocolate, coffee, citrus food, tomato andonions (Gonsalves et al., 2012). Not only this, dietary fat consumed in diet retards the processof gastric emptying (Gonsalves et al., 2012) and this further increases the possibility of GER.The principle aim of the study, conducted byPaul Terry et al.,2000, is to explore theunaddressed parts in the esophageal carcinoma that is the effect of diet in development ofdisease susceptibility. Their research question was whether observation of specific reflux-provoking diet imparts any amount of risk towards the development of susceptibility ofadenocarcinoma of the esophagus and gastric cardia. The study also tries to elucidate theeffect of meal size and time of meal consumption (that is bedtime) on esophagealadenocarcinoma.Outcome of the researchThere lays a strong association between the severity and frequency of reflux and riskfactor for developing esophageal and gastric cardia adeno carcinomas. The findings suggest
3CRITICAL ANALYSISthat consumption of reflux promoting food is not a concern of public health for the generalpopulation as dietary factors are not related with the threats of developing adenocarcinoma ofthe esophagus or gastric cardia.No significant trends were observed towards the development of the esophagealadeno carcinoma upon consumption of the reflux promoting food. Moreover there was apresence of non-significant, decreased risk of the disease development with the greaterconsumption of leeks, onions and garlic. Not only this, there was no relation between thedevelopment of squamous cell carcinoma and consumption of reflux causing food (however,data was not shown in this case). The size and the time of the meal also turned out to be non-significant in relation to the risk of the disease development, as elucidated via statisticalanalysis. The additional adjustments like the presence or severity of the reflux symptomsshowed no significant alteration in the findings.Study DesignThe study was done via analyzing the affect of intake of LES-relaxing foods in anationwide population based case control study, which was done inSweden. The study alsotried to elucidate dietary habits of these people and the subsequent affect on thepredisposition of esophagealadenocarcinoma. The study on done based on two core pillars ofbiology, histology and anatomy. The histological slides were analysed by the pathologist.Based on the histological and anatomical classification, the patients of cardia cancer andadenocarcinoma were separated. Cardia cancer was isolated based as adenocarcinoma whenthe centre was with the 2 cm proximal end and 3 cm from the distal end in comparison to thegastroesophageal junction (Yan, Wistuba, Emmert-Buck & Erickson, 2011). If there wasvisible appearance of Barrett's metaplasia, it was classified as esophageal, even if thepresence is within the cardia (Zhang, 2013).All the subjects of the focus group gave a face-to-face interview, which wasconducted by a group of professional interviewers from Statistics Sweden and the entireprocess of interview was computer oriented. A structured food frequency questionnairecontaining 63 different items of food and beverage was utilised to evaluate the dietary habitsof from the date of interview to 2 decades back. The questions mostly encompasses the rateof consumption of food, the number of servings (per day, month or annually), the time ofdinner, average size of the meals and it was assessed by photographs of 4 different proportionof 7 common Swedish dishes. The reflux symptoms are classified on the basis of presence or
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