Critical Evaluation of Association between Sodium Intake and Change in Uric Acid, Urine Albumin Excretion, and the Risk of Developing Hypertension -Cohort study
Research questionThe primary objective of the study was to establish if consumption of high sodium diet is associated with effects on blood pressure as well as hypertension if consumed in a chronically manner. The hypothesis that the researcher employed in the study was “Chronically high intake of sodium would be associated with an increase in endothelial dysfunction especially serum acid denoted as (SUA) and urine albumin excretion (UAE) and the high intake of Na would also be related with chances of hypertension among individual with higher UAE and SUA .” The study lacked the secondary objectives however based on the results provided it was evident that secondary or sub-objectives could play a significant role in refining the results down. This could also help or encourage the use of small sample, which offer high reliability of the information as well as boost the level of accuracy. This secondary objective should have been designed to cater on specific demographic (Between people 16-50 years and those between 51 and above). The study for example could use the following secondary objectives:i. To determine how high consumption of Na diet is associated with both blood pressure and hypertension among individuals aged 16-50 of both sexesii. To evaluate how high consumption of Na diet is associated with both blood pressure and hypertension among individuals aged 51 and above of both sexesStudy design:A prospective cohort study design was used to gather or collect blood pressure and hypertension data recorded from paramedic sheets and blood pressure and hypertension logs. Complete follow-up information was available for more than ten years since the first study employed was done between 1997 and 1998 and the other between 2003 and 2006 meaning that this information was available for research (Salluh 2010). Based on the nature of the diseases being examined in the study, this research design was employed because it can assist determined the risks factors associated with chance of new diseases. This is because prospective cohort studies have longitudinal observation time as well as the collection of results and information or data is at regular intervals hence reduction of recall error.In addition, the design was used since several outcomes that the study expected could be measured for one exposure, it is possible to measure the prevalence, and an incidence arising from the study as well as the design allows exposure to be measured before the start of disease or condition (hypertension and blood pressure). However, the study failed to state in the limitation section that the research design had some weaknesses such as costly and time-consuming (the previous studies indicated took a longer period to reach to concluded outcomes 1997 to 1998 and 2003 to 2006). In addition, the design did not also offer classification of individuals based on demographics and on exposure and outcome status since this can be affected by changes in diagnostic procedures.Subjects without prior prevalent hypertension were selected for the study. Among them, those that available for measurements were considered. In addition, an exclusion criterion was used in the study; those who were taking antihypertensive medication were excluded. The study was limited to 5556 participants; 4062 were considered in SUA analysis and 4146 subjects were inclusive in the analysis of UAE. The retention rate for the study was about 97%.Explanatory variableThe main exposure variable used in the study is the intake of sodium. The study measured the effects of the consumption of Na and its relationship to both blood pressure and hypertension. There were only two levels of exposure classified in the study however the study is considered to have limited itself to the two and in such cases it leads to limited evaluation and analysis of results. Exposure of Na intake to SUA and to UAE to hypertension and blood pressure conditions. With the level of biasness is data collection, the study did not ascertain accurate results but a generalization of the exposure result and outcome were employed (Grove & Lambert 2010)Study outcomeOver time, it was noted that higher intake Na is related with an increase in UAE and SUA. Among people with higher levels of SUA and urine UAE, higher Na intake is an exposure risk factor for contracting or developing hypertension. The case that the study used in the epidemiologic investigation is “It may be of interest to determine if higher intake of Na affects patients with higher UAE and SUA levels, but these changes with age.” The case is classified as suspected for reporting purposes (Brown & Derkits 2010). The outcome of the study is considered relevant since it addressed all the pending questions and critiques of most of the past studies. In addition, based on the data from the participants, this information was worth as it was evident that most of them faced hypertension complication yet they did not know the cause. To avoid “missing events” the data from the participants were analyzed independently and not repetition was allowed.
Measures of frequency and/or association
It is evident from the cohort study that there was no evidence of prevalence and incidence used to determine the estimates of the exposure of the outcome of the study; this is because the study did have new cases with a specified period of time as excepted of an incidence study. Among all the 5558 participants, there was not any new case over the population at risk. Based on the literature available it is evident that the study did not employ both the above conditions. However, it is clear that the study should have been under incidence study. This is because, if the study could have employed more demographics in the sample, such as younger population and the elderly above 65 years, new cases could have been evident within a specified period and it could offer a more accurate outcome as the one the study has indicated. According to the exposure risks evident, the study employed direct causal association since despite the fact that the high rates of Na caused hypertension and in some cases blood pressure, other conditions could have affected the analysis of the results.
There were cases of confounding in the study since in both cases; there were high risks of conflicting effects of the exposure rates. It is clear that people could be affected by high intake hence lead to both hypertension and blood pressure. Therefore, it is clear that the study employed SPSS sorting of data skills to avoid such cases. However, I consider that this was not the best statistical technique to be used. This is because sorting of data in using SPSS sorting methods could lead to biasness of results hence compromise the findings of the study hence the outcome. The best techniques that should have been used are to avoid duplication of data from the participants as well as the use of multivariate analysis could offer the same service.
There was a true association between the exposures and the effects. The confounding factor was age produced an observed estimate of association between higher intake of sodium and hypertension. The association was very strong since the results indicated a more protective effect. The estimates could be considered as over-estimates because of the stronger association. The results could be interpreted as generally accurate since it offered a more correlated results as indicated in previous results.
Sources of error
There were two sources of random error in the study. The first is that there could be sampling errors. Having had a sample of more than 5000 participants, there was high chances of taking part in random errors (Beuther & Sutherland 2007). The second source of random error is individual biological variation. Not all the participants exposed the same results because of varied biological reactions to the tests among others hence the error. However, the extent of random error was limited. There are two potentials source of bias such as mistakes in data collection. Based on the date offered the results ought to be generalized, this was true since the study did the same.
Statistical analysis
It is evident that the results were done using SPSS data analysis package. The was not relationship between participants with SUA since the p-value was greater 0.001 but that of UAE indicated that there was a strong relations p- 0.03 for participant with hypertension exposure. The analysis was true since it was able to be in line with previous literature.
Conclusion
The study was able to meet the central objective of the study; in addition, it was also able to support the hypothesis of the study. The study was able to shows that higher intake of Na lead to blood pressure and hypertension among patients with SUA and UAE. However, future study should consider undertaking studies with different demographics such as sex, gender, and age.
References
Beuther, D. A., & Sutherland, E. R, 2007. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. American journal of respiratory and critical care medicine, 175(7), 661-666.
Brown, A. S., & Derkits, E. J., 2010. Prenatal infection and schizophrenia: a review of epidemiologic and translational studies. American Journal of Psychiatry, 167(3), 261-280.
http://journals.psychiatryonline.org/article.aspx?articleid=102128
Grove, K. A., & Lambert, J. D, 2010. Laboratory, epidemiological, and human intervention studies show that tea (Camellia sinensis) may be useful in the prevention of obesity. The Journal of nutrition, 140(3), 446-453.
http://jn.nutrition.org/content/140/3/446.short
Salluh, J. I., Soares, M., Teles, J. M., Ceraso, D., Raimondi, N., Nava, V. S., … & Rocha, M. G, 2010. Delirium epidemiology in critical care (DECCA): an international study. Crit Care, 14(6), R210.
http://www.biomedcentral.com/content/pdf/cc9333.pdf
Diet and Carbohydrate Food Knowledge of Multi-Ethnic Women: A Comparative Analysis of Pregnant Women with and without Gestational Diabetes Mellitus
Research questionThe primary objective of the study was to establish if pregnant women and non-pregnant women with GDM could be affected with Gestational Diabetes Mellitus and how dietary therapy would reduce the rates of Gestational Diabetes Mellitus . The study did not have an hypothesis rather is used the research questions to get the results of the study right. This is not considered as the best way that the research could have employed since critics will come and state that they research was not up to standard as there was nothing being proved in the study yet it was an epidemiology research. The study lacked the secondary objectives however based on the results provided it was evident that secondary could play a significant role in refining the results down. I agree with the researcher that there was no need of a secondary variable as the paper only needed to indicate how dietary therapy was helpful to both pregnant and not pregnant women in order to avoid Gestational Diabetes Mellitus. The outcome of the study was that there is urgent need to offer nutrition =al education for all the group of women in United Arab Emirates . Study design:A cross-sectional comparative design was used to gather information about women without and those with pregnancy with GDM and possibilities of contracting Gestational Diabetes Mellitus . Complete follow-up information was not available since the study was done in a year. Based on the nature of the diseases being examined in the study, this research design was employed because it can assist determined the risks factors associated with chance of Gestational Diabetes Mellitus . This is because cross-sectional comparative design studies have vertical observation time as well as the collection of results and information or data is at regular intervals hence reduction of random and systematic error.In addition, the design was used since several outcomes that the study expected could be measured for one exposure, it is possible to measure the prevalence, and an incidence arising from the study as well as the design allows exposure to be measured before the start of disease or condition (Gestational Diabetes Mellitus) (Grove & Lambert 2010). The design did not also offer classification of individuals based on demographics and on exposure and outcome status since this can be affected by changes in diagnostic procedures. The retention rate for the study was high. There were various. In addition, the decision of the study to use the above design was that it offered a chance for the researchers to consider undertaking various follow ups to ensure the validity of information offered by the participants. The other reason why the study considered using the above design was that the study used a small sample size hence it offered a significant sample analysis. There were various strengths of using the research design. One of the strengths is that it offers an evaluation strategy for the study hence able to validate data. As far as the information was mostly quantitative, the design offered a chance to undertake critical regression analysis of the results and as well as the correlations between pregnant women and non-pregnant women and their exposure to Gestational Diabetes Mellitus. However, the study showed various weakness. The design was not able to cover the small sample a better analysis of the findings. Explanatory variableThe main exposure variable used in the study is the intake of carbohydrates. The study measured the effects of the carbohydrates and its relationship to both Gestational diabetes mellitus. There were only two levels of exposure classified in the study however the study is considered to have limited itself to the two and in such cases it leads to limited evaluation and analysis of results. With the level of biasness is data collection, the study did not ascertain accurate results but a generalization of the exposure result and outcome were employed.
Study outcomeThe study shows that that it is for women to take dietary therapy to avoid Gestational diabetes mellitus, this to both women without pregnancy and those pregnant. The case that the study used in the epidemiologic investigation is “It may be of interest to determine if how both type of women with GDM ought to take nutritional training to avoid Gestational diabetes mellitus . The case is classified as suspected for reporting purposes. The outcome of the study is considered relevant since it addressed all the pending questions and critiques of most of the past studies. In addition, based on the data from the participants, this information was worth as it was evident that most of them did not face Gestational diabetes mellitus . To avoid “missing events” the data from the participants were analyzed independently and not repetition was allowed.
Measures of frequency and/or association
It is evident from the a cross-sectional comparative study that there was evidence of incidence used to determine the estimates of the exposure of the outcome of the study; this is because the study did have new cases of women with the problem of Gestational diabetes mellitus emerged during the study. However, it is clear that the study should have not have been under incidence study since the outcome of the study was affected by the new cases. According to the exposure risks evident, the study employed direct causal association since despite the fact that the number of Gestational diabetes mellitus women patients increased other conditions could have affected the analysis of the results rather than limited carbohydrate foods.
There were no cases of confounding in the study since in both cases; there were no risks of conflicting effects of the exposure rates. It is clear that women who take less carbohydrate may lead to Gestational diabetes mellitus. Therefore, it is clear that the study employed SPSS multivariate analysis to avoid such cases. However, I consider that this was the best statistical technique to be used.
There was a true association between the exposures and the effects. The confounding factor was age of the women produced an observed estimate of association carbohydrate and Gestational diabetes mellitus multivariate. The association was very strong since the results indicated a more protective effect. The estimates could be considered as under-estimates because of the weak association.
Sources of error
There were one sources of random error in the study. There was random error cause is individual biological variation (Salluh et al., 2010). Not all the participants exposed the same results because of varied biological reactions to the tests among others hence the error. However, the extent of random error was limited. There are one possibilities source of bias such as mistakes in data collection and analysis of results hence the weak outcome. Generalized results were the best and the study offered the same.
Statistical analysis
It is evident that the results were done using SPSS data analysis package. There was relationship between women with GDM and Gestational diabetes mellitus disease since the p-value was greater 0.012.
Conclusion
The study was able to meet the central objective of the study; in addition, it was also able to support the hypothesis of the study. The study was able to shows that higher women should be advised on the dietary intake such as carbohydrate to avoid Gestational diabetes mellitus However, future study should consider undertaking studies with different demographics such women of age.
References
Grove, K. A., & Lambert, J. D, 2010. Laboratory, epidemiological, and human intervention studies show that tea (Camellia sinensis) may be useful in the prevention of obesity. The Journal of nutrition, 140(3), 446-453.
http://jn.nutrition.org/content/140/3/446.short
Salluh, J. I., Soares, M., Teles, J. M., Ceraso, D., Raimondi, N., Nava, V. S., … & Rocha, M. G, 2010. Delirium epidemiology in critical care (DECCA): an international study. Crit Care, 14(6), R210.
http://www.biomedcentral.com/content/pdf/cc9333.pdf
