chronic disease in malaysia

ObjectivesObjectives

• Understanding chronic diseasesUnderstanding chronic diseases

• Understanding risk factorsUnderstanding risk factors

• Understanding methods of Understanding methods of

preventionprevention

DefinitionDefinition

Significance epidemiological dataSignificance epidemiological data

Overview chronic diseases in Malaysia Overview chronic diseases in Malaysia

and its risk factorsand its risk factors

Discussion on few chronic diseasesDiscussion on few chronic diseases

OutlineOutline

IntroductionIntroduction

• Broad definition of chronic disease:Broad definition of chronic disease:

Illnesses that are prolonged, do not resolve Illnesses that are prolonged, do not resolve

spontaneously, and are rarely cured spontaneously, and are rarely cured

completely.completely.

• CDC's National Center for Chronic Disease CDC's National Center for Chronic Disease

Prevention and Health Promotion:Prevention and Health Promotion: … and … and

that are preventable, and that pose a that are preventable, and that pose a

significant burden in mortality, morbidity, significant burden in mortality, morbidity,

and cost.and cost.

Chronic Disease EpidemicChronic Disease Epidemic

Chronic Disease in USChronic Disease in US

• > 90 million Americans live with chronic dz> 90 million Americans live with chronic dz

• Account for 70% of all deaths Account for 70% of all deaths

• Account for > than 60% of the nation's Account for > than 60% of the nation's

medical-care costs. medical-care costs.

• Account for one third of the years of Account for one third of the years of

potential life lost before age 65 potential life lost before age 65

The Robert Wood Johnson Foundation, Annual Report 1994; The Robert Wood Johnson Foundation, Annual Report 1994; Health, United States, 1994Health, United States, 1994

Chronic Dz in M’siaChronic Dz in M’sia

• Total deaths in Malaysia, 2002 = Total deaths in Malaysia, 2002 =

119,000. 119,000.

• Total deaths related to chronic disease Total deaths related to chronic disease

in Malaysia, 2002 = 85,000.in Malaysia, 2002 = 85,000.

• Chronic diseases accounted for 71% of Chronic diseases accounted for 71% of

all deaths in 2002 all deaths in 2002

Malaysia NCD Surveillance 2005/06: CD among Malaysia NCD Surveillance 2005/06: CD among

Malaysian Adult Aged 25-64 Malaysian Adult Aged 25-64

• The data was obtained from 2.572 subjects, The data was obtained from 2.572 subjects,

with total response rate of 84.6%.with total response rate of 84.6%.

• ~ ~ 11.6 million adults aged 25-6411.6 million adults aged 25-64 years were years were

having at least one NCD risk factor. having at least one NCD risk factor.

• Only about 3%Only about 3% of Malaysian adults did not of Malaysian adults did not

have risk factor. have risk factor.

Common Risk Factors

Overweight & obesityOverweight & obesity

• Prevalence: overweight (31.6%); obesity (16.3%). Prevalence: overweight (31.6%); obesity (16.3%).

• Men (30.9%), women (32.4%) were overweight Men (30.9%), women (32.4%) were overweight

• Men (13.9%), woman (18.8%) were obese.Men (13.9%), woman (18.8%) were obese.

• 1 in 2 adults aged 25 to 64 years were either 1 in 2 adults aged 25 to 64 years were either

overweight or obese.overweight or obese.

• Indians > Malays and Chinese. Indians > Malays and Chinese.

Prevalence of Obesity

•Prevalence of overweight in Malaysia is expected to increase in Prevalence of overweight in Malaysia is expected to increase in

women over the next 10 years, but remain relatively constant in menwomen over the next 10 years, but remain relatively constant in men

Overweight and obesityOverweight and obesity

• Raised body mass index is a/w the Raised body mass index is a/w the

possibility of early death. possibility of early death.

• High Tg & LDL-cholesterol, low HDL-High Tg & LDL-cholesterol, low HDL-

cholesterol. cholesterol.

• 3 x more likely to have HPT 3 x more likely to have HPT

• 50% of Type 2 diabetics are obese. 50% of Type 2 diabetics are obese.

• Risk of breast and prostate cancer Risk of breast and prostate cancer

HypercholesterolemiaHypercholesterolemia

• Prevalence: 53.5%.Prevalence: 53.5%.

• About 53.1% of men and 53.9% of womenAbout 53.1% of men and 53.9% of women

• 1 in 2 adults aged 25-64 years had 1 in 2 adults aged 25-64 years had

hypercholesterolemia. hypercholesterolemia.

• Indians (61.3%), followed by Malays (54.7%) Indians (61.3%), followed by Malays (54.7%)

and Chinese (52.9%). and Chinese (52.9%).

Prevalence of Hypercholesterolemia

Unhealthy dietUnhealthy diet

• The prevalence of non-meeting of dietary The prevalence of non-meeting of dietary

guideline for vegetables and fruits intake guideline for vegetables and fruits intake

was 72.8%. was 72.8%.

• About 70.3% of men and 75.5% of women About 70.3% of men and 75.5% of women

did not meet the dietary guideline.did not meet the dietary guideline.

• ~ 8.7 million or most adults aged 25-64 ~ 8.7 million or most adults aged 25-64

years did not meet the dietary guideline years did not meet the dietary guideline

for vegetables and fruits intake. for vegetables and fruits intake.

Prevalence of Unhealthy Diet (Not enough vegetables and fruits)

~ 3.1 million Malaysian (1 in 2 men and 1 in 33 women), ~ 3.1 million Malaysian (1 in 2 men and 1 in 33 women),

aged 25-64 years were current smokers aged 25-64 years were current smokers

Smoking habitSmoking habit

• Prevalence of current smokers was Prevalence of current smokers was

25.5%. 25.5%.

• Men (46.5%), women (3.0%) were current Men (46.5%), women (3.0%) were current

cigarette smokers.cigarette smokers.

• ~ 3.1 million (1 in 2 men and 1 in 33 ~ 3.1 million (1 in 2 men and 1 in 33

women), aged 25-64 years were current women), aged 25-64 years were current

smokers. smokers.

Prevalence of Current Smoker

Physical inactivityPhysical inactivity

• Prevalence: 60.1%. Prevalence: 60.1%.

• About 55.4% of men and 65.1% of About 55.4% of men and 65.1% of

women were physically inactive.women were physically inactive.

• ~ 7.2 million or 1 in 2 for both men and ~ 7.2 million or 1 in 2 for both men and

women, aged 25-64 years were women, aged 25-64 years were

physically inactive. physically inactive.

Prevalence of Physical Inactivity

Diabetes mellitusDiabetes mellitus

• Diabetes is a lifelong disease. Diabetes is a lifelong disease.

• DM is a disease of the pancreas (an organ DM is a disease of the pancreas (an organ

behind your stomach). behind your stomach).

• DM occurs when the pancreas does not DM occurs when the pancreas does not

produce any insulin or pancreas produces produce any insulin or pancreas produces

very little insulin or when the body does very little insulin or when the body does

not respond appropriately to insulinnot respond appropriately to insulin

Diabetes mellitus in MalaysiaDiabetes mellitus in Malaysia


• 1 in 10 men and 1 in 8 women had high 1 in 10 men and 1 in 8 women had high

blood glucose. blood glucose.

• Known diabetes: 543,385Known diabetes: 543,385

• Newly diagnosed: 781,798Newly diagnosed: 781,798

• Indians (20.0%), Malays (11.1%) and Indians (20.0%), Malays (11.1%) and

Chinese (7.5%). Chinese (7.5%).

Prevalence of Raised Blood Glucose

Manifestations of DMManifestations of DM

• IDDM (type 1)IDDM (type 1)

*Increased thirst *Increased thirst

*Increased hunger (especially *Increased hunger (especially after eating) after eating)

*Dry mouth *Dry mouth

*Frequent urination *Frequent urination

*Unexplained weight loss *Unexplained weight loss

*Fatigue (weak, tired feeling) *Fatigue (weak, tired feeling)

*Blurred vision *Blurred vision

*Labored, heavy breathing *Labored, heavy breathing *Loss of consciousness (rare) *Loss of consciousness (rare)

• NIDDM (type 2)NIDDM (type 2)

*Slow-healing sores or cuts *Slow-healing sores or cuts

*Itching of the skin (usually *Itching of the skin (usually in the vaginal or groin area) in the vaginal or groin area)

*Yeast infections *Yeast infections

*Recent weight gain *Recent weight gain

*Numbness or tingling of the *Numbness or tingling of the hands and feethands and feet

*Low blood glucose levels*Low blood glucose levels

*Impotence or erectile *Impotence or erectile dysfunctiondysfunction

Complications of DMComplications of DM

Risk factorsRisk factors

• A family historyA family history

• Race or ethnic backgroundRace or ethnic background

• Being overweight & abnormal cholesterol levelsBeing overweight & abnormal cholesterol levels

• HypertensionHypertension

• AgeAge

• Drugs: thiazides, Steroid medicinesDrugs: thiazides, Steroid medicines

• Alcohol & Smoking Alcohol & Smoking

• History of gestational diabetes History of gestational diabetes

• Autoimmune diseaseAutoimmune disease

• Viruses Viruses

If you are diabeticIf you are diabetic

• Balanced dietBalanced diet

• Exercising regularly. Exercising regularly.

• Maintain your blood cholesterol and triglyceride Maintain your blood cholesterol and triglyceride

levels as near normal ranges levels as near normal ranges

• BP should not go over 130/80. BP should not go over 130/80.

• Taking medicine, if prescribed, and closely Taking medicine, if prescribed, and closely

following the guidelines on how and when to take following the guidelines on how and when to take

it. it.

• Monitoring blood glucose and BP levels at home.Monitoring blood glucose and BP levels at home.

• Keep to the appointmentsKeep to the appointments

HypertensionHypertension

What is hypertension?What is hypertension?

• BP > 140 mm Hg / 90 mm Hg, measured BP > 140 mm Hg / 90 mm Hg, measured

while at rest.while at rest.

• Causes: essential or secondary HPT (10%)Causes: essential or secondary HPT (10%)

• Mostly asymptomatic. Mostly asymptomatic.

• The most well known symptoms are The most well known symptoms are

headache felt at the back of the head, headache felt at the back of the head,

dizziness, fatigue and ringing in the ears. dizziness, fatigue and ringing in the ears.

Hypertension in MalaysiaHypertension in Malaysia


• Men vs women - 26.3% vs 25.0%.Men vs women - 26.3% vs 25.0%.

• 1 in 4 adults aged 25-64 years had HPT. 1 in 4 adults aged 25-64 years had HPT.

• Known hypertensives: 1.4 millionKnown hypertensives: 1.4 million

• Newly diagnosed:1.7 million.Newly diagnosed:1.7 million.

• Chinese (31.0%), Malays (23.4%) and Chinese (31.0%), Malays (23.4%) and

Indians (21.6%). Indians (21.6%).

Prevalence of Raised Blood Pressure

Hypertension risk factorsHypertension risk factors

Complications Complications of HPTof HPT

How can high BP can be How can high BP can be prevented?prevented?

• Control body weightControl body weight

• Exercise regularly - 30 minutes a day Exercise regularly - 30 minutes a day

• Limit daily intake of sodium (about 1 teaspoon of Limit daily intake of sodium (about 1 teaspoon of salt). salt).

• Take more fruits and vegetables and low fat Take more fruits and vegetables and low fat productsproducts

• Eat food that is rich in potassium (3,500 mg) Eat food that is rich in potassium (3,500 mg) potassium per day. potassium per day.

• SAY NO to alcohol or tobacco. SAY NO to alcohol or tobacco.

• Relaxation treatment: slow breathing exerciseRelaxation treatment: slow breathing exercise

Reduce high sodium foodReduce high sodium food

• Processed foods such as lunch meats, sausage, Processed foods such as lunch meats, sausage,

bacon, and hambacon, and ham

• Canned soups, bouillon, dried soup mixesCanned soups, bouillon, dried soup mixes

• Condiments (ketchup, soy sauce, salad dressings)Condiments (ketchup, soy sauce, salad dressings)

• Frozen and boxed mixes for potatoes, rice, and Frozen and boxed mixes for potatoes, rice, and

pasta, snacks (pretzels, popcorn, peanuts, chips), pasta, snacks (pretzels, popcorn, peanuts, chips),

pickled or marinated food. pickled or marinated food.

• AJINIOMOTO (monosodium glutamate)AJINIOMOTO (monosodium glutamate)

Increase high potassium dietIncrease high potassium diet

Heart attackHeart attack

Risk factorsRisk factors

StrokeStroke

PreventionPrevention

CancerCancer

World Health Organization (WHO) International Agency for Research on Cancer: World Cancer Report 2003)

Who is at risk for cancer?Who is at risk for cancer?

• EveryoneEveryone

• In the US, cancer is likely to affect 1 in 2 In the US, cancer is likely to affect 1 in 2

men and 1 in 3 women men and 1 in 3 women

• The amount of risk you have depends on a The amount of risk you have depends on a

few factors (tobacco use, lifestyle choices few factors (tobacco use, lifestyle choices

(such as diet and exercise), family history, (such as diet and exercise), family history,

and factors in your workplace and and factors in your workplace and

environment)environment)

Workplace or environment factors?Workplace or environment factors?

• Exposure to the sun can cause skin cancer, Exposure to the sun can cause skin cancer,

and breathing tobacco smoke puts you at risk and breathing tobacco smoke puts you at risk

of lung cancer and some other types of cancer.of lung cancer and some other types of cancer.

• Carcinogenic: asbestos, solvents and Carcinogenic: asbestos, solvents and

chemicals used for manufacturing or cleaning, chemicals used for manufacturing or cleaning,

smoke or fumes from burning materials, and smoke or fumes from burning materials, and

many others. many others.

Cancer of prostateCancer of prostate

Prostate cancer manifestationsProstate cancer manifestations

• Weak or interrupted flow of urine. Weak or interrupted flow of urine.

• Frequent urination (especially at night). Frequent urination (especially at night).

• Trouble urinating. Trouble urinating.

• Pain or burning during urination. Pain or burning during urination.

• Blood in the urine or semen. Blood in the urine or semen.

• A pain in the back, hips, or pelvis that doesn't go A pain in the back, hips, or pelvis that doesn't go

away. away.

• Painful ejaculation Painful ejaculation

How to detect?How to detect?

Prostate-specific antigen (PSA) level: PSA is a substance produced by the prostate and some other tissues in the body

Transrectal USG

Breast cancerBreast cancer

Techniques for breast Techniques for breast examination. examination.

How to detect?How to detect?

• The New Zealand Breast Cancer Foundation recommends

women between 40 and 50 have a yearly mammogram and twice

yearly from 50 years.

ConclusionsConclusions

• Chronic diseases is a major problem for Chronic diseases is a major problem for

MalaysiaMalaysia

• At least 80% of premature heart disease, At least 80% of premature heart disease,

stroke and type 2 diabetes, and 40% of stroke and type 2 diabetes, and 40% of

cancer could be prevented by reversing cancer could be prevented by reversing

a common factors.a common factors.

Common Risk Factors

chronic disease in malaysia

Travel