non-communicable diseases and lifestyle-related diseases

NON-COMMUNICABLE DISEASES– LIFESTYLE RELATED DISEASES

IEC

WILMA N. BERALDE, RM, RN, MANNDP – BalatanNon – Communicable Disease Coordinator

4 MAJOR NCDs IN THE PHILIPPINES

• CARDIOVASCULAR DISEASES

• CANCERS

• CHRONIC OBSTRUCTIVE PULMONARY DISEASES

• DIABETES MELLITUS

The Philippines is one of the 23 selectedcountries contributing to around 80% of the totalmortality burden attributable to chronic diseasesin developing countries, and 50% of the totaldisease burden caused by NCDs worldwide(Lancet, 2007)

Epidemiology of the Major NCDs

Common Risk Factors Leading to Major NCDs

Risk FactorsCardiovascular

DiseasesDiabetes Mellitus

CancersChronic

Respiratory Diseases

Smoking

Diet/Nutrition

Physical inactivity

Obesity

Alcohol

Raised blood pressure

Raised blood sugar

Abnormal blood lipids

* coronary artery disease, hypertension, stroke**chronic obstructive pulmonary disease, asthmaSource: WHO STEPwise Approach to Surveillance of NCD Risk, 2003

NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES

CANCER HEART DISEASE LUNG DISEASE DIABETESACCIDENTS &

INJURIES

Coronary Artery Disease

Myocardial Infarction

Congenital Heart Disease

Congestive Heart Failure

Hypertension

Cardiovascular Disease

• describes a range of diseases that affect the heart and blood vessels and includes:

Stroke

Arrhythmias

others.

Description of Major NCDs

– Coronary artery diseases

– Hypertension

– Cerebrovascular diseases (stroke)

• increased total cholesterol, high LDL, low HDL, smoking, obesity/overweight, physical inactivity, diabetes

• Family history, age, high salt intake, obesity, excess alcohol intake

• Age, sex, heredity, hypertension, smoking, diabetes, heart disease, high RBC, excessive alcohol intake, drug abuse

Cardiovascular diseases and their risk factors



INJURIES

HYPERTENSIONAn increase in blood pressure ≥ 140/90 mmHg in two (2) or

more separate occasions. One of the leading causes of disability among Filipinos due to

stroke.

Classification of blood pressure for adults

BLOOD PRESSURE CLASSIFICATION

SYSTOLIC BP DIASTOLIC BP

NORMAL LESS THAN 120 mmHgLESS THAN 80

mmHg

PRE HYPERTENSION 120 - 139 mmHg 80 – 89 mmHg

Stage 1 Hypertension

140 – 159 mmHg 90 – 99 mmHg

Stage 2 Hypertension

160 mmHg or Higher100 mmHg or

higher

HYPERTENSIONRISK FACTORS

Smoking

Excessive alcohol consumption

Overweight

Family history of hypertension, heart disease, diabetes and kidney disease

Sedentary lifestyle

Chronic stress

Advancing age

PREVENTION

Regular exercise and eating”heart healthy” diet

Excessive alcohol consumption and cigarette smoking also increases the likelihood of hypertension

HYPERTENSIONUSUAL SIGN AND SYMPTOMS

NOT ALL HYPERTENSIVE PATIENTS HAVE SYMPTOMS….

Headache

Dizziness

Blurring of visions

Nape/ neck discomfort

EARLY DETECTION IS AN IMPORTANT FACTOR FOR PREVENTING FURTHER COMPLICATIONS……

POSSIBLE COMPLICATIONS

Chronic, undiagnosed and untreated hypertension may result to:

Heart attack stroke kidney failure loss of vision

Lifestyle modification to prevent and manage hypertension

LIFESTYLE MODIFICATION

RECOMMENDATION APPROXIMATE SYSTOLIC BP REDUCTION

Weight reduction Maintain normal body weight 5-20 mmHg

Adopt DASH eating plan (dietary Approach to stop hypertension)

Consume a diet rich in fruits, vegetables, and low fat dairyproducts

8-14 mmHg

Dietary sodium (salt) restriction

Reduce dietary sodium intake 2 – 8 mmHg

Physical activity Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week)

4 -9 mmHg

Moderation of alcohol consumption

Limit consumption to no more than 2 drinks per day in most men and not more than 1 drink per day in women and lighter weight persons

2 -4 mmHg



INJURIES

Type 1 Type 2

Body’s failure to produce insulin and usually sets in among the young population groups

Secondary to decreased activity of the insulin produced which results in increased blood sugar level and usually sets in among the older age groups

– Diabetes • Family history, overweight, lack of physical activity, hypertension, HDL < 35mg/dl, triglyceride >250mg/dl, history of gestational diabetes, with impaired glucose tolerance

Diabetes and its risk factors


DIABETES

group of metabolic disorders characterized by high blood sugar level on 2 separate occasions

results when the body cannot properly regulate the amount of sugar (e.g. glucose in the blood)

DIABETES

4 clinical types of diabetesType 1 : INSULIN DEPENDENT DIABETES

Type 2 : NON-INSULIN DEPENDENT DIABETES

who can be managed through oral anti-diabetic

medications but may eventually also require insulin

treatment to attain good blood glucose control

Type 3 : GESTATIONAL DIABETES

who were first diagnosed to have diabetes during pregnancy

Type 4 :SECONDARY DIABETES

acquired diabetes that may be drug or chemical-induced such as those who are being treated for AIDS or from other endocrine diseases such as hyperthyroidism.

Values for the diagnosis of diabetes and other categories of hyperglycemia

Type of Testing FBS Values ClassificationCriteria for

Diagnoses of Diabetes Mellitus

Fasting blood sugar (FBS) - no caloric intake for at least 8 hours which means no food, juices, milk, but water is allowed

2-hour blood sugar test: performed after using 75 g glucose dissolved in water or after a good meal

109 mg% Normal Any of the following:

Symptoms of diabetes plus RBS> 200 mg/dL (11.1 mmol/L)

FBS> 126 mg/ dL (7.0 mmol)

2-hr blood sugar >200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test (OGTT)*

110- 125 mg% Impaired glucose tolerance

126 mg% Possible diabetes mellitus

* FPG estimation is the biochemical test of choice for screening in all age groups. In adults, FPG measurement has been found to be more reproducible than the 2-hour plasma glucose level following an OGTT.**OGTT is the gold standard for diagnosing diabetes and can be used as a screening test.

DIABETESRISK FACTORS FOR DIABETES

High blood pressure

High triglyceride levels

Giving birth to an 8 lb baby

Sedentary lifestyle

Obesity

Family history of type 2 diabetes mellitus among 1st

degree relatives

USUAL S/S OF DIABETES Fatigue excessive urination

Unexplained weight loss poor wound healing

Excessive thirst Excessive hunger

DIABETESPREVENTION

Diabetes , a lifestyle –related disease which can be prevented through regular exercise (at least 30 min every other day) and eating a “heart healthy” diet (i.e. low -salt ,low-fat diet)

Excessive alcohol consumption and cigarette smoking also increases the likelihood of diabetes



INJURIES

Cancer warning signs

Guidelines for Common Screening Procedures for Major NCDs

Change in bowel or bladder habits

A sore that does not heal

Unusual bleeding or discharge

Thickening or lump in the breast or elsewhere

Indigestion or difficulty swallowing

Obvious change in warts or moles

Nagging cough or hoarseness in voice

Unexplained anemia

Sudden weight loss

– Oral cancer

– Breast cancer

– Lung cancer

– Cervical cancer

• Smoking, excessive alcohol use, chronic irritation, Vitamin A deficiency

• Early menarche/late menopause, high fat diet, obesity, physical inactivity, alcohol, family history

• Smoking, radiation exposure

• Smoking, HPV infection, chlamydia infection, low intake of fruits and vegetables, family history

Some cancers and their risk factors


Screening guidelines for breast cancer (targets 15-60 years old and above)

• Monthly breast self-examination• Breast examination by health worker (annually) for all child-bearing

woman• Annual mammography for women over 50 years old and above• For certain high risk women, baseline mammography at age 35 with

repeat upon recommendation of attending physician• Genetic screening and counseling for high risk patients or if

appropriate• Referral to hospital for further management if found positive (+) for

mass or any abnormalities


Breast Self- Examination


Stand in front of a mirror. Check each breast for anything unusual (dimpling,

discharge).

Clasp your hands behind your head and press hands forward.

Check contour of breast.



Gently squeeze each nipple and look for discharge

While standing, raise one arm. Use finger pads to check the breast and

surrounding area – firmly, carefully and thoroughly.



Lines

CirclesWedges



Lie flat on your back, with one arm over your head and a pillow or folded towel under the shoulder. This position

flattens the breast and makes it easier to check.

Changes in the breast that should be noted and reported to a physician

• Any lump or hard knot found in the breast or armpit

• Any lump or thickening of the tissue that does not shrink or lessen aftr her next period

• Any change in the size, shape, or symmetry of her breast

• A thickening or swelling of the breast

• Any dimpling, puckering, or indention in the breast

• Dimpling, skin irritation, or other change in the breast skin or nipple

• Redness or scaliness of the nipple or breast skin

• Discharge from the nipple (fluid coming from the nipples other than breast milk), particularly if the discharge is clear and sticky, dark or occurs without squeezing the nipple

• Nipple tenderness or pain


– COPD

– Asthma

• Smoking

• Genetic predisposition, allergens, smoking, air pollution, respiratory infections

COPD and Asthma and their risk factors




INJURIES

Chronic Respiratory Disease

• The most common morbid conditions suffered by Filipinos are respiratory diseases.

Major causes of death due to Respiratory

causes

• Chronic Respiratory Diseases (Asthma, COPDs)

• Pneumonia

Top leading Respiratory causes of

Morbidity

• Acute Respiratory Infection

• Acute Lower Respiratory Tract Infection

• Pneumonia

• Bronchitis



INJURIES

Accidents are unintentional, unexpected and undesirable events while injuries are either intentional or unintentional events that result in damage or harm to a person (DOH, 2005).

Most accidents and injuries can be avoided. Their effects can be reduced through measures like road safety

education, installation of adequate walkways, streetlights, signages, and home safety management.

In high-income countries, road traffic injuries, self-inflicted injuries and interpersonal violence are the three leading causes of death among those aged 15 to 44 years. In the same age group, there are twice as many suicides and

three times as many traffic-related deaths as homicides.



INJURIES

Key Areas for the Primary Prevention of the Major NCDs

Promote Proper Nutrition

Encourage more physical activity and exercise

Promote smoke-free individuals and environment

Discourage excessive alcohol drinking

Manage stress effectively

Maintain regular health check-up

• Smoking cessation for active smokers to reduce risk

• Prohibit smoking inside living areas, houses and closed areas

• Avoid smoke-filled places

• Advocate for implementation of policies that support smoke-free environment

• Support policies/ordinances/laws that limit access of cigarettes to children and youth

PROMOTE SMOKE-FREE INDIVIDUALS AND ENVIRONMENT


• Discourage excessive alcohol drinking

• Regular health check-up for early diagnosis and prompt treatment

PROMOTE ALCOHOL-FREE ENVIRONMENT


• Limit intake of fatty, salty and preserved foods

• Increase intake of vegetables and fruits

• Avoid high caloric low-nutrient value food like junk food, instant noodles, soft drinks

• Start developing healthy habits in children

PROMOTE PROPER NUTRITION


• Moderate physical activity of at least 30 minutes for most days

• Integrate physical activity and exercise into regular day-to-day activities

• Promote walking as one form of exercise that is possible for all including older persons and persons with cardiovascular disease

ENCOURAGE MORE PHYSICAL ACTIVITY


• Manage stress effectively

• Regular health check-up for early diagnosis and prompt treatment

PROMOTE A STRESS-FREE ENVIRONMENT


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non-communicable diseases and lifestyle-related diseases

Healthcare