Non-communicable diseases(NCDs) and its Prevention

INTRODUCTION

Non communicable disease account for a large and increasing burden of disease worldwide. It is currently estimated that non communicable disease accounts for approximately 60% of global deaths and 43% of global disease burden. This is projected to increase to 73% of deaths and 60% of disease burden by 2020.

NON-COMMUNICABLE DISEASES (NCDs)

HypertensionCoronary Heart DiseaseDiabetesStrokeMalignanciesObesityBlindnessPsychiatric disordersOthers

Non-communicable diseases are the leading killer today and are on the increase.

Nearly 80% of these deaths occurred in low- and middle-income countries.

NCDs are the leading cause of death in the world, responsible for 63% of the 57 million deaths that occurred in 2008.

GLOBAL STATUS OF NDCS

GLOBAL STATUS (cont..)

The majority of these deaths - 36 million - were attributed to cardiovascular diseases and diabetes, cancers and chronic respiratory diseases.

NCDs are largely preventable by means of effective interventions that tackle shared risk factors, namely: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol.

NCDs are not only a health problem but a development challenge as well.

80% of premature heart disease and stroke is preventable.

Risk factors for NCDsTobacco use

Alcohol consumption

Raised blood pressure

Obesity

Diet

Physical inactivity

Diabetes mellitus

High serum cholesterol

Behavioral risk factors

• Tobacco• Alcohol• Physical

inactivity• Nutrition

Behavioral risk factors

• Tobacco• Alcohol• Physical

inactivity• Nutrition

Physiological risk factors

• Body mass index• Blood pressure• Blood glucose• Cholesterol

Physiological risk factors

• Body mass index• Blood pressure• Blood glucose• Cholesterol

Disease outcomes

• Heart disease • Stroke• Diabetes• Cancer• Respiratory diseases

Disease outcomes

• Heart disease • Stroke• Diabetes• Cancer• Respiratory diseases

The causal chain explains the risk factor approach for surveillance of non communicable diseases

Changes in life style

Abundance of food

Lack of physical activity

smoking

stress

Emotional disturbance

aging

obesity

hyperlipidemia

Chronic atherosclerosis Coronary occlusion

HTN

Changes artery walls

Thrombotic tendency

Myocardial

infarction

OBESITY

Defined as abnormal or excessive fat accumulation that presents a risk to health.

It is the most prevalent form of malnutrition.

It is one of the most significant contributors of ill health.

Central fat distribution or abdominal fat distribution or android obesity is more serious than gynoid fat distribution.

OBESITY

•Obesity is growing problem across the globe.

•Worldwide, more than 300 million adults are obese, according to (WHO).

•Obesity is the second-leading cause of preventable death, surpassed only by smoking.

Global Status

Obesity is a major risk factor for a number of serious health conditions, including:Coronary heart disease. Cancer. Diabetes. Fatty liver disease. Gallbladder disease.High blood pressure..Osteoarthritis. Stroke. Sleep apnea and other breathing

problems.

BMI• Body mass index or BMI is a

simple and widely used method for estimating body fat mass.

• BMI is calculated by dividing the subject's weight in kg by the square of his or her height in meter:

Assessment of Obesity

BMI Classification

Less than 18.5 Underweight

18.5–24.9 Normal weight

25.0–29.9 Overweight

30.0–34.9 Class I obesity

35.0–39.9 Class II obesity

WAIST CIRCUMFERENCE

•Your waist size is a clue to whether you're at high risk for type 2 diabetes high blood pressure, high cholesterol and heart disease.

•To measure your waist circumference, use a tape measure. Start at the top of your hip bone, then bring the tape measure all the way around, level with your belly button.

For your best health, your waist should measure no more than 40 inches or ≥ 102 cm for men, 35 inches or ≥ 88 cm for women

Waist-Hip RatioWaist–hip ratio (WHR) is the

ratio of the circumference of the waist to that of the hip.

Measured simply at the smallest circumference of the natural waist, usually just above the belly button, and the hip circumference be measured at its widest part of the buttocks or hip.

Causes of Obesity

Physical inactivity.

Diet.

Drugs.

Medical conditions.

Genetics.

23

Hypertension

The Silent killer

Hypertension is high blood pressure. Blood pressure is the force of blood pushing against the walls of arteries as it flows through them.

DEFINITION

Global burden of hypertension

• The biggest increase in prevalence was expected to be in developing (increase of 24%) and third world countries (increase of 80%) as the rapidly take on the more western lifestyle.

• Scientists are now claiming that 1 in 3 adults in the world will have high blood pressure in 2025. By 2025, the number will increase by about 60% to a total of 1.56 billion as the proportion of elderly people will increase significantly. 

1. PrimaryChronic high blood

pressure without a source or associated with any other disease

Most common form of hypertension

2. SecondaryElevation of blood

pressure associated with another disease such as kidney disease

Genetics-some people are prone to hypertension simply based off of their genetic makeup

Family History- your risk for high blood pressure/hypertension increases if it is in your family history

EnvironmentInactivityStressObesityAlcoholHigh Sodium DietTobacco UseAge

Causes

Blood Pressure Classification

Risk factors for hypertension include:

ModifiableBody weightSodium chloride intakeAlcohol intakePhysical activityPsychosocial factorsSocio-economic statusHormonal contraceptives

Non-modifiableAgeSex/genderHeredityEthnicity/race

Risk factors for hypertension may be classified as:

NON-MODIFIABLE RISK FACTORS

(a) AGE: Blood pressure rises with age in both sexes and the rise is grater in those with higher initial blood pressure.

(b) SEX: Early in life there is little evidence of a difference in blood pressure between the sexes. However, at adolescence, men display a higher average level. This difference is most evident in young and middle aged adults.

(c) GENETIC FACTORS: There is considerable evidence that blood pressure levels are determined in part by genetic factors.

(d) ETHNICITY: Population studies have consistently revealed higher blood pressure levels in black communities

MODIFIABLE RISK FACTORS

(a )Obesity: Epidemiological observations have identified obesity as a risk factor for hypertension. The greater the weight gains the grater the risk of high

blood pressure .

(b )SALT INTAKE: There is an increasing body of evidence to the effect that a high salt intake (i.e., 7-8 g per day) increases blood pressure proportionately. Low sodium intake has been found to lower the blood

pressure .

(c ) SATURATED FAT: The evidences suggest that saturated fat raises blood pressure as well as serum cholesterol.

MODIFIABLE RISK FACTORS (cont..)

(d) DIETARY FIBRE: Several studies indicate that the risk of CHD and hypertension is inversely related to the consumption of dietary fibre. Most fibers reduce plasma total cholesterol and LDL cholesterol.

(e) ALCOHOL: High alcohol intake is associated with an increased risk of high blood pressure.

(f) PHYSICAL ACTIVITY: Physical activity by reducing body weight may have an indirect effect on blood pressure.

)g (ENVIRONMENTAL STRESS: The term hypertension itself implies a disorder initiated by tension or stress. However, it is an accepted fact that psychosocial factors operate through mental processes, consciously or

unconsciously to produce hypertension.

)h (SOCIO-ECONOMIC STATUS: In countries that are in post-transitional stage of economic and epidemiological change, consistently higher levels of blood pressure

have been noted in lower socio-economic groups .

PREVENTION OF HYPERTENSION

The WHO has recommended the following approaches in the prevention of hypertension :

1 .Primary Prevention ) a (Population strategy

) b (High- risk strategy

2 .Secondary Prevention.

PRIMARY PREVENTION

• Primary prevention has been defined as “all measures to reduce the incidence of disease in a population by reducing the risk of onset”. The earlier the prevention starts the more likely it is to be effective.

a)POPULATION STRATEGY The population approach is directed at the whole

population, irrespective of individual risk levels.

small reduction in the average blood pressure of population would produce a large reduction in the incidence of cardiovascular complications such as stroke and CHD.

Population strategy (cont..) The following non-pharmacotherapeutic interventions:

(a) NUTRITION: Dietary changes are of paramount importance. These comprise: (i) Reduction of salt intake to an average of not more than 5 g per day (ii) Moderate fat intake (iii) The avoidance of a high alcohol intake, and (iv) Restriction of energy intake appropriate to body needs

(b) WEIGHT REDUCTION: The prevention and correction ofover weight/obesity is a prudent way to reducing the risk of hypertension and indirectly CHD.

(c) EXERCISE PROMOTION: The evidence that regular physical activity leads to a fall in body weight, blood lipids and blood pressure goes to suggest that regular physical activity should be encouraged as part of the strategy for risk-factor control.

(d) BEHAVIOURAL CHANGES: Reduction of stress and smoking. modification of personal life- style. yoga and meditation could be profitable.

(e) HEALTH EDUCATION: The general public require preventive advice on all risk factors and related health behaviour. The whole community must be mobilized and made aware of the possibility of primary prevention.

(b) HIGH-RISK STRATEGY

This is also part of primary prevention. The aim of this approach is “to prevent the attainment of levels of blood pressure at which the institution of treatment would be considered”.

Detection of high-risk subjects should be encouraged by the optimum use of clinical methods Since hypertension tends to cluster in family history of hypertension and “tracking” of blood pressure from childhood may be used to identify individuals at risk

CARDIOVASCULAR DISEASE

Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). While the term technically refers to any disease that affects the cardiovascular system, it is usually used to refer to those related to atherosclerosis (arterial disease).

Definition

CVD are present in many forms and have

different categories and include:-

Hypertension (high blood pressure) Coronary heart disease (heart attack) Cerebrovascular disease (stroke) Peripheral vascular disease Heart failure Rheumatic heart disease Congenital heart disease Cardiomyopathies

Global Burden of Cardiovascular Disease

Number one cause of death globally and is projected to remain the leading cause of death.

An estimated 17.5 million people died from cardiovascular disease in 2005, representing 30 % of all global deaths.

Of these deaths, 7.6 million were due to heart attacks and 5.7 million were due to stroke.

Statistics, cont

Around 80% of these deaths occurred in low and middle income countries (LMIC).

If appropriate action is not taken, by 2015, an estimated 20 million people will die from cardiovascular disease every year, mainly from heart attacks and strokes. (WHO, 2005)

Percentage breakdown of deaths from cardiovascular diseases

RISK FACTORSModifiable Non modifiable

Mortality rate per 100,000 of cardiovascular diseases was:

• All heart diseases 56.8 • Rheumatic HD 0.7 • Ischemic HD 36.4 • Pulmonary HD 1.6 • Other heart diseases 18.1 • CVA 29.8 • Essential hypertension 13

Cardiovascular Disease Mortality Indicator

PREVENTION

CHD is primarily a mass disease.So, the strategy should be therefore mass

approach.Should focus mainly on control of risk

factors.

Population Strategy

SPECIFIC INTERVENTIONS

It involves preventing the emergence and spread of CHD risk factors and life styles that have not yet appeared or become endemic.

Prevention should be multifactorial because the aetiology is multifactorial.

The aim should be to change the community as a whole, not the individual subjects living in it.

PRIMORDIAL PREVENTION

HIGH RISK STRATEGY

SECONDAY PREVENTION

Cardiovascular diseases and stroke are major cause of illness, disability and death worldwide which causes an increase in personal and community health care costs. This really requires a competent plan to address this important and serious issue.

Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or alternatively, when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar

TYPES OF DIABETES1) Type 1 Diabetes

usually diagnosed in childhood

affected by hereditary

sometimes there are no symptoms frequently called the ‘insulin-needed’ group

Patients with type 1 diabetes need insulin daily to survive

Types of diabetes (cont.…)2)Type 2 Diabetes

most common.usually occurs in adulthood. Body is incapable of responding to insulin Rates rising due to increased obesity and failure

to exercise and eat healthy

3) Gestational Diabetes blood sugar levels are high during pregnancy in

womenWomen who give birth to children over 9 lbs.high risk of type 2 diabetes and cardiovascular

disease

Types of diabetes (cont.…)4) Pre-diabetesAt least 79 million people are diagnosed with pre-diabetes each yearabove average blood glucose levels, not high enough to be classified under type 1 or type 2 diabeteslong-term damage to body, including heart and circulatory system .Starts with unhealthy eating habits & inadequate exercise.

FPG 2-hr PG on OGTT

126 mg/dl 7 mmol/l

100 and <126

5.5 and < 7 mmol/l<100

(5.5 mmol/l)

200 11.1 mmol/l

140 and <200 7.8 and < 11.1mmol/l

<140 7.8 mmol/l

GlucosePrediabetes

Normal

Diabetes Mellitus

TolerancePrediabetes

Diabetes Mellitus

Normal

mg/dL mg/dL

• BrainCerebrovascular

disease• Transient ischemic

attack• Cerebrovascular

accident• Cognitive

impairment• Heart

Coronary artery disease• Coronary

syndrome• Myocardial

infarction• Congestive heart

failureExtremities

Peripheral vascular disease

• Ulceration• Gangrene• Amputation

Macrovascular Microvascular

EyeRetinopathyCataractsGlaucoma

KidneyNephropathy

• Microalbuminuria

• Gross albuminuria

• Kidney failure

NervesNeuropathy

• Peripheral• Autonomic

Globally•382 million people have diabetes

•By 2035, this number will rise to 592 million

In Bangladesh•8.4 million people had diabetes in 2013

•8.4 million people are likely to have diabetes in 2035

Global Barden

The global increase in diabetes will occur because of population ageing and growth, and because of increasing trends towards obesity, unhealthy diets and sedentary lifestyles.

Worldwide, 3.2 million deaths are attributable to diabetes every year.

One in 20 deaths is attributable to diabetes; 8,700 deaths every day; six deaths every minute.

At least one in ten deaths among adults between 35 and 64 years old is attributable to diabetes

Global Barden (cont..)

Major risk factors

Family history

Obesity

Age (older than 45)

History of gestational diabetes

High cholesterol

Hypertension

Risk Factor For Type-1Genetic predisposition

In an individual with a genetic predisposition, an event such as virus or toxin triggers autoimmune destruction of -cells probably over a period of several years.

Risk Factor For Type-2

Family History Obesity Habitual physical inactivity Previously identified impaired glucose

tolerance. IGT or impaired fasting glucose (IFG) Hypertension Hyperlipidemia

PREVENTION1) Primary Prevention Lifestyle Changes Can Prevent Diabetes. Avoiding

stress, smoking can reduce the chance of DM. Physical activity decreases insulin resistance and

can aid in both preventing type 2 diabetes mellitus and managing the disease.

 Dietary intake of saturated fat and decreased intake of fibre can result in lowered insulin sensitivity and impairment of glucose tolerance. In general, reduction in the overall calories, reduced intake of saturated fats & refined sugars and increased intake of grains, fruits and vegetables would be of utility in preventing diabetes

PREVENTION (cont..)2) Secondary Prevention This would be through early diagnosis and prompt treatment, mainly by way of screening programme. It is done by population screening and selective random screening.Selective screening undertaken in groups of people known to be at high risk, as those with family history, obese persons (BMI > 25), aged more than 40 years in high prevalence populations, women giving history of GDM, those with history of IGT / IFG, or those with hypertension or dyslipidaemia.It reduces the complication of DM.

Triad of Treatment Diet Discipline(Exercise, life

style) Drug(Medication)

Oral hypoglycemics Insulins

Diabetic Meal Plan Using the Food Guide Pyramid

REMEMBER….TAKE CONTROL OF

YOUR LIFE! DON’T LET DIABETES

CONTROL YOU!

CANCER

Cancermedical term: (malignant

neoplasm) is a class of diseases in which a group of cells display uncontrolled growth, invasion and sometimes metastasis (spread to other locations in the body via lymph or blood).

STATISTICS>9.7 million cases are

detected each year6.7 million people will die

from cancerCancer causes about 13%

of all deaths.20.4 million people living

with cancer in the world today

2020 15 million people will die from cancer

Lung, breast, colorectal, stomach and liver cancers

In high-income countries, the leading causes of cancer deaths are lung cancer among men and breast cancer among women.

In low- and middle-income countries cancer levels vary according to the prevailing underlying risks.

STATISTICS (cont..)

What causes cancer? Heredity Immunity Chemical Physical Viral Bacterial Lifestyle

Heredity• Colorectal

carcinoma North America,

Australia, New Zealand

• Stomach cancer Korea, Japan, and

China• Liver cancer West and Central

Africa • Prostate cancer Europe, North

America, and Oceania

Immunity

HIV / AIDS

Immunosuppression

Virus’s Hepatitis B

Human T-cell

Leukaemia virus

Epstein Barr Virus

Human Papilloma Virus

(HPV)

Bacterial H. pylori

Other Parasites: Schistosoma spp Clonorchis sinensis

Chemical Alcohol Asbestos Wood dust Rubber, plastics, dyes Tar / bitumen Aflatoxin Alkylating agents Tobacco

Life style

SmokingSingle biggest cause of cancer25-40% smokers die in middle age 9 in 10 lung cancersKnow to cause cancer in 1950

Life style (cont..)Obesity

- Highly caloric diet, rich in fat, refined carbohydrates and animal protein- Low physical activity

Consequences:- Cancer - Diabetes- Cardiovascular disease- Hypertension

AgeOccupation

PREVENTION1)Do not smoke; if you smoke, stop doing so. If

you fail to stop, do not smoke in the presence of non-smokers.

2)Avoid Obesity.3)Undertake some brisk, physical activity every

day.4)Increase your daily intake and variety of

vegetables and fruits: eat at least five servings daily. Limit your intake of foods containing fats from animal sources.

5)Avoid exposure to radiation and harmful chemical.

Prevention (cont..)

At least one third of the 10 million new cases of cancer each year are preventable through reducing tobacco and alcohol use, moderating diet and immunizing against viral hepatitis B.

Early detection and prompt treatment where resources allow can reduce incidence by a further one third.

Effective techniques are sufficiently well established to permit comprehensive palliative care for the remaining more advanced cases.

Common Screening test for Cancer

Breast Cancer: Self-examination of breast, Mammography, FNAC of breast lump.

Cancer of Cervix: PAPS Smear, VIA(Vaginal Inspection by acetic acid)

Prostatic Cancer: PSA test

Lung cancer: chest X-ray

Colon Cancer: Colonoscopy

WHO’s approach to cancer has four pillars:

Prevention,

Screening,

Early detection,

Treatment

Palliative care.

Non-communicable diseases:parameters for estimation of parameters for estimation of behavioral and metabolic risk factorsbehavioral and metabolic risk factors

Current daily tobacco smoking: the percentage of the population aged 15 or older who smoke tobacco on a daily basis.

Physical inactivity: the percentage of the population aged 15 or older engaging in less than 30 minutes of moderate activity per week or less than 20 minutes of vigorous activity three times per week, or the equivalent.

Raised blood pressure: the percentage of the population aged 25 or older having systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥90 mmHg or on medication to lower blood pressure.

Non-communicable diseases:parameters for estimation of behavioral and metabolic risk factors

Raised blood glucoseRaised blood glucose: the percentage of the population aged 25 or older having a fasting plasma glucose value ≥ 5.5 mmol/L (100 mg/dl) or on medication for raised blood glucose.

OverweightOverweight: the percentage of the population aged 20 or older having a body mass index (BMI) ≥ 25 kg/m2.

ObesityObesity: the percentage of the population aged 20 or older having a body mass index (BMI) ≥30 kg/m2.

Raised cholesterolRaised cholesterol: the percentage of the population aged 25 or older having a total cholesterol value ≥ 5.0 mmol/L (190 mg/dl).

Prevention and Control of NCDs Millions of deaths can be prevented by stronger

implementation of measures that exist today.

These include policies that promote government-

wide action against NCDs:

Stronger anti-tobacco control

Promoting healthier diets,

Physical activity,

Reducing harmful use of alcohol\

Along with improving people's access to essential

health care.

Thanks …