Non communicable disease, second year students

University of Juba, non communicable diseases lecture for 3rd semester.

1. Non Communicable Diseases Lec 2 Prepared by Dr. Niveen Gama

2. Objectives; Non communicable diseases Global burden Obesity Hypertension Cardiovascular diseases Diabetes Cancer

3. Non communicable diseases; A ccount 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.

4. Non communicable diseases; Hypertension Coronary heart disease Diabetes Stroke Malignancies Obesity Blindness Psychiatric disorders Others

5. Global status of NCD 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.

6. GLOBAL STATUS OF NDCS M ajority 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.

7. NCD is not only a health problem but a development challenge as well. 80 % of premature heart disease and stroke is preventable

8. Obesity; An 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 ganoid fat distribution.

9. Obesity Obesity is a 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 .

10. obesity 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.

11. Body Mass Index; 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

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

13. Waist-Hip Ratio Waist–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.

14. Causes of Obesity ; Physical inactivity inactivity. Diet. Drugs. Medical conditions. Genetics.

15. Hypertension (The silent killer); Is high blood pressure. Blood pressure is the force of blood pushing against the walls of arteries as it flows through them.

16. 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.

17. Classification of Hypertension; Primary or chronic hypertension: blood pressure without a source or associated with any other disease Most common form of hypertension Secondary ht : Elevation of blood pressure associated with another disease such as kidney disease

18. Classification of Hypertension; Genetic factors; 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 Environment Inactivity Stress Obesity Alcohol High Sodium Diet Tobacco Use Age Causes

19. Risk factors; 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. (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.

20. Risk factors 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.

21. Risk factors 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

22. PREVENTION OF HYPERTENSION   WHO has recommended the following approaches in the prevention of hypertension: 1.Primary Prevention ) a) Population strategy ) b) High- risk strategy 2.Secondary Prevention.

23. 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. 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.

24. prevention Population strategy The   following non- pharmaco -therapeutic 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, (iv) Restriction of energy intake appropriate to body needs ( b) WEIGHT REDUCTION: The prevention and correction of over weight/obesity is a prudent way to reducing the risk of hypertension and indirectly CHD.

25. prevention (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 behavior. The whole community must be mobilized and made aware of the possibility of primary prevention.

26. 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

27. Cardiovascular diseases CVD 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

28. Global burden; 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.

29. Stats; 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 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 CHD is primaril y a mass disease. So, the strategy should be therefore mass approach. Should focus mainly on control of risk factors. Population Strategy

30. 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 etiology 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.

31. Diabetes; 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

32. Types of diabetes;   TYPES OF DIABETES 1)  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

33. Types of diabetes 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

34. Types of diabetes 3) Gestational Diabetes blood sugar levels are high during pregnancy in women Women who give birth to children over 9 lbs. high risk of type 2 diabetes and cardiovascular disease

35. Brain Cerebrovascular disease Transient ischemic attack Cerebrovascular accident Cognitive impairment Heart Coronary artery disease Coronary syndrome Myocardial infarction Congestive heart failure Extremities Peripheral vascular disease Ulceration

36. Gangrene Amputation Macro vascular Microvascular Eye Retinopathy Cataracts Glaucoma Kidney Nephropathy Microalbuminuria Gross albuminuria Kidney failure Nerves Neuropathy Peripheral

37. Globally 382 million people have diabetes 8.4 million people had diabetes in 2013 8.4 million people are likely to have diabetes in 2035 Global Barden

38. Globally   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..)

39. Risk factors Major risk factors Family history Obesity Age (older than 45) History of gestational diabetes High cholesterol Hypertension Risk Factor For Type-1 Genetic predisposition In an individual with a genetic predisposition, an event such as virus or toxin triggers autoimmune destruction of β- cells probably over a period of several years.

40. Risk factors Risk Factor For   Type-2 Family History Obesity Habitual physical inactivity Previously identified impaired glucose tolerance. IGT or impaired fasting glucose (IFG) Hypertension Hyperlipidemia

41. Prevention 1) 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 fiber 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

42. prevention 2) Secondary Prevention This would be through early diagnosis and prompt treatment, mainly by way of screening program . 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 dyslipidemia. It reduces the complication of DM.

43. Prevention Triad of Treatment Diet Discipline(Exercise, life style) Drug(Medication) Oral hypoglycemic Insulins  Diabetic Meal Plan   Using the Food Guide Pyramid

44. Cancer; 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 ).

45. Statistics; 9.7 million cases are detected each year 6.7 million people will die from cancer Cancer 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

46. 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.

47. What causes cancer ? Heredity Immunity Chemical Physical Viral Bacterial Lifestyle

48. 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

49. 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

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

51. Life style Smoking ; Single biggest   cause of cancer 25-40% smokers die in middle age , 9 in 10 lung cancers Obesity –   Highly caloric diet, rich in fat, refined carbohydrates and animal protein - Low physical activity Consequences: - Cancer - Diabetes - Cardiovascular disease - Hypertension Age Occupation

52. Prevention; 1) Avoid smoking 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.

53. Prevention 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.

54. 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.

55. Non communicable diseases Non-communicable diseases: parameters for estimation of behavioral 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.

56. Non-communicable diseases: parameters for   estimation of behavioral and metabolic risk factors Raised 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. Overweight: the percentage of the population aged 20 or older having a body mass index (BMI) ≥ 25 kg/m2. Obesity: the percentage of the population aged 20 or older having a body mass index (BMI) ≥30 kg/m2. Raised cholesterol: the percentage of the population aged 25 or older having a total cholesterol value ≥ 5.0 mmol /L (190

57. Refrences ;