Non-communicalbe diseases and its prevention

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.

1. Non-communicable
diseases(NCDs) and its
Prevention

2. 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.

3. NON-COMMUNICABLE DISEASES
(NCDs)
Hypertension
Coronary Heart Disease
Diabetes
Stroke
Malignancies
Obesity
Blindness
Psychiatric disorders
Others

4. 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

5. 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.

6. NCDs are not only a health
problem but a development
challenge as well.
80% of premature heart
disease and stroke is
preventable.

8. Risk factors for NCDs
Tobacco use
Alcohol consumption
Raised blood pressure
Obesity
Diet
Physical inactivity
Diabetes mellitus
High serum cholesterol

10. 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

11. 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

12. OBESITY

13.  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

14. •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

15. 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.

16. 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

17. 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

18. 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.

19. 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

20. 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.

21. Causes of Obesity
Physical inactivity.
Diet.
Drugs.
Medical conditions.
Genetics.

23. 23
Hypertension
The Silent killer

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

25. 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.

26. 1. Primary
Chronic high blood pressure
without a source or
associated with any other
disease
Most common form of
hypertension
2. Secondary
Elevation of blood pressure
associated with another
disease such as kidney
disease

27. 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
Environment
Inactivity
Stress
Obesity
Alcohol
High Sodium Diet
Tobacco Use
Age
Causes

28. Blood Pressure Classification

31. Risk factors for hypertension include:
Modifiable
Body weight
Sodium chloride intake
Alcohol intake
Physical activity
Psychosocial factors
Socio-economic status
Hormonal contraceptives
Non-modifiable
Age
Sex/gender
Heredity
Ethnicity/race

32. 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

33. 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.

34. 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.

35. )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.

36. 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.

37. 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.

38. 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 of
over weight/obesity is a prudent way to reducing the risk of
hypertension and indirectly CHD.

39. (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.

40. (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

41. CARDIOVASCULAR DISEASE

42. 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

43. 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

44. 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.

45. 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)

46. Percentage breakdown of deaths
from cardiovascular diseases

47. RISK FACTORS
Modifiable Non modifiable

48. 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

49. PREVENTION

50. CHD is primarily a mass disease.
So, the strategy should be therefore mass approach.
Should focus mainly on control of risk factors.
Population Strategy

51. SPECIFIC INTERVENTIONS

52. 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

53. HIGH RISK STRATEGY

54. SECONDAY PREVENTION

55. 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.

57. 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

58. 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

59. 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 women
Women who give birth to children over 9 lbs.
high risk of type 2 diabetes and cardiovascular disease

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

61. FPG 2-hr PG on OGTT
³126 mg/dl
³ 7 mmol/l
³100 and <126
³ 5.5 and < 7
mmol/l
<100
(5.5 mmol/l)
³200
³ 11.1 mmol/l
³140 and <200
7.8 and < 11.1
mmol/l
<140
³ 7.8 mmol/l
GlucosePrediabetes
Normal
Diabetes Mellitus
TolerancePrediabetes
Diabetes Mellitus
Normal
mg/dL mg/dL
³

62. •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
•Gangrene
•Amputation
Macrovascular Microvascular
Eye
Retinopathy
Cataracts
Glaucoma
Kidney
Nephropathy
•Microalbuminuria
•Gross albuminuria
•Kidney failure
Nerves
Neuropathy
•Peripheral
•Autonomic

65. 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

66. 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..)

67. Major risk factors
Family history
Obesity
Age (older than 45)
History of gestational diabetes
High cholesterol
Hypertension

68. 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 b-cells probably
over a period of several years.

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

70. 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
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

71. 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.

72. Triad of Treatment
Diet
Discipline(Exercise, life
style)
Drug(Medication)
Oral hypoglycemics
Insulins

73. Diabetic Meal Plan Using the Food
Guide Pyramid

74. REMEMBER….T
AKE CONTROL
OF YOUR LIFE!
DON’T LET
DIABETES
CONTROL YOU!

75. CANCER

76. Cancer
medical 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).

77. 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

78. 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..)

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

80. 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

81. Immunity
HIV / AIDS
Immunosuppression

82. Virus’s
Hepatitis B
Human T-cell
Leukaemia virus
Epstein Barr Virus
Human Papilloma Virus
(HPV)

83. Bacterial
H. pylori
Other Parasites:
Schistosoma spp
Clonorchis sinensis

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

85. Life style
Smoking
Single biggest cause of
cancer
25-40% smokers die in
middle age
9 in 10 lung cancers
Know to cause cancer
in 1950

86. Life style (cont..)
Obesity
- Highly caloric diet, rich in fat,
refined carbohydrates and animal
protein
- Low physical activity
Consequences:
- Cancer
- Diabetes
- Cardiovascular disease
- Hypertension
Age
Occupation

87. PREVENTION
1)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.

90. 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.

91. 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

92. WHO’s approach to cancer has four pillars:
Prevention,
Screening,
Early detection,
Treatment
Palliative care.

94. Non-communicable diseases:
parameters for estimation of behavioral and parameters for estimation of behavioral and
metabolic risk factorsmetabolic 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.

95. 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).

96. 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.

98. Thanks …