Chronic Disease

Epidemiology
By
Dr.Amany Mokhtar
Professor of Public Health and
Preventive Medicine, Faculty of Medicine
Ain Shams University
Amany_mokhtar@yahoo.com

Disease categories
Group 1: Communicable, maternal, perinatal and
nutritional conditions
Group 2: Noncommunicable diseases
Group 3: Injuries

Chronic disease: definition

(by The commission on chronic illness in USA )
Permanent
Residual disability
Caused by non-reversible pathological alterations
Require special training of the patient for
rehabilitation
Require a long period of supervision, observation,
or care.

Chronic diseases include the following:

Cancer
Nutrition and Diabetes.
Coronary heart disease
Hypertension and hemorrhagic stroke
Psychosocial diseases
Genetic diseases
Asthma and chronic obstructive pulmonary disease.
Arthritis and Osteoporosis

Why chronic disease epidemiology has been studied separately?

The Triad Model of Agent Host Environment

which was used to study disease causation of
infectious diseases dont explain many of the
chronic diseases.

The Web Model of disease epidemiology

Chronic diseases with its multi-factorial origin and

interactions of risk factors are better studied by
the Web Model of disease epidemiology

CAUSES OF CHRONIC DISEASES

Chronic diseases have multi-factorial origin

The health-related risks of cigarettes

Understanding the health risks associated with
obesity, inactivity, and increased energy
Metabolic syndrome:
Abdominal obesity
Atherogenic dyslipidemia,
Elevated blood pressure,
Insulin resistance or glucose intolerance
Prothrombotic state

Top 10 causes of death in Egypt

1 Ischemic heart diseases 6
21%

Chronic obstructive
pulmonary disease
4%
Chronic kidney disease
3%

2 Stroke
14%

3 Cancer
9%

Road injuries
2%

4 Cirrhosis
9%

Hepatitis
2%

5 Lower respiratory
infections
4%

1
0

Diabetes
1%

Source: GBD Compare,2010

Deaths from Major Categories in

Egypt (1989)

5%

68%

27%

Communicable,m
aternal,perinatal
and nutritional
conditions
Non
communicable
diseases
Injuries

Deaths from Major Categories in

Egypt(1999)

6%

78%

16%

Communical,mater
nal,perinataland
nutritional
conditions
Non communicable
diseases
Injuries

Deaths by cause , all ages, Egypt 2002

Communicable,
maternal, perinatal
and nutritional
21%

Injuries

18%
4%

2%
5%

Cardiovascular
diseases
Cancer
Chronic respiratory
diseases

8%
42%

Diabetes
Other chronic
diseases

NCDs are estimated to account for 78 % of all deaths.

Deaths from Major Categories in

Egypt (2004)

5%

82%

13%

Communicable,
maternal,perina
tal and
nutritional
conditions
Non
communicable
diseases

Deaths from Major Categories in

Egypt (2008)

6%

82%

12%

Communicable,ma
ternal,perinatal
and nutritional
conditions
Non
communicable
diseases
Injuries

Proportional mortality (% of total deaths, all

ages) , Egypt , 2008

26%

12%
6%

3%
3%
11%

39%

Communicable,
maternal, perinatal
and nutritional
Cardiovascular
diseases
Chronic respiratory
diseases
Other chronic
diseases

Injuries

Cancer
Diabetes

NCDs are estimated to account for 82% of

Deaths from Major Categories in Egypt

from 1989-2008
Progressive increase in non-communicable disease
mortality along years.
Mortality from communicable diseases was
relatively declining
Double burden of disease : a persistent though much
diminished communicable disease burden and a
large and rapidly growing NCD disease burden
Difference in the profile of the developing countries
as compared to the developed

Comparison between developing and

developed countries as regard the causes of
mortality-2000
Developing Countries

Developed Countries

11%
42%

8% 6%

47%
86%

Communical,maternal,perinataland
nutritional conditions
Non communicable diseases
Injuries

The Rising NCD Challenge in

Developing Regions

Sources: World Bank analysis based on the WHO Global Burden of Disease,

Age-standardized mortality rates by cause

(per 100 000 population): WHO regions
900
800

749

Communicable

798
779

Non- communicable
706

676

700
600

534

532

500

Injuries

455

400

334

300

254

200
100
0

76

107
34

72

63

101

51

63

91

74

64

Age-standardized mortality rates by cause

(per 100 000 population ) : Income groups
800

749

700

757
636

658

600

Communicable
Noncommunicable

608

500
380

400
300

233

200
100
0

76

124
34

82

125

81

31 41

The disability adjusted life year DALY

It is a health gap measure that combines the potential

years of life lost due to premature death and the years
of healthy life lost due to poor health or disability.
The DALY combines in one measure the time lived with
disability and the time lost due to premature mortality.
One DALY= one year lost of healthy life, i.e one year
lived with poor health
DALY = YLL+YLD
YLL = years of life lost due to premature mortality.
YLD = years lived with disability

Years of Life Lost ( YLL ) due

to NCDs
70
65
61

60

60

55

50
40
32

%
30

29

31

24

20
8

10
0
Egypt

Regional average

12

11

14

By the year 2020

Non-communicable diseases will cause 7 out of
every 10 deaths in developing countries.
If the present trend is maintained, the health
systems in low-and middle-income countries will
be unable to face the upcoming problems of
chronic diseases.
Urgent and efficient preventive strategies should
deal seriously with risk factors : smoking, alcohol,
physical inactivity and western diet.

Food Guidance System

History of USDAs
Food Guidance System
6
1
19 Food for

Children

70
19
s

199
2
201
1

40
9
1
s

5
200

s0
5
19 0s
196

My Pyramid Basics and Dietary

Guidelines

--1992-Food Guide Pyramid

--2005-MyPyramid

Major new features in MyPyramid

Emphasis on daily exercise and weight control
Emphasis on eating fresh fruits and vegetables.
Emphasis on whole grain breads and cereals
which are rich in bran instead of white bread.
Good sources of healthy unsaturated fats :olive,
soy, corn, sunflower, peanut, and other vegetable
oils, trans-fat-free margarines, and fatty fish

Major new features in MyPyramid cont.

Emphasis on eating more legumes (vegetable proteins

and high in soluble fiber)
Eating nuts daily (they are a healthy fat and linked to
less heart disease)
Choosing lower saturated fat protein foods such as fish,
skinless chicken, and vegetable protein foods in place of
red meats. Egg whites are very high in protein.Fish
contain omega-3 fatty acids which protect against heart
disease and cancer.
Using low fat milk and yogurt in place of high fat dairy
products.

Major new features in MyPyramid cont.

Limiting intake of red meat and butter.

Limiting high glycemic foods such as soda drinks,
french fried potatoes, and highly refined foods
including baked goods high in trans-fatty acids
Limiting salt intake.
Take a daily multi-vitamin tablet for most people,
which should include vitamin D.
Adequate intake of water.

Anatomy of My Pyramid
Activity
Activity is represented by the steps and the person climbing them, as a
reminder of the importance of daily physical activity.
Moderation
Moderation is represented by the narrowing of each food group from
bottom to top. The wider base stands for foods with little or no solid
fats or added sugars. These should be selected more often. The
narrower top area stands for foods containing more added sugars and
solid fats. The more active you are, the more of these foods can fit into
your diet.
Personalization
Personalization is shown by the person on the steps, the slogan, and the
URL. Find the kinds of amounts of food to eat each day at
MyPyramid.gov

Anatomy of My Pyramid cont.

Proportionality
Proportionality is shown by the different widths of the food group
bands. The widths suggest how much food a person should choose
from each group. The widths are just a general guide, not exact
proportions. Check the Web site for how much is right for you.
Variety
Variety is symbolized by the 6 color bands representing the 5 food
groups of the Pyramid and oils. This illustrates that foods from all
groups are needed each day for good health.
Gradual Improvement
Gradual improvement is encouraged by the slogan. It suggests that
individuals can benefit from taking small steps to improve their diet
and lifestyle each day.

MyPyramid Food Intake Patterns

Calorie
Level

1,000

1,200

1,400

1,600

1,800

2,000

2,200

2,400

2,600

2,800

3,000

3,200

Fruits

1 cup

1 cup

1.5
cups

1.5
cups

1.5
cups

2
cups

2
cups

2
cups

2
cups

2.5
cups

2.5
cups

2.5
cups

Vegetables

1 cup

1.5
cups

1.5
cups

2
cups

2.5
cups

2.5
cups

3
cups

3
cups

3.5
cups

3.5
cups

4
cups

4
cups

Grains

3 oz

4 oz

5 oz

5 oz

6 oz

6 oz

7 oz

8 oz

9 oz

10 oz

10 oz

10 oz

Meat and
Beans

2 oz

3 oz

4 oz

5 oz

5 oz

5.5 oz

6 oz

6.5 oz

6.5 oz

7 oz

7 oz

7 oz

Milk

2
cups

2
cups

2
cups

3
cups

3
cups

3
cups

3
cups

3
cups

3
cups

3
cups

3
cups

3
cups

Oils

3 tsp

4 tsp

4 tsp

5 tsp

5 tsp

6 tsp

6 tsp

7 tsp

8 tsp

8 tsp

10 tsp

11 tsp

Discretionary
calorie
allowance

165

171

171

132

195

267

290

362

410

426

512

648

MyPlate

www.choosemyplate.gov

What Is MyPlate?
Food guidance system
Graphics used to summarize guidelines to healthy eating
MyPlate was released in June 2011.
Recommendations are for 2 years of age and older.
Visual depiction of the recommendations in the Dietary
Guidelines for Americans 2011
Online components provide personalized diet plan based on
the latest nutrition and health recommendations from
Dietary Guidelines Advisory Committee Report
DRIs

Why Change From a Pyramid to a Plate?

Simplifies the way you should eat

Provides a clear visual cue
Gives consumers a fast, easy-to-grasp reminder of
the basics of a healthy diet
The familiar plate is a simple reminder to make better choices
The easy-to-remember visual cue provides a way to control
portion sizes

MyPlate Illustrates the Five Food

Groups

MyPlate Recommendations
"Make half your plate fruits and vegetables
"Switch to 1% or skim milk"
"Make at least half your grains whole"
"Vary your protein food choices.
The guidelines also recommend
portion control while still enjoying food, as
well as reductions in sodium and sugar
intakes.
http://en.wikipedia.org/wiki/MyPlate

MyPlate:Daily Amount of Food from

Each Food Group
Calorie
level

1600

1800

Fruits

1 cups

1 cups

2 cups

2 cups

Vegetables

2 cups

2 cups

2 cups

3 cups

Grains

5 oz-eq

6 oz-eq

6 oz-eq

7 oz-eq

Protein Foods 5 oz-eq

5 oz-eq

5 oz-eq

6 oz-eq

Dairy

3 cups

3 cups

3 cups

3 cups

Oils

5 tsp

5 tsp

6 tsp

6 tsp

40

2000

2200

THANK
YOU