NON-COMMUNICABLE

DISEASES(NCDS)
 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)
 Hypertension
 Coronary Heart Disease
 Diabetes
 Stroke
 Malignancies
 Obesity
 Blindness
 Psychiatric disorders
 Others
 GLOBAL STATUS OF NDCS
 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.
 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 NCDs
 Tobacco use
 Alcohol consumption
 Raised blood pressure
 Obesity
 Diet
 Physical inactivity

 Diabetes mellitus
 High serum cholesterol
 The causal chain explains the risk factor
approach for surveillance of non
communicable diseases

Behavioral risk Physiological Disease

factors risk factors outcomes

• Tobacco • Body mass index • Heart disease

• Alcohol • Blood pressure • Stroke
• Physical inactivity • Blood glucose • Diabetes
• Nutrition • Cholesterol • Cancer
• Respiratory diseases
 Natural History of NCDs
stress
Changes in life style

Emotional
Abundance Lack of smoking disturbance
of food physical
activity
aging

obesity HTN

Thrombotic tendency
hyperlipidemia
Changes
artery
walls
Chronic atherosclerosis Coronary occlusion

Myocardial
infarction
OBESITY
 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.
 Global Status
• 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.
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.
 Assessment of Obesity
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:
 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 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.
 Causes of Obesity

Physical inactivity.

Diet.

Drugs.

Medical conditions.

Genetics.
 Hypertension

The Silent killer

23
 DEFINITION

Hypertension occurs when the pressure

against the wall of the arteries becomes
too high.
 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. 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
 Causes/Risk Factors
 Genetics-some people are prone to hypertension simply based
on 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/ Fat Diet
 Tobacco Use
 Age
Blood Pressure Classification
 Risk factors for hypertension include:

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

(h) SOCIO-ECONOMIC STATUS:

 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 of

over 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.
CARDIOVASCULAR DISEASE
 Definition

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).
 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.

 Around 80% of these deaths occurred in low and middle

income countries (LMIC).
Percentage breakdown of deaths
from cardiovascular diseases
 RISK FACTORS
Modifiable Non modifiable

Cigarette Smoking
AGE
High BP

Elevated Serum
SEX Cholesterol

Diabetes

GENETIC HISTORY Obesity

Sedentary Habits

FAMILY HISTORY
Stress
Cardiovascular Disease Mortality Indicator
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
 PREVENTION

Population • Prevention in Whole Population

Strategy • Primordial Prevention

High Risk Strategy

Secondary Prevention
 Population Strategy

So, the strategy should be therefore mass approach.

Should focus mainly on control of risk factors.

Biggest
reduction
In Total in
Population Mortality

Small
changes in
risk factor
levels
 SPECIFIC INTERVENTIONS

Physical Activity
Blood Pressure
Smoking
Dietary Changes

• Prudent • Regular
• Limitation of • No safer
cigarette Diet. physical
consumption
• Reduced activity.
of fatty acids.
• smoke salt • Encourage
• Reduction in
free
society intake. children to
dietary
• Avoidance continue
Cholesterol.
of high throughou

alcohol t their life.

intake.
 PRIMORDIAL PREVENTION

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.
 HIGH RISK STRATEGY

Identifying Risk Specific Advice

Bring them under

Can be started only when preventive care. Motivate
those high risk them to take positive
individuals are identified. action against all the
identified factors.

An elevated BP should be
BP, Increased serum treated.
cholesterol levels, Family
history of CHD, OCP’S. Nicotine chewing gum to
wean from smoking.
SECONDAY PREVENTION

Cessation
of
Smoking

Healthy
Nutritio
n
Control of Exercise
Hyperten
sion and
Promoti
Diabetes on
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 Mellitus
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 DIABETES
1) Type 1 Diabetes
 usually diagnosed in childhood

 affected by hereditary

 sometimes there are no symptoms

 frequently called the ‘insulin-dependent’ 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 women
 Women who give birth to children over 9 lbs.
 high risk of type 2 diabetes and cardiovascular disease
 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.
GLUCOSE TOLERANCE CATEGORIES
FPG 2-hr PG on OGTT
mg/dL mg/dL
126 mg/dl 200
Diabetes Mellitus Diabetes Mellitus
 7 mmol/l  11.1 mmol/l
100 and <126
Prediabetes
 5.5 and < 7 Glucose 140 and <200 Prediabetes
 7.8 and < 11.1 Tolerance
mmol/l
mmol/l
<100 Normal <140 Normal
(5.5 mmol/l)
 7.8 mmol/l
 Complications of Diabetes
Macrovascular Microvascular
• Brain
Cerebrovascular disease Eye
• Transient ischemic Retinopathy
attack Cataracts
• Cerebrovascular Glaucoma
accident
• Cognitive impairment
• Heart
Coronary artery disease Kidney
• Coronary syndrome Nephropathy
• Myocardial • Microalbuminuria
infarction • Gross albuminuria
• Congestive heart • Kidney failure
failure
Extremities
Peripheral vascular Nerves
disease Neuropathy
• Ulceration • Peripheral
• Gangrene • Autonomic
• Amputation
Global Barden
Globally
• 382 million people have
diabetes

• By 2035, this number will rise

to 592 million
 Global Barden (cont..)
 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
 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 b-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
 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
 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
 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) .
 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
 STATISTICS (cont..)
 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.
 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
Chemical
 Alcohol
 Asbestos
 Wood dust
 Rubber, plastics, dyes
 Alkylating agents
 Tobacco
 Life style

Smoking
 Most common cause
of cancer
 25-40% smokers die
in middle age
 9 in 10 lung cancers
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
 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.
 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 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.
 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
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 …