NUTRITION RELATED- NON COMMUNICABLE DISEASES (NR-

NCDs)Malimu E Z

KAMPALA INTL UNIVERSITY

Definitions

• Non-communicable diseases (NCDs)- diseases that are not spread through contact

• Caused by:– Lifestyles (how people live, personal behaviors)– Genetics (conditions people are born with)– Environmental hazards

• Nutrition related Non communicable disease (NR-NCDs)

• Chronic illnesses result from altered dietary pattern and changed lifestyle

• Term NR-NCD incorporates the effects of diet, physical activity and body composition

Historical nutrition pattern

• Human diet and activity patterns and nutritional status have undergone a sequence of major shifts

• Shifts- defined as broad patterns of food use and of corresponding nutritional related diseases

• Since 18th century, the pace of diet and activity change appears to have accelerated

History contd…

• Dietary and activity changes parallel major changes in health status as well as major demographic and socio-economic changes

• Obesity, level and age composition of morbidity and mortality emerge early

• Large shifts in dietary and physical activity patterns- reflected in nutritional outcome average size and body composition

History contd…• Three major changes have taken place:1. Demographic transition- the shift from pattern

of high fertility and high mortality to one of low fertility and low mortality (typical of modern industrialized countries)

2. Epidemiological transition-the shift from a pattern of prevalent infectious diseases associated with malnutrition, period of famine and poor environment sanitation to a pattern of prevalent chronic and degenerative diseases associated with urban-industrial lifestyles

History contd…

3. Nutrition transition-increased consumption of unhealthy foods compounded with increased prevalence of overweight in middle to low income countries– Has serious implications in terms of public health

outcomes and risk factors

Major NR-NCDs

• Obesity• Diabetes mellitus• Cardiovascular diseases (CVDs)• Hypertension and strokes• Osteoporosis• Dental diseases• Some types of cancers

Obesity

• Abnormal or excessive fat accumulation and adipose tissue, that health may be impaired (WHO)– Result of chronic positive balance– BMI 18-24.5 normal– BMI 25-29.9 grade I-overweight– BMI 30-39.9 grade II-obese– BMI > 40 grade III frank or morbid obesity• Children: weight for height two z scores above the

international reference

Factors associated with obesity epidemic

• High calorie-density foods i.e the use of cooking oil rich in fat

• Increased portion sizes, access to plentiful• Inexpensive foods-fast/junk foods• Sedentary lifestyle, lack of exercise• Commercial practices• Overweight as evidence of social status• Westernized diet as symbol of social status• Beliefs and attitudes about body image

Cardiovascular diseases (CVDs)

• Are growing contributor to global disease burdens

• Cause 1/3 of all deaths globally, 10% SSA• WHO (2003) estimates:– By 2020 heart diseases and stroke- leading cause

of both death and disability worldwide– Deaths projected to increase to more than 24M a

year by 2030

CVDs

• A high intake of dietary fats strongly influences risk of CVD

• SFAs (diary products and meat) raise cholesterol levels

• PUFAs- soybean, sunflower oils, fatty fish and plant foods lower risk of CVDs

Risk factors for CVDs• Obesity• High BP• High blood cholesterol levels• Physical inactivity• Heredity- history of CVD in family• Gender- men• Increasing age- over 65 years• Cigarette/tobacco use• History of diabetes

Un-modifiable risk factors

Hypertension and stroke

• HT-BP 140/90 mmHg or more• A common medical problem, silent killer• Mostly people in the middle and old age• HT- a powerful, independent risk factor fro

CVD• Dietary potassium lowers the risk• Regular frequent intake of fruits and

vegetables- protective against hypertension

HT risk factors

• High salt containing diet• Calorie dense foods• Less physical activity• Obesity• Ignorance• Urbanization-sedentary lifestyle, high stress

level

Diabetes mellitus

• Type I- Juvenile diabetes (insulin dependent)• Type II- Adult onset- Non insulin dependent-

insulin resistance and relative insulin deficiency– Occurring in children and adolescents who are

overweight also• A global diabetes pandemic is enfolding with

rapid increases in prevalence of type II

• Over 6% of the world’s population is projected to be diabetic by 2025

• Tanzania (urban): 5% diabetic, 20% HT• South Africa: 8% diabetic, 33% HT

Risk factors- Diabetes type I

• Early foods like early exposure to cow milk in replacement of breast feeding

• Obesity (increase risk especially for type I)• Having type I diabetic parent• Born by an older mother 40+ yrs of age• Having a mother with pre-eclampsia

Risk factors for Type II DM

• Over ¾ related to high body weight• High BP 140/90 or higher• HDL< 35mg/dl or TG levels >- 250 mg/dl• Age 45 and above• Family history of diabetes• Genetic- Indian, African American, American

Indian etc

Osteoporosis and dental diseases

• Osteoporosis- is a disease of bones that leads to an increase risk of fracture– Over consumption of dietary proteins– Less physical activity– Less vegetables

• Dental disease– Bottle feeding– High sugar containing foods e.g. ice creams– Ignorance – Urbanization-processed foods

Cancers

• Some types of cancers– Dietary factors:• 30% of all cancers in Western countries• Approx. 20% in developing countries (where most of

the cancers are related to chronic infections)

– Good nutrition- assist in fighting cancers, manage symptoms and aid healing and recovery

Risk factors for cancer

• Nutritional and lifestyle factors– High fat- risk of colon, uterus and prostate cancer– Overweight and lack of physical activity, breast,

esophagus, kidney, uterus cancer– Alcohol- mouth, throat, esophagus, larynx, liver

and breast cancers– Tobacco use- lung, larynx, mouth, esophagus,

bladder, kidney , throat, stomach, pancreas or cervix

Prevention of NR-NCDs

• Education starting at school and setting examples of healthy living

• Dietary guidelines- educate public about healthy eating

• Promoting healthy behavior in general and reducing fast food facilities and use of sat fats

• Screening populations regularly- HT, overweight checking BMI, diabetes checking blood sugar levels

Prevention contd…

• Mass promotion of physical activity• Price policies and other food policies that might

retard or arrest the rapid shift towards energy- dense diets

• Inter-sectoral collaboration- e.g in Finland- national price and food labeling policies were combined with nutrition education programmes

• DASH diet (DASH= Dietary Approaches to Stop Hypertension)