Lifestyle DiseasesObesity, Type II Diabetes, CVD, Cancer

If I knew I was goingto live this long,

I would have takenbetter care of myself. ~Mickey Mantle

(died of liver cancer at age 64)

#1 Cause of Preventable Death

TOBACCOCVD -cardiovascular disease

CLRD -chronic lowerrespiratory disease

Cancer –lung, mouth, lips, nasal cavity (nose) and sinuses, larynx (voice box), pharynx (throat), esophagus (swallowing tube), stomach, pancreas, kidney, bladder, uterus, cervix, colon/rectum, ovary, and acute myeloid leukemia

A New Epidemic!

SedentaryDeath

Syndrome(SeDS)

Sedentary Death Syndrome

InactivityPoor Diet

ObesityDiabetes (Type II)CVDCancerAlso osteoarthritis And osteoporosis

Lifestyle Disease

• Any non-infectious disease that is caused or promoted by your behavior and choices you make

• Obesity, type II diabetes, cardiovascular disease (CVD, such as high blood pressure, heart attack, and stroke), multiple forms of cancer, osteoarthritis, osteoporosis, chronic back pain

Risk Factor• Risk is the probability, the chance, that something (usually

negative) will happen

• A risk factor (in relation to diseases) is anything that increases your chance of developing a disease or condition – High fat diet, cholesterol– Smoking– Stress– Lack of exercise– UV radiation

Leading Causes of US Deaths (2010)1. Heart disease: 599,4132. Cancer: 567,6283. Chronic lower respiratory diseases: 137,3534. Stroke (cerebrovascular diseases): 128,8425. Accidents (unintentional injuries): 118,0216. Alzheimer's disease: 79,0037. Diabetes: 68,7058. Influenza and Pneumonia: 53,6929. Nephritis, nephrotic syndrome, nephrosis: 48,93510. Intentional self-harm (suicide): 36,909

www.cdc.gov/nchs/FASTATS/lcod.htm

Obesity

• BMI (body mass index)– (705 x weight in pounds)/(height in inches)2

• Exceptions because of percent lean body mass, but a good general rule– Percent body fat correlates well with the lifestyle

diseases; BMI is often a good surrogate measure of that

Obesity

BMI Disease Risk Category

<18.518.5-21.9922.0-24.9925.0-29.9930.0-34.9935.0-39.99

>40.0

IncreasedLow

Very lowIncreased

HighVery high

Extremely high

UnderweightAcceptableAcceptableOverweight

Obesity IObesity IIObesity III

• BMI tables are for ADULTS only though• Use table on page 205 to view appropriate teen

weights

• Again, these are guidelines to help people know the correct ranges

• Trend of increased obesity is causing increasing health problems and health care costs (http://www.cdc.gov/obesity/data/trends.html)

Obesity

• For children and adolescents (aged 2–19 years), the BMI value is plotted on the CDC growth charts to determine the corresponding BMI-for-age percentile.

• Overweight is defined as a BMI at or above the 85th percentile and lower than the 95th percentile.

• Obesity is defined as a BMI at or above the 95th percentile for children of the same age and sex.

WHO stats on obesity

• 65% of world population live in countries where overweight and obesity kills more people than being underweight

• 2010: 43% of children <5 are overweight• Child obesity in US has tripled in past 30 years• In 2008:

– >1/3 of US children/teens are overweight or obese– 1.5 billion adults >20 years overweight or obese

Obesity

So what?

Adverse metabolic effects on…• Blood pressure• Cholesterol• Triglycerides• Insulin resistance

Obesity

• Respiratory difficulties• Chronic musculoskeletal problems• Skin problems• Infertility

• CVD problems– High blood pressure; high cholesterol– Heart disease; heart attack– Stroke

• Insulin resistance and Type II diabetes• Certain cancers (especially hormone-related and

large bowel cancers)– Breast, colon, prostate, endometrium, kidney, gall

bladder

• Gall bladder disease

Obesity

Diabetes

• Chronic disease affecting how the body uses glucose for energy

• Glucose—the basic sugar that fuels all bodily functions

• Insulin—the hormone that helps glucose move from the blood stream and into cells

• Pancreas—the organ that produces insulin

• Whether no insulin, too little insulin, or cells not responding appropriately to insulin,

• Sugar builds up in the blood and causes damage to eyes, kidneys, nerves, circulatory system, heart– Blindness– Kidney failure– Circulatory problems– Limb amputations– Heart attacks and stroke

Diabetes

• 5-10% of diabetics

• Body does not produce insulin

• Must have insulin (injections or pump) to maintain health

• Must always monitor sugar intake and blood sugar level

• Thought to be an autoimmune disease

• Genetic predisposition?

Type I Diabetes (NOT a lifestyle disease)

• 90-95% of diabetics

• Body produces too little insulin, or produces enough but cells don’t respond appropriately

• Used to only appear in adults, but now also in children and teens

• Major correlation to obesity and inactivity

Type II Diabetes

• Risk Factors– High-fat, high-calorie diet– High cholesterol– Overweight or obese

• Management– Weight management– Monitored diet– Exercise/physical activity– Insulin (sometimes)

Type II Diabetes

Diabetes

• In 2010, 7th leading cause of death

• Increases risk for heart disease and stroke(>75% of diabetics die from heart disease or stroke)

• Diabetes costs the US ~$174 annually!($116 billion is direct medical cost)

Diabetes

• #1 reason for…– Adult blindness– Kidney failure– Limb amputation

• Also linked to…– A form of dementia– Some forms of cancer– Some forms of lung disease

Diabetes Complications

Diabetes

• Survey results released by the American Diabetes Association (November, 2009)– Less than half of the respondents chose diabetes

when asked whether diabetes, breast cancer or AIDS causes the most deaths.

– Diabetes kills more than breast cancer and AIDS combined.

Number (in Millions) of Civilian/Noninstitutionalized Persons with

Diagnosed Diabetes, United States, 1980–2006

CDC 2010 Report on Diabetes

10/22/2010 press release:

• Currently, ~1 in 10 US adults have diabetes

• By 2050, expected to be 1 in 3!

Metabolic Syndrome

Increased risk for…• Atherosclerosis and CHD• Stroke• Type II DiabetesBiggest risks factors for having it are…• Abdominal fat (waist circumference)• Insulin resistance (from diet, stress, genetics)

(Also, lack of exercise, genetics, and age)

Metabolic SyndromeThree or more of the following:• Blood pressure equal to or higher than 130/85 mmHg• Fasting blood sugar equal to or higher than 100 mg/dL• Large waist circumference (length around the waist):

– Men - 40 inches or more– Women - 35 inches or more

• Low HDL cholesterol: – Men - under 40 mg/dL– Women - under 50 mg/dL

• Triglycerides equal to or higher than 150 mg/dL

Cardiovascular Disease• Hypertension (high blood pressure)

is a major risk factor for CVD– Control with weight management, medication,

exercise, proper nutrition, and avoiding tobacco

• Arrythmias—irregular heartbeats– One type, ventricular fibrillation, can cause

sudden cardiac arrest (heart stops beating)

• Atherosclerosis—plaque builds up in arteries– Can restrict blood flow or completely block (clot)

• Angina—pain in heart when not enough oxygen (restricted blood flow)

• Blood clot:– If in artery feeding heart (coronary) Heart attack– If in artery feeding brain (carotid) Stroke

Cardiovascular Disease

• Heart Attack—damage to the heart muscle because of reduced or blocked blood supply– Usually because of atherosclerosis– Ventricular fibrillation follows often

• Congestive Heart Failure—gradual weakening of heart until can’t perform its job– High blood pressure, atherosclerosis, heart valve

defect, or illegal drug use (raising heart rate)

Cardiovascular Disease

• Stroke– blood flow to brain is blocked, or– blood vessels in brain burst (cerebral hemorrhage)

– High BP is leading cause of stroke– All the same causes as other CVDs

Cardiovascular Disease

http://video.about.com/heartdisease/Heart-Attack.htmhttp://www.medicinenet.com/heart_disease_pictures_slideshow/article.htm

• Heredity (genetic component)• Gender

– Men greater risk CVD and heart attack earlier in life

– Women less likely to survive a heart attack

• Age– CVD risk increases with age– Most who die of CVD are 65 or older

CVD Risk Factors—Can’t Control

CVD Risk Factors—Can Control• Tobacco use• High blood pressure (BP)• High cholesterol (LDL, not HDL)• Physical inactivity• Excess weight (raises BP and cholesterol)• Abdominal fat (apple-shaped, not pear-shaped)• Excess stress (raises BP)• Alcohol and drug use (raises BP, arrythmias)• Type II Diabetes

CVD and Diabetes Risk FactorsYou CAN Control

• Diet and Exercise– Reduce fat and cholesterol– Maintain healthy blood pressure– Maintain recommended weight for height– at least 20-60 minutes vigorous activity 3-5 days

per week

• Do not use tobacco products

Blood Pressure

• Normal blood pressure– Adult: < 120/80 mmHg

• Hypertension (high blood pressure)– Adult: >140/90– Teens: >95%ile for age, height, gender

– Teens at >90%ile are 3x more likely to have hypertension as adults

Cholesterol

• Total cholesterol (adult): –<200 mg/dL = desirable–>240 mg/dL = 2x risk of heart disease

Cholesterol—HDL is Good • HDL—

– <40 mg/dL men = increased risk heart disease– <50 mg/dL women = increased risk heart disease– >60 mg/dL = protection against heart disease

• To raise HDL:– Maintain appropriate weight for height

• Healthy diet (low in fat, especially trans-fats)• 30-60 minutes physical activity more days than not

– Avoid tobacco products(*Estrogen also raises HDL)

Cholesterol—LDL is Bad • Higher LDL = risk heart attack and stroke• LDL build up in arteries (atherosclerosis)• LDL—

– <100 mg/dL is Optimal– 160-189 mg/dL is High– >190 mg/dL is Very High

• To lower LDL:– Maintain appropriate weight for height

• Healthy diet (low in fat, especially trans-fats)• 30-60 minutes physical activity more days than not

– Avoid tobacco products

Fats• Unsaturated = good

– Necessary for growth and normal body function– Liquid at room temperature– Olives; olive and canola oils; nuts; avocados;

soybeans, corn, sunflower, and sesame oils; fish and fish oils

• Saturated = not good– Raises LDL– Solid at room temperature– Butter, shortening, animal fats, tropical oils (palm

kernel, coconut oils), whole dairy foods, meat

Fats (cont.)

• Trans-fats = Really bad!– Man-made saturated fats (by hydrogenating

vegetable oils)

– Raise LDL and lower HDL (double whammy!)

– In packaged baked goods (cookies, crackers)– In fried foods

Did you know...

• That working off a bottle of soda or fruit juice takes 50 minutes of running?

• That a calorie of HFCS (sweetener in sodas and other foods) causes more weight gain than a calorie of cane sugar?

• That aspartame (Nutrisweet, Equal) has almost 100 side effects, including slow, steady weight gain?!

Sugar v. HFCS

• High-fructose corn syrup (HFCS) has been used as natural sweetener since 1970s– Enzyme to make invented in 1957– Commercially available in 1970s– Since 1977, sugar is much more expensive– HFCS tastes as sweet as sugar

• Recent study shows that calorie for calorie, HFCS causes more weight gain (published in March 2010)

www.themoneytimes.com/featured/20100326/high-fructose-corn-syrup-worse-sugar-id-10105392.html

Exercise Guidelines for Teens• Aerobic Exercise—1 hour physical activity/day

– Most of hour at moderate to vigorous level (50% to 85% training intensity)

• Strength Training—at least 3 days/week• Flexibility Training—3 to 7 days/week

• Benefits:Maintain healthy weightLess risk of diseaseMore lean body mass (less fat)Increased BMR

Less injuriesAge wellEndorphins

Smoking (aside from causing cancers)• Tar

– Thickens mucous so cilia can’t remove well– Bronchitis, Emphysema, COLD– Makes it harder for lungs to get oxygen

• Nicotine– Increases heart rate, increases BP– So heart needs more oxygen– Triggers formation of blood clots

• CO– Binds to RBCs so oxygen cannot—less oxygen to heart and rest

of body

Cancer• Uncontrolled cell growth

Tumor—abnormal mass of tissue that has no natural role in the body

• Benign—noncancerous• Malignant—cancerous; can spread

– Metastatsis—the spread of cancer from its origin to other parts of the body

Warning Signs

C—change in bowel habitsA—a sore that doesn’t healU—unusual bleeding or dischargeT—thickening or a lump somewhere in/on bodyI—indigestion or difficulty swallowingO—obvious change wart or moleN—nagging cough or hoarsness

Categories

1. Lymphomas—immune (lymphatic) system2. Leukemias—blood forming organs3. Carcinomas—glands, body linings

– Skin, digestive tract, lungs

4. Sarcomas—connective tissue– Bones, ligaments, muscle

• 5-10% of cancers are hereditary

• Many cancers have an external cause– Carcinogen—any substance that causes cancer– Promoter—any substance that along with another

substance or substances causes cancer or enhances cancer cell growth

• ~60% of cancers could be prevented through healthy lifestyle choices

Risk Factors

• Genetic predisposition• Environmental exposures

– TOBACCO (major cause of cancer in US)– Diet– Obesity– Radiation– Certain viruses– Chemical exposures (occupational or community)

Tobacco Use

• At least 43 carcinogens in tobacco and smoke

• First hand and second hand smoke associated with lung cancer and other diseases

Diet

• High fat and low fiber diets increase risk of colon, breast, and prostate cancers

• Certain nutrients, such as antioxidants found in fruits and vegetable, help to protect the body from cancer

Early detection is KEY!

Self-examination• Breast cancer• Testicular cancer• Skin cancerMedical Examination• Pap smear (cervical cancer)• Prostate exam (prostate cancer)• Colonoscopy• MammogramBiopsy—removal of a small piece of tissue for

examination

Treatment• Surgery• Radiation therapy• Chemotherapy

–Traditional (various chemicals)–Immunotherapy (use chemicals and immune

response)–Hormone therapy (use hormone treatments)

• Remission—state of time when the cancer is under control and symptoms disappear

• Cured—cancer free

• Breast– Most common, non-skin cancer in women– Average woman has a 1 in 8 risk of being

diagnosed with breast cancer during lifetime– Second leading cause cancer death in women– Incidence and mortality decreasing slightly this

decade– Early detection (BSE) is very important to survival

Female Reproductive Cancers

Female Reproductive Cancers• Cervical

– Incidence and mortality declining– Early detection is easy (Pap smear)– Protection (vaccine)

• Ovarian– Lowest incidence of female reproductive (~3%)– Highest mortality (~5th leading cause of cancer death for

women)– Lack of early symptoms

Male Reproductive Cancers• Testicular—Young age

– Rare in general, but– Most common cancer in males aged 15-35– Often curable if caught and treated early

(SELF-EXAMS are key!!!)

• Prostate—Old age– Most common, non-skin cancer in men– Average man has a 1 in 6 risk of being diagnosed during

lifetime; only 1 in 34 will die– Second leading cause cancer death in men

Lung Cancer• Most common, non-skin cancer• #1 cause of cancer death

– 29% of all cancer deaths– More than breast, prostate, and colon combined!

(even though more women diagnosed with breast cancer and more men diagnosed with prostate—think about early symptoms and detection)

• 1 in 13 chance of diagnosis for men; 1 in 16 chance for women

• Smoking increases risk significantly– Male smokers 23x more likely to get lung cancer– Female smokers 13x more likely

Colorectal Cancer

• Third most common cancer• Third leading cause cancer death• Risk increases with age• Slight decrease in incidence and mortality

Leukemias

• One of most common childhood cancers• 4 types: CLL, CML, ALL, AML• ALL and AML more common in children• Most ALL and AML can be cured• Chemotherapy and/or bone marrow

transplant

Lymphomas

• Hodgkin’s and Non-Hodgkin’s (NHL)• NHL like ALL• Most common cancer in teens• Early symptoms:

– Swelling of lymph nodes

• Chemotherapy and radiation• Good prognosis with full treatment

Skin Cancer

• Not related to the sedentary lifestyle, but another lifestyle disease that plagues our country