Chronic Disease In MalaysiaPresentation Transcript
Chronic diseases in Malaysia Dr. Rashidi Ahmad MD(USM), MMed(USM), FADUSM, AM 24 th August 2008 Pantai Batu Buruk, KT
Understanding chronic diseases
Understanding risk factors
Understanding methods of prevention
Significance epidemiological data
Overview chronic diseases in Malaysia and its risk factors
Discussion on few chronic diseases
Broad definition of chronic disease: Illnesses that are prolonged, do not resolve spontaneously, and are rarely cured completely.
CDC's National Center for Chronic Disease Prevention and Health Promotion: … and that are preventable, and that pose a significant burden in mortality, morbidity, and cost.
Chronic Disease Epidemic
Chronic Disease in US
> 90 million Americans live with chronic dz
Account for 70% of all deaths
Account for > than 60% of the nation's medical-care costs.
Account for one third of the years of potential life lost before age 65
The Robert Wood Johnson Foundation, Annual Report 1994; Health, United States, 1994
Chronic Dz in M’sia
Total deaths in Malaysia, 2002 = 119,000.
Total deaths related to chronic disease in Malaysia, 2002 = 85,000.
Chronic diseases accounted for 71% of all deaths in 2002
Malaysia NCD Surveillance 2005/06: CD among Malaysian Adult Aged 25-64
The data was obtained from 2.572 subjects, with total response rate of 84.6%.
~ 11.6 million adults aged 25-64 years were having at least one NCD risk factor.
Only about 3% of Malaysian adults did not have risk factor.
Common Risk Factors
Overweight & obesity
Prevalence: overweight (31.6%); obesity (16.3%).
Men (30.9%), women (32.4%) were overweight
Men (13.9%), woman (18.8%) were obese.
1 in 2 adults aged 25 to 64 years were either overweight or obese.
Indians > Malays and Chinese.
Prevalence of Obesity
Prevalence of overweight in Malaysia is expected to increase in women over the next 10 years, but remain relatively constant in men
Overweight and obesity
Raised body mass index is a/w the possibility of early death.
High Tg & LDL-cholesterol, low HDL-cholesterol.
3 x more likely to have HPT
50% of Type 2 diabetics are obese.
Risk of breast and prostate cancer
About 53.1% of men and 53.9% of women
1 in 2 adults aged 25-64 years had hypercholesterolemia.
Indians (61.3%), followed by Malays (54.7%) and Chinese (52.9%).
Prevalence of Hypercholesterolemia
The prevalence of non-meeting of dietary guideline for vegetables and fruits intake was 72.8%.
About 70.3% of men and 75.5% of women did not meet the dietary guideline.
~ 8.7 million or most adults aged 25-64 years did not meet the dietary guideline for vegetables and fruits intake.
Prevalence of Unhealthy Diet (Not enough vegetables and fruits)
~ 3.1 million Malaysian (1 in 2 men and 1 in 33 women), aged 25-64 years were current smokers
Prevalence of current smokers was 25.5%.
Men (46.5%), women (3.0%) were current cigarette smokers.
~ 3.1 million (1 in 2 men and 1 in 33 women), aged 25-64 years were current smokers.
Prevalence of Current Smoker
About 55.4% of men and 65.1% of women were physically inactive.
~ 7.2 million or 1 in 2 for both men and women, aged 25-64 years were physically inactive.
Prevalence of Physical Inactivity
Diabetes is a lifelong disease.
DM is a disease of the pancreas (an organ behind your stomach).
DM occurs when the pancreas does not produce any insulin or pancreas produces very little insulin or when the body does not respond appropriately to insulin
Diabetes mellitus in Malaysia
1 in 10 men and 1 in 8 women had high blood glucose.
Known diabetes: 543,385
Newly diagnosed: 781,798
Indians (20.0%), Malays (11.1%) and Chinese (7.5%).
Prevalence of Raised Blood Glucose
Manifestations of DM
IDDM (type 1)
*Increased thirst *Increased hunger (especially after eating) *Dry mouth *Frequent urination *Unexplained weight loss *Fatigue (weak, tired feeling) *Blurred vision *Labored, heavy breathing *Loss of consciousness (rare)
NIDDM (type 2)
*Slow-healing sores or cuts *Itching of the skin (usually in the vaginal or groin area) *Yeast infections *Recent weight gain *Numbness or tingling of the hands and feet *Low blood glucose levels *Impotence or erectile dysfunction
Complications of DM
A family history
Race or ethnic background
Being overweight & abnormal cholesterol levels
Drugs: thiazides, Steroid medicines
Alcohol & Smoking
History of gestational diabetes
If you are diabetic
Maintain your blood cholesterol and triglyceride levels as near normal ranges
BP should not go over 130/80.
Taking medicine, if prescribed, and closely following the guidelines on how and when to take it.
Monitoring blood glucose and BP levels at home.
Keep to the appointments
What is hypertension?
BP > 140 mm Hg / 90 mm Hg, measured while at rest.
Causes: essential or secondary HPT (10%)
The most well known symptoms are headache felt at the back of the head, dizziness, fatigue and ringing in the ears.
Hypertension in Malaysia
Men vs women - 26.3% vs 25.0%.
1 in 4 adults aged 25-64 years had HPT.
Known hypertensives: 1.4 million
Newly diagnosed:1.7 million.
Chinese (31.0%), Malays (23.4%) and Indians (21.6%).
Prevalence of Raised Blood Pressure
Hypertension risk factors
Complications of HPT
How can high BP can be prevented?
Control body weight
Exercise regularly - 30 minutes a day
Limit daily intake of sodium (about 1 teaspoon of salt).
Take more fruits and vegetables and low fat products
Eat food that is rich in potassium (3,500 mg) potassium per day.
SAY NO to alcohol or tobacco.
Relaxation treatment: slow breathing exercise
Reduce high sodium food
Processed foods such as lunch meats, sausage, bacon, and ham
Canned soups, bouillon, dried soup mixes
Condiments (ketchup, soy sauce, salad dressings)
Frozen and boxed mixes for potatoes, rice, and pasta, snacks (pretzels, popcorn, peanuts, chips), pickled or marinated food.
AJINIOMOTO (monosodium glutamate)
Increase high potassium diet
Cancer World Health Organization (WHO) International Agency for Research on Cancer: World Cancer Report 2003)
Who is at risk for cancer?
In the US, cancer is likely to affect 1 in 2 men and 1 in 3 women
The amount of risk you have depends on a few factors (tobacco use, lifestyle choices (such as diet and exercise), family history, and factors in your workplace and environment)
Workplace or environment factors?
Exposure to the sun can cause skin cancer, and breathing tobacco smoke puts you at risk of lung cancer and some other types of cancer.
Carcinogenic: asbestos, solvents and chemicals used for manufacturing or cleaning, smoke or fumes from burning materials, and many others.
Cancer of prostate
Prostate cancer manifestations
Weak or interrupted flow of urine.
Frequent urination (especially at night).
Pain or burning during urination.
Blood in the urine or semen.
A pain in the back, hips, or pelvis that doesn't go away.
How to detect?
Prostate-specific antigen (PSA) level: PSA is a substance produced by the prostate and some other tissues in the body Transrectal USG
Techniques for breast examination. How to detect?
The New Zealand Breast Cancer Foundation recommends women between 40 and 50 have a yearly mammogram and twice yearly from 50 years.
Chronic diseases is a major problem for Malaysia
At least 80% of premature heart disease, stroke and type 2 diabetes, and 40% of cancer could be prevented by reversing a common factors.