Introduction to Non-Communicable Diseases - for MBBS students

1. NON COMMUNICABLE DISEASES
(NCDS)
Department of Community Medicine
JNIMS

2. OVERVIEW OF PRESENTATION
• Introduction
• Risk factors
• Prevention

3. NCDS: CDC
• Noncommunicable diseases (NCDs), also known as chronic,
‘life-style diseases’
• Not passed from person to person
• They are of long duration and generally slow progression

4. NCDS: TYPES
• Cardiovascular disease (Coronary heart disease, Stroke)
• Cancer
• Chronic lung disease
• Diabetes
• Chronic Neurologic Disorders (Alzheimer’s, dementias)
• Arthritis/Musculoskeletal diseases
• (In some, Mental Health and RTAs)

5. INTRODUCTION
• NCDs - kill 41 million/ year, 71% of all deaths globally
• 77% of all NCD deaths - In LMIC
• Cardiovascular diseases - 17.9 million people annually, cancers
(9.3 million), respiratory diseases (4.1 million), diabetes (1.5
million)
• These four groups of diseases account for over 80% of all
premature NCD deaths

6. TRANSITIONS IN SOCIETY: MAJOR SHIFT IN POPULATION’S
HEALTH
1. Demographic transition-high fertility to low fertility, increased
life-expectancy -Ageing population
2. Economic transition-Increasing per capita income
3. Social transition-Industrialisation and resulting urbanisation
4. Nutrition transition-Shift in dietary consumption
5. Epidemiologic transition-Shift from infectious to NCDs

7. RISK FACTORS
1. Non-Modifiable Risk Factors
2. Modifiable Risk Factors
1. Behavioural Risk Factor
2. Metabolic Risk Factor

8. RISK FACTORS-NON-MODIFIABLE
1. Age
2. Sex
3. Race/ Ethnicity
4. Genetics/ Family History

9. RISK FACTORS-MODIFIABLE
BEHAVIOURAL
1. Tobacco use
2. Physical Inactivity
3. Unhealthy Diet
4. Harmful use of alcohol

10. TOBACCO
• Tobacco kills up to half of its users
• Kills more than 8 million people each year
• Any amount of tobacco is harmful
• No safe way to use tobacco

11. TOBACCO
• Types – Smoking and Smokeless Tobacco
• Novel and emerging Nicotine and Tobacco products
• ENDS-Electronic Nicotine Delivery System, ENNDS-
Electronic Non-Nicotine Delivery System
• HTP-Heated Tobacco Products

12. SMOKING
TOBACCO
1.Roll-Your-Own (RYO)
2.Cigars
3.Cigarettes
4.Bidis
5.Kreteks
6.Pipes
7.Water Pipes-Hookah

13. SMOKELESS
TOBACCO
1.Moist Snuff – Grounded Tobacco-Khaini
2.Dry Snuff – Powdered Tobacco, Inhaled
3.Chewing Tobacco – Gutkha, pan etc
Traditional Smokeless Tobacco Products

14. ENDS
1.Nicotine
2.Vaping (Vape-aerosol)
3.E-cigs, Mods, Vapes, Tank system etc
4.Currently approved- quit Smoking aid
5.Gateway to drugs
6.EVALI: e-cigarette or vaping associated
acute lung injury

16. HEATED TOBACCO LEAF
• Produces aerosol
• Heat actual tobacco leaf
• QOS, Ploom, Glo and PAX vaporizers

17. PHYSICAL INACTIVITY
• WHO defines physical activity as any bodily movement
produced by skeletal muscles that requires energy expenditure
• Physical Activity
• Leisure time
• For transport to get to and from places
• As part of a person’s work

18. PHYSICAL INACTIVITY
• Obesity, Dyslipidaemia, Hyperglycaemia, Raised BP, Cancers
etc
• People who are insufficiently active have a 20% to 30%
increased risk of death compared to people who are
sufficiently active

19. PHYSICAL INACTIVITY
• Moderate-intensity physical
activity: Physical activity that
is between 3 and less than
6 times METS
• One MET is the energy
equivalent expended by
an individual while seated
at rest

20. PHYSICAL INACTIVITY
• Vigorous-intensity Physical
Activity: Physical activity that
is performed at 6.0 or more
METS

21. UNHEALTHY DIET
• Better nutrition is related to improved infant, child and maternal
health, stronger immune systems, safer pregnancy and childbirth
• Lower risk of non-communicable diseases (such as diabetes and
cardiovascular disease), and longevity
• Conditions associated with unhealthy diet (2002)
• 19% of Gastrointestinal cancer
• 31% of Coronary heart disease
• 11% of stroke

22. DIET: ENERGY
• Energy intake (calories) should be in balance with energy
expenditure
• To avoid unhealthy weight gain
• Total fat should not exceed 30% of total energy intake
• Intake of saturated fats should be less than 10% of total
energy intake
• Intake of trans-fats less than 1% of total energy intake

23. DIET: SUGAR AND SALT
• Limiting intake of free sugars to less than 10% of total energy
intake
• 50 g/ day (for a person requiring 2000 Kcal)
• A further reduction to less than 5% of total energy intake is
suggested
• Keeping salt intake to less than 5 g per day (equivalent to
sodium intake of less than 2 g per day)

24. DIET: FRUITS & VEGETABLES
• At least 400 g (i.e. five portions) of fruit and vegetables per day

25. DIET: FRUITS &
VEGETABLES
• Reduce Bowel cancer
• Decrease post-prandial rise of blood
sugar
• Reduce absorption of fats from bowel

26. HARMFUL USE OF ALCOHOL
• 5.3 % of all deaths
• More than 200 disease and injury conditions
• Beyond health consequences, the harmful use of alcohol
brings significant social and economic losses

27. 3 MILLION DEATHS CAUSED BY
ALCOHOL: WHO 2018

28. RISK FACTOR: HARMFUL ALCOHOL USE
• Harmful drinking is defined as alcohol consumption that results in
physical or psychological harm
• High Risk Drinking:
• Men: >40gm of pure alcohol/ day (>20gm)
• Women: >20gm of pure alcohol/ day (>10gms)
• Binge drinking:
• Men: >7 standard drinks/ occasion
• Women: > 5 standard drinks/ occasion

29. STANDARD DRINK
• Low-alcohol (light) beer (2.7%): 1 1/4 of a 375ml can
• Mid-strength beer (3.5%): 1 stubby, total volume 375ml
• Regular beer (4.9%): 1 pot, 285ml
• White or red wine (12%): 1 small glass, 100ml
• Spirits or liqueurs (40%): 1 nip, 30ml

30. RISK FACTORS-METABOLIC
Behavioral risk factors lead to metabolic/ Biological risk factor
1. Overweight/Obesity
2. Raised blood pressure
3. Hyperglycemia (high blood glucose levels)
4. Hyperlipidemia (high levels of fat in the blood)

31. OVERWEIGHT/ OBESITY
• 2016
• More than 1.9 billion adults-Overweight, 650 million-Obese
• 39%-Overweight, 13%-Obese
• Overweight and obesity - abnormal or excessive fat accumulation that may
impair health
• Associated with - Cardiovascular diseases (mainly heart disease and
stroke),diabetes, musculoskeletal disorders (especially osteoarthritis), some
cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder,
kidney, and colon).

33. RAISED BLOOD PRESSURE
• Hypertension, also known as high or raised blood pressure, is a
condition in which the blood vessels have persistently raised
pressure
• Increase the risk of MI, Stroke, Renal Failure etc
• Globally - 1.28 billion adults aged 30-79 years have hypertension
• An estimated 46% of adults with hypertension are unaware that
they have the condition – Silent Killer

35. RAISED BLOOD SUGAR
• 2014 - 422 million (Adults-8.4%)
• 2019 - 1.5 million deaths were directly caused by diabetes
• major cause of blindness, kidney failure, heart attacks, stroke
and lower limb amputation
• Adults with diabetes have a two- to three-fold increased risk of
heart attacks and strokes

36. RAISED BLOOD SUGAR

37. RAISED CHOLESTEROL
• Raised cholesterol is estimated to cause 2.6 million deaths
• Raised total cholesterol among adults was 39%
• Increase the risks of heart disease and stroke
• Total cholesterol ≥5.0 mmol/L or 190 mg/dl

38. ENVIRONMENTAL RISK FACTORS
• Globalisation
• Urbanisation
• Poverty
• Low education
• Stress

40. LEVELS OF PREVENTION
• Primordial
• Primary
• Secondary
• Tertiary

41. THANK YOU