Health talk on NCD in Malaysia

1. PENYAKIT TIDAK
BERJANGKIT (NCD)

3. Types of NCDs
• Cardiovascular disease (e.g.,
Coronary heart disease, Stroke)
Diabetes
Cancer
Chronic respiratory disease
•
•
•

4. Risk Factor: Definition
“An aspect of personal behavior or
lifestyle, an environmental exposure,
or a hereditary characteristic that is
associated with an increase
in the occurrence of a particular
disease, injury or other health
condition.”
Principles of Epidemiology, CDC, 2006

5. Modifiable Risk Factor
• A behavioral risk factor that can be reduced or
controlled by intervention, thereby reducing the
probability of disease.
• WHO has prioritized the following four:
I. Physical inactivity,
II. Tobacco use,
III.Alcohol use, and
IV.Unhealthy diets (increased fat and sodium, with low
fruit and vegetable intake).

6. Non-Modifiable Risk Factor
A risk factor that cannot be reduced or controlled
by intervention; for example:
•
•
•
•
Age,
Gender,
Race, and
Family history (genetics).

7. Common Risk Factors

9. Global Trends Causes of Deaths
Projected Deaths in 2015 and 2030
0
5
10
15
20
25
30
2004 2015 2030 2004 2015 2030 2004 2015 2030
Deaths(millions)
High income Middle income Low income
Other infectious
HIV, TB, malaria
Mat//peri/nutritional
CVDT
Cancers
Other NCDs
Intentional injuries
Other unintentional
Road traffic accidents
http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part2.pdf

10. NCD IN MALAYSIA
 Ancaman kesihatan baru
 Jumlah pesakit meningkat setiap tahun.
 10 penyebab utama penyakit negara
 60% ( ~ 35 juta) jumlah kematian di dunia
disumbang oleh NCD (WHO)
NHMS 2015 adults 18 years and above
 17.5% (3.5 m) have diabetes
 30.3% (6.1 m) have hypertension
 47.7% (9.6 m) have hypercholesterolemia

11. NCD RISK FACTORS
 Common, preventable risk factors underlie
most NCDs.
 These risk factors are a leading cause of the
death and disability burden in nearly all
countries, regardless of economic
development.

12. 1.Tobacco Use
• Tobacco kills nearly 6 million people each year.
http://www.who.int/mediacentre/factsheets/fs339/en/index.html

13. MALAYSIA : PREVALENCE OF
SMOKING BY SEX (1996, 2006,
2011 & 2015)
%
• 1996 &2006 – adult 18 & above

14. Malaysia : Prevalence of smoking by states, ≥ 15 years (2015)
%

15. Tobacco Use: Health Effects
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine, 2006,
3(11): e442.

16. Tobacco Use: Health Effects
(cont.)
Among smokers:
•
•
•
•
Cancer
Coronary heart disease
Diseases of the lungs
Peripheral vascular
disease
Stroke
Fetal complications and
stillbirth
•
•
• Second-hand smoke
causes:
• Heart disease, including
heart attack
• Lung cancer

17. 2. UNHEALTHY DIET

18. Global Changes in Diet
http://www.pitt.edu/~super4/41011-42001/41171.pdf
• Most countries have increased overall daily
consumption of:
• Daily calories,
• Fat and meats, and
• Energy dense and nutrient-poor foods such
as:
‒ Starches
‒ Refined sugars
‒ Trans-fats

19. Unhealthy Diet: Health Effects
•
•
•
•
•
•
•
Coronary heart disease
Stroke
Cancer
Type 2 diabetes
Hypertension
Diseases of the liver and gallbladder
Obesity

20. 3.PHYSICAL INACTIVITY

21. Global Changes in Physical Activity
• 31% of the world’s population does not get enough
physical activity.
• Many social and economic changes contribute to
this trend:
•
•
•
Aging populations,
Transportation, and
Communication technology.
1. http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html
2. http://www.sciencedirect.com/science/article/pii/S0140673612608988

22. Global Changes in Physical
Activity (cont.)
Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT; Lancet Physical Activity Series Working Group.
Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life
expectancy. Lancet. 2012 Jul 21;380(9838):219-29

23. Physical Activity: Health Effects
Reduces:
•  High blood
pressure
• Adverse lipid
profile
• Arthritis pain
Reduces risk of:
• Type 2 diabetes
• Certain cancers
• Heart attacks
• Stroke
• Falls
http://www.health.gov/paguidelines/factsheetprof.aspx

24. 4.HARMFUL USE OF ALCOHOL

25. Harmful Use of Alcohol: Effects
Immediate effects:
• Diminished brain
function
•
•
•
Loss of body heat
Fetal damage
Risk for unintentional
injuries
•
•
Risk for violence
Coma and death
Long-term effects:
•
•
•
•
Liver diseases
Cancers
Hypertension
Gastrointestinal
disorders
• Neurological issues
• Psychiatric issues

26. Metabolic Risk Factors
http://www.who.int/nmh/events/2012/discussion_paper3.pdf
• “Metabolic" refers to the biochemical processes
involved in the body's normal functioning
Behaviors (modifiable risk factors) can lead to
metabolic/physiologic changes.
WHO has prioritized the following four metabolic
risk factors:
•
•
‒
‒
‒
‒
Raised blood pressure
Raised total cholesterol
Elevated glucose
Overweight and obesity

27. 1.OBESITY

28. KADAR OBESITI DI SELURUH
DUNIA
17.7%
MALAYSIA

30. 1.Puberty
2.Men above 30
3.Pregnancy
4.The freshman year of college
5.Injury
6.Depression
7.Menopause and peri-menopause
(Women in their 50’s )
LIFE STAGE: CRITICAL PERIODS FOR
WEIGHT GAIN

31. OBESITI

34. COMPLICATIONS OF
OBESITY

37. 2.HIPERTENSI / TEKANAN DARAH
TINGGI

38. Overview of NCD’s and Risk Factors
Raised Blood Pressure
Measurement Normal Pre-Hypertensive Hypertensive
Systolic
mmHg
Diastolic
mmHg
<120 120-139 140+
<80 80-89 90+

40. 36.4
27.9
32.8
34.1
29.9
28.4
42.9
41.1
28.7 29.1
40.5
27.1
22.5
27.4
38.327.5
33.8
25.8
32.5
28.5
29.8
36.4
35.4
25.5
26.286.9 26.8
37.3
33.8
24.1
20.0
15.0
10.0
5.0
0.0
25.0
30.0
35.0
40.0
45.0
Prevalence(%)
MALAYSIA : PREVALENCE OF HYPERTENSION BY
STATE,
≥18 YEARS (2011 & 2015)
2011 2015

41. FAKTOR RISIKO HIPERTENSI

44. Raised Blood Pressure: Health Effects
•
•
•
Leading risk factor for stroke
Major risk factor for coronary heart disease
Risk of CVD doubles for
each increment of 20/10 mmHg of blood pressure
Other complications of raised blood pressure:•
‒ Heart failure
‒ Peripheral vascular disease
‒ Renal impairment
‒ Retinal hemorrhage
‒ Visual impairment

45. Hypertension and Excessive
Sodium Intake
• Sodium, through hypertension, is a major cause of
cardiovascular disease deaths and disability.
• About 10% of cardiovascular disease is caused by
excess sodium intake.
• 8.5 million deaths could be prevented over 10 years
if sodium intake were reduced by 15%.

46. Sources of Sodium
• People are unaware of how much dietary sodium
they are eating.
• In the U.S. 75% of sodium consumed comes from
processed and restaurant foods.
• In China and Japan, 75% of sodium consumed
comes from cooking with high sodium products.

47. Recommendations and Actual
Intakes WHO/PAHO
• Recommendations
• A population salt intake of less than 5 grams or
approximately 2,000 milligrams of sodium, per person per
day is recommended to reach national targets or in their
absence. This level was recommended for the prevention
of cardiovascular diseases.
• Actual Intake
• Latest global estimates show that average sodium intake
varies from 2,000 to 7,200 milligrams of sodium per
person per day.

52. 3.DIABETES MELLITUS
Diabetes : keadaan di mana paras
gula dalam darah adalah tinggi dari
normal.
Bila paras gula dalam badan
meningkat:
 Merosakkan sel yang memerlukan
glukosa untuk bahan bakar dan

55. Diabetes: Burden of Disease
1. http://www.who.int/mediacentre/factsheets/en/
2.http://www.idf.org/regions
• 347 million people worldwide have diabetes.
• In 2004, an estimated 3.4 million people died from consequences of
high blood sugar.
• Healthy diet, regular physical activity, maintaining a normal body
weight and avoiding tobacco use can prevent or delay the onset of
type 2 diabetes.

56. GOLONGAN RISIKO TINGGI UNTUK
MENDAPAT DIABETES
Berat badan berlebihan atau
obesiti.
Semakin berat >> semakin
tinggi risiko diabetes.
Faktor pemakanan
Lebih makanan bergoreng/lemak
tinggi dan kurang pengambilan
makanan berserat

57. 11.6
15.2
17.5
7.2
8.3
47.50
8.0
9.2
4.2
4.9 4.7
20.0
18.0
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
NHMS 2011
Prevalence(%)
NHMS III (2006)
Total diabetes Known Undiagnosed
NHMS 2015
IFG
MALAYSIA : PREVALENCE OF DIABETES,
≥18 YEARS
(2006, 2011, 2015)
NHMS II
(1996)
NHMS III
(2006)
NHMS 2011 NHMS 2015
Age group S30 years S18 years S18 years Est. Population ≥18 years
Prevalence 8.3% 11.6% 15.2% 2,622,284 17.5%
Known diabetes 6.5% 7.0% 7.2% 1,247,366 8.3%
Undiagnosed 1.8% 4.5% 8.0% 1,374,918 9.2%
IGT* / IFG** 4.3% * 4.2% ** 4.9% ** 481,477

58. 19.8
25.4
18.5
16.7
19.3
14.8
18.1
19.4
20.6
15.5
18.6
14.2
14.8
17.4
19.2
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Prevalence(%)
PREVALENCE OF DIABETES, ≥18
YEARS,
BY STATES (2006, 2011 & 2015)
NHMS 2015NHMS III (2006) NHMS 2011

59. Berita baik
adalah jika
seorang DM
dapat
mengawal
diabetes
dengan baik,
ia membantu
mengelakkan
atau
melambatkan
komplikasi

63. 22.8% (5 m) currently smoked tobacco (
NHMS 2015)

65. Pencegahan COPD
Berhenti Merokok - Terapi
gentian nikotin/pengurangan
keinginan merokok.

68. NCD BOLEH DICEGAH
Hampir 80% penyakit jantung, stroke dan diabetes
jenis II boleh di cegah daripada berlaku
Dengan menyingkirkan faktor risiko NCD
Penggunaan tembakau, pemakanan tidak sihat, tidak
aktif fizikal dan pengambilan alcohol.