This document discusses non-communicable diseases (NCDs), also known as chronic diseases. It provides an overview of NCDs, their risk factors, and levels of prevention. The main points are: NCDs such as heart disease, cancer, diabetes and lung disease account for over 80% of all premature deaths globally. The largest risk factors are tobacco use, physical inactivity, unhealthy diet, and harmful alcohol use. Behavioral risk factors can lead to metabolic risk factors like obesity, high blood pressure, high blood glucose, and high cholesterol. Prevention strategies target these modifiable risk factors at the primordial, primary, secondary, and tertiary levels.

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