NON COMMUNICABLE DISEASES

OBESITY Obesity: excess body fat Over wt: (pre obese) wt excess of average for a given ht & age > Assessment Obesity if Body wt 10% BMI Under wt. <18.5 N. wt 18.5-24.9 Pre obese 25.0-29.9 Obese C1/ moderate 30.0-34.5 Obese Obese C2/ severely 35.0-39.9 Obese Obese C3/ Morbidity 40+ Obese Waist Central obesityapple/pear shape measurement Brocas index Ht(cm)-100 Skin fold At tricep, subscapular, suprailiac region thickness complication complication 1. CVS ds 2. CHD 3. Gall stone & other digestion disorders 4. Stroke 5. DM type 2 6. JRN 7. Arthritis of knee, hip & lumbar spines 8. Cancers CHD Impairment of heart function dt inadequate blood flow to heart cz by obst changes in coronary circulation to heart Aka ISCHAEMIC HEART DS (IHDS)- epidemic by WHO - Epidemic - Angina pectoris on effort. MI arrhythmia, HF, sudden death Magnitude & burden: 1. CHD Incidence rate difficult to compute bcs different presentation. Mortality=CRUDE INDICATOR 2. CHD In industries countries: 25-30% death. 1st leading cause of death 3. CHD death rate r mask by other death (infectious ds) problem in diagnosis & reporting Highestlowest 1. North Europe ( Scotland, Finland) 2. South Europe(Italy, France) 3. Japan Dvlping countries: dt changes of life style DM Chr ds dt deficiency effectiveness of insulin. Affect CHO, protein, fat. H2O. electrlytrs Magnitude of prob: 1. Number exceed: 45% in dvlped country 200% in dvlping country 2. Dt industrialization & socioeconomic 3. Egypt: 3% adult hv DM CANCER Magnitude of prob: 1. 12% death thru world 2. In dvlped countries: 6th 2nd ranking lead to death 3. In developing countries: 3rd ranking

descriptive epidemiology place

time

Different time USA: 1920 Britain: 1930 European: after that Dvlping countries: catch up dt western life style

Dvlped countries: 1. Different age structure of population: higher % reaches older age (70-90 yr) 2. Better facilities of diagnosis: discovered cases 3. Life in industrial communities: expose to stress & sedentary occupation Incidence & prevalence dt: 1. Prolongation of lofe span 2. Changing life style 3. Better diagnosis 4. Improve medical care 5. Not eliminated from community by rapid death Increase by age Peak at 10-12 year age Decline from early adolescence No predilection

- Japan>US - EGYPT: Cancer bladder urban>rural>mountain area - Multiple factors: environment, food habit, life style, genetic factor, inadequacy in detection & reporting of cancer

Person Age sex

Increase with age : 29-35: 45-49 (dt estrogen)

Middle-age Older men > = when menopause

Incidence & mortality steady increase 1. Better technique for case-finding & detection 2. In dvlped countries: incidence & death 3. Demographic aging: more people live longer 4. Changes in life style & environmentexposure to risk factors Infancy & preschool>childhood>older > ,:GIT : thyroid, biliary passage : cancer lips. Larynx, lung, bronchus, tongue, pharynx, esophagus

OBESITY Multifactorial Genetic factor Physical inactivity Eating habit Wt between identical twins Vicious circle Sweet & fat Energy require: 2000Kcal/day If consume 100Kcal/day extrawt gain 5 kg/year BMI higher in Lower SES & accelerate wt gain during adulthood Overeating dt Depression, Anxiety, Frustration, Loneliness Hypothyrodisim Cushings synd Hypothalamic tumor Aging Critical event as after marriage-pregnancy ^ retirement - Smoking cessation Family history HTN , DM Occupation, Life style, Habits Personality Social class

CHD Dt genetic/environm ental factor Dt atherosclerosis Smoker, rich cholestrol Type A High social class

Genetic

Immune mechanism Obesity

Socioeconomi c status Psychological Familial tendency Endocrine Life changes

DM In NIDDM 2.3X incidence Dt genetic / environmental factor Cell mediated & humoral reaction against B cell of pancreas - Depend on degree & duration of obesity - > + NIDDM dt dimish biochemical action of insulin & peripheral cell response to insulin lead to hperglycemia

CANCER Ethnic non-white: GIT & genital backgroun system d White: skin Religion in Jewish & Muslim Marital Married : cervix status unmarried: breast Socio in low SE economic SE : breast Etiology:multifactorial Genetic Familial aggregation Environment Tobacco & alcohol Dietary factor: smoked fish Occupational exposure: Asbestos & arsenic lung c A.aminec. bladder benzene leukemia Infection: - HBV Hepatocellular carcinoma - EBV burketts lymphoma, nasopharyngeal carcinoma Physical agents:sun, radiation Pollution:air pollution Drugs:estrogen

susceptibility

Risk factors:multifactorial Risk markers Risk factors Not Modifiable modifiable - Age - Cigarette - Sex smoking - FH - HTN - Genetic - Hyperlipidemia - Type of - Diabetes personality - Obesity - Sedentary habit - Stress

Risk factor: environmental Sedentary NIDDM by alter interaction life style btwm insulin & receptor Malnutrition PEM in early infancy & childhood Diet In quantity Viral Rubella infection Mumps Human coxsackie v Chemical rodenticide agents drug & poison Stress Surgery Trauma

prevention

OBESITY 1ry 2ry 1. Promoting healthy 1. Screening& eating & inducing assessment of dietary changes condition 2. Proper feeding & 2. Managing of obesity raring of children - Behavior 3. physical activity modification - Dietary changes - Physical activity 3. Managing health consequences of obesity

CHD 1ry 2ry 1. Control risk factor 1. Screenin among population g high - Dietary : fat risk grp intake 2. Drug, - Smoking: surgery, program pace- BP: 2-3 mmHg maker - Physical activity 3. Control 2. Identification of risk high risk of grp: risk factor factor & markers 3ry Rehabilitation: occupation & psychological

DM 1ry 2ry 1. Identification those at 1. Screening risk/potential: 2. Rx 3. Health + family history in twins, education: parents & sibling - Incidental/Grp >40 yr age education in Obese organized with obstetric history of section delivering baby >4.5 kg & - Maintain ideal excess weight bdy wt Premature atherosclerosis - Train self care 2. Health education for good Maintains optimal bdy wt prognosis by balancing food intake Physical exercise Avoidance diabetogenic drug by prone individual: contraceptive pill, corticosteroid Family life education:avoid marry among diabetic Family planning for: High parity diabetics Diabetics + vascular + renal failure Ds >25 yr habitual foetal loss 3ry Rehabilitation: occupation & psychological

CANCER 1ry 2ry 1. Health education 1. Early detection - Control tobacco of cases: & alcohol screening test consumption for - Improve cervixal,breast,o personal ral hygiene 2. Rx: surgical, - Immunization radiation, - Early detection chemotherapy & treatment precancerous (cervicitis & wart) 2. Protect worker from occupation exposure 3. Reduce amount of radiation 4. Food, drug & occupational material must tested for carcinogen 5. Environmental pollution 3ry 1. Relief pain 2. Rehabilitation: occupation & psychological

Smoking 80% manifest below age of 40 years Cessation of smoking reduce risk factor by 50-70% Mechanism: 1. Nicotine adrenergic stimulation BP & O2 2. CO atherogenesis (formation artheroma) block blood vessels 3. HDL

HTN systolic & diastolic >140/90 BP

High Serum cholesterol >220 mg/dl LDL HDL

DM Genetic factors Physical activity Type A personality Alcohol Oral contraceptive Hormones

Other risk Risk 2-3 x higher FH risk of premature death Determination of total Cholesterol & LDL Sedentary life style Restlessness Risk to CHD & HTN Have high systolic & diastolic BP Risk to MI Men>women dt estrogen