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Group: 4

Prepared by: Ashmita Sharma

Arati Kuwar Purnima Timilsina

Rajiv Nepal Indra Acharya

Tika Bdr. Thapa

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Chronic Diseases • Chronic diseases are diseases of long duration

and generally of slow progression. • Chronic diseases, such as heart disease, stroke,

cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality in the world, representing 63% of all deaths.

• Out of the 36 million people who died from chronic disease in 2008, nine million were under 60 and ninety per cent of these premature deaths occurred in low- and middle-income countries.

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Diabetes

• Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.

• Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.

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• 347 million people worldwide have diabetes.• In 2004, an estimated 3.4 million people died

from consequences of high fasting blood sugar. • More than 80% of diabetes deaths occur in low-

and middle-income countries .• WHO projects that diabetes will be the 7th

leading cause of death in 2030.• Healthy diet, regular physical activity, maintaining

a normal body weight and avoiding tobacco use can prevent or delay the onset of type 2 diabetes.

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Type 1 diabetes• Type 1 diabetes (previously known as insulin-

dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin.

• Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly.

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Type 2 diabetes• Type 2 diabetes (formerly called non-insulin-

dependent or adult-onset) results from the body’s ineffective use of insulin.

• Type 2 diabetes comprises 90% of people with diabetes around the world , and is largely the result of excess body weight and physical inactivity.

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Gestational diabetes• Gestational diabetes is hyperglycaemia with

onset or first recognition during pregnancy.• Symptoms of gestational diabetes are similar to

Type 2 diabetes. Gestational diabetes is most often diagnosed through prenatal screening, rather than reported symptoms.

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Cancer • Cancer is a generic term for a large group of

diseases that can affect any part of the body. • Other terms used are malignant tumours and

neoplasms. • This process is referred to as metastasis.

Metastases are the major cause of death from cancer.

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Cancer is a leading cause of death worldwide and accounted for 7.6 million deaths (around 13% of all deaths) in 2008. The main types of cancer are:

• lung (1.37 million deaths)• stomach (736 000 deaths)• liver (695 000 deaths)• colorectal (608 000 deaths)• breast (458 000 deaths)• cervical cancer (275 000 deaths)• About 70% of all cancer deaths occurred in low- and

middle-income countries. Deaths from cancer worldwide are projected to continue to rise to over 13.1 million in 2030.

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• Cancer causing viral infections such as HBV/HCV and HPV are responsible for up to 20% of cancer deaths in low- and middle-income countries.

• About 70% of all cancer deaths in 2008 occurred in low- and middle-income countries.

• Deaths from cancer worldwide are projected to continue rising, with an estimated 13.1 million deaths in 2030.

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Cardio Vascular Diseases • Cardiovascular diseases (CVDs) are a group of

disorders of the heart and blood vessels and they include:

• coronary heart disease,• cerebrovascular disease,• peripheral arterial disease• rheumatic heart disease,

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• congenital heart disease,• deep vein thrombosis and pulmonary

embolism,• Heart attacks and strokes are usually acute

events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain.

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• An estimated 17.3 million people died from CVDs in 2008, representing 30% of all global deaths. Of these deaths, an estimated 7.3 million were due to coronary heart disease and 6.2 million were due to stroke .

• Low- and middle-income countries are disproportionally affected: over 80% of CVD deaths take place in low- and middle-income countries and occur almost equally in men and women .

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• Most cardiovascular diseases can be prevented by addressing risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity, high blood pressure, diabetes and raised lipids.

• 9.4 million deaths each year, or 16.5% of all deaths can be attributed to high blood pressure. This includes 51% of deaths due to strokes and 45% of deaths due to coronary heart disease.

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OSTEOPOROSIS• Osteoporosis is defined as a progressive systemic

skeletal disorder characterized by low bone mineral density (BMD), deterioration of the microarchitecture of bone tissue, and susceptibility to fracture.

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Types of osteoporosis Osteoporosis can be subdivided into 3 types: (1) involutional, or primary, osteoporosis in which

no underlying cause can be identified; (2) secondary osteoporosis in which the underlying

cause (eg, steroid use) is known; and (3) rare forms of the disease, such as juvenile,

pregnancy-related, and postpartum osteoporosis.

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Overweight and obesity

• Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health.

• A crude population measure of obesity is the body mass index (BMI).

• A person with a BMI of 30 or more is generally considered obese. A person with a BMI equal to or more than 25 is considered overweight.

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• Worldwide obesity has nearly doubled since 1980.

• In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.

• 35% of adults aged 20 and over were overweight in 2008, and 11% were obese.

• 65% of the world's population live in countries where overweight and obesity kills more people than underweight.

• More than 40 million children under the age of five were overweight in 2011.

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Refrences • 1) Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ,

Paciorek CJ et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet, 2011, 378(9785):31–40. (2) Global health risks. Mortality and burden of disease attributable to selected major risks. Geneva, World Health Organization, 2009.(3) Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 2006, 3(11):e442.(4) Global status report on noncommunicable diseases 2010. Geneva, World Health Organization, 2011.

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Diet, nutrition and the prevention of cancer

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Abstract

• Objective: To assess the epidemiological evidence on diet and cancer and make public health recommendations.

• Design: Review of published studies, concentrating on recent systematic reviews, meta-analyses and large prospective studies.

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Review• Dietary factors have been thought to account

for about 30% of cancers in Western countries1, making diet second only to tobacco as a preventable cause of cancer.

• Then contribution of diet to cancer risk in developing countries has been considered to be lower, perhaps around 20%2.

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International comparisons, migrants and timetrends

• It was noted that developed Western countries have diets high in animal products, fat and sugar, and high rates of cancers of the colorectum, breast and prostate.

• In contrast, developing countries typically have diets based on one or two starchy staple foods, low intakes of animal products, fat and sugar, low rates of these ‘Western’ cancers, and sometimes high rates of other types of cancer such ascancers of the oesophagus, stomach and liver.

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• Studies have shown that cancer rates often change in populations which migrate from one country to another, and change over time within countries.

• However, the international variations in diet and cancer rates continue to suggest that diet is an important risk factor for many common cancers, and therefore that cancer may be partly preventable by dietary changes.

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Review of the role of diet in the aetiology of themajor cancers

• Cancers of the oral cavity, pharynx and oesophagus:

• In developed countries, the main risk factors are alcohol and tobacco, and up to 75% of these cancers are attributable to these two lifestyle factors .

• The mechanism of the effect of alcohol on these cancers is not known, but may involve direct effects on the epithelium.

• Overweight/obesity is an established risk factor specifically for adenocarcinoma (but not squamous cell carcinoma) of the oesophagus.

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• In developing countries, around 60% of cancers of the oral cavity, pharynx and oesophagus are thought to be due to micronutrient deficiencies.

• The relative roles of various micronutrients are not yet clear, but deficiencies of riboflavin, folate, vitamin C and zinc may all be important.

• Consistent evidence that consuming drinks and foods at a very high temperature increases the risk for these cancers.

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Nasopharyngeal cancer• consistently associated with a high intake of

Chinese style salted fish, especially during early childhood as well as with infection with the Epstein–Barr virus.

Colorectal cancer• The best established dietary-related risk factor

is overweight/ obesity. • Alcohol probably causes a small increase in risk.• Adult height is weakly associated with

increased risk, and physical activity has been consistently associated with a reduced risk.

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Stomach cancer• Risk is increased by high intakes of some traditionally

preserved salted foods, especially meats and pickles and that risk is decreased by high intakes of fruits and vegetables perhaps due to their vitamin C content.

Breast cancer• Much of this international variation is due to

differences in established reproductive risk factors such as age at menarche, parity and age at births, and breastfeeding, but differences in dietary habits and physical activity may also contribute.

• Oestradiol and perhaps other hormones play a key role in the aetiology of breast cancer.

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Cancer of the liver• The major risk factor for hepatocellular

carcinoma is chronic infection with hepatitis B, and to a lesser extent, hepatitis C virus.

• Ingestion of foods contaminated with the mycotoxin aflatoxinis an important risk factor among people in developing countries with active hepatitis virus infection.

• Excessive alcohol consumption is the main diet-related risk factor for liver cancer.

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Cancer of the pancreas• Overweight/obesity possibly increases the

risk. • Some studies have suggested that risk is

increased by high intakes of meat, and reduced by high intakes of vegetables.

Lung cancer Heavy smoking ,low dietary intake of vitamin

A, lower intake of fruits, vegetables and related nutrients (such as b-carotene) than controls increases the risk.

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Cancer of the cervix• The major cause of cervical cancer is infection

with certain subtypes of the human papillomavirus.

• Fruits, vegetables and related nutrients such as carotenoids and folate tend to be inversely related with risk.

Cancer of the ovary• Risk is reduced by high parity and by long-term

use of combined oral contraceptives.• Some studies have suggested that risk is

increased by high intakes of fat or dairy products, and reduced by high intakes of vegetables.

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Prostate cancer• Diets high in red meat, dairy products and

animal fat have frequently been implicated in the development of prostate cancer,

• Lycopene, primarily from tomatoes, has been associated with a reduced risk in some observational studies.

Bladder cancer• Smoking increases the risk for bladder cancer.• Studies suggest that high intakes of fruits and

vegetables may reduce risk

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• Cancer of the endometrium• As with breast cancer, the effect of obesity in

postmenopausal women on the risk for endometrial cancer is probably mediated by the increase in serum concentrations of oestradiol.

• Some case-control studies have suggested that diets high in fruits and vegetables may reduce risk and that diets high in saturated or total fat may increase risk, but the data are limited.

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Kidney cancer• Overweight/obesity is an established risk

factor for cancer of the kidney.• an increase in risk with high intakes of meat

and dairy products and a reduced risk with high intakes of vegetables.

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Meat• International correlation studies show a strong

association between per capita consumption of meat and colorectal cancer mortality

• In addition, high iron levels in the colon may increase the formation of mutagenic free radicals.

• high consumption of preserved and red meat probably increases the risk for colorectal cancer.

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Fat• high fat intake may increase the levels of cytotoxic free

fatty acids or secondary bile acids in the lumen of the large intestine and increases breast cancer risk.

Folate • methyl-deplete diet (i.e. a diet low in folate and

methionine and high in alcohol) ,is associated with an increased risk of colon cancer.

• use of folic acid containing multiple vitamin supplements has been associated with lower risk of colon cancer.

• A diminished folate status may contribute to carcinogenesis by alteration of gene expression and increased DNA damageand chromosome breakage.

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Fruits, vegetables and fibre

• Fibre increases stool bulk and speeds the transit of food through the colon, thus diluting the gut contents and perhaps reducing the absorption of carcinogens by the colonic mucosa.

• Many case-control studies of colorectal cancer have observed moderately lower risk in association with high consumption of dietary fibre, and/or fruits and vegetables but the results of recent large prospective studies have been inconsistent.

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• the association with fruits and vegetables is principally due to an increase in risk at very low levels of consumption or that high intakes of refined flour or sugar (rather than low intakes of fibre) increase risk through chronic hyperinsulinaemia or other mechanism.

Calcium• Several observational studies have supported

this hypothesis and two trials have suggested that supplemental calcium may have a modest protective effect on the recurrence of colorectal adenomas.

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Overweight/obesityObesity increases breast cancer risk in postmenopausal women by around 50%, probably by increasing serum concentrations of free oestradiol.

Alcohol• The only other established dietary risk factor for

breast cancer is alcohol. • There is now a large amount of data from well-

designed studies which consistently shows a small increase in risk with increasing consumption, with about a 7% increase in risk for an average of one alcoholic drink every day.

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Conclusions on the effects of diet on cancer risk

• Strengths and weaknesses of the evidence• Attaining definitive evidence to confirm.• relationship tested in multiple randomised

trials to achieve a clear conclusion.• uncertainty about the time in life and number

of years before diagnosis.• Practical problems with compliance in long-

term studies.• Because dietary behaviours are often

associated with other aspects of lifestyle that could affect cancer risk

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Conclusions on the effects of diet on cancer risk

Strengths and weaknesses of the evidence• Attaining definitive evidence to confirm.• relationship tested in multiple randomised trials to

achieve a clear conclusion.• uncertainty about the time in life and number of

years before diagnosis.• Practical problems with compliance in long-term

studies.• Because dietary behaviours are often associated

with other aspects of lifestyle that could affect cancer risk

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• many dietary factors may not act in isolation and it may be their interaction with other dietary, lifestyle and/or genetic factors that may alter cell growth and affect cancer risk.

• due to potential confounding by the multitude of lifestyle and other environmental factors that vary geographically.

• case-control studies provided the large majority of data on diet and cancer.

• Concerns on methodological biases, related to both the selection of study participants and the recall of diet after the diagnosis of cancer,.

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Dietary factors which convincingly increase risk

• Overweight/obesity• Alcoholic beverages• Aflatoxin• Chinese-style salted fish

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Conclusions on dietary factors and cancer

• Review on diet and cancer mortality, about one third of cancers have generally been thought to be related to dietary factors.

• After tobacco, overweight/obesity appears to be the most important avoidable cause of cancer in populations with Western patterns of cancer incidence.

• Physical activity reduces the risk for colorectal cancer and probably reduces the risk for breast cancer.

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• Public health policy with respect to nutrition and cancer should be based on the best available scientific research.

• Avoiding overweight/obesity, limiting alcohol intake and increasing physical activity will reduce cancer risk, as will limiting consumption of Chinese-style salted fish and minimizing dietary exposure to aflatoxin in populations where these dietary factors are important.

• Risk will probably be decreased by increasing the average intake of fruits and vegetables, and by limiting intake of preserved and red meat, salt preserved foods and salt, and very hot drinks and food. Public health policy should, therefore, be focussed on these factors.

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Thank you