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GLOB 3100 October 8, 2012

Non Communicable (Chronic Disease)

Dr. Colleen OBrien Cherry

Chronic Disease: What is it?



Cardiovascular Disease

Mental Disorders


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Key Terms

Cardiovascular Disease: A disease of the heart or blood vessels. This term encompasses both ischemic heart disease and stroke. Ischemic Heart Disease: A disturbance of the heart function due to inadequate supply of oxygen to the heart muscle. Stroke: Sudden loss of function of the brain due to clotting or hemorrhaging Cholesterol: A fat-like substance that is made by the body and is found naturally in animal-based foods such as meat, fish, poultry, eggs Diabetes: An illness caused by poor control by the body of blood sugar Blood glucose: Main source of energy for the body
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http://gamapserver.who.int/gho/interactive_charts/nc d/mortality/total/atlas.html

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So, whats happening???

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Pace of the transition is accelerating in developing countries, and is occurring at a faster rate than it did for Western countries!

A series of changes in diet, physical activity, health and nutrition, collectively known as the nutrition transition (FAO 2002)

Figure 2. Stages of the Nutrition Transition

Urbanization, economic growth, technological changes for work, leisure, & food processing, mass media growth
Pattern 1 Paleolithic man/ Hunter-gathers Pattern 2 Settlements begin/ Monoculture period/ Famine emerges Pattern 3 Industrialization/ Receding Famine Pattern 4 Noncommunicable Disease Pattern 5 Desired societal/ Behavioral Change

Wild plants & animals water Labor intensive

Cereals dominate water Labor-intensive

Starchy, low variety, low fat, high fiber water Labor-intensive work job/home

Increased fat, sugar, processed foods caloric beverages Shift in technology of work and leisure

Reduced fat, increased fruit, veg, CHO, fiber Increase water, Reduce caloric beverage intake Replace sedentarianism w/ purposeful activity

Lean & robust, high disease rate

Nutritional deficiencies emerge, stature declines

MCH deficiencies, weaning disease, stunting

Obesity emerges, range of other NR-NCDs

Reduced body fatness, Reduced NR-NCDs

Low fertility, Low life expectancy

High fertility, high MCH mortality, low life expectancy

Slow mortality decline

Accelerated life expectancy, shift to increased DR-NCD, increased disability period

Extended health aging, reduced DR-NCD

Source: Popkin 2002 revised 2006.

Cardiovascular disease Cause of about 30% of all deaths worldwide Leading cause of death in low- and middle-income countries, and highincome countries Rates vary by region 80% of burden of CVD is due to ischemic heart disease, stroke, and congestive heart failure

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Risk Factors


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Obesity is a global issue!


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Threats to the Developing World

Health Effects of Obesity
Increase in Chronic Disease
80% of deaths attributable to NCD worldwide occurred in low and middle income countries during 2005
(WHO 2008-2013)

Economic Consequences
Obesity reduces productivity as people develop chronic health conditions and experience activity limitations Chronic disease is estimated to cost developing countries $84 billion by 2015 if nothing is done to curb growth

Loss of Resource s

including 90% of Type 2 diabetes

is attributable to excess weight; diabetes projected to increase in the developing world from approximately 84 million to 228 million by 2030


High Cost

Double burden of Infectious and Chronic disease can have disastrous effects on a developing economy!

Prevalence of overweight [BMI (in kg/m2) 25] and underweight (BMI < 18.5) in women aged 2049 y in 36 developing countries ranked by per capita gross national income (GNI; in brackets).

Mendez M A et al. Am J Clin Nutr 2005;81:714-721

2005 by American Society for Nutrition



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Why is the death rate due to CVD lower in France than the US?


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I believe I am successful at managing patients with CVD risk factors because?


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Could the adoption of practices of the French culture of care improve CVD outcomes in the US?
Doctor-Patient Relationship

Prevention / Healthy Lifestyle

Motivation of Doctor

Culture of Care
EMRs Doctor Knowledge

Use of Guidelines


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