1. Group: 4
Prepared by:
Ashmita Sharma
Arati Kuwar
Purnima Timilsina
Rajiv Nepal
Indra Acharya
Tika Bdr. Thapa
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2. 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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3. 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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4. • 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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5. 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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6. 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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7. 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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8. 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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9. 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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10. • 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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11. 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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12. • 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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13. • 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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14. • 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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15. 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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16. 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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17. 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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18. • 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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19. 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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20. Diet, nutrition and the prevention of
cancer
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21. 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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22. 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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23. International comparisons, migrants and time
trends
• 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 23

24. • 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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25. 25

26. Review of the role of diet in the aetiology of the
major 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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27. • 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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28. 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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29. 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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30. 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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31. 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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32. 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. 32

33. 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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34. • 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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35. 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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36. 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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37. 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. 37

38. 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. 38

39. • 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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40. Overweight/obesity
Obesity 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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41. 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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42. 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 42

43. • 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,.43

44. Dietary factors which convincingly increase
risk
• Overweight/obesity
• Alcoholic beverages
• Aflatoxin
• Chinese-style salted fish
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45. 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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46. • 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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47. 47

48. Thank you
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