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Recognising and combatting the threat of NCDs
Shirzad Chunara MHSc RD
5 July 2013
  • In 2008, non-communicable diseases were responsible for an astounding 63 per cent of deaths world-wide – more than all other causes combined. Known as NCDs, they include diabetes, heart disease and cancers, and are a growing concern to people of South East Asian descent. However, these diseases are largely preventable and their impact can be significantly reduced.

  • Non-communicable diseases like diabetes, cancer and heart disease are the leading cause of mortality around the world, but they can be prevented by diet and lifestyle changes. Photo: TheIsmaili.org Nutrition Centre Non-communicable diseases like diabetes, cancer and heart disease are the leading cause of mortality around the world, but they can be prevented by diet and lifestyle changes. TheIsmaili.org Nutrition Centre

    According to the United Nations, non-communicable diseases (NCDs) were the cause of some 36 million deaths around the world in 2008. That represented an astounding 63 per cent of deaths world-wide that year, making NCDs “responsible for more deaths than all other causes combined.”

    Sadly, that number is growing; it is projected that non-communicable diseases will cause an estimated 52 million deaths in 2030. In a series of publications on non-communicable diseases, the medical journal The Lancet noted that “NCDs remain the least recognised group of conditions that threaten the future of human health and well-being.” However, these diseases are largely preventable and their impact can be significantly reduced.

    What are NCDs?

    Non-communicable diseases are medical conditions or diseases that a person develops over time, often due to unhealthy behaviours such as smoking, living a sedentary lifestyle and maintaining a poor quality diet.

    They are called “non-communicable” because the diseases are not infectious or transmissible from person to person. In other words, you cannot “catch” an NCD from another person since they are not caused by an organism, such as a virus or parasite. Some examples include cardiovascular diseases such as strokes and heart attacks, diabetes, cancer and chronic respiratory diseases like asthma, shortness of breath or chronic bronchitis.

    Some risk factors for non-communicable diseases can be managed, while others cannot. Photo: TheIsmaili.org Nutrition Centre Some risk factors for non-communicable diseases can be managed, while others cannot. TheIsmaili.org Nutrition Centre

    According to the World Health Organization, deaths from NCDs will increase by 17 per cent in the next decade. In Africa, India and China that number will be even higher. People may be living longer, but conditions like obesity, high blood pressure, high cholesterol and uncontrolled blood sugar are becoming more prevalent, so people are living longer unhealthy lives.

    The World Health Assembly has recently endorsed an important United Nation's health goal: to reduce avoidable death from NCDs by 25 per cent by the year 2025. Reducing the behaviours that increase the risk of heart disease, diabetes, and cancer is a priority for many governments and communities.

    Higher rates among South East Asians

    “Within the next hour, nine people will die of heart disease in Canada,” warns Dr Alykhan Nanji, a Canadian internal medicine specialist. The issue is a particular concern for South East Asians, who have the highest rates of diabetes and risk factors that can lead to heart disease, such as hypertension and high cholesterol. “We are on the verge of a cardiovascular epidemic-worldwide,” he says.

    Dr Alykhan Nanji speaks to members of the audience after delivering a presentation to the Jamat about the risk of NCDs. Photo: Shirzad Chunara Dr Alykhan Nanji speaks to members of the audience after delivering a presentation to the Jamat about the risk of NCDs. Shirzad Chunara

    An article published by The India Express in November 2010 notes that obesity rates are on the rise in India, almost doubling in the past 10 years. “The prevalence of obesity ranges between 30 and 50 per cent in Delhi, Jaipur and Chennai and more often in women, resulting in multiple cardiovascular risk factors," said Dr Anoop Misra, Director and Head Department of Diabetes, Obesity and Metabolic Diseases, Fortis Healthcare.

    The incidence of NCDs appears to be increasing quickly especially in countries like India and Pakistan. The poor often have higher smoking rates and less access to preventive medical care and support. Maternal undernourishment means that babies are born with lower birth weights, which has been linked to NCDs in adulthood. Issues of chronic stress related to poverty and limited access to healthy food choices can also induce NCDs.

    Societal change is also a contributing factor. Middle-income families from rural communities are moving to more urbanised communities and adopting sedentary behaviours. They now eat more fried and sweet foods outside the home, more processed foods, red meats, refined (white) grains, and high-fat dairy products – usually desserts. At the same time there is a reduction of physical activity and an increase in stress, prompting reduced sleep, increased alcohol and tobacco consumption and the use of comfort foods that are high in sugar, fat and salt.

    Dr Nanji also notes that studies show South Asians to be more genetically susceptible to developing heart disease, and suffer higher death rates than those of Canadian or European origin. On average among European men, the first heart attack is seen at age 62, whereas in the South East Asian population, the average age of the first heart attack occurs at around 52 years.

    Changing behaviours can reduce NCDs

    Having your blood pressure checked regularly can help you to monitor your risk level for non-communicable diseases. Photo: Raeesa Bhanji Having your blood pressure checked regularly can help you to monitor your risk level for non-communicable diseases. Raeesa Bhanji

    While genetics cannot be changed, healthy lifestyle choices can reduce the risk of developing NCDs considerably. For example, the Nurses' Health Study has found that in women, maintaining a desirable body weight, eating a healthy diet, exercising regularly, and not smoking could alone account for an 84 per cent reduction in cardiovascular risk.

    Risk factors for NCDs include abnormal blood lipids (for example high LDL or bad cholesterol), smoking, hypertension (high blood pressure), abdominal obesity (carrying fat around the tummy), lack of daily fruit and vegetable consumption, lack of regular physical activity, excessive alcohol consumption, diabetes, and psychosocial factors such as stress. The good news is that improving these behaviours can considerably reduce the risk of developing NCDs.

    Some prevention strategies:

    1. Parents should provide nutritionally adequate foods to their children throughout childhood starting at birth, when mothers may choose to exclusively breastfeed their newborns for the first six months. Modelling a healthy lifestyle and equipping children with the skills to choose healthier foods and get plenty of exercise when they are young will give them a great start.
    2. Visit the doctor and find out about your risk level for NCDs by getting your blood levels checked for glucose (sugar levels), lipids (fat levels, including cholesterol), and measuring your weight, blood pressure, waist circumference, and so on. If you do not have a doctor, try to access a health clinic, where a nurse can provide you with an assessment. Support children and elder family members by taking them for regular check-ups as well.
    3. Learn more about reducing your risk of developing NCDs. Talk to health care professionals, attend information sessions, and read more about diabetes, heart disease and other NCDs that may be a concern to you and your family. With more knowledge, you will be better equipped to improve your lifestyle.
    4. Gaining or losing too much weight can be a concern and may increase the chances of developing chronic conditions at any age, so be aware of what your ideal weight should be and work towards that goal.
    5. Choose healthier behaviours like eating healthy meals together and being more physically active by playing sports or games and walking more often. Simple dietary changes, such as reducing salt and increasing fruits and vegetables in your diet can help to reduce blood pressure, and could make a big difference in cutting your risk.
    6. If alcohol or smoking are part of your lifestyle, seek support in quitting. Find strategies to deal with stress, such as meditation and yoga, and talk to a health care professional, especially if you are having difficulty sleeping.

    The Ismaili Nutrition Centre publishes articles that can help address specific risk factors associated with non-communicable diseases. We will continue to provide information on various conditions related to different diseases, as well as advice on how to improve lifestyle behaviours in order to help the global Jamat reduce the prevalence of NCDs such as heart disease, diabetes and cancer.

    References

    1. Report by the Secretary-General on the prevention and control of non-communicable diseases (A/66/83), United Nations General Assembly, Sixty-sixth session, 19 May 2011.
    2. Horton, Richard. ‘Non-communicable Diseases: 2015 to 2025', The Lancet 381.9866 (2013), pp. 509–10. 12 Feb 2013.
    3. Nanji, Alykhan. Applying Global Best Practices Locally: South East Asians and Heart Disease, Aga Khan Health Board Canada Presentation, Edmonton, Canada, 9 Mar 2013.
    4. Thacker, Teena. ‘Obesity on the Rise in India, Says Lancet' (Editorial), The Indian Express, 12 Nov 2010.
    5. Yusuf, Salim, et al. ‘Effect of Potentially Modifiable Risk Factors Associated with Myocardial Infarction in 52 Countries (the INTERHEART Study): Case-control Study', The Lancet 364.9438 (2004), pp. 937-52.
    6. Nurses' Health Study
    7. World Health Organization. Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Health Care in Low Resource Settings, Switzerland: WHO, 2010.