Public Health 150 Non communicable Diseases. Zuo Feng Zhang, MD, PhD Professor of Epidemiology October 31, 2011

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1 Public Health 150 Non communicable Diseases Zuo Feng Zhang, MD, PhD Professor of Epidemiology October 31, 2011

2 What are NCDs? NCD is a medical condition or disease, which is not infectious NCDs are diseases or medical conditions with long duration and relatively slow progression NCDs are usually called Chronic Diseases

3 Why NCDs Are Important in Public Health? 57 million deaths that occurred globally in million 63.2%, almost two thirds were due to NCDs 9 million death that occurred among people under age 60 mainly cardiovascular diseases, cancers, diabetes and chronic lung diseases

4 UN High Level meeting on NCDs, September 19 20, 2011

6 Number of deaths for leading causes of death in the US Heart disease: 631,636 Cancer: 559,888 Stroke (cerebrovascular diseases): 137,119 Chronic lower respiratory diseases: 124,583 Accidents (unintentional injuries): 121,599 Diabetes: 72,449 Alzheimer's disease: 72,432 Influenza and Pneumonia: 56,326 Nephritis, nephrotic syndrome, and nephrosis: 45,344 Septicemia: 34,234

12 US

14 Cardiovascular Diseases CVDs include diseases of the heart, vascular diseases of the brain and diseases of blood vessels. CVDs are responsible for over 17.3 million deaths per year and are the leading causes of death in the world WHO. Global Atlas on Cardiovascular Disease Prevention and Control. Mendis S, Puska P, Norrving B editors. World Health Organization, Geneva 2011

15 Heart and Brain WHO. Global Atlas on Cardiovascular Disease Prevention and Control. Mendis S, Puska P, Norrving B editors. World Health Organization, Geneva 2011

16 Proportion of Death caused by CVDs WHO. Global Atlas on Cardiovascular Disease Prevention and Control. Mendis S, Puska P, Norrving B editors. World Health Organization, Geneva 2011

17 Distribution of CVDs

20 What Is Tumor/Cancer?

21 Tumor is a disorder of cells A neoplasm (Greek, Neo New, plasma, thing formed) is the autonomous growth of tissue that have escaped the normal restraints on cell proliferation and exhibit varying degrees of fidelity to their precursors. It is usually appears as a tumor ( a swelling) made of mass of cells. Abnormal growth of cells, Unlimited growth of cells.

22 Tumors In general, neoplasms are irreversible, and their growth is for the most part, autonomous.

23 Benign versus Malignant Tumors Benign tumors do not penetrate (invade) adjacent tissue borders, nor do they spread (metastasize) to distant sites. They remain localize overgrowths in the area in which they arise Benign tumors are more differentiated than malignant tumors, that is, they are more closely resemble their tissue of origin.

24 Invasion and Metastasis Malignant tumors (cancer) are capable of invasion (spread of the neoplasms into adjacent structures) and metastasis (implantation of the neoplasms into noncontiguous sites).

25 Oral Premalignant Lesions Oral Leukoplakia Oral submucous fibrosis Erythroplakia Invasive oral cancer Second Primary Cancers following a first primary oral cancer Esophageal Cancer Oral Cancer Lung Cancer

27 Cancer Statistics 12.7 million new cases in million deaths from cancer (13.3% of overall deaths) in 2008

28 Incidence and Mortality, World 2008

30 Cancer

31 Cancer

33 Cancer

34 Projected demographic effects on cancer incidence and mortality New cancers (in 1,000,000s) of all cancers Region World More developed regions Less developed regions Africa Asia (Japan) Asia (Other) Europe Latin America/Caribbean North America Oceania Africa Asia (Japan) Asia (Other) Europe Latin America North America Number of new cases (in millions) New deaths (in 1,000,000s) of all cancers Region World More developed regions Less developed regions Africa Asia (Japan) Asia (Other) Europe Latin America/Caribbean North America Oceania Africa Asia (Japan) Asia (Other) Europe Latin America North America Number of deaths (in millions)

35 Projected demographic effects on cancer incidence and mortality New cancers (in 100,000s) Cancer site Lung Breast Colon/rectum Stomach Prostate Liver Cervix Esophagus Lung Breast Colon/rectum Stomach Prostate Liver Cervix Esophagus ,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 Number of new cases New deaths (in 100,000s) Cancer site Lung Stomach Liver Colon/rectum Breast Esophagus Cervix Prostate Lung Stomach Liver Colon/rectum Breast Esophagus Cervix Prostate ,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 Number of deaths

36 Cancer Incidence and Mortality in China and World, 2008 China New Cases Incidence Deaths Mortality Male 1,622,502 (24.5%) Female 1,194,708 (19.8%) Total 2,817,210 (22.2%) ,222,199 (28.9%) ,148 (22.0%) ,958,347 (25.88%) World Male 6,617, ,219, Female 6,044, ,345, Total 12,662, ,564, Globocan, 2008 Incidence and Mortality are per 100,000 Population: China: 1,331,460,000; World: 6,775,235,700; China/World: 19.65%

37 Age Standardized Incidence Rates (/100,000) US China World Site Males Females Males Females Males Females Stomach Lung Liver Esophagus Colon/Rectum Breast Leukemia Pancreas Cervix Brain Prostate Source: GLOBOCAN 2002

42 COPD Chronic obstructive pulmonary disease (COPD) is a life threatening lung disease that interferes with normal breathing it is more than a smoker s cough. An estimated 64 million people have COPD worldwide in More than 3 million people died of COPD in 2005, which is equal to 5% of all deaths globally that year. Almost 90% of COPD deaths occur in low and middle income countries. The primary cause of COPD is tobacco smoke (through tobacco use or second hand smoke). The disease now affects men and women almost equally, due in part to increased tobacco use among women in high income countries. COPD is not curable, but treatment can slow the progress of the disease. Total deaths from COPD are projected to increase by more than 30% in the next 10 years without interventions to cut risks, particularly exposure to tobacco smoke.

43 COPD

44 Diabetes

45 Diabetes More than 346 million people worldwide have diabetes. There is an emerging global epidemic of diabetes that can be traced back to rapid increases in overweight, obesity and physical inactivity.

46 Diabetes Diabetes is predicted to become the seventh leading cause of death in the world by the year Total deaths from diabetes are projected to rise by more than 50% in the next 10 years.

47 Diabetes There are two major forms of diabetes. Type 1 diabetes is characterized by a lack of insulin production and type 2 diabetes results from the body's ineffective use of insulin. A third type of diabetes is gestational diabetes. This type is characterized by hyperglycaemia, or raised blood sugar, which has first appeared or been recognized during pregnancy.

48 Diabetes Type 2 diabetes is much more common than type 1 diabetes. Type 2 accounts for around 90% of all diabetes worldwide. Reports of type 2 diabetes in children previously rare have increased worldwide. In some countries, it accounts for almost half of newly diagnosed cases in children and adolescents.

49 Diabetes Cardiovascular disease is responsible for between 50% and 80% of deaths in people with diabetes. Diabetes has become one of the major causes of premature illness and death in most countries, mainly through the increased risk of cardiovascular disease (CVD).

50 Diabetes Diabetes is a leading cause of blindness, amputation and kidney failure. Lack of awareness about diabetes, combined with insufficient access to health services and essential medicines, can lead to complications such as blindness, amputation and kidney failure.

51 Diabetes Type 2 diabetes can be prevented. Thirty minutes of moderate intensity physical activity on most days and a healthy diet can drastically reduce the risk of developing type 2 diabetes. Type 1 diabetes cannot be prevented.

52 Percentage of Cancer Deaths Attributed to Various Factors (Doll R and Peto R, JNCI, 1981) Tobacco Use: 30% (25% 40%) Diet:35% (10% 70%) Infection: 10%? (1%?) Reproductive & Sexual Behavior: 7% (1% 13%) Occupation: 4% (<2% 8%) Alcohol: 3% (2% 4%) Geophysical factors (natural radiation): 3% (2 4%) Pollution: 2% (<1% 5%) Food additive: <1% ( 5% 2%) Medicines and Medical Procedures: 1% (0.5% 3%) Industrial consumer products <1% (<1% 2%) Unknown:?,?

53 Lichtenstein P, Holm NV, Verkasalo PK, Iliadou A, Kaprio J, Koskenvuo M, Pukkala E, Skytthe A Hemminki K NEJM 2000

54 Study Design in GWA Studies Multistage approach to reduce the amount of genotyping required, without sacrificing power. In stage 1, a full set of SNPs is genotyped, and a p value threshold is used to identify a subset of SNPs with putative associations. Joel N. Hirschhorn & Mark J. Daly Nature Reviews Genetics 6, , 2005

55 Published Genome-Wide Associations through 06/2011, 1,449 published GWA at p 5x10-8 for 237 traits National Human Genome Research Institute (NHGRI) GWA Catalog /GWASt di

66 Tobacco causes 10% of CVD death

72 Diseases Caused by Tobacco Use Cigarette smoking increases the risk of: Coronary heart disease Atherosclerotic peripheral vascular disease Cerebrovascular disease Cancers of the lung, larynx, mouth, esophagus, bladder, pancreas, kidney, and cervix Chronic obstructive pulmonary disease Intrauterine growth retardation, premature rupture of membranes Low birthweight babies, perinatal mortality Cataract, macular degeneration; hip fracture Peptic ulcer disease Possibly liver, stomach, and colorectal cancers and acute myelocytic leukemia

73 Disease Caused by Tobacco Use Involuntary smoking (environmental tobacco smoke) is a cause of: Lung cancer and coronary heart disease in nonsmokers Respiratory infections and symptoms in the children of parents who smoke Smokeless tobacco causes: Oral Cancer Oral leukoplakia Dental caries (possibly) Cigars cause: Cancers of the mouth, larynx, and lung Coronary heart disease COPD

74 Physical Activities

75 The Benefits of Physical Activity Regular physical activity is one of the most important things you can do for your health. Control your weight Reduce your risk of cardiovascular disease Reduce your risk for type 2 diabetes and metabolic syndrome Reduce your risk of some cancers (colon, breast, endomentrial and lung cancers) Strengthen your bones and muscles Improve your mental health and mood Improve your ability to do daily activities and prevent falls, if you're an older adult Increase your chances of living longer CDC, 2011

76 Harmful Use of Alcohol

81 Obesity

83 Key facts Worldwide obesity has more than doubled since In 2008, 1.5 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese. 65% of the world's population live in countries where overweight and obesity kills more people than underweight. Nearly 43 million children under the age of five were overweight in Obesity is preventable.

84 Obesity Globally, 44% of diabetes, 23% of ischaemic heart disease and 7 41% of certain cancers are attributable to overweight and obesity.

85 Obesity Body Mass Index (BMI) is a number calculated from a person's weight and height. BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems. /bmi/adult_bmi/english_bmi_calculator/bmi_ calculator.html

86 BMI Classification Body Mass Index (BMI) is a simple index of weight for height that is commonly used to classify underweight, overweight and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in metres (kg/m 2 ). For example, an adult who weighs 70kg and whose height is 1.75m will have a BMI of BMI = 70 kg / (1.75 m 2 ) = 70 / 3.06 = 22.9

87 The International Classification of adult underweight, overweight and obesity according to BMI

88 Fattest Countries in the World

91 Diet

100 Exhibit 16 1 American Cancer Society (ACS) Guidelines on Nutrition and Physical Activity for Cancer Prevention ACS Recommendations for Individual Choices 1. Eat a variety of healthful foods, with an emphasis on plant sources. Eat five or more servings of a variety of vegetables and fruits each day. Choose whole grains in preference to processed (refined) grains and sugars. Limit consumption of red meats, especially those high in fat and processed. Choose foods that help maintain a healthful weight. 2. Adopt a physically active lifestyle. Adults: engage in at least moderate activity for 30 minutes or more on five or more days of the week; 45 minutes or more of moderate-to-vigorous activity on five or more days per weekmay further enhance reductions in the risk of breast and colon cancer. Children and adolescents: engage in at least 60 minutes per day of moderate-to-vigorous physical activity at least five days per week. 3. Maintain a healthful weight throughout life. Balance caloric intake with physical activity. Lose weight if currently overweight or obese. 4. If you drink alcoholic beverages, limit consumption. ACS Recommendations for Community Action Public, private, and community organizations should work to create social and physical environments that support the adoption and maintenance of healthful nutrition and physical activity behaviors. Increase access to healthful foods in schools, worksites, and communities Provide safe, enjoyable, and accessible environments for physical activity in schools, and for transportation and recreation in communities. Source: Reprinted with permission from T Byers, et al., American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer with Healthy Food Choices and Physical Activity. CA: A Cancer Journal for Clinicians, Vol 52, pp , 2002, Lippincott Williams & Wilkins.

101

Nutrition and Cancer Prevention. Elisa V. Bandera, MD, PhD

Nutrition and Cancer Prevention Elisa V. Bandera, MD, PhD The Causes of Cancer in the US. Sedentary lifestyle 5% Other 12% Family history 5 % Occupation 5% Tobacco 30% Reproductive factors 3% Pollution