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1. NUTRITION RELATED- NON
COMMUNICABLE DISEASES (NR-
NCDs)
Malimu E Z
KAMPALA INTL UNIVERSITY

2. Definitions
• Non-communicable diseases (NCDs)- diseases
that are not spread through contact
• Caused by:
– Lifestyles (how people live, personal behaviors)
– Genetics (conditions people are born with)
– Environmental hazards

3. • Nutrition related Non communicable disease
(NR-NCDs)
• Chronic illnesses result from altered dietary
pattern and changed lifestyle
• Term NR-NCD incorporates the effects of diet,
physical activity and body composition

4. Historical nutrition pattern
• Human diet and activity patterns and
nutritional status have undergone a sequence
of major shifts
• Shifts- defined as broad patterns of food use
and of corresponding nutritional related
diseases
• Since 18th
century, the pace of diet and activity
change appears to have accelerated

5. History contd…
• Dietary and activity changes parallel major
changes in health status as well as major
demographic and socio-economic changes
• Obesity, level and age composition of
morbidity and mortality emerge early
• Large shifts in dietary and physical activity
patterns- reflected in nutritional outcome
average size and body composition

6. History contd…
• Three major changes have taken place:
1. Demographic transition- the shift from pattern
of high fertility and high mortality to one of low
fertility and low mortality (typical of modern
industrialized countries)
2. Epidemiological transition-the shift from a
pattern of prevalent infectious diseases
associated with malnutrition, period of famine
and poor environment sanitation to a pattern of
prevalent chronic and degenerative diseases
associated with urban-industrial lifestyles

7. History contd…
3. Nutrition transition-increased consumption
of unhealthy foods compounded with
increased prevalence of overweight in middle
to low income countries
– Has serious implications in terms of public health
outcomes and risk factors

8. Major NR-NCDs
• Obesity
• Diabetes mellitus
• Cardiovascular diseases (CVDs)
• Hypertension and strokes
• Osteoporosis
• Dental diseases
• Some types of cancers

9. Obesity
• Abnormal or excessive fat accumulation and
adipose tissue, that health may be impaired
(WHO)
– Result of chronic positive balance
– BMI 18-24.5 normal
– BMI 25-29.9 grade I-overweight
– BMI 30-39.9 grade II-obese
– BMI > 40 grade III frank or morbid obesity
• Children: weight for height two z scores above the
international reference

10. Factors associated with obesity
epidemic
• High calorie-density foods i.e the use of cooking
oil rich in fat
• Increased portion sizes, access to plentiful
• Inexpensive foods-fast/junk foods
• Sedentary lifestyle, lack of exercise
• Commercial practices
• Overweight as evidence of social status
• Westernized diet as symbol of social status
• Beliefs and attitudes about body image

11. Cardiovascular diseases (CVDs)
• Are growing contributor to global disease
burdens
• Cause 1/3 of all deaths globally, 10% SSA
• WHO (2003) estimates:
– By 2020 heart diseases and stroke- leading cause
of both death and disability worldwide
– Deaths projected to increase to more than 24M a
year by 2030

12. CVDs
• A high intake of dietary fats strongly
influences risk of CVD
• SFAs (diary products and meat) raise
cholesterol levels
• PUFAs- soybean, sunflower oils, fatty fish and
plant foods lower risk of CVDs

13. Risk factors for CVDs
• Obesity
• High BP
• High blood cholesterol levels
• Physical inactivity
• Heredity- history of CVD in family
• Gender- men
• Increasing age- over 65 years
• Cigarette/tobacco use
• History of diabetes
Un-modifiable risk factors

14. Hypertension and stroke
• HT-BP 140/90 mmHg or more
• A common medical problem, silent killer
• Mostly people in the middle and old age
• HT- a powerful, independent risk factor fro
CVD
• Dietary potassium lowers the risk
• Regular frequent intake of fruits and
vegetables- protective against hypertension

15. HT risk factors
• High salt containing diet
• Calorie dense foods
• Less physical activity
• Obesity
• Ignorance
• Urbanization-sedentary lifestyle, high stress
level

16. Diabetes mellitus
• Type I- Juvenile diabetes (insulin dependent)
• Type II- Adult onset- Non insulin dependent-
insulin resistance and relative insulin
deficiency
– Occurring in children and adolescents who are
overweight also
• A global diabetes pandemic is enfolding with
rapid increases in prevalence of type II

17. • Over 6% of the world’s population is projected
to be diabetic by 2025
• Tanzania (urban): 5% diabetic, 20% HT
• South Africa: 8% diabetic, 33% HT

18. Risk factors- Diabetes type I
• Early foods like early exposure to cow milk in
replacement of breast feeding
• Obesity (increase risk especially for type I)
• Having type I diabetic parent
• Born by an older mother 40+ yrs of age
• Having a mother with pre-eclampsia

19. Risk factors for Type II DM
• Over ¾ related to high body weight
• High BP 140/90 or higher
• HDL< 35mg/dl or TG levels >- 250 mg/dl
• Age 45 and above
• Family history of diabetes
• Genetic- Indian, African American, American
Indian etc

20. Osteoporosis and dental diseases
• Osteoporosis- is a disease of bones that leads to
an increase risk of fracture
– Over consumption of dietary proteins
– Less physical activity
– Less vegetables
• Dental disease
– Bottle feeding
– High sugar containing foods e.g. ice creams
– Ignorance
– Urbanization-processed foods

21. Cancers
• Some types of cancers
– Dietary factors:
• 30% of all cancers in Western countries
• Approx. 20% in developing countries (where most of
the cancers are related to chronic infections)
– Good nutrition- assist in fighting cancers, manage
symptoms and aid healing and recovery

22. Risk factors for cancer
• Nutritional and lifestyle factors
– High fat- risk of colon, uterus and prostate cancer
– Overweight and lack of physical activity, breast,
esophagus, kidney, uterus cancer
– Alcohol- mouth, throat, esophagus, larynx, liver
and breast cancers
– Tobacco use- lung, larynx, mouth, esophagus,
bladder, kidney , throat, stomach, pancreas or
cervix

23. Prevention of NR-NCDs
• Education starting at school and setting
examples of healthy living
• Dietary guidelines- educate public about
healthy eating
• Promoting healthy behavior in general and
reducing fast food facilities and use of sat fats
• Screening populations regularly- HT,
overweight checking BMI, diabetes checking
blood sugar levels

24. Prevention contd…
• Mass promotion of physical activity
• Price policies and other food policies that might
retard or arrest the rapid shift towards energy-
dense diets
• Inter-sectoral collaboration- e.g in Finland-
national price and food labeling policies were
combined with nutrition education programmes
• DASH diet (DASH= Dietary Approaches to Stop
Hypertension)