IEC

NON-COMMUNICABLE
–DISEASES
LIFESTYLE RELATED DISEASES

WILMA N. BERALDE, RM, RN, MAN

NDP – Balatan
Non – Communicable Disease Coordinator
 4 MAJOR NCDs IN THE
PHILIPPINES

• CARDIOVASCULAR DISEASES
• CANCERS
• CHRONIC OBSTRUCTIVE PULMONARY
DISEASES
• DIABETES MELLITUS
Epidemiology of the Major NCDs

 The Philippines is one of the 23 selected

countries contributing to around 80% of the total
mortality burden attributable to chronic diseases
in developing countries, and 50% of the total
disease burden caused by NCDs worldwide
(Lancet, 2007)
 Common Risk Factors Leading to Major NCDs
Chronic
Risk Factors Cardiovascular Diabetes Cancers Respiratory
Diseases
Diseases
Mellitus
Smoking    

Diet/Nutrition    

Physical inactivity    

Obesity    

Alcohol   

Raised blood   
pressure
Raised blood sugar   

Abnormal blood   
lipids

* coronary artery disease, hypertension, stroke

**chronic obstructive pulmonary disease, asthma
Source: WHO STEPwise Approach to Surveillance of NCD Risk, 2003
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE ACCIDENTS &
INJURIES
DIABETES

Cardiovascular Disease
• describes a range of diseases that affect the heart and blood vessels and includes:
Coronary Artery Disease

Myocardial Infarction

Congenital Heart Disease

Congestive Heart Failure

Hypertension

Stroke

Arrhythmias

others.
 Description of Major NCDs
Cardiovascular diseases and their risk factors
– Coronary artery diseases
• increased total cholesterol, high LDL,
low HDL, smoking,
obesity/overweight, physical
– Hypertension
inactivity, diabetes
• Family history, age, high salt intake,
obesity, excess alcohol intake
– Cerebrovascular diseases • Age, sex, heredity, hypertension,
smoking, diabetes, heart disease, high
(stroke) RBC, excessive alcohol intake, drug
abuse
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE ACCIDENTS &
INJURIES
DIABETES
 HYPERTENSION
An increase in blood pressure ≥ 140/90 mmHg in two (2) or
more separate occasions.
One of the leading causes of disability among Filipinos due to
stroke.
BLOOD PRESSURE SYSTOLIC BP DIASTOLIC BP
CLASSIFICATION

LESS THAN 80
NORMAL LESS THAN 120 mmHg mmHg

PRE HYPERTENSION 120 - 139 mmHg 80 – 89 mmHg

Stage 1
Hypertension 140 – 159 mmHg 90 – 99 mmHg

Stage 2 100 mmHg or

Hypertension 160 mmHg or Higher higher
Classification of blood pressure for adults
 HYPERTENSION
 Smoking RISK FACTORS
 Excessive alcohol consumption
 Overweight
 Family history of hypertension, heart disease, diabetes and
kidney disease
 Sedentary lifestyle
 Chronic stress
 Advancing age

PREVENTION
 Regular exercise and eating”heart healthy” diet
 Excessive alcohol consumption and cigarette smoking
also increases the likelihood of hypertension
 HYPERTENSION
USUAL SIGN AND SYMPTOMS
NOT ALL HYPERTENSIVE PATIENTS HAVE SYMPTOMS….
 Headache
 Dizziness
 Blurring of visions
 Nape/ neck discomfort
EARLY DETECTION IS AN IMPORTANT FACTOR FOR PREVENTING
FURTHER COMPLICATIONS……
POSSIBLE COMPLICATIONS
Chronic, undiagnosed and untreated hypertension may
result to:
Heart attack stroke kidney failure loss of vision
Lifestyle modification to prevent and manage
hypertension
LIFESTYLE RECOMMENDATION APPROXIMATE SYSTOLIC
MODIFICATIO BP REDUCTION
N
Weight reduction Maintain normal body weight 5-20 mmHg
Adopt DASH eating Consume a diet rich in fruits, 8-14 mmHg
plan (dietary vegetables, and low fat
Approach to stop dairy products
hypertension)

Dietary sodium (salt) Reduce dietary sodium intake 2 – 8 mmHg

restriction
Physical activity Engage in regular aerobic physical 4 -9 mmHg
activity such as brisk walking (at
least 30 min per day, most days of
the week)

Moderation of Limit consumption to no more than 2 -4 mmHg

alcohol consumption 2 drinks per day in most men and
not more than 1 drink per day in
women and lighter weight persons
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE ACCIDENTS &
INJURIES
DIABETES
Body’s failure to Secondary to
produce insulin decreased
and usually activity of the
sets in among Type 1 Type 2 insulin produced
the young which results in
population increased blood
groups sugar level and
usually sets in
among the older
age groups
Description of Major NCDs

Diabetes and its risk factors

– • Family history, overweight, lack of

Diabetes physical activity, hypertension,
HDL < 35mg/dl, triglyceride
>250mg/dl, history of gestational
diabetes, with impaired glucose
tolerance
 DIABETES
group of metabolic disorders
characterized by high blood sugar level
on 2 separate occasions

results when the body cannot properly

regulate the amount of sugar (e.g.
glucose in the blood)
 DIABETES
4 clinical types of diabetes
Type 1 : INSULIN DEPENDENT DIABETES
Type 2 : NON-INSULIN DEPENDENT DIABETES
who can be managed through oral anti-diabetic
medications but may eventually also require
insulin treatment to attain good blood glucose
control
Type 3 : GESTATIONAL DIABETES
who were first diagnosed to have diabetes during
pregnancy Type 4 :SECONDARY DIABETES
acquired diabetes that may be drug or chemical-induced such as those who are
being treated for AIDS or from other endocrine diseases such as hyperthyroidism.
Values for the diagnosis of diabetes and other categories of
hyperglycemia
Criteria for
Type of Testing FBS Values Classification Diagnoses of
Diabetes Mellitus
Fasting blood sugar 109 mg% Normal Any of the following:
(FBS) - no caloric intake 110- 125 mg% Impaired
for at least 8 hours Symptoms of diabetes
which means no food, glucose
plus RBS> 200
juices, milk, but water is tolerance mg/dL (11.1
allowed 126 mg% Possible mmol/L)

2-hour blood sugar test: diabetes FBS> 126 mg/ dL (7.0

performed after using mmol)
75 g glucose dissolved in
water or after a good mellitus
2-hr blood sugar >
meal 200 mg/dL (11.1
mmol/L) during an
oral glucose tolerance
test (OGTT)*

* FPG estimation is the biochemical test of choice for screening in all age groups. In adults,
FPG measurement has been found to be more reproducible than the 2-hour plasma glucose
level following an OGTT.
 DIABETES
RISK FACTORS FOR DIABETES
 High blood pressure
 High triglyceride levels
 Giving birth to an 8 lb baby
 Sedentary lifestyle
 Obesity
 Family history of type 2 diabetes mellitus among 1st
degree relatives
USUAL S/S OF
 Fatigue DIABETES excessive urination
 Unexplained weight loss poor wound healing
 Excessive thirst Excessive hunger
 DIABETES
PREVENTION
 Diabetes , a lifestyle –related disease which can
be prevented through regular exercise (at least
30 min every other day) and eating a “heart
healthy” diet (i.e. low -salt ,low-fat diet)

 Excessive alcohol consumption and cigarette

smoking also increases the likelihood of
diabetes
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE ACCIDENTS &
INJURIES
DIABETES
Guidelines for Common Screening
Procedures for Major NCDs

Cancer warning signs

Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in warts or moles
Nagging cough or hoarseness in voice
Unexplained anemia
Sudden weight loss
 Description of Major NCDs
Some cancers and their risk factors
– Oral cancer • Smoking, excessive alcohol
use, chronic irritation, Vitamin
A deficiency
– Breast cancer • Early menarche/late
menopause, high fat diet,
obesity, physical inactivity,
alcohol, family history
• Smoking, radiation
– Lung cancer exposure
• Smoking, HPV infection,
chlamydia infection, low
– Cervical cancer intake of fruits and vegetables,
family history
 Guidelines for Common Screening
Procedures for Major NCDs
Screening guidelines for breast cancer
(targets 15-60 years old and above)
• Monthly breast self-examination
• Breast examination by health worker (annually) for all child-bearing
woman
• Annual mammography for women over 50 years old and above
• For certain high risk women, baseline mammography at age 35 with
repeat upon recommendation of attending physician
• Genetic screening and counseling for high risk patients or if
appropriate
• Referral to hospital for further management if found positive (+) for
mass or any abnormalities
Guidelines for Common Screening
Procedures for Major NCDs

Br ast Self- Examination

e

Stand in front of a Clasp your hands

mirror. Check each behind your head and
breast for anything press hands forward.
unusual (dimpling, Check contour of
discharge). breast.
Guidelines for Common Screening
Procedures for Major NCDs

Breast Self- Examination

Gently squeeze each nipple While standing, raise one arm. Use
and look for discharge finger pads to check the breast and
surrounding area – firmly, carefully and
thoroughly.
Guidelines for Common Screening
Procedures for Major NCDs
Breast Self- Examination

Lines

Wedges Circles
Guidelines for Common Screening
Procedures for Major NCDs

Breast Self- Examination

Lie flat on your back, with one arm over your head and a
pillow or folded towel under the shoulder. This position
flattens the breast and makes it easier to check.
 Guidelines for Common Screening
Procedures for Major NCDs
Changes in the breast that should be noted and reported to a
physician
• Any lump or hard knot • Dimpling, skin irritation,
found in the breast or or other change in the
armpit breast skin or nipple
• Any lump or • Redness or scaliness of
thickening the nipple or breast skin
of the tissue that • Discharge from the
does nipple (fluid coming
not shrink or lessen aftr from
her next period the nipples other than
• Any change in the size, breast milk), particularly
shape, or symmetry of if the discharge is clear
her breast and sticky, dark or
• A thickening or swelling occurs
of the breast without squeezing the
• Any dimpling, nipple
• Nipple tenderness or
puckering,
or indention in the pain
breast
 Description of Major NCDs
COPD and Asthma and their risk factors
– • Smoking
COPD
• Genetic predisposition,
allergens, smoking, air
– pollution, respiratory
Asthma infections
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE ACCIDENTS &
INJURIES
DIABETES

Chronic Respiratory Disease

• The most common morbid conditions suffered by Filipinos are respiratory diseases.

Major causes of death Top leading

due to Respiratory Respiratory causes of
causes Morbidity
• Chronic Respiratory • Acute Respiratory
Diseases (Asthma, Infection
COPDs) • Acute Lower
• Pneumonia Respiratory Tract
Infection
• Pneumonia
• Bronchitis
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE ACCIDENTS &
INJURIES
DIABETES
 NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE ACCIDENTS &
INJURIES
DIABETES
 Accidents are unintentional, unexpected and undesirable
events while injuries are either intentional or
unintentional events that result in damage or harm to a
person (DOH, 2005).
 Most accidents and injuries can be avoided.
 Their effects can be reduced through measures like road safety
education, installation of adequate walkways, streetlights,
signages, and home safety management.
 In high-income countries, road traffic injuries, self-inflicted
injuries and interpersonal violence are the three leading
causes of death among those aged 15 to 44 years.
 In the same age group, there are twice as many suicides and
three times as many traffic-related deaths as homicides.
 Key Areas for the Primary Prevention of the
Major NCDs

 Promote Proper Nutrition

 Encourage more physical activity and exercise
 Promote smoke-free individuals and environment
 Discourage excessive alcohol drinking
 Manage stress effectively
 Maintain regular health check-up
Key Areas for the Primary Prevention of the
Major NCDs

PROMOTE SMOKE-FREE INDIVIDUALS

AND ENVIRONMENT
• Smoking cessation for active smokers to reduce
risk
• Prohibit smoking inside living areas, houses and
closed areas
• Avoid smoke-filled places
• Advocate for implementation of policies that support smoke-
free environment
• Support policies/ordinances/laws that limit access of
cigarettes
to children and youth
Key Areas for the Primary Prevention of the
Major NCDs

PROMOTE ALCOHOL-FREE ENVIRONMENT

• Discourage excessive alcohol drinking

• Regular health check-up for early diagnosis and prompt
treatment
Key Areas for the Primary Prevention of the
Major NCDs

PROMOTE PROPER NUTRITION

• Limit intake of fatty, salty and preserved foods

• Increase intake of vegetables and fruits
• Avoid high caloric low-nutrient value food like junk food, instant
noodles, soft drinks
• Start developing healthy habits in children
Key Areas for the Primary Prevention of the
Major NCDs

ENCOURAGE MORE PHYSICAL ACTIVITY

• Moderate physical activity of at least 30 minutes for most

days
• Integrate physical activity and exercise into regular
day-to-
day activities
• Promote walking as one form of exercise that is possible for all
including older persons and persons with cardiovascular
disease
Key Areas for the Primary Prevention of the
Major NCDs

PROMOTE A STRESS-FREE ENVIRONMENT

• Manage stress effectively

• Regular health check-up for early diagnosis and prompt
treatment
wilmarmrnman