Transcript NCDs-presentation-Antalya

The New Challenges for
Obstetricians.
The Prevention of NCDs
L. Cabero Roura
Barcelona
Non communicable diseases
Disease that is not transmitted by another person, a vector, or the environment.
NCDs
• Diabetes
• Obesity
• Hypertension
• Isquemic CVD
• Ictus
• Rheumatic diseases
• Cancer
• Others
Global Causes of Death
Injuries
Communicable
diseases,
maternal and
perinatal
conditions, and
nutritional
deficiencies
9%
Noncommunicable
diseases
31%
60%
Source: WHO, World Health Report 2000—Health Systems: Improving
Performance (Geneva: WHO, 2000).
NCDs : leeding cause of mortality
• A vicious circle may ensue: poverty exposes
people to behavioural risk factors for NCDs
and, in turn, the resulting NCDs may become
an important driver to the downward spiral
that leads families towards poverty
Low economic growth
NCDs
MM
Poverty
Poor health
The scope
• Mortality and morbidity data reveal the
growing and disproportionate impact of the
epidemic in lower resource settings.
• Over 80% of cardiovascular and diabetes deaths,
and almost 90% of deaths from chronic obstructive
pulmonary disease, occur in low- and middle-income
countries.
• More than two thirds of all cancer deaths occur in
low- and middle-income countries
Trends in Death in Developing Areas
Deaths (millions)
NCDs
Comm. Dis.
Injuries
40
30
20
10
0
1990
2000
2010
2020
Global Burden of Disease
Non Communicable Diseases (NCDs)
Vulnerable Population Groups
Impact
- Humanitarian
- Social
- Economic
Non Communicable Diseases (NCDs)
Vulnerable Population Groups
Impact
- Humanitarian
- Social
- Economic
Total deaths around the world:
58 million
Total deaths around the world:
58 million
Deaths from noncommunicable
diseases around the world:
35 million
Total deaths around the world:
58 million
Deaths from noncommunicable
diseases around the world:
35 million
Deaths from noncommunicable
diseases in developing
countries:
28 million
Total deaths around the world:
58 million
Deaths from noncommunicable
diseases around the world:
35 million
Deaths from noncommunicable
diseases in developing
countries:
28 million
Deaths from noncommunicable
diseases in developing
countries which could have
been prevented: an estimated
14 million
VITAL EVOLUTION
ENVIROMENTAL
FACTOS
GENETIC FACTORS
MOTHER
FETUS
NEWBORN
ADULT
Many diseseases of maturity
have their origins early in life
NUTRITION
DIABETES
ANEMIA
HYPERTENSION
TOBACCO
MOTHER
DRUGS
STRESS
FETUS
NEWBORN
ADULT
INFECTIONS
OBESITY
NUTRITION
DIABETES
ANEMIA
HYPERTENSION
TOBACCO
MOTHER
DRUGS
STRESS
IUGR
PREMATURITY
PPH
POSTPARTUM INFECTIONS
FETUS
NEWBORN
ADULT
WHO Definition
Hb <9,5g/l
INFECTIONS
OBESITY
MORTALITY
SDR
GROWTH
NEUROLOGIC
DEFICIENCIES
HYPERTENSION
CARDIOVASCULAR
DISEASES
ARTERIOSCLEROSIS
OBESITY
OVER
UNDER
NUTRITION
DIABETES
ANEMIA
HYPERTENSION
TOBACCO
MOTHER
DRUGS
STRESS
CONGENITAL
DEFECTS
IUGR
PREMATURITY
MACROSOMIA
FETAL INFECTIONS
FETUS
INFECTIONS
OBESITY
NEWBORN
MORTALITY
SDR
NEUROLOGIC PROBLEMS
NUTRITIONAL PROBLEMS
IMMUNE COMPETENCES
ADULT
HYPERTENSION
CARDIOVASCULAR
DISEASES
ARTERIOSCLEROSIS
DIABETES
OBESITY
Epidemiological studies show importance of
development:
Smaller babies have higher adult risk of:
• Hypertension
• Altered plasma lipids
• Raised plasma fibrinogen and CRP
• Impaired glucose tolerance, type 2 diabetes
and central obesity
• Endothelial dysfunction
Greater
Mismatch;
Inadequate
response to
environment;
Greater risk
of disease
Too poor
Too rich
Quality of developmental
environment
Socioeconomic
development
Even poorer rural
economies
Greater
Mismatch;
Inadequate
response to
environment;
Greater risk
of disease
Migrants to cities
consume high fat, high
GI diet, less physical
activity
Too poor
Too rich
Quality of developmental
environment
Mother’s body composition
& nutrition
Healthy
childhood
body comp.,
metabolism &
cardiovascular
function
HEALTH
Match
between induced
phenotype &
post-natal
environment
Unhealthy
childhood
body comp.,
metabolism &
cardiovascular
function
DISEASE
The Future
Fetal and Infant growth &
developmental adaptations
Epigenetic modification of
gene expression
Mismatch
between induced
phenotype &
post-natal
environment
The Recurring Nightmare:
Cycles of Disease with a Poor Start to Life
Gestational
diabetes
Women malnourished
Low pregnancy weight gain
Suboptimal
low
birth weightfetal
development
Very poor
postnatal
environment
Enriched postnatal
environment
due to nutritional
transition
Obesity
Insulin resistance
Stunting
Maternal
morbidity
Large
babies
Premature
death and
morbidity
Fat
mothers
Large
babies
Modified from Gluckman and Hanson 2005
NUTRITION
DIABETES
ANEMIA
HYPERTENSION
TOBACCO
MOTHER
DRUGS
STRESS
FETUS
INFECTIONS
OBESITY
NEWBORN
ADULT
FETAL DEFECTS
FETAL GROWTH ANOMALIES
FETAL-NEONATAL DEATH
NEONATAL MORBIDITY
PREMATURITY/SDR
OBESITY
INFANT AND ADULT DIABETES
CARDIOVASCULAR DISEASES
SCHIZOPHRENIA
NUTRITION
DIABETES
ANEMIA
HYPERTENSION
TOBACCO
MOTHER
DRUGS
STRESS
FETUS
INFECTIONS
OBESITY
NEWBORN
ADULT
PREECLAMPSIA
IUGR
MATERNAL DEATH
FETAL-NEONATAL DEATH
NEONATAL MORBIDITY
PREMATURITY/SDR
ADULT HYPERTENSION
CARDIOVASCULAR DISEASES
NUTRITION
DIABETES
ANEMIA
HYPERTENSION
TOBACCO
MOTHER
DRUGS
STRESS
FETUS
INFECTIONS
OBESITY
NEWBORN
ADULT
FETAL DEFECTS
FETAL GROWTH ANOMALIES
MATERNAL DEATH
FETAL-NEONATAL DEATH
NEONATAL MORBIDITY
PREMATURITY/SDR
ADULT DIABETES
ADOLESCENT/ADULT OBESITY
CARDIOVASCULAR DISEASES
HYPERTENSION
NUTRITION
DIABETES
ANEMIA
HYPERTENSION
TOBACCO
MOTHER
DRUGS
STRESS
FETUS
NEWBORN
ADULT
Strong IMPACT
INFECTIONS
OBESITY
NON COMUNICABLE DISEASES
MOTHER
FETUS
VITAL CICLE
NEWBORN
ADULT
NON COMUNICABLE DISEASES
MOTHER
FETUS
VITAL CICLE
NEWBORN
ADULT
Good news
• Effective interventions are available, and
abundant evidence now demonstrates their
clear and measurable impact in a range of
resource settings.
Behavior Change Successes
• Reducing malnutrition (micronutrient initiatives)
• Reducing maternal obesity
• Diagnose and treat the diabetes during pregnancy
• Preventing anemia (iron supplements)
• Preventing malaria (insecticide-treated bednets)
• Helping children survive (breastfeeding)
• Improving maternal health (safe motherhood movement, emergency
obstetric care)
• Making family planning a norm (worldwide efforts)
• Combating HIV/AIDS (Uganda program)
Sumary
• A well-constructed alliance between the
NCD and maternal and women’s health
fields has the potential to strengthen both.
It is time to overcome the words
and make the facts¡¡¡
Castells Humans
Key messages
• • The majority of noncommunicable diseases can be averted
through interventions and policies that reduce major risk
factors.
• • Many preventive measures are cost-effective, including for
low-income countries.
• • Some preventive actions can have a quick impact on the
burden of disease at the population level.
• • Interventions that combine a range of evidence-based
approaches have better results.
• • Comprehensive prevention strategies must emphasize the
need for sustained interventions over time.
Many things we need can wait, the
child cannot. Now is the time his
bones are being formed, his blood is
being made, his mind is being
developed. To him we cannot say
tomorrow.
His name is today.
Gabrielle Mistral, Su Nombre es Hoy