Changes leading to lifestyle related diseases

Lifestyle diseases in India

Changes leading to lifestyle related diseases

Demographic shifts

Sedentary lifestyle

Changing food habits

Socio-economic changes

Lets look at these factors in detail…

Determinants of change

Rapid urbanization

Migration from rural to urban areas 53% increase in urban units in the last

decade Emergence of satellite towns Currently 35 satellite towns in India

Increasing stress levels

Increasing among people in their 30s and 40s

IT professionals , banking and BPO employees the most affected

Decrease in average sleep by two hours over the decade

Unhealthy diet

Processed food industry shows 40-50% growth rate

Metropolitans are the largest consumers of processed food

Consumer spending on processed food increased at an average rate of 7.6% (2011)

Increasing alcohol & tobacco consumption

Increasing concern among young urban individuals

30% Y-O-Y growth in alcohol consumption

14% of Indians smoke daily

Source :- ASSOCHAM reports 2011, NCBI reports 2012

Common Lifestyle Diseases

Diabetes Mental Health Nutrition Deficiency

Obesity Cardio Vascular diseases

Cardio Vascular diseases in India

Types of Cardiovascular diseases

Coronary Heart Disease (CHD):

I. A disease of the blood vessels supplying the heart muscle that can lead to a heart attack

II. CHD is the most prevalent heart disease in India, contributing more than 85% of all CVD related deaths in 2004.

Cerebrovascular Disease (Stroke):

I. A stroke is caused when the supply of oxygen to a part of brain stops

II. Stroke was the second largest cause of death due to heart disease in India

Hypertensive Heart Disease:

I. It refers to coronary artery disease, heart failure, and enlargement of the heart that occur because of high blood pressure

II. Mainly prevalent in people aged over sixty years

Congenital Heart Disease:

I. A defect in the structure of the heart and great vessels of a new-born and result from abnormal foetal heart development

Cardiac challenges in India

Lowaccessibility

Lowavailability

Lowaffordability

Lack of a concerted policy

I. Low economical and efficient service delivery infrastructure

II. India trains only about 150 cardiologists every year

I. Around 60% of the hospitals in India are located in the urban areas and cater to only 30% of the population

II. Only 13% of the rural population has access to a primary healthcare facility

I. Big hospitals in Tier I cities are typically driven by use of advanced medical technology, thus raising the cost of treatment

II. Negligible coverage of rural population under health insurance schemes and plans

III. Around 28% of all diseases in the rural areas go untreated due to financial constraints

I. In India, the growing incidence of CVDs is not yet seen as a public health challenge

II. Absence of a strong policy targeted towards CVD’s

Source :- Deloitte report on CVD risk in India

Heart risk around major cities in India

Source :- IISC, Bangalore health survey

Diabetes in India

Types of Diabetes in India

Type 1 diabetes

I. People with type 1 diabetes produce very little or no insulin

II. The disease may affect people of any age, but usually develops in children or young adults

III. People with this form of diabetes need injections of insulin every day in order to control the levels of glucose in their blood

Type 2 diabetes

I. Accounts for at least 90% of all cases of diabetes

II. It is characterized by insulin resistance and relative insulin deficiency

III. It is often, but not always, associated with overweight or obesity, which itself can cause insulin resistance and lead to high blood glucose levels

Gestational diabetes (GDM)

I. Form of diabetes consisting of high blood glucose levels during pregnancy

Facts about Diabetes

Cardiovascular disease is responsible for between 50% and 80% of deaths in people with diabetes

80% of diabetes deaths occur in low- and middle-income countries

Diabetes is a leading cause of blindness, amputation and kidney failure

Thirty minutes of moderate-intensity physical activity on most days and a healthy diet can drastically reduce the risk of developing type 2 diabetes

Total deaths from diabetes are projected to rise by more than 50% in the next 10 years.

Source :- Diabetes association of India

A whole new market catering the Diabetic

World diabetes curve

Source :-WHO reports 2013

Prevalence of Diabetes Mellitus in Indian population

Obesity in India

Obesity Index

Common obesity symptoms

Sleep apneaSnoring

Excessive sweatingDepressionFeeling out of breath

Back or joints pain

Causes of obesity

Physical inactivity Unhealthy diet and eating habits

Pregnancy Lack of sleep Certain medications

Physical Inactivity

Globally, around 31% of adults aged 15 and over were insufficiently active in 2008 (men 28% and women 34%). Approximately 3.2 million deaths each year are attributable to insufficient physical activity.

The South East Asian Region showed 15% for men and 19% for women inactive. The current levels of physical inactivity are partly due to insufficient participation in physical activity during leisure time and an increase in sedentary behavior during occupational and domestic activities. Likewise, an increase in the use of "passive" modes of transport has also been associated with declining physical activity levels.

Increased urbanization has resulted in several environmental factors which may discourage participation in physical activity such as:

1. violence2. high-density traffic 3. low air quality, pollution4. lack of parks, sidewalks and sports/recreation facilities.

Source :- WHO Health Reports

Unhealthy diet and eating habits

Unhealthy diets (especially those which have a high content in fats, free sugars and salt) is one of the leading causes of non-communicable diseases (NCDs) including cardiovascular diseases (CVD), type 2 diabetes and certain cancers.

2.7 million deaths are attributable to diets low in fruits and vegetables. Worldwide, low intake of fruits and vegetables is estimated to cause

1. about 19% of gastrointestinal cancer,2. about 31% of coronary heart disease, and3. 11% of stroke

Source :- WHO Health Reports

Lack of sleep

Sleep deprivation occurs when an individual fails to get enough sleep. The amount of sleep that a person needs varies from one person to another, but on average most adults need about seven to eight hours of sleep each night to feel alert and well rested

Importance of sleep :-

1. Sleep boosts immunity2. Sleep can slim you down (Studies have shown that people who sleep less than

seven hours a day are 30% more likely to be obese)3. Sleep boosts your mental wellbeing4. Sleep prevents diabetes (Studies have suggested that people who usually sleep

less than five hours a night have an increased risk of having or developing diabetes)

5. Sleep increases your sex drive6. Sleep wards off heart disease7. Sleep increases your fertility (Difficulty conceiving a baby has been claimed as one

of the effects of sleep deprivation)

Source :- NHS Choices

Impact of lack of sleep

The primary effect of sleep deprivation is excessive daytime sleepiness. A sleep-deprived person is likely to fall asleep when forced to sit still in a quiet or monotonous situation, such as during a meeting or class. This degree of severe sleepiness can be a safety hazard, causing drowsy driving and workplace injuries.

The other effects of sleep deprivation are widespread:

Mood

• Irritability• Lack of motivation• Anxiety• Symptoms of depression

Performance

• Lack of concentration• Attention deficits• Reduced vigilance• Longer reaction times• Distractibility• Lack of energy• Fatigue• Restlessness• Lack of coordination• Poor decisions• Increased errors• Forgetfulness

Factors contributing to obesity

Geneticsaffect the amount of body fat stored and distributed. It also affects how efficiently body converts food into energy

Family history family members tend to have similar eating, lifestyle and activity habits

Agewith ageing, hormonal changes and a less active lifestyle increase your risk of obesity

Socio-economic issues also links to obesity as they determine affordability and access to different food needs

Effect of Obesity on Health

High blood pressure

Additional fat tissue in the body needs oxygen and nutrients in order to live, which requires the blood vessels to circulate more blood to the fat tissue. This increases the workload of the heart because it must pump more blood through additional blood vessels. More circulating blood also means more pressure on the artery walls

Diabetes

Obesity is the major cause of type II diabetes. Obesity can cause resistance to insulin, the hormone that regulates blood sugar

Heart disease

Atherosclerosis (hardening of the arteries) is present 10 times more often in obese people compared to those who are not obese. Coronary artery disease is also more prevalent because fatty deposits build up in arteries that supply the heart

Osteoarthritis

Obesity can affect the knees and hips because of the stress placed on the joints by extra weight

Psychosocial effects

In a culture where often the ideal of physical attractiveness is to be overly thin, people who are overweight or obese frequently suffer disadvantages. Overweight and obese persons are often blamed for their condition and may be considered to be lazy or weak-willed.

Prevalence of obesity/ overweight (BMI) in India

Rural India

Urban India

Treatment for obesity

Dietary changes

Reducing calories and eating healthier are vital to overcoming obesity. A slow and steady weight loss program over the long term is considered the safest way to lose weight and the best way to keep it off permanently.

Exercise and activity

Increased physical activity or exercise also is an essential part of obesity treatment. The American College of Sports Medicine recommends that people who are overweight or obese get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to lose a modest amount of weight.

Behavior changes

A behavior modification program can help you make lifestyle changes, lose weight and keep it off. Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity.

Prescription weight-loss medication

Losing weight requires a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may help.

Surgical treatments for obesity

Weight-loss surgery

In some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery offers the best chance of losing the most weight, but it can pose serious risks. Weight-loss surgery limits the amount of food you're able to comfortably eat or decreases the absorption of food and calories, or both

Weight-loss surgery for obesity may be considered if:

1. You have extreme obesity, with a body mass index (BMI) of 40 or higher2. Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as

diabetes or high blood pressure3. You're committed to making the lifestyle changes that are necessary for surgery to work

Common weight-loss surgeries include:

4. Gastric bypass surgery5. Laparoscopic adjustable gastric banding (LAGB)6. Gastric sleeve7. Biliopancreatic diversion with duodenal switch

Nutritional deficiency in India

Impact of nutrition on the lifecycle

Behavioral mechanism due to nutritional deficiency

Poornutrition

Poor mentaldevelopment &

behavior

Alterations indevelopment

of CNS

“Functionalisolation”

Emotional reactivity,impaired

stress response

Malnutrition of women by residence & education

Source :- NFHS - 3

Anemia among men & women aged between 15-49 years

39%

15%

45%

2%

Women

MildModerateNone Severe

39%

15%76%

1%

Men

MildModerateNone Severe

Source :- NFHS - 3

Trends in malnutrition among married women (15-49 years)

Source :- NFHS - 3

Anaemia

Anaemia is a condition in which the number of red blood cells (RBCs), and consequently their oxygen-carrying capacity, is insufficient to meet the body’s physiological needs

The function of the RBCs is to deliver oxygen from the lungs to the tissues and carbondioxide from the tissues to the lungs. This is accomplished by using haemoglobin. Iron is necessary for synthesis of haemoglobin. Iron deficiency is thus thought to be the most common cause of anaemia

Iron deficiency is a consequence of :-

1. Decreased iron intake2. Increased iron loss from the body3. Increased iron requirement

Iron deficiency adversely affects :-

4. The immune status and morbidity from infections5. The use of energy sources by muscles and thus the physical capacity and work

performance

Source :- UNICEF reports

A concern for the women

Factors leading to Nutritional Anaemia

1. Insufficient quantity of iron-rich foods and “iron enhancers” in the diet and low bioavailability of dietary iron

2. Excessive quantity of “iron inhibitors” in diet, especially during mealtimes (e.g.,tea, coffee; calcium-rich foods)

3. Iron loss during menstruation4. Increased iron requirement due to tissue, blood and energy requirements during

pregnancy5. Teenage pregnancy6. Repeated pregnancies with less than 2 years’ interval7. Poor environmental sanitation and unsafe drinking water


Fig showing :- Prevalence of anaemia in India and neighboring countries

Fig showing :- Prevalence of anaemia among different age groups


Fig. showing :- Prevalence of anaemia among pregnant women

Fig. 2.2: Prevalence of anaemia among adolescent girls (12–19 years) and young women (20–29 years) in India


Adverse effects of anaemia

Reduced physical development- Decreased work output- Decreased work capacity

Impaired sexual and reproductive development- Irregular menstruation- Low pre-pregnancy iron stores- LBW babies and preterm delivery

Reduced cognitive development- Diminished concentration- Disturbance in perception- Poor learning ability

Importance of Vitamins in the body

Vitamins don't give you calories or energy but do help you stay healthy. You cannot make vitamins so you must get them from the foods you eat.

There are two types of vitamins:

1. Water soluble (include vitamins B1, B2, B3, B6, B12, vitamin C, biotin and folate)

2. Fat soluble (include vitamins A, D, E and K)

Role of Vitamins in overall well being

Vitamin and supplement market in India

• Vitamins and dietary supplements witnessed strong current value growth of 13% in 2012, reaching Rs45.2 billion

• Amway India lead the vitamins and dietary supplements market with a 24% value share in 2012. The primary brand of the company, responsible for its consistent leading position, is Nutrilite, under which the company offers multivitamins, combination supplements, pediatric supplements and more

• In the food supplement category, the majority share is held by herbal food products and supplements, closely followed by functional digestives

• Vitamins and dietary supplements is expected to increase by a constant value CAGR of 9% in the forecast period. This is expected to be driven primarily by paediatric vitamin and dietary supplements.

• Consumers in urban India, due to their fast-paced lifestyles and westernized eating habits, are expected to shift towards supplements in order to replenish their daily diets with the necessary vitamins and dietary supplements.

Source :-Euromonitor reports

Weekly consumption on basis of household wealth

Importance of Calcium in the body

Musclecontraction

Nerve conduction

Hormone energy release

production

BloodCoagulation

Maintenance of the immune system

Calcium deficiency & related issues

Calcium deficiencies are wide spread with only a third to a half of the necessary requirements, being consumed.

• Let’s look at the early signs of Calcium deficiency in the body :-

• Tetany - One of the first signs of a deficiency is a nervous affliction called Tetany, which is characterized by muscle cramps, numbness and tingling in the arms and legs.

Osteoporosis - Another calcium deficiency ailment is Osteoporosis, in which the bones become porous and fragile because calcium is withdrawn from the bones and other areas faster than it is deposited in them.

• Other symptoms :-

- Cramps- Joint pains- Heart palpitations- Increased cholesterol levels- Slow pulse rates- Insomnia

- Impaired growth- Excessive irritability or nerves- Brittle nails- Eczema- Numbness or tingling of the arms and/or legs

Stress related issues

Stress related symptoms

Work related stress

Stress at work

Passive

Active

High Strain

Low Strain

Job Demands

Job

Cont

rol

High

Low

HighLow

Individual Consequences of Stress

Psychological

• Anxiety• Depression• Low self-esteem• Sleeplessness• Frustration• Family problems• Burnout

Behavioral

• Excessive smoking• Substance abuse• Accident proneness• Appetite disorders• Violence

Physiological

• High blood pressure• Muscle tension• Headaches• Ulcers, skin diseases• Impaired immune systems• Musculoskeletal disorders• Heart disease• Cancer

Stress Management techniques

YogaMeditation Acupressure Music Therapy Pills

Yoga & Meditation

Yoga has many styles, forms and intensities. Hatha yoga, in particular, is practised for stress management. Hatha is one of the most common styles of yoga, and liked for its slower pace and easier movements.

Meditation is considered a type of mind-body complementary medicine. Meditation produces a deep state of relaxation and a tranquil mind. Meditation focuses attention and eliminate the stream of jumbled thoughts that may be crowding the mind and causing stress. This process results in enhanced physical and emotional well-being

The health benefits of yoga

The potential health benefits of yoga include:-

1. Stress reduction. A number of studies have shown that yoga can help reduce stress and anxiety. It also enhances mood and overall sense of well-being.

2. Improved fitness. Practicing yoga can lead to improved balance, flexibility, range of motion and strength.

3. Management of chronic conditions. Yoga helps reduce risk factors for chronic diseases, such as heart disease and high blood pressure. Yoga also help alleviate chronic conditions, such as depression, pain, anxiety and insomnia

Acupressure & alternate therapies

Acupressure techniques

Internationally practiced technique for relaxation, wellness promotion, and the treatment of various health conditions. Multiple human studies suggest the effectiveness of wrist-point (P6) acupressure for treating nausea.

It is proposed that acupressure may reduce muscle pain and tension, improve blood circulation, release endorphins, and release/eliminate toxins. The mechanism of action may be similar to other techniques such as acupuncture (stimulation of acupoints with needles), moxa (burning with a stick including dried mugwort leaves), or other forms of manual stimulation. Techniques that involve soft tissue manipulation may have similar effects on the body as therapeutic massage

Music therapy

Music therapy may involve either listening to or performing music, with or without the presence of a music therapist. Music therapists are professionally trained to design specialized applications of music according to an individual's needs

Stress reliving pills

There are certain drugs that are very helpful in controlling the symptoms of depression and if taken regularly, they help in combating the problem. There are various drugs which available which cater to stress related issues such as,

1. Celexa2. Prozac 3. Paxil4. Elavil5. Luvox6. Luvox CR 7. Prozac Weekly8. Vanatrip

Detoxification programs

Detox is the process of eliminating toxins from the body through proper diet exercise, supplement etc.

A detox allows the body to cleanse itself naturally, effectively eliminating toxins that are stored deep within the tissue and organs for optimal inner and outer health.

As toxins are eliminated from the body, digestive system functions better, your skin is clearer, you feel leaner and lighter. A detox helps you kick-start a weight loss program, build lean muscle, reduce stress, identify food allergies, identify the foods that are weighing you down or making you feel less energetic etc.

A detox can help to improve functioning of the liver, lungs, colon and the circulation of blood which also works to improve other areas of the body including the skin and complexion. A body detox improves energy levels, boost metabolism, eliminate headaches or body pains and have a lasting impact on emotional health and well-being.

Others risk factors

Blood pressure (to which 13% of global deaths are attributed)

Tobacco use (9%)

Raised blood glucose (6%)

Physical inactivity (6%)

Overweight and obesity (5%)

Source :- NCBI reports, 2012

Overall prevalence of High Blood Pressure in India

Prevalence of smoking in different states of India