Nutrition in Health and Disease:
Implications for Public Health in
Russian Federation
First Forum on NCD (Non-communicable Disease)
Prevention and Healthy Lifestyle Promotion
October 10-11, 2012
Keith C. Norris, MD, FACP
Professor and Executive VP for Research and Health Affairs,
Charles R. Drew University
Assistant Dean for Clinical and Translational Science,
Geffen School of Medicine, UCLA
Healthy citizens are the greatest
asset any country can have
- Winston Churchill
Trinity Lavra of St. Sergius or Troitse-Sergiyeva Lavra – a World Heritage site
Overview/Objective of Presentation
• Russian Federation State of Health
• Review the role of noncommunicable
diseases (NCD) on health in Europe and
the Russian Federation
• Public Health Recommendations for
Nutrition as a key NCD risk factor
Factors Associated with Global Mortality
High blood pressure (BP)*
2. Tobacco use
3. High blood glucose*
4. Physical inactivity
5. Overweight and obesity*
6. High cholesterol*
7. Unsafe sex
8. Alcohol use*
9. Childhood underweight*
10. Indoor smoke from solid fuels
*Nutrition related risk factors
59 million total global deaths in 2004 - World Health Organization
Global Mortality Risks
• High BP is the leading mortality risk factor followed by
– Together responsible for over 20% of deaths globally
• Low fruit and vegetable intake, lack of exercise, alcohol
and tobacco use, high BMI, high cholesterol, high blood
glucose, and high BP:
– responsible for more than half of CV deaths, the leading
cause of death in the world.
• Overweight/obesity is the 5th leading risk for death.
– Responsible for 7 per cent of deaths globally.
World Health Organization
Impact of Selected Diet-related Risk Factors on
DALYs: Attributable Disability-Adjusted Life Year
Rates for Selected Diet-related Risk Factors
World Health Organization -2004
Probability of Being Healthy by Age,
Sex and Region
Andreev EM, McKee M, Shkolnikov VM. Health expectancy in the Russian Federation: a new perspective on
the health divide in Europe. Bull World Health Organ. 2003;81(11):778-87.
Life Expectancy Between 1980 – 1998 For The Russian
Federation, Other NIS, Select Eastern European Countries,
Japan and the United States
Survival rates are low
but increasing in
Russia !
Food security in the Russian Federation at
Moscow 2011 Conference on NCDs:
Russian Federation and WHO
• Develop and strengthen policies/programs on
healthy lifestyles and NCD prevention.
– Global strategy for the prevention and control of
NCDs and its action plan
– National health plans and sustainable development
• Highlight the magnitude of the impact of NCDs
• Review experience on NCD prevention/control;
• Provide evidence to strengthen global and
national initiatives to prevent/control NCDs
Decree to improve population health
outcomes on May 7th, 2012*
- President Vladimir Putin
*Prevention of Non-Communicable Diseases
Red Square and Moscow Kremlin – a World Heritage site
2008-2013 WHO (World Health Organization) Action
Plan for the Global Strategy for the Prevention and
Control of Non-communicable Diseases
Major Nutritional Problems in the World
• Protein-energy malnutrition
• Obesity
• Micronutrient deficiency
Iron deficiency anemia
Vitamin A deficiency
Iodine deficiency disorders
Zinc deficiency
Folate deficiency
• Nutrition-related chronic diseases
– Need for high quality foods
– Medical nutrition
Public Health Importance of Nutrition
• Morbidity and mortality risk factor
– Increased risk of premature death
– Diabetes, heart disease, hypertension, some cancers,
• Russia: Prevalence of obesity – ~20%*
• Russia: Prevalence of overweight/obese – ~50%
• U.S. : Prevalence of obesity - ~34%*
• U.S. : Prevalence of overweight/obese – ~65%
* Sources: OECD Health Data 2011; national sources for non-OECD countries.
Nutrition and Food security in the Russian Federation at
Global Prevalence of Obesity
WHO 2008 males
Let’s Avoid the Obesity Trends Among U.S. Adults,
(BRFSS 1990 – 2008)
Obesity rates in the US have
doubled in less than 30 years!!!
Obesity = (*BMI ≥30, or ~ 30 lbs.
overweight for 5’ 4” person
No Data
CDC Behavioral Risk Factor Surveillance System (BRFSS);
Why is Fat Bad?
• Increase in fat cells leads to increase release of
• Hormones and signaling factors that increase:
Oxidative stress
Blood pressure
• There may be times when that is helpful for survival
• In a sedentary, western style civilization excess
“adipokines” are harmful
Fain JN, Tagele BM, Cheema P, Madan AK, Tichansky DS. Release of 12 adipokines by adipose tissue,
nonfat cells, and fat cells from obese women. Obesity (Silver Spring). 2010 May;18(5):890-6.
2008-2013 WHO (World Health Organization) Action
Plan for the Global Strategy for the Prevention and
Control of Non-communicable Diseases
Raise NCD priority in development work at global and
national levels
Establish and strengthen national policies and plans for
the prevention and control of NCDs
Promote interventions to reduce the main shared
modifiable risk factors for NCDs:
– tobacco use, unhealthy diets, physical inactivity and
harmful use of alcohol
Promote research for NCD prevention/control
Promote partnerships for NCD prevention/control
Monitor and evaluate progress of NCDs and their
OBJECTIVE 3: To promote interventions to reduce
tobacco use, UNHEALTHY DIETS, physical
inactivity and harmful use of alcohol
• Promote and support exclusive breastfeeding for the first
six months of life
– Ensure optimal feeding for infants and young children
• Develop a national policy and action plan on food and
2008-2013 WHO Action Plan
OBJECTIVE 3 (continued): To promote interventions to
reduce tobacco use, UNHEALTHY DIETS, physical
inactivity and harmful use of alcohol
• Establish and implement food-based dietary
guidelines and support healthy food composition by:
– reducing salt levels
– eliminating industrially produced trans-fatty acids
– decreasing saturated fats
– limiting free sugars
2008-2013 WHO Action Plan
OBJECTIVE 3 (continued): To promote interventions
to reduce tobacco use, UNHEALTHY DIETS, physical
inactivity and harmful use of alcohol
• Provide accurate and balanced information for
consumers to promote well-informed, healthy
• Prepare and implement a framework and/or
mechanisms for promoting the responsible
marketing of foods and non-alcoholic beverages
to children
– reduce the impact of foods high in saturated fats,
trans-fatty acids, free sugars, or salt.
2008-2013 WHO Action Plan
Healthy Russia: A Call To Action
The Kazan Kremlin
Nutrition Related Public Health Strategies
•Key Actions
•Increased focus on a healthy diet and lifestyle
•Focus on prevention
•Motivate positive behavior change
•Increase awareness of risk of key medical conditions
•Key Outcomes
•Improve health and quality of life
•Reduce health care costs
Things to Watch for in Nutrition Messaging!
•Is attention drawn away from other modifiable risk factors?
•Are there decreased use of other services?
•Is there a false sense of security?
•Is there a too much focus on specific nutrients/foods?
•Are misleading claims being made?
•Are the public health messages being diluted or
When you have exhausted all possibilities,
Remember haven't.
- Author Unknown

Russian Federation and WHO