Chronic Disease Prevention Dr M Zulfadli MED402 muhammadzulfadli.mehat@xmu.edu.my DEFINITION OF CHRONIC DISEASE Chronic diseases are medical conditions that persist over a long period of time and often require ongoing medical management and care. These conditions can affect various organs and systems in the body and can lead to long-term disability or premature death. Risk factors for chronic diseases include unhealthy diet, physical inactivity, tobacco use, excessive alcohol consumption, and environmental factors such as air pollution. Prevention and management of chronic diseases involve a multidisciplinary approach that includes lifestyle modifications, regular health screenings, medication management, and in some cases, surgical interventions. EXAMPLES OF CHRONIC DISEASE ? CHRONIC DISEASE PREVENTION Chronic disease prevention involves strategies to reduce the risk of developing long-term health conditions such as heart disease, stroke, diabetes, and cancer. It focuses on promoting healthy lifestyle choices, including diet, physical activity, and tobacco cessation, to mitigate the risk factors associated with chronic diseases. Prevention strategies aim to address the root causes of chronic diseases and reduce the burden of preventable conditions on individuals and healthcare systems. Examples of chronic disease prevention strategies include promoting healthy eating, encouraging regular physical activity, and discouraging tobacco and excessive alcohol use. IMPORTANT OF CHRONIC DISEASE PREVENTION Reducing the incidence and impact of chronic diseases on individuals and healthcare systems Enhancing the overall health and well-being of the general population Lowering rates of illness and mortality Improving quality of life and reducing healthcare costs Addressing social determinants of health and health disparities Empowering individuals to take control of their health and make informed decisions Promoting health equity and ensuring that all people have the opportunity to live their healthiest lives OVERVIEW OF CHRONIC DISEASE Chronic diseases are long-lasting medical conditions that require ongoing medical management and care. These conditions typically develop over a long period of time and may have multiple underlying causes, such as genetic, environmental, and lifestyle factors. Examples of chronic diseases include heart disease, stroke, diabetes, cancer, chronic obstructive pulmonary disease (COPD), and arthritis. Unhealthy food, physical inactivity, cigarette use, excessive alcohol intake, and air pollution are chronic disease risk factors. Chronic disease prevention and management need lifestyle changes, health tests, medication management, and even surgery. Chronic diseases affect quality of life, healthcare expenses, and productivity. To lessen the burden of chronic diseases on individuals and society, early diagnosis, prevention, and appropriate care are essential. OVERVIEW OF CHRONIC DISEASE Over the 20th century, chronic diseases replaced infectious diseases as the predominant cause of morbidity and premature death in developed countries. Even infectious diseases like HIV have become "chronic" due to efficient therapies in the absence of a cure, making the phrase "chronic disease" less meaningful. Chronic diseases can be managed for years or decades but not cured. The following conditions are considered chronic diseases: ➢ Not directly transmissible person to person. ➢ Routinely span years and often decades. ➢Degenerative in some way, relating to aberrant or declining function of some body part or system. ➢Often propagated by fundamental physiologic imbalances or disturbances, such as inflammation. OVERVIEW OF CHRONIC DISEASE Cardiovascular diseases (including stroke), cancer, lung diseases, and diabetes and related metabolic disorders are the biggest causes of years lost, lives lost, and costs. These disorders are the major global killers. Osteoarthritis, chronic pain syndromes, and depression also cause significant morbidity and cost without causing death. OVERVIEW OF CHRONIC DISEASE The Human Toll The top causes of global mortality are heart disease, cancer, stroke, diabetes, and chronic lung disease. More than 60% of global deaths are caused by this short list. Chronic illness mortality can exaggerate its consequences. Humans will suffer chronic degradation until the "rectangularization" of the mortality curve becomes a reality. As life expectancy increases, so does organ system degradation. If we live long enough, we will die of chronic, degenerative disease, which is just a point on this continuum. However, chronic illness mortality underestimates human cost in another important way. Chronic diseases reduce ability, function, vitality, and quality before premature death. Chronic diseases, caused by a few lifestyle factors and obesity, make this an increasingly important issue. OVERVIEW OF CHRONIC DISEASE The Human Toll These patterns demonstrate the relevance of including chronic disease's chronicity in human cost estimates. As serious and possibly disabling diseases start at younger ages, mortality becomes a less useful measure of their whole burden. OVERVIEW OF CHRONIC DISEASE The Financial Toll In the medical community, there are snide remarks made regarding the relative financial costs of life and death. Financially speaking, death is cheap because costs for maintaining life and providing for its treatment end. Chronic illness may make life extremely expensive. The costs of managing chronic disease are increasing as we become increasingly more efficient at delaying death through the use of medications, treatments, and medical technology. Technology and pharmacological advancements typically result in increased costs but tend to improve treatment and function (favourable) (unfavourable). Reduced productivity, absenteeism, presenteeism (attending work while sick), and related impacts, known as externalities or indirect costs (or benefits; externalities can be positive or negative), are substantial and may exceed direct costs. OVERVIEW OF CHRONIC DISEASE Common Elements in Pathogenesis PREVENTABILITY OF CHRONIC DISEASE Over the past two decades, literature has shown that the primary causes of premature death—which are also the leading causes of chronic morbidity— are overwhelmingly preventable by existing measures. 10 factors—mostly behaviours—caused chronic diseases. CONDITION-SPECIFIC PREVENTION Obesity Obesity is linked to most major chronic disorders. Obesity as a disease is relevant for various reasons. Obesity as a disease may have drawbacks. Diseases are aberrant biological functions treatable by medicine (e.g., pharmacotherapy, surgery).Bariatric surgery and Anti obesity medicines should be prioritised if obesity is aberrant. Bariatric surgery and weight control medicines are useful, but focusing on them may distract from policies and programmes that encourage better feet and fork use. Thus, blaming obesity on a diseased body may reduce the chance of fixing the obesogenic (fat-causing) environment. Low resting energy expenditure, genetic variants that cause weight gain and weight loss, and ethnicity that raises obesity risk are nonmodifiable risk factors for obesity. Modifiable risk factors are mostly diet and exercise. Exercise increases lean body mass, another risk factor. Insomnia raises obesity risk in multiple ways, making it a controllable risk factor CONDITION-SPECIFIC PREVENTION Obesity Primary obesity prevention focuses on food and exercise. Secondary prevention involves clinically assessing weight, height, and waist circumference (BMI) and plotting BMI on growth charts for youngsters. Tertiary prevention for established obesity frequently includes metabolic medication and bariatric surgery. CONDITION-SPECIFIC PREVENTION Obesity CONDITION-SPECIFIC PREVENTION Type 2 Diabetes Mellitus Type 1 diabetes is an autoimmune disease that destroys the islets of Langerhans' insulin-producing beta cells. Type 2 diabetes is mostly a lifestyle condition of developing insulin resistance caused by extra body fat. Type 2 diabetes mellitus, also known as "adult-onset diabetes," can be prevented by treating insulin resistance and preventing the buildup of excess visceral fat, which is a major cause in most cases. Preventing type 2 diabetes is crucial given its high health care expenditures and projected prevalence. Obesity and type 2 diabetes share several risk factors. Some ethnic groups have higher diabetes rates due to genetic susceptibility. Epidemic (or hyperendemic) obesity is the main cause of type 2 diabetes's spread from adults to children and adults. CONDITION-SPECIFIC PREVENTION CONDITION-SPECIFIC PREVENTION Stroke (Cerebrovascular Accident) A stroke, often known as a brain attack, happens when a brain blood artery bursts or is blocked. Stroke morbidity has been reduced with thrombolytic therapy, which restores blood flow and saves brain tissue damaged by ischemia. Hemorrhagic stroke can occur with or without such therapy. Hemorrhagic stroke is rare, unpredictable, and less preventative than ischemic stroke. CONDITION-SPECIFIC PREVENTION Cardiovascular Disease Cardiovascular disease (CVD) is a broad term for heart or blood vessel illness. Due to: blood clot (thrombosis) fatty deposits inside an artery harden and restrict it (atherosclerosis). CONDITION-SPECIFIC PREVENTION Chronic Lung Disease A condition that affects the lungs and respiratory system. It develops slowly and may worsen. Chronic lung disease can be caused by smoking or breathing in second-hand smoke, chemical fumes, dust, or other air pollutants. COPD, emphysema, bronchitis, and pneumoconiosis are the third major causes of death. Age and genetic abnormalities like α1-antitrypsin deficiency and cystic fibrosis are nonmodifiable risk factors for chronic lung disease. Pollution, profession, and cigarette smoke are modifiable risk factors. Chronic pulmonary disease prevention and therapy emphasise tobacco avoidance and smoking cessation. Secondary prevention involves managing early-stage disease to avoid progression. Asthma, COPD, and chronic bronchitis are treated with pharmacotherapy, including steroids. Tertiary prevention may involve home oxygen for functionally limited hypoxemia patients, drugs to manage symptoms and progression, and pulmonary rehabilitation after decompensation. CONDITION-SPECIFIC PREVENTION Cancer Cancer development is predictable, like the evolution of atherosclerotic plaque to clinically severe coronary disease. Age and genetic mutations are nonmodifiable cancer risk factors (e.g., BRCA). Diet, exercise, weight, cigarette usage, infectious agents, and toxins can be modified. Cancer prevention largely includes avoiding pathogens like: Human papillomavirus (HPV), implicated in cervical cancer, anal and penile cancers, and head and neck cancers Hepatitis B virus (HBV), implicated in hepatocellular carcinoma Toxins, such as tobacco and excess alcohol Industrial chemicals at the worksite and potentially contaminating the environment and food supply CONDITION-SPECIFIC PREVENTION Cancer CONDITION-SPECIFIC PREVENTION Oral Health Dental caries is one of the few disorders so frequent without basic care that screening is improper. Routine dental cleanings with fluoride are the standard of care. The following main methods avoid oral chronic disease: 1. 2. 3. 4. 5. Good oral hygiene (routine brushing and flossing). Adequate intake of fluoride from water or dental treatment. Routine dental visits. Avoidance of excess alcohol. Avoidance of toxins, such as tobacco. CONDITION-SPECIFIC PREVENTION Dementia, Chronic Pain, and Arthritis Dementia is a broad group of disorders, some of which can be prevented by vitamin supplementation and others by nothing. Chronic pain, especially arthritis, causes morbidity and indirectly death. Physical inactivity, which causes obesity and diabetes, may cause deadly myocardial infarctions. Osteoarthritis (OA) may be the best example of a degenerative disease caused by "wear and tear." Friction wears away knee, hip, hand, and other joint cartilage, causing symptoms. References
