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

ill
Trinity Lavra of St. Sergius or Troitse-Sergiyeva Lavra – a World Heritage site

• 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
Factors Percentage
1.
2.
3.
4.
5.
6.
7.
8.
High blood pressure (BP)*
Tobacco use
High blood glucose*
Physical inactivity
Overweight and obesity*
High cholesterol*
Unsafe sex
Alcohol use*
9.
10.
Childhood underweight*
Indoor smoke from solid fuels
*Nutrition related risk factors
4.8
4.5
4.0
3.8
12.8
8.7
5.8
5.5
3.8
3.3
59 million total global deaths in 2004 - World Health Organization

Global Mortality Risks
• High BP is the leading mortality risk factor followed by tobacco
– 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 5 th leading risk for death.
– Responsible for 7 per cent of deaths globally.
World Health Organization

Impact of Selected Diet-related Risk Factors on
Disability
World Health Organization -2004
DALYs: Attributable Disability-Adjusted Life Year
Rates for Selected Diet-related Risk Factors

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 www.fao.org/docrep/007/y5069e/y5069e06.htm

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 frameworks .
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

th
*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
– Others?
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, others
•
• 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 www.fao.org/docrep/007/y5069e/y5069e06.htm
CDC: http://www.cdc.gov/nchs/data/hestat/obesity_adult_07_08/obesity_adult_07_08.htm

WHO 2008 males
Global Prevalence of Obesity

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!!!
1990
Obesity = ( *BMI ≥30, or ~ 30 lbs. overweight for 5 ’ 4 ” person
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
CDC Behavioral Risk Factor Surveillance System (BRFSS);
2008

Why is Fat Bad?
•
•
•
•
Increase in fat cells leads to increase release of
“adipokines”
•
•
•
•
•
Hormones and signaling factors that increase:
Inflammation
Oxidative stress
Blood pressure
Diabetes
Other
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
1.
2.
3.
4.
5.
6.
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 harmful use of alcohol
, physical inactivity and
Promote research for NCD prevention/control
Promote partnerships for NCD prevention/control
Monitor and evaluate progress of NCDs and their determinants.

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 nutrition
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 choices
• 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

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 contradicted?