Russian Federation and WHO

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 Church


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

Factors Percentage









High blood pressure (BP)*

Tobacco use

High blood glucose*

Physical inactivity

Overweight and obesity*

High cholesterol*

Unsafe sex

Alcohol use*



Childhood underweight*

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 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


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

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

Decree to improve population health outcomes on May 7


, 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


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


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!!!


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);


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 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

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 contradicted?

When you have exhausted all possibilities,

Remember haven't.

- Author Unknown