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Non-Communicable Diseases and Adolescents

Introduction Non Communicable Diseases (NCDs) are leading cause of death worldwide including India. So much so that about 53% of deaths in our country are because of NCDs. Majority of NCD related deaths are attributed to four groups of diseases, cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases. Main risk factors for NCDs include dietary habits , physical inactivity, tobacco and alcohol use.

Other risk factors include high blood pressure, high cholesterol levels, high blood glucose levels, and genetic susceptibility (history of premature death or disability due to coronary heart disease or stroke, diabetes, and hypertension).

Definition

Communicable diseases

  • Diseases that are transmissible from one person or animal to another
  • The disease may spread directly via another species (vector) or environment
  • Illness arises when the infectious agent invades the host, or sometimes as a result of toxins produced by bacteria in food
  • The spread of diseases through a population is determined by environmental and social conditions which favour the spread of infectious agent, and the relative humidity of the population
  • An understanding of the disease and the measures necessary for its containment and management is important.

Non-communicable diseases

  • Diseases that do not spread from one person to another.
  • Examples include cancer, heart disease, diabetes, Hypertension etc.
  • Risk factors such as a person's lifestyle, habits and environment are known to increase the likelihood of certain non-communicable diseases. They include age,gender,genetics, exposure to pollutants, behaviour such as smoking or chewing tobacco, unhealthy diet and physical inactivity which can lead to hypertension and obesity.
  • Most NCDs are considered preventable because they are caused by modifiable risk factors

Why adolescents are important in control of NCDs

Treating NCDs bears a huge cost in terms of money and productive lives lost. Hence, it is wise to prevent NCDs by all means. Focusing on prevention of even risk factors in young people is likely to be more effective. Adolescence is probably the last best opportunity to build positive health habits and to limit the harmful behaviors. Adolescence is an age of developing brain and the time of habit formation. Habits adopted during this time are likely to persist in adult life. Hence, it is important to detect and manage harmful behaviors related to NCDs early.

These risk factors can be less damaging if identified early in life when habits are still forming. This offers for better health, more years of productivity and certainly a lesser cost of health care to nation.

Main Behavioural risk factors in adolescent for NCD

Risk Factor Current Status Implications on Health
Tobacco Use

Most (90%) of adult smokers begin smoking before age of 18 years.

One in four adolescents who smoke start using tobacco before the age of ten

Exposed young people have two to three times the risk of asthma and lower respiratory conditions.

Smoking by teen girls as adverse effect on fertility as well as morbidity and mortality in the fetus, newborn, infant and toddlers.

     
Physical inactivity/or lack of exercise

Insufficient physical activity and unhealthy sedentary behaviors are no rise.

Rapid urbanization is also a driving force behind these risks

Inactivity may lead to high blood pressure and overweight/obesity, which can trigger NCDs, such as cardiovascular diseases, diabetes, and cancers in adulthood
Poor eating habits/unhealthy diets

 

Food containing high levels of saturated fats, trans-fat, sugar and salt lead to weight gain and adverse metabolic changes

unhealthy diet also leads to overweight /obesity and various nutritional deficiencies

Overweight and obesity are important determinants of health, increases in blood pressure unfavourable cholestrol levels and increased resistance to insulin.

They raise the risks of coronary heart diseases, stroke, diabetes mellitus, and many forms of cancer

Alcohol consumption

Adolescents who begin drinking earlier are more likely to become dependent on alcohol within 10 years than those who begin drinking at an older age.

Major risk factor for premature death and disability. There is a direct relationship between harmful levels of alcohol consumption and NCDs such as cancers and cardiovascular disease.

This also increases risk of road traffic accidents, unprotected sex,intentional and unintentional injuries,poor mental health, and gender-based violence.

Why is Adolescent period important for prevention of NCD’s

Best period to begin Factors influencing interventions needed Policies

Adolescence is the last best opportunity to build positive health habits and limit harmful ones.

Unless prevention is done from the adolescent,age habits are very hard to change once they get established as a life style.

Some risks, such as poor nutrition, begin in childhood and are a clear precursor for later health problems.

Adolescence is a time when the influence of peers is extremely important

Parental influence of being role model for healthy or unhealthy life styles is maximum during this period.

Media influences and the targeted marketing of unhealthy products and lifestyles for adolescent are on rise.

To lower the likelihood of youth smoking and chewing tobacco, protect against alcohol use, and support healthy diet and physical activity.

Communities must also work together to promote physical activity and healthy eating habits based on cultural appropriateness, especially within schools.

Some of the most cost-effective strategies to combat tobacco use and harmful use of alcohol include raising taxes and enforcing bans on advertising especially targeted to adolescents.

Public promotion of what constitutes a healthy diet and the appropriate amount of physical activity specifically 60 minutes a day for adolescents, is important.

National and local governments can do more to ensure their communities are eating healthier by encouraging clear food labels; managing food taxes and subsidies; promoting healthy eating in schools and workplaces; restricting marketing of junk food and sugary beverages to children and adolescents; and providing incentives for the food industry to prepare foods with less sodium, trans-fat and saturated fat.

Identification of the risk factors in adolescents

As stated above many of the risk factors might have already started in the adolescents. Thus it is better to identify them as early as possible. It is important to look for the risk factors in all adolescents and if found then ‘selective screening’ by some blood tests can be added to clinical screening.

Risk Factors - Non-Communicable Diseases

Modifiable Risk Factors Non-Modifiable Risk Factors

Leading risk factors

  • Tobacco Use (in any form)
  • Alcoholism
  • Physical Inactivity or sedentary lifestyle
  • Overweight/Obesity
  • High Blood Pressure
  • High Cholesterol Levels
  • High Blood Glucose level

Other Risk factors

  • Unhealthy diet
  • Stress
  • Certain infections that can lead to cancer
  • Environmental pollution
  • Occupational exposures toxins
  • Age
  • Sex
  • Family history
  • Genetic factors

History

It is important to include some questions related to unhealthy diet, physical activity or inactivity, smoking and substance (including tobacco and alcohol) use/misuse, and then family history of diabetes, hypertension, coronary heart diseases, stroke or early (<45 years of age) death or disability due to acquired heart disease or stroke in parents or grand parents. These questions can be incorporated in HEADSS review of psychosocial interview. Some questions are given below for illustration.

  1. Do you exercise or participate in outdoor games atleast five days a week?
  2. Do you watch T.V. / computer or spend time on mobile for more than two hours per day?
  3. Do you consume fruits, fruit juices or green leafy vegetables in your routine diet atleast five days a week?
  4. Does anybody in your family (parents, siblings, grandparents or maternal grandparents etc) have high blood pressure, diabetes, or any heart disease?
  5. Do you consume any kind of tobacco (Bidi, Cigarette, Hookah, Gutkha etc.)?
  6. Do you consume any kind of alcohol (Beer, Whisky, Vodka etc.) or drugs (Ganja, Charas etc.)?
  • A thorough physical examination should include assessment of weight and BMI, blood pressure, and systemic examination.
  • We must identify whether unhealthy diets, overweight or obesity, hypertension, inadequate physical activity or sedentary behaviors are present.
  • Adolescents having one or more risk factors should be considered for targeted screening blood tests.
  • Whenever one or more risk factors are identified especially family history, then in such cases screening for risk factors may be advised using serum cholesterol, fasting blood sugar and blood pressure.

Whenever these screening tests are abnormal then a thorough physical examination and detailed laboratory evaluation is required and such adolescents should be referred to experts’ evaluation.

Management of Risk factors for NCDs

Behavioral risk factors like smoking, alcohol intake, inadequate physical activity and sedentary activities, and unhealthy diets can be managed by appropriate counseling of parents and adolescents. Healthy habits are likely to be followed when the whole family is ready to change and adopt healthy habits. Barriers to healthy habits should be identified and managed accordingly. Algorithm (I am too thin/too fat) can be used for management of overweight and obesity.

It is important to identify genetic risk factors like enhanced susceptibility in view of family history as described above. Such adolescents and family should be advised to adopt healthy dies, regular physical activity, and less (<2 hours per day) of sedentary activities (screen time like television, video games and mobile phones).

Smoking and other tobacco use should be managed by counseling techniques. Following texts from WHO Job Aids can be used to educate parents and adolescents for promoting healthy eating and physical activity, for prevention of unintentional injuries and for preventing use of tobacco, alcohol and other substances.

Healthy Eating

Adolescents need a healthy diet to grow and develop, and to function optimally. A healthy diet consists of:

  • a variety of foods balanced across the major food groups;
  • a sufficient amount of food to meet an adolescent’s needs.

There are five basic food groups:

  • starchy foods such as rice and other cereals, potatoes, noodles and pasta
  • fruit and vegetables
  • milk and dairy products such as yogurt and cheese
  • meat, fish, poultry, eggs, nuts and legumes
  • foods and drinks high in fat and/or sugar.

Balanced food intake

A young person should eat a diet balanced across the five food groups. They should eat:

  • plenty of fruit and vegetables
  • adequate quantities of rice and other cereals, potatoes, noodles and pasta
  • some milk and dairy products such as yoghurt and cheese and
  • some meat, fish, poultry, eggs and/or nuts and legumes.
  • The relative proportion of the five groups is depicted in the diagram on page 155.
  • In addition, they should:
    • choose foods that are low in salt and
    • limit foods that contain a lot of fat or sugar.

Adequate food intake

If adolescents do not have enough to eat, they will be underweight. Being undernourished will affect their physical growth and development as well as their ability to learn and to work. Young women who are underweight tend to have babies who are smaller and more liable to health problems.

If adolescents have too much to eat, particularly foods high in fat and sugar, this can lead to them becoming overweight. Being overweight can lead to health and social problems during adolescence and later in life.

Messages for adolescents

  1. Eating a sufficient amount and a wide variety of healthy foods is important for you to grow and develop normally.
  2. While it is important that you eat enough food for your body to grow and develop normally, it is important to remember that eating too much food can make you overweight; this is not good for your health.
  3. Eating healthily means having regular meals and avoiding unhealthy snacks (especially those that contain a lot of fat or sugar).

Messages for parents

What you should know:
  1. Your son or daughter needs to eat a wide variety and a sufficient amount of healthy foods to grow and develop normally.
  2. If your son or daughter develops healthy eating habits during their adolescent years, these habits are likely to continue for the rest of their lives.

What you should do:

  1. Talk to your son or daughter about healthy foods and healthy eating.
  2. Support your son or daughter to develop healthy eating habits.
  3. Provide your son or daughter with a good role model by eating healthily yourself.

Physical activity

Regular physical activity has important physical, mental and social benefits both during adolescence and later in life. Physical activities include sports such as football and exercise such as jogging. They also include regular daily activities such as walking to school and work done at home (e.g. cleaning the floor) or at work (e.g. painting a room).

Messages for adolescents

Around sixty minutes of physical activity on most, if not all days, can provide you with the following benefits:

Physical benefits
  • It will help your bones and muscles grow and develop.
  • It will help you remain (or become) fit and trim.

Mental benefits

  • It can help to build your self-confidence and self esteem.
  • It can help you study and work better.
  • It can help you calm down when you are anxious, sad or angry.

Social benefits

  • Participating in sports can help you meet people and develop a sense of camaraderie.
  • It can also help you learn how to play by the rules, how to cooperate with members of your team, and how to deal with both victory and defeat. Too little activity can lead to overweight and associated health problems. Too much activity, not balanced with an adequate diet, can lead to poor growth and development.

Messages for parents

What you should know:

  1. Many adolescents need to be encouraged to build in some regular physical activity in their daily lives.
  2. Developing this habit in adolescence and maintaining it into adulthood will help them prevent health problems that inactivity contributes to such as high blood pressure and diabetes.

What you should do:

  1. Encourage your son or daughter to engage in regular physical activity for around 60 minutes on most, if not all days. Encourage them to match their physical activity with an adequate diet.
  2. Provide incentives and opportunities for your son or daughter to engage in regular physical activity.
  3. Provide your son or daughter with a good role model, by engaging in regular physical activity yourself.

Sources :

  1. Rashtriya Kishor Swasthya Karyakram - Resource Book by Ministry of Health and Family Welfare
  2. Rashtriya Kishor Swasthya Karyakram - Facilitator Guide by Ministry of Health and Family Welfare


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