Chronic Diseases Of Lifestyle Research Articles

Diet, exercise, and the challenge of combating obesity in primary care.

Obesity has reached epidemic proportions in the United States and in most industrialized nations. More than 60% of US adults are now overweight or obese, predisposing over 97 million Americans to a host of chronic lifestyle diseases, particularly cardiovascular disease. Despite the existence of explicit evidence-based consensus reports on the health risks of obesity and the health benefits of even moderate amounts of weight loss, many patients do not receive advice from their health care providers to lose weight or on how to do so effectively. Even modest physical activity and small incremental healthy dietary changes when incorporated into one's lifestyle have a positive effect on weight loss and promote the maintenance of favorable body weight and body composition changes with advancing age. This article describes elements of effective counseling and practical guidelines for developing a healthy lifestyle approach for overweight and obese individuals.

Changes in public health in South Africa from 1876.

The present population in South Africa, roughly 43 million inhabitants, is made up of Africans (77.2%), whites (10.5%), Coloureds (mixed race) (8.8%) and Indians (2.5%). In 1900 the infant mortality rate (IMR) among Africans was 330 per 1,000 live births; this has now fallen to 50-60. In Soweto, a primarily African city, IMR averages 20-25. Life expectancy in the past was only 25-30 years; by 1995, this reached 63 years. However, this could fall again due to the rapidly spreading HIV/AIDS epidemic. Life expectancy could fall to 40-45 years by 2010 with the AIDS epidemic being the cause of half of all deaths--a disastrous change from the previous relatively commendable public health situation. Formerly, the most common causes of deaths in young people were infections, diseases associated with malnutrition and gastroenteritis. Adults died almost solely from infections, including typhoid, dysentery, malaria and tuberculosis (TB). Even though diseases associated with malnutrition are less common today, many infections still remain a major problem, particularly TB, which is increasing. As late as 1970, Africans who reached 50 years had longer life expectancy than whites due to the low prevalences of the chronic diseases of lifestyle. This is no longer so, due to the recent rises in non-communicable disorders/diseases, principally obesity in women, hypertension, diabetes, stroke and the cancers of prosperity. In the not so distant future, the level of control of HIV/AIDS related diseases will be the major health/disease regulating factor among Africans. Among white, Coloured and Indian populations, there have been falls in the mortality rates of the young and, despite rises in lifestyle diseases, increases in life expectancy are continuing. For all populations other important public health regulatory factors include water supply, sanitation, clinic/hospital services and personal environmental factors, employment, dietary pattern and intake, smoking practices and alcohol consumption and physical activity, particularly in urban dwellers. Unfortunately, public health expenditure, also a highly regulating factor, has fallen from 8.2% of the gross domestic product in 1994 to 4.1% in 2000.

CO-EXISTENCE OF OVER- AND UNDERNUTRITION RELATED DISEASES IN LOW INCOME, HIGH-BURDEN COUNTRIES: A CONTRIBUTION TOWARDS THE 17TH IUNS CONGRESS OF NUTRITION, VIENNA AUSTRIA 2001

Adequate nutrition is a basic human right, but globally it remains unmet for many pre-school children. Poverty, food insecurity and malnutrition continue to be obstacles to human rights, quality of life and dignity. The 1995 goal to eradicate poverty in the world by 2020 is not on target in developing countries; rather, poverty has been increasing. Over 800 million people suffer from malnutrition in developing countries and over 20 % of the populations are hungry. About one third of the world's population suffer from micronutrient deficiencies and hundreds of millions suffer from chronic diseases of lifestyle. Prevalence rates, particularly low birth weight, stunting and underweight, remain high particularly in Eastern Africa and South Central Asia. More than a third of all children in developing countries remain constrained in their physical growth and cognitive development. The 1990 ambitious goal of halving childhood underweight prevalence by the year 2000 has not been achieved by most countries. Global progress in fighting malnutrition is slow and crippled by rapid increase of both communicable and non-communicable diseases, the so-called “double burden of disease”. About 115 million people suffered from obesity related diseases in the year 2000. Overweight and obesity (globesity) prevalence is advancing rapidly in developing countries. Cardiovascular diseases (CVD), myocardial infarction, angina pectoris and stroke as one of the most important causes of mortality and morbidity globally, will continue to be first and second leading causes of death in the world. Most developing countries, including South Africa, currently are in the process of transition and experiencing the double burden of both communicable and non-communicable diseases in which chronic diseases of lifestyle such as CVD have emerged while the battle against infectious diseases has not been won. In the last few years the HIV/AIDS epidemic has spread extremely rapidly and is likely to double overall mortality rates, undermine child survival and halve the life expectancy over the next five years. The co-existence of over- and under-nutrition calls for urgent innovative strategies and interventions to tackle the problem. The importance of prevention as the most sensible strategy is emphasised. This overview emphasises that, in planning nutrition strategies and interventions in low income, high-burden countries such as South Africa risk factors for both over- and under-nutrition and related diseases should be targeted and addressed. Keywords: over- and under-nutrition, double burden of disease and developing countries. (Af. J. Food and Nutritional Sciences: 2001 1 (1): 34-42)

Nutrition activities in South Africa

South Africa has had a history of racial inequities. The poverty rate in the black population is more than 60%, compared with less than 5% for the Indian and white populations. Poverty is particularly severe in non-urban areas, where the rate is 73.7%. The inequalities in socio-economic status have been mirrored in the nutritional status of South Africans; on the one hand we have stunted, underweight children, while on the other, obese adults at risk for chronic diseases of lifestyle. Much of the previous nutrition research in South Africa concentrated on nutritional diseases of lifestyle of the higher socio-economic groups; however in the new democratic dispensation there has been a move towards research in the area of under-nutrition. In fact, the very first large research study in South Africa’s new democracy (1994) was the first ever, truly representative national nutrition survey of children under the age of six [1]. This survey revealed that stunting was a major problem as was sub-clinical vitamin A deficiency. These disorders were more pronounced in the historically disadvantaged provinces and in rural compared to urban areas. To address nutritional problems in South Africa, the Integrated Nutrition Programme was established by the government in 1996. This program aims to combine direct nutrition interventions, such as nutrition education, micronutrient supplementation and food fortification, with indirect interventions such as health care, provision of safe and clean water, agricultural production and parasite control [2]. The main aims of the program are to: Enable all mothers to exclusively breastfeed their

PHYSICAL ACTIVITY IS A MODIFIABLE RISK FACTOR IN A PERI-URBAN COMMUNITY IN SOUTH AFRICA

994 The present study examined predictors of physical activity in a working class, peri-urban community in South Africa, and the associated risks for chronic diseases of lifestyle. In 1996, a random sample of 500 plots was drawn from a total of 1079 plots in the peri-urban community of Mamre, 45 km from central Cape Town. All occupants between the ages of 15 and 64 years were invited to participate. The response rate was 64.5% (N = 974). Sociodemographic and anthropometric data were obtained by trained field workers, and physical activity was assessed using 7-day physical activity recall. Blood pressure and oral glucose tolerance, in response to a 75 g glucose load, were also measured. Levels of physical activity (kcal/kg/day) were higher in men than women (P < 0.0001), in employed persons compared to unemployed persons (59.7 ± 8.9 vs 52.7 ± 9.7 kcal/kg/d, P < 0.001) and in those with tertiary education compared to those without tertiary training (P < 0.008). More than 35% of young women under the age of 25 years, and women and men over the age of 55 years were in the lowest quartile of total energy expenditure for physical activity. Physical activity levels were highest in persons working as unskilled laborers (P < 0.0001). Energy expenditure associated with physical activity was inversely related to systolic blood pressure, as well as, fasting and 2 hour blood glucose concentrations (P < 0.05). Low levels of physical activity significantly predicted hypertension (P < 0.03), and was also an independent risk factor for non-insulin dependent diabetes mellitus (NIDDM), along with age, family history and waist circumference (P = 0.05). These results show the important relationships between age, education and employment on patterns of physical activity in a peri-urban, working class community. Furthermore, low levels of physical activity are a significant risk factor for NIDDM and hypertension, even in communities undergoing rapid epidemiological transition.

Assessing the Health Needs of a Community through Participatory Research

Introduction: Each community has unique needs for health care based on the experiences and problems of that community. The health care provider must have an understanding of the needs of the community that s/he is serving. Needs assessment at the community level is of particular importance in the identification of problems presenting at the primary care level. The assessment of these needs must not only be based on objective indicators, but also on the very real requirements of that population. This necessitates a process of participatory research, where the community forms an active partner in the identification of needs. Method: A household survey was conducted in a peri-urban community using community members as ield workers,and assessing needs on a multi-disciplinary level. Results: 337 Questionnaires were analysed.The total surveyed population comprised 1612 people.The demographic proile is that of a poor, urbanised, ageing, Afrikaans, religious community, with a high unemployment figure, dependent on pension schemes and state health services. A significant number regard their health as poor. A 9% acute morbidity was reported. 72,1% of respondents smoke. The study found a high self-reported prevalence of chronic diseases of lifestyle. Conclusions: Peoples' perception of their own health status influence their decisions about if, when and where health care will be sought.The low self assessed health status is a strong indicator of the need for health care in this community.The prevention, management and rehabilitation of chronic diseases is an important priority for this community.They are in need of holistic care encompassing physical, spiritual, social, economic and ecological dimensions of the community.

DIFFERENCES IN HEALTH-RELATED PHYSICAL FITNESS IN AN ETHNICALLY DIVERSE INTERNATIONAL HIGH SCHOOL 82

Although there is growing evidence on the status of physical fitness in adolescent populations, relatively few studies have examined multiple minority groups while including boys and girls. The purpose of this study was to examine anthropometric and health-related fitness measures of an ethnically diverse international high school designed to have an equal distribution of minorities and whites. 109 adolescents (mean age = 14.6±0.7 yr; girls, n=58; boys, n=51) including 22 Afro-Americans (AA), 30 Hispanics (HS), 26 Asians (AS), and 31 Caucasians (CC) participated as part of a required physical education program. ANOVA with Newman-Keuls post hoc comparisons revealed significant racial and ethnic differences within each gender. Among girls, significant anthropometric differences existed with respect to BMI and body wt. (AA>HS, AS, CC; p<.01) while significant body composition differences existed in calf skinfold (AA>HS, AS; p<.01) and sum of calf and triceps skinfolds (AA and CC>AS; p<.05). CC girls were significantly(p<.01) slower in mile run time than AA,HS, and AS. Regarding boys, significant anthropometric and body composition differences occurred in BMI(HS>AA, AS, CC; p<.01; AA>AS and CC>AS; p<.05), triceps skinfold (HS>CC>AA, AS; p<.01), and sum of calf and triceps skinfolds(CC>AA, AS; p<.01). Significant differences also existed in mile run times for the boys (HS>CC; p<.05; HS>AA, AS and AA>AS; p<.01; greater = slower time) and 60 sec timed sit-ups (AA>AS, p<.05; AA>CC, p<.01; AS>CC and HS>CC, p<.01). These results are in contrast to previous research which indicates a lack of fitness differences, based on ethnicity, in low socioeconomic groups. Health-related fitness measures known to track and be associated with major chronic lifestyle diseases in both men and women are identified.

Urbanization and the Risk for Chronic Diseases of Lifestyle in the Black Population of the Cape Peninsula, South Africa

Men and women have experienced differing patterns of urbanization. Men spent more time in the city as migrant labourers, which could be attributed to the influx control legislation during the apartheid years. To investigate urban exposure among black people of the Cape Peninsula, South Africa, in relation to unhealthy lifestyles and the risk factors for chronic diseases of lifestyle. Blood pressure, height, weight and serum cholesterol were measured in a random sample of 986 persons, aged 15-64 years. Sociodemographic details, urban exposure, dietary intake patterns and personal habits were elicited by questionnaire. An urbanization index (percentage of life spent in a city), the dietary Keys score and body mass index were calculated. Linear regression modelling for cholesterol and hypertension, and multiple correspondence analysis for risk factors and demographic characteristics were performed. The degree of urbanization had no effect on total serum cholesterol concentrations, which were very low compared with other groups in South Africa. Hypertension was independently related to age, obesity and the degree of urbanization. Smoking patterns were influenced by the degree of urbanization in women only. Correspondence analysis identified groups with clusters of risk factors: formal housing-westernized diet-highly urbanized; male-normal weight-increased exercise-alcohol-smoking; female-obesity-non-smoking; and hypertension-ageing. Those who spent larger proportions of their lives in an urban setting tended to have unhealthier lifestyles and higher risk for chronic diseases lifestyle compared with their less urbanized counterparts. Groups to whom intervention should be targeted were also identified.

Urbanization and the risk for chronic diseases of lifestyle in the black population of the Cape Peninsula, South Africa

Urbanization and the risk for chronic diseases of lifestyle in the black population of the Cape Peninsula, South Africa

Knowledge about modifiable risk factors for non-communicable diseases adults living with HIV in Rwanda.

Non-communicable diseases (NCD) are of international public health concern. Of more concern are people living with HIV (PLHIV), who have the increased risk of developing NCDs, such as hypertension, stroke and diabetes. Research has revealed that there is a relationship between knowledge of NCD risk factors and risk perceptions in the general population. Therefore, an assessment of PLHIV's NCD risk factors knowledge is quite critical, to design effective NCD prevention programmes. To assess the level of knowledge of modifiable risk factors for NCDs and its associated factors among adults living with HIV in Rwanda. A cross-sectional quantitative design was used to collect the data. The study targeted PLHIV who visited the out-patients' public health centres in three purposively selected provinces of Rwanda. The knowledge assessment questionnaire relating to risk factors for chronic diseases of lifestyle was used to collect the data. Data were analysed using SPSS version 23. Of the 794 respondents, 64.6% were women, and the mean age was 37.9 (±10.8) years. The results revealed that the majority of the respondents (65.0%) had low levels of knowledge about NCD risk factors, while some (35.6%) were of the opinion that they had a low risk of contracting NCDs. Good knowledge was significantly associated with high educational status, a low CD4+ cell count (< 350 cells/mm3) and normotension. The current study findings highlight the need for comprehensive health education, to raise awareness of non-communicable diseases' risk factors for adults living with HIV in Rwanda.