May 14, 2007

In 2004, the World Health Assembly, the highest decision-making body of the World Health Organisation adopted an international strategy to counteract the ever-rising impact of unhealthy lifestyle and diet on quality of life and life expectancy It is intended to provide, evidence-based strategic guidance to nations and health agencies, researchers and practitioners on how to go about reversing the impact of disease such as heart disease, type 2 diabetes, cancer, overweight and obesity and dental decay on health, wellbeing and economic prosperity This global strategy is universally acknowledged to be both highly ambitious and absolutely essential.

But what does all this grand strategy and scientific expertise mean for the man, woman and child on the street? Can individuals use this massive undertaking to improve their own personal health? Read on for some key insights on how, and why to use this internationally recognised science-based initiative to inform your daily lifestyle and diet choices.....

Many Health Gains Achieved, but the Best is Yet to Come

Life expectancy has increased dramatically in many countries in Asia, and is now approaching life expectancy in some of the most affluent parts of the world such as the US, Europe and Australia. However, with the exception of Japan which has the highest life expectancy in the world, there are further gains in longevity to be made in the region. An even more important goal however, is to improve the quality of life in those additional years of old age.

'Chronic disease is responsible for 60% of the 56 million deaths and 46% of the burden of the disease in the Asia region. 45% of these cases occur in those under 70 years of age.' Dr Richard Nesbitt, WHO Regional Director in the opening address of the WHO Western Pacific Region Workshop on the Implementation of the Global Strategy for Prevention of Chronic Disease, October 2006.

The Challenge for Asia

Asia has been less successful in extending years of healthy living than it has in extending total life expectancy. For example, the World Health Organisation estimates that 22% of cardiovascular disease (CVD) in China begins in those aged 35-64 years, compared to only 12% in the USA. 52% of CVD deaths in India occur in those under 70 years of age, compared to only 23% of CVD deaths in Europe, and many of these deaths will have been preceded by years of ill health. Ill health associated with CVD which includes conditions such as angina, heart failure and strokes, results in diminished quality of life and erosion of financial well being due to loss of paid work, impaired ability to look after others, expensive medical treatment, erosion of personal independence, reduced capacity to enjoy or continue leisure activities.

Those in Asia also face reduced quality of life and early death, as a result of other chronic degenerative disease included in the WHO strategy, namely cancer, osteoporosis-related fractures and dental disease as well as the complications that overweight and obesity bring to other conditions such as gall bladder disease, recovery after surgery and many others.

Type 2 diabetes is responsible for an even greater impact on life expectancy, quality of life as well personal and national economic prosperity in the Asia region, and this impact is expected to rise. Professor Kun Ho Yoon of Kangnam St Mary's Hospital in Seoul, S Korea forecasts that China and India will have 20 million type 2 diabetics each by 2025.

Type 2 Diabetes in Asia - the Greatest Challenge

It is becoming increasingly apparent that many in Asia are far more susceptible to developing type 2 diabetes and the ensuing complications, than their Caucasian peers. Many in Asia develop type 2 diabetes at a much earlier age (typically before age 50 compared to over 60 years of age), and at much lower levels of excess body fat than western counterparts and thus are more likely to have to face the ill health, the inconvenience and the financial burdens of the disease in the middle of their working life rather than approaching or in retirement. Additionally, those in China, India and the ASEAN countries face more of the complications associated with the disease which include loss of eyesight, heart and kidney disease, loss of nerve sensitivity and even limb amputations.

Medical experts are still trying to understand why those of Asian ethnicity are more prone to developing type 2 diabetes, but some of the common features which contribute to this predisposition are a tendency to concentrate excess body fat around the abdominal area instead of more even distribution all around the body; a tendency for the cells to become less responsive to normal levels of insulin in the blood; and lower than optimal weight at birth due to poor maternal health during pregnancy, especially if immediately followed by rapid catch up growth in first year of life.

As well as internal physiological influences, Professor Yoon also outlines a number of external environmental conditions common in Asia's urban populations that exacerbate the problem of type 2 diabetes for Asians, and indeed many of the other chronic diseases targeted by the WHO strategy: Poor urban planning, the enthusiastic adoption of mechanisation and motorisation both in leisure and work activities, a commitment to extended academic study and long periods of time spent in front of TV, and computer screens all lead to highly inactive, sedentary lifestyles and extremely low levels of physical activity.

'The Causes are Known, the Way Forward is Clear'

This quote is taken from the WHO publication, Preventing Chronic Disease, a Vital Investment. It sums up exactly why the global strategy was endorsed internationally, and goals such as a 2% reduction in chronic disease mortality per year over the next decade have been set. There is irrefutable evidence that changes to diet and lifestyle can prevent premature onset of chronic disease. WHO estimate that a staggering 80% of early cases of heart disease, stroke and type 2 diabetes and 40% of cancers could be prevented with changes to diet and lifestyle. More active and earlier management of conditions of ill health could also substantially reduce the burden of premature death and disease. In the same publication the statistics speak for themselves, - 2.6 million deaths per year are attributed to overweight and obesity, 4.4 million to elevated raised blood cholesterol levels, 7.1 million to high blood pressure.

A Basket of Solutions

Personal diet and lifestyle choices can make a real and very substantial difference to every individual's chances for a longer and crucially healthier life. Happily, research has demonstrated that many of the diet and lifestyle choices proven to actively reduce risk, work in the prevention of not 1, but 2 and in some cases even more of the chronic disease conditions. These common causal characteristics for CVD, type 2 diabetes, osteoporosis, cancer, overweight and obesity are within the power of every man, woman and child to modify.

The most important lifestyle choice is regular physical activity. A low level of physical activity is now recognised as a major risk factor for CVD, type 2 diabetes, cancer, overweight and obesity, and osteoporosis. In fact, physical inactivity is the only diet and lifestyle factor that ranks in the top levels of supporting evidence for all these chronic diseases. Tobacco use is also a lifestyle choice which is known to reduce life expectancy and quality of life, by increasing the risk of cancer and CVD. Alcohol use in moderation appears to exert some positive influences but these benefits quickly disappear if more than recommended levels are consumed on a regular basis.

Overweight and obesity as well as being regarded as a health problem in its own right, has also been identified as a very influential personal characteristic in susceptibility to developing CVD, type 2 diabetes, and many cancers (the substantial contribution that overweight makes to the risk of developing cancer is well documented in the scientific world but is often overlooked or underestimated by the general population).

A moderate diet which retains some of the pleasure and health benefits of recent changes to the food supply in the region, but which avoid excess and imbalance is the last but by no means least important personal choice available to all. For many a reduction in energy dense foods which means less fats and added sugars and more fruit and vegetables, more high fibre and complex grain products, more essential fatty acids especially the omega-3 fats and more calcium and vitamin D rich foods are indicated.

Personal Diet and Lifestyle Choices with Convincing Evidence of Chronic Disease Risk Reduction

 

	CVD	Type 2 Diabetes	Overweight and Obesity	Cancer	Osteoporosis
áPhysical Activity	ü	ü	ü	ü	ü
á Fruit and Vegetables	ü		ü	ü
áWhole Grains and Non-starch  Polysaccharides; â Energy Dense Foods	ü		ü
áCalcium and Vitamin D					ü
áEssential Fatty Acids	ü
â Saturated and/or trans Fats	ü	ü
áWeight Management	ü	ü	ü	ü	ü
â Sodium  and/or Salt-Preserved Foods	ü			ü
Moderate or No Alcohol	ü			ü	ü

Personal People Power

Clearly international agencies such as WHO and national governments have a responsibility to drive forwards the global strategy to reduce the burden of chronic disease. The incentives to do so are powerful - a 2% reduction in death due to chronic disease in the next 10 years could save 36 million lives (50% of which would be amongst those under 70 years of age) and contribute 36 billion USD to China's economic growth and 15 billion USD for India. Failure is estimated to result in 200-550 billion USD loss to the Asia region, and immeasurable levels of suffering through ill health, medical costs and bereavement.

However, in view of the massive role that personal individual lifestyle choices play in the onset and development of chronic disease, individuals also have a very influential role
in their own future health prospects.

The scientifically proven and measurable benefits of a balanced diet in extending healthy years of life may not be new news and may not hold the exotic attraction of some of the extravagant claims made by self-styled therapists and diet gurus in the numerous diet books and web pages around the world. But, the weight of evidence for their benefits is overwhelming and is readily available and free to everyone who is serious about improving their own and their children's health.

The benefits start to accumulate as soon as healthful changes are made, but obviously, the earlier they are adopted, the greater will be the benefit. For these reasons, national and international strategies are likely to place strong emphasis on the young, and put a major onus on parents to both provide healthful diet and lifestyle choices and to lead by example.

In many ways, we are the heirs of the choices that were made by previous generations: politicians, business leaders, financiers and ordinary people. Future generations will in turn be affected by the decisions that we make today. Each of us has a choice: whether to continue with the status quo, or to take up the challenge and invest now in nurturing a lifestyle that will benefit the current and future generations of our community and nation. 'Preventing Chronic Diseases: A Vital Investment'

Further Reading:

(1.) WHO/FAO (2003) Technical Report T 916 'Diet, Nutrition and Prevention of Chronic Disease'
(2.) WHO Preventing Chronic Disease, A Vital Investment
(3.) Popkin B (2001) Journal of Nutrition 131;871S-873S 'Transition and Obesity in the Developing World'
(4.) Yoon KH, et al (2006) Lancet Vol. 368, Issue 9548, 11 November 2006, Pages 1681-1688 'Epidemic Obesity and Type 2 Diabetes in Asia'