CC BY
7Received by the Editor 19.10.2020
IRSTI 76.33.29+76.75.29
UDC 613.84+612.821.44-06-084
PREVALENCE OF BEHAVIORAL RISK FACTORS OF NON-INFECTIOUS DISEASES
N. Murzagulov, S. Muratbekova
Independent joint-stock company "Sh. Ualikhanov Kokshetau University", Kokshetau city, Kazakhstan
The data of domestic and foreign literature on the prevalence of risk factors for the development of chronic noncommunicable diseases is presented. The main emphasis is made on studying the prevalence of the main behavioral risk factors for chronic noncommunicable diseases (poor nutrition, low physical activity, alcohol abuse and smoking).
Keywords: Behavioral risk factors, noncommunicable diseases, prevalence.
РАСПРОСТРАНЕННОСТЬ ПОВЕДЕНЧЕСКИХ ФАКТОРОВ РИСКА НЕИНФЕКЦИОННЫХ ЗАБОЛЕВАНИЙ
Н.А. Мурзагулов, С.К. Муратбекова
НАО «Кокшетауский университет им. Ш.Уалиханова», Кокшетау, Казахстан
Представлены данные отечественной и зарубежной литературы по распространенности факторов риска развития хронических неинфекционных заболеваний. Основной упор сделан на изучение распространенности основных поведенческих факторов риска хронических неинфекционных заболеваний (нерациональное питание, низкая физическая активность, злоупотребление алкоголем и курение).
Ключевые слова: Поведенческие факторы риска, неинфекционные заболевания, распространенность.
ИНФЕКЦИЯЛЬЩ ЕМЕС АУРУЛАРДАГЫ МШЕЗ-ЦУЛЫЩТЫЦ ТЭУЕКЕЛ ФАКТОРЛАРЫНЬЩ ТАРАЛУЫ
Н.А. Мурзагулов, С.К. Муратбекова
«Ш.Уэлиханов атындагы Кекшетау университетЬ>КеАК, Кекшетаук., ^азакстан
Созылмалы ж^кпалы емес аурулардьщ дамуыньщ кауш факторларыньщ таралуы туралы отандык жэне шетелдж эдебиеттердщ деректерi келтiрiлген. Непзп екпiн созылмалы ж^кпалы емес аурулардыц негiзгi кауш-катер факторларыныц таралуын зерттеуге багытталган (д^рыс тамактанбау, физикалык белсендiлiктiн темендiгi, алкогольдi iшiмдiктер мен темеш шегу).
ТYЙiндi сездер: кауш-катердщ мшез-к¥лык факторлары, ж^кпалы емес аурулар, таралуы.
Noncommunicable diseases (NCDs) are diseases, usually of a chronic nature, with slow progression, long duration and, as a rule, not transmitted from one person to another. NCDs are the main cause of morbidity, mortality and disability across all regions of the World Health Organization (WHO). The four leading groups of NCDs - cardiovascular disease (CVD), cancer, respiratory disease and diabetes mellitus (DM) - are the fundamental cause of the global burden of disease and premature death [1,2]. The State Program for the Development of the Healthcare System of Kazakhstan for 2016-2020 "Densaulyk" provides the following statistical data: high cholesterol levels, high blood pressure, alcohol consumption and smoking are the cause of 87,5% of the burden of chronic diseases [3]. Chronic noncommunicable diseases (CNCDs) account for about 77% of the disease burden and 86% of all deaths in Europe, increasing the burden on the health system, slowing economic development and threatening the well-being of most populations, in particular the elderly. The Republic of Kazakhstan has one of the highest rates of premature mortality from NCDs in the European Region: in 2012, this figure reached 648,31 per 100,000 population in the age range of 3069 years. This translates into significant socio-economic implications for the country's development and requires immediate health system strengthening in response to the growing burden of NCDs [4]. Achieving the 25 x 25 target of reducing premature mortality due to the four major NCDs - CVD,
chronic respiratory disease, malignancy and diabetes mellitus - by 25% from 2010 levels by 2025 will largely depend on the achievement of the target for reducing the level of key risk factors for chronic diseases (alcohol and tobacco use, salt intake, obesity, and increased blood pressure and blood glucose) [5-7].
According to 2016 data, the risks of dying from NCDs were highest in middle- and low-income countries, particularly in sub-Saharan Africa, and for men in Central Asia and Eastern Europe. Countries in Europe have the highest burden of CNCDs worldwide [8,9]. Disease groups such as malignant neoplasms and CVD are responsible for about 3/4 of deaths in the European Region and in middle- and low-income countries, and three main groups of NCDs, according to the DALY (Disability adjusted life years) indicator - CVD, mental disorders and malignant neoplasms - together account for more than 1/2 of the total disease burden [10,11]. With 8,2 million deaths and 14,1 million new cases in 2012, cancer is one of the leading causes of death worldwide, with 70% of deaths occurring in middle- and low-income countries. As the leading cause of CVD in 2015, hypertension is the predominant risk factor for morbidity, affecting 24% of adult men and 20% of adult women, or 1,13 billion adults worldwide [12,13]. WHO has identified risk factor surveillance as the main pillar in the fight against NCDs, focusing on primary prevention through comprehensive, nationwide programs targeting and controlling major risk factors [14]. According to WHO data for 2013, up to 4/5 of cases of stroke, coronary heart disease and type II diabetes, as well as over 1/3 of cases of malignant neoplasms can be effectively prevented by influencing behavioral risk factors, mainly such as tobacco, poor diet, low physical activity and alcohol abuse [15].
According to WHO estimates, 15 million people aged 30 to 69 died from NCDs in 2015. NCDs cause an estimated 38 million deaths annually, and 75% of these deaths occur in middle and low-income countries. This imbalance in the burden of disease is projected to continue to negatively impact conditions in middle- and low-income countries, with mortality rates from NCDs in those countries expected to be eight times higher than in developed countries by 2030. These hazards, which themselves progress in the face of poverty and weak health systems, have enormous potential to slow and ultimately harm the economic development of middle- and low-income countries, creating a vicious cycle of poverty and ill health [16,17]. Among the causes of death associated with NCDs, CVD accounts for almost 1/2, malignant neoplasms 1/4, diabetes mellitus 1/5 and respiratory diseases 1/10. By 2020, it is estimated that 80% of the global disease burden will be caused by NCDs, leading to 7 in 10 deaths [18]. The main risk factors for NCDs include high blood pressure, tobacco use, alcohol abuse, insufficient physical activity, high cholesterol and blood glucose, overweight and obesity, and inadequate intake of fruits and vegetables, which account for about 80,0 % of deaths caused by CVD, including stroke. In countries with middle and low income, about 80% of premature deaths are associated with NCDs, and 90% of deaths associated with NCDs occur before the age of 60, that is, all age groups are vulnerable [19]. The combined effects of demographic shifts, globalization and economic growth have created an environment in which more and more children and adolescents are exposed to risk factors for NCDs than ever before in history, which include, but are not limited to tobacco and alcohol use, high-diet foods processed foods and reduced physical activity - threaten to shorten the life expectancy of today's adolescents by many years due to increased CVDs, malignant neoplasms, mental disorders, respiratory diseases and injuries in middle age [20].
Nearly half of all deaths in Asia are now associated with NCDs, which account for 47% of the global burden of disease. Eighty percent (80%) of NCDs are found in middle and low-income countries in Asia, as a result of economic development, which is shifting from traditional foods to inexpensive ultra-processed foods (UPFs), reduced physical activity and sedentary lifestyles. UPF products are widely available and relatively cheaper compared to whole and unprocessed foods. This situation has accelerated the growing burden of NCDs associated with high consumption of UPF products, as a result of aggressive marketing of UPF products as high-calorie, ready-to-eat, and affordable in middle- and low-income countries [21]. Many studies show a relationship between being overweight and an increased risk of CVD, type 2 diabetes, dyslipidemia, and some cancers. The prevalence of overweight and obesity in developing countries is gradually increasing as people experience changes in diet and physical activity due to the influence of Western culture. More than
1/3 of women and 1/4 of men in Africa are overweight, according to a WHO report, and these proportions are expected to rise by 41% and 30%, respectively, over the next decade. Recent trends in urbanization in developing countries, given that more than 1/2 of the world's population live in urban areas, and the globalization of the food market are contributing to changes in people's behavior and lifestyles. Lifestyle changes associated with the transition from traditional to modern dietary habits have led to the emergence and progression of overweight and obesity[17,22,23].
Eating habits are an important aspect in promoting and maintaining good health throughout life. Unhealthy nutrition is a modifiable and preventable risk factor that, along with other elements such as physical inactivity, tobacco and other harmful substances, have led to NCDs becoming a leading cause of disability and early death, affecting quality of life and organization of health systems. Nutrition-related NCDs are the most common cause of morbidity and mortality in most countries in the eastern Mediterranean, Asia and Europe, especially CVD, type II diabetes and malignant neoplasms [24,25]. Nutrition is an important determinant of human health, providing the essential building blocks for growth, development and maintenance of health throughout life. In this context, the existing burden of malnutrition and overeating requires changes for the health authorities on the appropriate nutritional management recommendations. Modern lifestyles and easy access to high-energy, low-nutrient foods are considered as important aspects of the prevalence of NCDs. J.B.Maaike et al.[26], in their study of the role of nutrients in NCDs throughout life, concluded that inappropriate intake of nutrients is common in older people and poses a risk of developing NCDs with aging, therefore, optimizing nutrition can reduce the risk and progression of NCDs. An unhealthy diet is one of the leading risk factors for rising trends in metabolic risk factors such as blood pressure, lipids, blood glucose and body mass index (BMI), and a cause of death and disability worldwide. An analysis of publicly available dietary studies has shown that even in high-income states, more than 3/4 of the adult population does not reach the recommended intake of significant amounts of vitamins
[27]. High sodium intake (predominantly with salt) has been identified as a major risk factor for CVD due to high blood pressure. Globally, 1,655 million annual deaths from cardiovascular causes were associated with Na intake above the recommended daily limit (no more than 2 g / day), with 61,9% of deaths in men and 38,1% in women. Among other risk factors for NCDs, consumption of beverages with sugar content has been found to accelerate the development of obesity and weight gain, which is one of the main risk factors for CVD, type 2 diabetes and cancer. A study that analyzed the consumption of sugar-sweetened beverages for the burden of CVD associated with obesity found that 184,000 deaths / year globally were associated with the consumption of these beverages. Unbalanced dietary fat intake has been identified as another risk factor for CVD, in particular high intake of trans and saturated fats and inadequate intake of polyunsaturated fats. Globally, it has been estimated that 711,800 deaths each year are associated with suboptimal consumption of polyunsaturated fats, which corresponds to 10.3% of global deaths from coronary heart disease; and 250 and 537 thousand deaths from this pathology are associated with high consumption of saturated and trans fats, respectively
[28]. Due to the multifactorial nature of the development of NCDs and their long latency period, it is extremely difficult to determine a clear cause-effect relationship between nutritional factors and NCDs. However, there is growing evidence that good nutrition throughout a person's life cycle is key to promoting health and well-being, and during particularly sensitive periods of life, such as pregnancy, infancy, early childhood and old age [6,27,28].
The prevalence of obesity is increasing equally globally, particularly in urban settings in developing countries. As an example, obesity rates have doubled globally since 1980, ending up in 2008, 600 million adults were obese, and in 2011, more than 40 million children under 5 years of age were overweight or obese [29,30]. An energetic imbalance between calories consumed and consumed is believed to be a fundamental cause of obesity and overweight. Being overweight is associated with many types of cancer, as well as other conditions like type II diabetes, hypertension and CVD. Overweight and obesity are associated with more deaths worldwide than underweight. Worldwide, more people are obese than underweight - this happens in all regions, with the exception of some countries in the African continent sub-Saharan and Asia [31]. In Europe, the prevalence of obesity reported in selected countries ranges from 9% to 23% among women and from 9% to 27% among
men. A meta-analysis conducted by Antje Wienecke et al., studying the population-attributable risk of developing 13 types of cancer depending on BMI showed that 9% of all cancer cases in Germany - 40,748 cases - could be associated with overweight in 2010 year [32]. According to the WHO, the prevalence of overweight and obesity among adolescents and children aged 5-19 years has increased sharply from 4% in 1975 to just over 18% in 2016. Growth was observed in approximately the same way among boys and girls: in 2016, 18% of girls and 19% of boys were overweight [33]. According to the results of the 5th national survey in 2012, 31,2% of adults were overweight or obese in the Republic of Kazakhstan[3].
In many countries of Europe and Asia, the life expectancy of women at birth is on average 6 years longer than that of men, and in Kazakhstan this difference is 11 years, in Russia 10 years. According to WHO experts, the leading cause of gender differences is behavioral risk factors, which include low physical activity, unhealthy diet, smoking and obesity[34.35].
Physical inactivity has been identified as the fourth leading risk factor for global mortality (6% of global deaths). This risk factor follows high blood pressure (13%), tobacco use (9%) and high blood glucose (6%). Overweight and obesity are responsible for 5% of global deaths. Physical activity has important health benefits and can reduce the risk of some of the major NCDs, such as diabetes, hypertension, obesity, depression, and musculoskeletal problems. Physical inactivity is assessed by WHO as the principal cause of approximately 21-25% of the burden of colon and breast cancer, 27% of type 2 diabetes and approximately 30% of the burden of coronary heart disease. In addition, the effect of physical activity on life expectancy has been identified in several studies with an expected increase in life expectancy of up to 7 years and a reduction in premature mortality of 20-40% [36,37]. Although inadequate physical activity is generally recognized as a leading risk factor for NCDs, progress in promoting policy on this issue remains insufficient in many countries. Low levels of physical activity are widespread: an estimated 51% of people in the United States of America and 31% of people worldwide do not reach the recommended physical activity target of at least 150 minutes per week. Participation in regular exercise has been shown to reduce the risk of stroke and coronary heart disease, type 2 diabetes, hypertension, colon and breast cancer, and depression. In their study, S.C. Moore et al.[38], Conducting research on the effect of physical activity on the development of 26 types of cancer among 1,44 million adults, concluded that physical activity during leisure time is associated with low risks of disease in about 13 types of cancer. In addition, physical activity is a critical determinant of energy expenditure and therefore is fundamental to energy balance and weight control. A meta-analysis by D.Hupin et al. [39] shows that even minimal levels of physical activity can reduce mortality by 22% in adults aged 60 years. The economic impact of physical inactivity in health care costs is significant, mainly due to indirect costs such as the cost of reduced economic production due to illness associated with disability and premature death from NCDs. Deaths from NCDs increase with increasing body weight and increase markedly when people are classified as obese. Regular and systematic physical activity is a protective factor against unhealthy weight gain. For these reasons, WHO adopted resolution WHA55.23 in 2002 and formulated a global strategy to address physical activity and health in 2004. Subsequently, a 10% relative reduction in the prevalence of low physical activity was identified as one of nine targets to be achieved by 2020 in the Global Action Plan 2013-2020 for NCDs[40].
In 2016, the harmful use of alcoholic beverages killed approximately 3 million people (5,3% of total deaths worldwide). Mortality due to excessive alcohol use is higher than that from diseases such as tuberculosis, HIV/AIDS and diabetes. Globally, in 2016, more than half of the world's population (57% or 3,10 billion people) aged 15 and over had abstained from alcohol in the previous 12 months. About 2.30 billion people are currently drinkers [41,42]. Alcohol is consumed by more than half of the population in only three WHO regions — the Americas, Europe and the Western Pacific. The general consumption of alcoholic beverages per capita in the world aged 15 years and older increased from 5,5 to 6,4 liters of pure alcohol from 2005 to 2010 and was still at 6,4 liters in 2016. The highest per capita consumption of alcoholic beverages is observed in the countries of the WHO European Region. There are significant gender differences in the prevalence of alcohol use disorders. Worldwide, WHO estimates that approximately 46,0 million women and 237,0 million men suffer
from alcohol-related disorders. Similar results are reported by MDGlantz et al., studying the prevalence of alcohol use in 29 different WMH (mental health disorders) studies among 27 countries between 2001 and 2015, concluded that the prevalence of alcohol use disorders is much higher among men than women. Also, those who were married, had a higher income level, were more educated, and those who were older at the time of the interview had a lower risk of developing alcohol-related abnormalities [41]. Alcohol use disorders are most prevalent in high-income countries. Among men in 2016, about 2,3 million deaths were attributed to alcohol consumption, while women suffered 0,7 million deaths. In Kazakhstan, in 2016, the prevalence of deviations associated with the abuse of alcoholic beverages among men was 10.3, and among women 2,2 per 100,000 population. The prevalence of alcohol dependence in Kazakhstan in 2016 was 5,5 among men and 1,4 among women (per 100,000 population). In 2016, of all alcohol-related deaths in the world, 28,7% are injuries, 21,3% are diseases of the digestive system, 19% are CVD, 12,9% are infectious diseases and 12,6% are malignant neoplasms. The harmful use of alcohol was responsible for about 1,7 million deaths from NCDs in 2016, including about 1,2 million deaths from diseases of the digestive system and the cardiovascular system (0.6 million for each disease) and 0,4 million deaths from malignant neoplasms. Globally, alcohol was responsible for 7,2% of all premature deaths in 2016 among those under 69. Young people were disproportionately affected by alcohol compared to older people, and 13,5% of all alcohol-related deaths occurred in the 20-39 age group [42].
The harmful effects of smoking on mortality from cancer, CVD and respiratory disease have been known for decades. WHO research on the global tobacco epidemic found that 25% of adults worldwide, or 950 million men and 177 million women, smoked in 2013. Smoking prevalence is highest in high-income countries. [43-45] Although the number of smokers in the world is still very high, from 2000 to 2015 the number of smokers fell by 28,6 million from 1,143 billion to 1,112 billion, which is about 15% of the world's population. If countries maintain tobacco control at their current levels, the number of smokers is projected to decline by another 20 million between 2015 and 2025. Analysis of trends by sex shows that the number of current smokers among women has decreased in all regions, while the decline among men has occurred almost exclusively in the Americas and Europe. WHO projections for the period 2015-2025. Indicate a continuing decline in women in all regions and an increase in men in Africa, the Eastern Mediterranean and Southeast Asia. Analysis by age group shows that most people start smoking at a young age. Surveys of children aged 13-15 around the world show that 24 million of them smoke. Surveys of adults show that the first large influx of smokers occurs among people aged 15-24, after which there is a slight increase in the smoking population. According to WHO, the prevalence of smoking in the Republic of Kazakhstan is 43,8% among men and 7% among women aged 15 and older. The WHO estimates that tobacco (smokers and smokeless) use currently causes about 6 million deaths worldwide each year, with many of these deaths occurring prematurely. Of this number of deaths, 10% die from exposure to secondhand smoke. While tobacco smoking is often associated with poor health, disability, and death from chronic disease, it is also associated with an increased risk of death from infectious diseases. In line with the UN mandate to tackle four NCDs in 2013, the World Health Assembly set a global voluntary tobacco control target to reduce premature mortality from NCDs. If the 194 WHO Member States collectively achieve a 30% reduction from the 2010 level of 22,1%, the prevalence of tobacco smoking is expected to be 15,4% by 2025[46.47].
Summarizing the above data, we can conclude that today behavioral risk factors are the key reason for the development of CHNDI all over the world, in particular, in Kazakhstan. Modifiable risk factors such as unhealthy diet, tobacco use, lack of physical activity and alcohol abuse are common causes of most NCDs. It is necessary to study the impact of not only a certain risk factor, but also the possible combined effect of various risk factors of NCDs on the health of the population, taking into account the peculiarities of the territorial distribution in different regions of the country, and, in accordance with the data obtained, develop a general and local strategies for the prevention of chronic diseases.
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