CHAPTER 14

Preventing Chronic Disease: Physical

Activity and Healthy Eating
TOPICS :
RISK FACTORS FOR CHRONIC DISEASES
WEB OF CAUSATION
RISK FACTOR FOR CORONORY HEART DISEASE
Physical Inactivity as a Risk Factor
HILLS CRITERIA TO PROVE THE CAUSATION
INFLAMMATION AND CORONARY HEART DISEASE
ATHERIOSACLEOROSIS
Healthy Eating and Physical Activity to Combat Inflammation
Obesity, Inflammation, and Chronic Disease
THE METABOLIC SYNDROME .
 CHRONIC DISEASE:
“HUMAN HEALTH CONDITION IN WHICH DISEASE IS
PRESISETENT OR LONG LASTING “
CHRONIC CONDITION EFFECTS MULTIPLE AREAS OF BODY
DISEASE LAST FOR MORE THAN THREE MONTH IT WOULD
BE CONSIDER AS CHRONIC DISEASE
FOR EXAMPLE:CORONORY HEART DISEASE ETC
RISK FACTORS FOR CHRONIC
DISEASES:
There are three risk factors for chronic diseases which was
studying by Epidemiologists( are the scientists who play a major
role in exploring the distribution of diseases in the population and
the factors that have an impact on those diseases). that includes:
BEHAVIORAL INHERITED

ENVIRONMENT
INHERITED ENVIORNMNT BEHAVIOURAL
Inherited/Biological:
These factors include the following:
■ Age :Older individuals have more chronic diseases than younger
individuals.
■ Gender : Men develop cardiovascular disease at an earlier age
than women, but women experience more strokes than men .
■ Race : African Americans develop about 30% more heart disease
than non-Hispanic whites .
■ Susceptibility to disease :Several diseases have a genetic
component that increases the potential for having a disease
 ENVIRONMENTAL:
Environmental factors that affect health and disease
include the following:
■ Physical factors (e.g., climate, water, altitude,
pollution)
■ Socioeconomic factors (e.g., income, housing,
education, workplace characteristics)
■ Family (e.g., parental values, divorce, and
extended family and friends)
 BEHAVIOURAL:
It includes smoking, inadequate physical activity and diet
SMOKING : The actual causes of death describe which behaviors
(e.g., smoking) are linked to death That smoking is at the top of the list
should be no surprise given its connection to both lung cancer and
cardiovascular diseases. In fact, it is the number one actual cause of
deaths, accounting for 18% of all deaths.
PHYSICAL INACTIVITY
: no physical activity like by watching [TV, video, computer]) can lead to
severe conditions like atherosclerosis that leads to heart attack
DIET : high calorie diet can lead to artery damage that result plaque
formation in it that lead to atherosclerosis
WEB OF CAUSATION:
“IT IS THE RELATIONSHIP OF MULTIPLE FACTORS THAT ALL CONTRIBUTE TO THE CAUSE OF A
DISEASE”
For example that in atherosclerosis condition there are many factors that contribute to it
includes
i. SMOKING
ii. HYPERTENTION
iii. ENVIRONMENT
iv. OBESEITY ATHEROSCLEROSIS
v. DIBETIES TYPE 2
vi. LESS PHYSICAL ACTIVITY
vii. GENETICS
 EXPLAINATION:
They act alone and interact each other to cause atherosclerosis, a
condition in which a fatty plaque builds up in (not on) the inner wall of an
artery. Many of the risk factors interact to cause overweight, obesity, and
type 2 diabeates—problems that are connected to cardiovascular
disease. Trying to tease out the effect that one factor has on another and
on the final disease process is a difficult task that makes work in
epidemiology interesting and challenging. The factors in the web of
causation are positively associated with the development of
cardiovascular diseases but are not sufficient in and of themselves to
cause them. These are called risk factor, and they play a major role in
developing prevention programs aimed at reducing disease and
premature death associated with degenerative diseases. To expand on
this risk factor concept, we will focus on coronary heart disease.
RISK FACTORS FOR CORONARY
HEART DISEASE:
Coronary heart disease (CHD) is associated with a gradual
narrowing of the arteries serving the heart due to a thickening of
the inner lining of the artery. This process, called atherosclerosis, is
the leading contributor to heart attack and stroke deaths
Historically, risk factors for CHD were divided into
primary, or major
secondary, or contributing.
PRIMARY FACTOR
Primary meant that a factor in and of itself increased the
risk of CHD
SECONDART FACTOR
secondary meant that a certain factor
increased the risk of CHD only if one of the primary factors was already
present, or that its significance had not been precisely determined
E.G : physical inactivity) or characteristics (e.g., obesity)
 MAJOR CONTRIBUTING FACTORS:
■ Age
■ Family history
■ Cigarette smoking
■ Sedentary lifestyle
■ Obesity
■ Hypertension
■ Dyslipidemia
■ Prediabetes
◦
dThe risk factors for CHD include some you cannot change
(e.g., age and family history) and many you can
change(cigarette smoking, inactivity, obesity,
hypertension, dyslipidemia, and prediabetes
 HILLS CRITERIA:
Sir Austin Bradford Hill explain the multiple risk factor that which risk factor strongly
 
contribute to cause the disease these criteria include:
•Temporal ASSOCIATION : Does the cause precede the effect?
•Plausibility : the association consistent with other knowledge ?
•Consistency: Have similar results been shown in other studies?
•Strength: What is the strength of the association (relative risk) between the cause and the
effect? Relative risk is sometimes expressed as the ratio of the risk of disease among those
exposed to the factor to the risk of those unexposed. The greater the ratio, the stronger
the association
•Coherence :Is increased exposure to the possible cause associated with increased effect?
•Reversibility :Does the removal of the possible cause lead to a reduction of the disease
risk?
•STUDY DESIGN : Is the evidence based on strong study design?
•JUDGING THE EVIDENCE : How many lines of evidence lead to the conclusion?
Physical Inactivity as a Risk Factor
The concern about whether a risk factor is causally related to
cardiovascular disease has special significance for physical activity.
Physical inactivity is an independent risk factor for CHD.
The relative risk of CHD due to inactivity (1.9) is similar to that of
hypertension (2.1) and high cholesterol (2.4). The fact that a large
percentage of the population is inactive indicates the enormous
impact a change in physical activity habits can have on the
nation’s risk for CHD.
Physical Activity and Health
■ Lower rates of all-cause mortality, total
cardiovascular disease (CVD), and
coronary heart disease incidence and
mortality
■ Increased weight loss and reduced amount of
weight regain after weight loss
■ A lower incidence of obesity, type 2 diabetes,
and metabolic syndrome
■ A lower risk of colon and breast cancer
■ An improvement in the ability of older adults
to do activities of daily living
■ Reduced risk of falls in older adults at risk of
falling
■ A reduction in depression and cognitive
decline in adults and older adults
 ■ The risk of many chronic diseases was
reduced about 20% to 40% by regular
participation in physical activity
 INFLAMMATION AND
CORONARY HEART DISEASE
We have just seen that a wide variety of risk factors are linked to
heart disease. But how are these risk factors connected
physiologically to the actual appearance of the disease In
atherosclerosis, the narrowing of the coronary artery can result in a
reduction in blood flow that may ultimately lead to a heart attack
ATHEROSCLEROSIS:
“ THE HARDENING OF ARTRY DUE TO
PLAQUE FORMATION IS CALLED ATHEROSCLEROSIS”
NORMAL ARTERY VS
ATHEROSCLEROSIS ARTERY:
 HOW PLAQUE FORM IN THE
ARTERY
•The decrease in the diameter of the lumen is due to a buildup of lipid and
fibrous materials (plaque) in the inner lining of the artery, called the TUNICA
INTIMA when LDL IS ENTER FROM LUMEN TO THE TUNICA INTIMA IT
BECOME OXIDIXED AND IS CALLED OXIDIZED LDL
•OXIDIZED LDL ACTIVATES THE ENDOTHELIUM CELLS thus adhesion molecules
on its surface that can bind readily to leukocytes (especially monocytes and T
cells) in BLOOD
•■ Once bound to the adhesion molecules, the endothelial cells secrete
chemokines that attract the monocytes to enter the intima, where they
mature into macrophages
The macrophages develop scavenger receptors
on their surface that help them ingest large
amounts of modified LDL cholesterol.
■ The macrophages become loaded with fatty
droplets and develop into foam cells . These foam cells and the
T cells make up the “fatty streak,” the earliest
form of atherosclerotic plaque.
■ As the process continues, the macrophages
multiply due to growth factors they produce,
and the size of the plaque increases.
■ As this is developing, some of the smooth
muscle cells in the middle layer (media) of
the artery move to the top layer of the intima
(near the lumen) where they multiply and,
with connective tissue, form a fibrous matrix
cap over the fatty core of the plaque
At some point, the foam cells release inflammatory
signals that lead to the digestion and weakening
of the fibrous matrix cap. If the cap ruptures, the
chemicals from the foam cell interact with factors
in the blood to form a clot (thrombus) that might
be large enough to completely block an artery
Obesity, Inflammation, and Chronic
Disease:
It is now recognized that a low-grade chronic inflammation is
linked to a wide variety of chronic diseases, including
hypertension, heart disease and stroke, some cancers,
respiratory conditions, type 2 diabetes, and the metabolic
syndrome
The chronic low-grade inflammation is characterized by a two-
to threefold increase in inflammatory cytokines (e.g., tumor
necrosis factor alpha [TNF-α], interleukin-6 [IL-6], and C-
reactive protein [CRP]).
 INFLAMATORY CYTOKININ
Inflamatory cytokinin is a type of signaling molecule that secrete from the
cytokine that is secreted from immune cells like helper t cells and microphage
that promote inflammation e.g
interleukin 1 and tumor necrosis factor alpha etc.
TUMOR NECROSIS FACTOR ALPHA [TNF-Α]: it is chiefly produced by
activated macrophage and it is signaling protein involved in systemic
inflammation
C REACTIVE PROTEIN: CRP is a protein made by liver .CRP levels in the
blood increase when there is a condition causing inflammation somewhere in
the body.
CRP TEST : test used to determine the c reactive protein
in the blood to detect inflammation due to chronic condition
INTERLEUKIN -6
INTERLEUKIN 6 IS PRODUCED AT A SITE OF INFLAMMATION AND
PLAY A KEY ROLE IN ACUTE PHASE RESPONSE
Healthy Eating and Physical Activity
to Combat Inflammation :
As mentioned earlier, there is an abundance of research showing
that regular participation in physical activity reduces the risk of many
chronic diseases.
As mentioned earlier, there is an abundance of research showing
that regular participation in physical activity reduces the risk of many
chronic diseases.
EXERCISE TRAINING MIGHT
REDUCE CHRONIC
INFLAMMATION
POTENTIAL mechanisms through which exercise training might reduce chronic
inflammation in obesity:
Acute exercise stimulates IL-6 release from
skeletal muscle, which suppresses pro inflammatory cytokines.
■ Exercise training may increase angiogenesis
(creation of new blood vessels) in adipose
tissue to result in an increase in blood flow
and a reduction in hypoxia and associated
chronic inflammation in adipose tissue.
■ Exercise also reduces adhesion molecule
production in endothelial cells and lowers
vascular wall inflammation.
■ Exercise training may reduce the expression
of toll-like receptors (that recognize molecules
tied to pathogens) and the number of pro inflammatory monocytes
IT IS CLEAR THA It is clear that anti-inflammatory activity is not the only
mechanism responsible for the health benefits of exercise . Exercise affects a
wide variety of risk factors (e.g., blood pressure, abdominal fat.
METABOLLIC SYNDROME:
Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart
disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high
blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.

Having just one of these conditions doesn't mean you have metabolic syndrome. But it does
mean you have a greater risk of serious disease. And if you develop more of these conditions,
your risk of complications, such as type 2 diabetes and heart disease, rises even higher.

ALSO CALLED SYNDROME X: Because it is the cluster of abnormalities

Symptoms
HAVING FOLLOWING SYMPTOMS PERSON IS
CONSIDER TO BE METOLIC SYNDROME PATIENT
■ Abdominal obesity: waist circumference >102
cm in men and >88 cm in women
■ Hypertriglyceridemia: ≥150 mg/dl
■ Low high-density lipoprotein (HDL)
cholesterol: <40 mg/dl in men and <50 mg/dl
in women
■ High blood pressure: ≥130/85 mm Hg
■ High fasting blood glucose: ≥100 mg/dl
Causes

metabolic syndrome is closely linked to overweight or obesity and inactivity

. Risk factors

Age. Your risk of metabolic syndrome increases with age

Obesity. Carrying too much weight, especially in your abdomen, increases your risk of
metabolic syndrome.

Diabetes. you're more likely to have metabolic syndrome if you had diabetes during
pregnancy (gestational diabetes) or if you have a family history of type 2 diabetes.
Complications

Heart and blood vessel disease. High cholesterol and high

blood pressure can contribute to the buildup of plaques in
your arteries. These plaques can narrow and harden your
arteries, which can lead to a heart attack or stroke.
Type 2 diabetes. If you don't make lifestyle changes to
control your excess weight, you may develop insulin
resistance, which can cause your blood sugar levels to rise.
Eventually, insulin resistance can lead to type 2 diabetes.
Prevention

A lifelong commitment to a healthy lifestyle may prevent the

conditions that cause metabolic syndrome. A healthy lifestyle includes:

Getting at least 30 minutes of physical activity most days

Eating plenty of vegetables, fruits, lean protein and whole grains
Limiting saturated fat and salt in your diet
Maintaining a healthy weight
Not smoking
DIAGNOSE: