HEALTHY LIFE-STYLE, NUTRITION

AND NON-COMMUNICABLE
DISEASES
 Definition of Healthy Lifestyle
• A healthy lifestyle is a way of life which helps to keep and improve people’s health and well
being

• Non-Communicable Diseases are chronic illnesses requiring long-term care and adherence to
positive lifestyle measures

• Majority of NCDs share four common modifiable lifestyle risk factors, which are:

– Unhealthy eating

– Physical inactivity

– Tobacco use

– Alcohol taking

• Following diagnosis, every patient and their family/ treatment supporter need to learn about
lifestyle preventive measures for NCDs and their management
 Role of Health Care Providers in Behaviour
Change
• Understanding the importance of a healthy lifestyle

• Every visit or interaction with a healthcare provider is

an opportunity for providing information and
education on the risk factors, particularly for people
with existing NCDs

• Primary healthcare workers play an important role in

helping patients to change their unhealthy lifestyles
and maintain healthy behaviours and practices
 The 5As

1. ASK

2. ADVISE

3. ASSESS

4. ASSIST

5. ARRANGE

• The 5As is a tool used for brief interventions.

• The 5As is a tool used for brief interventions.

• It summarizes what a health worker can do to help

someone who is ready to change

• Can be integrated into regular visits by health providers

of any level, either at community or facility level

• Risk-factor counselling should be integrated with

existing programme delivery at all levels of care
 Healthy Eating for Non-Communicable
Diseases
• Key nutrients in foods include carbohydrates,
proteins, fats, vitamins and minerals

• Foods are grouped together into five main

groups

• Foods in the same group provide high amounts

of similar amounts of the key nutrients of that
food group
• The groups include:

– Cereal, tubers, roots and green bananas – carbohydrates

– Legumes, pulses, seeds, nuts, and foods of animal sources

including fish and insects - proteins

– Vegetables – Vitamins and minerals

– Fruits – Vitamins and minerals

– Oils and fats high sources of energy and fat-soluble vitamins

 Benefits of Cereals, Roots and Plantains
(Starchy foods)
• Provide:

– Carbohydrates/starch (energy)

– Fiber

– A wide range of vitamins and minerals

– Moderate consumption of Cereals and wholegrain

foods can reduce the risk of developing NCDs
 Benefits of Legumes and Pulses, Nuts and
Seeds
• Provides rich sources of:

– Proteins

– Soluble fibre

• Some also contain iron and Zinc

 Animal Source Foods
• High quality protein, supplying all the essential amino
acids in the right quantities

• Red meat is a very good source of iron

• Milk and milk products are good sources of protein, fat,

vitamins, minerals and a very good source of calcium

• They also supply protein, riboflavin (vitamin B2), vitamin

B12, and potassium
 Benefits of Fruits
• Sources of vitamins, minerals, sugar, and fiber
• Improves body immunity
• Regular consumption of fruit is generally
associated with reduced risks of NCDs
 Benefits of Vegetables
• Low in fat and calories but are bulky and
filling due to high content of dietary fiber
• Sources of essential minerals, trace elements
and vitamins (antioxidant vitamins A, C, and E)
• When eaten regularly, reduces the incidence
of most NCDs
 Benefits of Fats and Oils
• Gives the body energy and help it to absorb
fat-soluble nutrients, such as vitamin A, D, E
and K
• Some foods have invisible fat or oil that can
cause damage to the body when consumed in
excess
• Consumption of excessive fat and oil can lead
to an increased risk for NCDs
 The Benefits of a Healthy Diet
• A healthy diet protects against malnutrition in all its
forms and plays a crucial role in the prevention of
non-communicable diseases and associated risk
factors.

• It is therefore important to follow the

recommendations for healthy eating which involves:

– variety, moderation and balance of food intake from the

different food groups
• Healthy dietary practices should start early in life by
breastfeeding:

– It fosters healthy growth and improves cognitive development

– The exact makeup of a diversified, balanced and healthy diet

will vary depending on individual characteristics

– age, gender, lifestyle, physiological and degree of physical

activity, cultural context, locally available foods and dietary
customs
 Principles of Healthy Eating
• To meet the nutrient requirements essential for good health, it is advised to eat a
mixed diet consisting of food from each of the five food groups daily, in the
recommended quantities

• Eat plenty of green leafy vegetables, red and yellow vegetables and fruits every
day

• Eat beans, peas, lentils, cowpeas, pigeon peas, soya, nuts, and edible seeds
regularly (at least four times a week)

• Eat lean meat, fish and seafood, poultry, insects, or eggs at least twice a week

• Drink fresh milk, fermented milk, or yoghurt every day

• Use oils in moderation in meals

Nutrition Advice for People
with Specific Health
Conditions
 Type 2 Diabetes Mellitus
• Avoid sugar, honey and sugary beverages

• Avoid Alcohol

• No need of taking supplements or artificial sweeteners

• Reduce intake of carbohydrates if overweight/obese until ideal body weight is

achieved

• Continue maintaining the ideal body weight

• Encourage consumption of fibre-rich diet (whole grains, vegetables and whole

fruits)

• Maintain regular physical exercises

 Individual Counseling
• Discuss the outcome of the assessment with the diabetic client/patient

• Explain how the diagnosis has been arrived at

• Involve the patient in the formulation of the diet

• Discuss other factors that may affect the disease e.g. stress

• Fill in the knowledge gap identified in the assessment

• The focus of nutritional counselling should be aimed at modifying individual existing habits:

– Food choice

– Meal composition

– Meal timing

– DO NOT set rigid targets

 Cardiovascular diseases
• Diet is an important risk factor in coronary heart
disease

• Food-related risk factors include obesity, high blood

pressure, uncontrolled diabetes and a diet high in
saturated fats

• A low-saturated fat, high-fibre, high-plant food diet

can substantially reduce the risk of developing heart
disease
 hypertension
• Aims of nutritional management

• To control blood pressure within the normal ranges

• To achieve a gradual weight loss in overweight and obese

individuals and maintain their weight slightly below the normal

• To reduce sodium intake based on the severity

• To maintain adequate nutrition

• Regulate fat intake

 Cancer
• There is no single food or food component that can alone prevent cancer

• Research suggests that a diet rich in vegetables, fruits, whole grains, beans and
legumes can help significantly lower the risk for a variety of cancers

• There are multiple food components and chemicals found in certain foods that aid in
preventing cancer

• Phytochemicals that naturally occur in plants are chemicals that reduce inflammation,
enhance the immune system, and have many other protective properties against
cancer

• Antioxidants found in certain foods and beverages

• A high-fibre diet has also been shown to significantly decrease the risk of colorectal
cancer, particularly due to fibre’s ability to bind carcinogens in the colon
 Key Points

• A balanced diet is that which include different food groups as follows:

– Cereal, tubers, roots and green bananas - carbohydrates/starch

– Legumes, nuts, and animal source foods

– Vegetables – Vitamins and minerals

– Fruits – Vitamins and minerals

• It is important to provide nutrition education to people living with NCDs

and family members
 PHYSICAL ACTIVITY AND NON-
COMMUNICABLE DISEASES
• Definition of Physical Activity
• Physical activity is defined as any bodily movement produced by skeletal muscles that
require energy utilization.

• It includes:

– Exercise (planned, structured, repetitive, and purposeful)

– Playing/sports and games

– Working

– Active transportation/commuting

– House chores

– Recreational activities
 Types of Activities
• Swimming

• Cycling

• Yoga/Pilate

• Dancing

• Brisk walking

• Housework/ gardening
 Benefits of Physical Activity
• Helps to manage body weight through energy expenditure

• Helps to achieve physical fitness including cardiovascular fitness,

flexibility of joints, muscle strength and endurance

• Helps in building and maintaining healthy bone density

• Boosts the immune system

• Helps in the prevention and control of diseases such as heart disease

(hypertension, stroke, and myocardial infarction), lipid abnormalities
(triglycerides and HDL cholesterol), Type 2 diabetes and obesity
• Improves musculoskeletal conditions such as osteoarthritis and low back pain

• Improves mental and psychological health by reducing depression, anxiety and

stress

• Helps control risky behaviours, particularly among children and young people
(e.g. tobacco use, alcohol/substance use, unhealthy diet and violence)

• Benefits communities through increased productivity in the workplace, lower

worker absenteeism and turnover and better-performing schools

• It also helps to control blood glucose levels to further reduce diabetes and
tuberculosis risk
• Moderate physical activity/exercises can help lower blood glucose in two
ways

• When you exercise muscles use glucose from the bloodstream,

consequently lowering blood glucose levels

• After activity, muscles remain more sensitive to the effect of insulin,

therefore, maintaining the utilization of glucose for a longer period

• Regular moderate-intensity physical activity of 30 to 60 minutes at least 3

times a week is advised

• There is no evidence that doing moderate-intensity PA causes any harm to

pregnancy
Principle of Performing Physical Activity
 Tips to Increase Physical Activity
• Engage in one or more of the types of PA

• Physical activities can be performed as part of one’s occupation, during

commuting and as recreational/leisure time PA

• To be ready anytime, carry some comfortable sports/exercise gear or keep

them in your office

• Choose activities that you enjoy and can do regularly

– Fitting activity into a daily routine can be easy - such as taking a brisk 10-minute walk
to and from the parking lot or bus stop

– Make sure to do at least 10 minutes of the activity at a time, shorter bursts of activity
will not have the same health benefits
 When should I see the Doctor?
• See your doctor or other healthcare provider if any of these apply to you:

• You have a heart condition, or you have had a stroke

• During or right after exercise, you often have pains or pressure in the left or mid-
chest area, left neck, shoulder or arm

• You have developed chest pain or discomfort within the last month

• You tend to lose consciousness or fall due to dizziness

• You feel extremely breathless after mild exertion

• You take medicine for blood pressure, a heart condition or a stroke

 Key Points
• It is advised to perform physical activities at least 4 to 5
days per week

• Lack of physical activity has been identified as the

fourth leading risk factor for global mortality

• Physical Activity helps in the prevention and control of

diseases such as heart disease (hypertension, stroke,
myocardial infarction), lipid abnormalities (triglycerides
and HDL cholesterol), Type 2 diabetes and obesity
TOBACCO AND NON-COMMUNICABLE
DISEASES
Global and National Burden of Tobacco Use
on NCDs
• Tobacco is one risk factor common to all major NCDs

• Globally, tobacco kills 8 million people annually, of

whom, more than 7 million are a result of direct
tobacco use while around 1.2 million are non-
smokers exposed to second-hand smoke

• In Tanzania, tobacco kills 14,700 people every year,

translating into 4% of all deaths
Different Tobacco Products
Pictorial Representation of the Smokers
Body
Global 2025 Target to reduce Tobacco Use
Cigarette Contents
 Global Health Burden of Tobacco
• Tobacco use →
– kills 8 million people annually
– kills 1million second-hand smokers
• Tobacco →
– has killed 100 million in 20th century
– will kill 1bn in 21st century
• NCDs kill 35million people annually (80% in Low- and
Middle-Income Countries (LMIC))

• Tobacco → responsible for 1 out of 6 NCDs deaths

 National Health Burden of Tobacco
• NCDs are responsible for 27% of all deaths in Tanzania

• Tobacco use led to 14,700 deaths/year (4% of all deaths); 577,000 Disability-Adjusted Life Years
(DALYs)

• Global Adult Tobacco Survey (GATS) – 8.7% population smoke (14.6% men, 3.2% women)

• Global Youth Tobacco Survey (GYTS) -9.7% of youth smokers

• 13.8% of adults exposed to secondhand smoke (SHS) at home

• 32.9% exposed to SHS at workplaces

• 77.0% exposed in bars & nightclubs

• 31.1% exposed in restaurants

• 15.3% exposed in university campuses

 Harmful/Deadly Effects of Tobacco Use
• Global Statistics on Tobacco-related Cancers

• Smoking is responsible for:

– 80 to 90% of lung cancers

– 50% men, 30% women bladder cancer

– 30% pancreatic cancer

– 85% head & neck cancers – mouth, tongue, throat, nasal cavities &
sinuses
• Doubles the risk of oesophageal cancer

• 20% of kidney cancers

• Doubles the risk of stomach cancer

• 12% of fatal colon cancer

• 25% of acute myelogenous leukaemia

• Women smokers for 25 years or more – twice likely to develop

ovarian cancer
• Smoking can:

– Increase the risk of liver cancer

– Accelerate damage to cervical tissues caused by

HPV primary cause of cervical cancer

– Triple the risk of skin cancer – squamous cell

carcinoma
 Statistics on Tobacco related Cancers in
Tanzania
• 32% of all cancers tobacco-related

– Cost to the government. >$40m/year

• Major cancer sites and prevalence of smoking:

– Cervix - 35.7% (20/56)

– Head and neck – 25.7% (9/35)

– Larynx – 83.0% (5/6)

– Lung – 60.0% (3/5)

– Oesophagus – 66.7% (18/27)

– Urinary bladder – 37.5% (3/7)

– Smokers were 3.9 times more likely to get cancer than non-smokers
Tobacco and Cancer
 Smoking Related Cancers
• Breast cancer – pre-menopausal breast cancer & aggressive
forms of breast cancer- current & former smokers

• Prostate cancer – smoking increases the likelihood of

development/diagnosis

• Hepatoblastoma (rare children liver cancer) – parents who

smoked before or during pregnancy- starts with the foetus.

– Risk is twice as much if one parent smoked; 5 times if both

smoked
 Smoking and Cardiovascular Disease
• Smoking weakens the heart and increases blood pressure

• Smoking causes constricted and clogged arteries and heart attack

• Causes one-tenth of cardiovascular disease

• Second leading cause of CVD after high blood pressure

• Risk of coronary heart disease -25% higher in female smokers than in male smokers

• The risk of a non-fatal heart attack increases by 5.6 % of every cigarette smoked - persists even at only 1
to 2 cigarettes per day

• Chewing tobacco more than doubles the risk of heart attack

• Smoking bans – decrease the rates of heart attacks

• Evidence indicates – smoke-free laws are one of the most cost-effective ways to prevent heart attacks
 Smoking and Diabetes
• Smoking leads to type 2 diabetes: smokers are 30 – 40% more likely to get type 2 diabetes than
non-smokers

• Tobacco use can increase blood sugar levels and lead to insulin resistance

• People with diabetes who smoke – are more likely to have trouble with insulin dosing and
controlling their disease

• Smokers with diabetes have higher risks for complications, including:

– Heart and kidney disease

– Poor blood flow in the legs and feet that can lead to infections, ulcers, and possible amputation, (see
diagram of diabetes foot)

– Retinopathy

– Peripheral neuropathy
 Smoking and Chronic Obstructive
Pulmonary Disease (COPD)
• COPD – almost always caused by smoking

• Smoking accounts for as many as 9 out of 10 COPD-related

deaths

• COPD – most often in people 40years or older – current or

former smokers

• Smoking during childhood and teenage – can slow lung

growth & development resulting in an increased risk of
developing COPD in adulthood
 Smoking and Mental Health
• Mental health disorders – closely tied to tobacco use → high smoking rates

• Current smoking prevalence increased with a greater number of mental

illnesses - 18.3% for people with no illnesses to 61.4% for people with 3 or
more mental illnesses

• Tobacco use may:

– Cause or worsen anxiety disorders

– Increase the severity of symptoms of schizophrenia & bipolar disorders

• Persons with mental illness die disproportionately from smoking-related

diseases
 Tobacco and Oral health
• Smoking or chewing tobacco:

• Cause 80 – 90% of oral cancers

• Increased risk of periodontal disease

• Bad breath

• Tooth discolouration

• Increased build-up of dental plaque

• Delayed healing following tooth extraction; periodontal treatment or oral surgery

• Smoking + alcohol consumption: greater risk of oral cancer than the combined risk of
smokers only and those who only drink alcohol
Effect of Smoking on Pregnancy
 Miscarriage and stillbirth

 Ectopic pregnancy

 Placental abruption

 Placenta previa

 Preterm birth

 Low birth weight

 Birth defects – congenital heart defects,

problems with the structure of the heart,
cleft lip, cleft palate
 Secondhand Smoke
• Second-hand smoke (SHS) is a combination of:

– smoke from a burning cigarette (sidestream smoke) &

– smoke exhaled by a smoker (mainstream smoke)

• Can cause many of the same diseases as active smoking. At

high risk:

– Service industry workers – bar & restaurant attendants

– Pregnant women – both mother & unborn baby

• Infants & children

– frequent colds & respiratory infections

– slow/incomplete lung growth; asthma & chronic coughs; chronic

and/or recurrent ear infections

– sudden infant death syndrome (SID); high blood pressure;

learning & behaviour problems; cataracts; poor dental health

– increased likelihood that the children themselves will become

smokers
 Thirdhand Smoke
• Thirdhand smoke (THS) – harmful toxins that linger in places where
people have smoked

• THS contain toxic chemical cancer-causing agents – arsenic & cyanide

• THS can cling to hair, clothes, dust, furniture, car upholstery, restaurant
walls, anywhere

• Nicotine in tobacco smoke reacts with normal chemicals in indoor air

to form new carcinogens

• Toxic chemicals continue to be produced on any surface smoke touches

leading to increased exposure & contamination
Hazards of Tobacco Farming and Processing

• Green tobacco sickness (GTS) - nicotine poisoning

from tobacco leaves

• Farmers smoke raw tobacco

• Drying, curing & processing - individuals become

de-facto smokers

• Suffer similar consequences as smokers

 Management of Quitting Smoking and its
Effects
• Smokers should be encouraged/assisted to quit smoking.

• Why quit?

– Quit for your health and avoid smoke-related diseases

– Quit for your finances → smoking is very expensive – try to calculate the
yearly expenditure

– Quit for your looks → cosmetic benefits – better looks – smokers’ skin age
faster

– Quit for the people in your life → protect loved ones from SHS and THS
• Difficulty of Quitting

– Whether a teen smoker or a lifetime pack-a-day

smoker – quitting can be tough

– Smoking – physical addiction & psychological habit

– Nicotine withdrawal symptoms

Nicotine Withdrawal Symptoms
• Most withdrawal symptoms peak 2 -3 days
after the last cigarette – subside gradually

• Unpleasant but temporary – get better as

toxins are flushed from the body
 Quitting Smoking
• Quit smoking cold turkey - giving up smoking all at once without the aid of any
nicotine replacement therapy (NRT) products or drugs

• Systematically decreasing cigarettes

• Reduce nicotine intake gradually

• Nicotine replacement therapy or non-nicotine medication to reduce withdrawal

symptoms

• Utilising nicotine support groups

• Trying hypnosis, acupuncture or counselling

• May succeed with one method or a combination – see what works best
Coping with Nicotine Withdrawal
Symptoms
 Self-Stop Smoking Plan - Start
S = Set a quit date - within the next two weeks

T = Tell family, friends & co-workers that you plan to quit – support &
encouragement

A = Anticipate and plan for challenges – withdrawal symptoms

R = Remove cigarettes & other tobacco products from home, car &
work (no emergency pack!)

T = Talk to your doctor/counsellor about getting help to quit –

medication for withdrawal symptoms
Challenges of Tobacco Control in Tanzania

• Lack of effective tobacco control policies that

abide by the World Health Organisation (WHO)
Framework Convention on Tobacco Control
(FCTC)

• UN - World leaders adopted the 2030 Agenda for

Sustainable Development with 17 Sustainable
Development Goals and 169 Targets including
NCDs and tobacco control (25 September 2015)
Solution to Tobacco Control in Tanzania
• Fully implement the WHO FCTC

• First treaty in public health International law –

reaffirms the right of all people to the highest
standard of health

• Comprehensive tool for effective & sustainable

tobacco control has 12 (38) important Articles for
effective tobacco control
 Key Points
• Tobacco is one risk factor common to all major NCDs namely cancer, cardiovascular disease,
diabetes and chronic respiratory disease

• Smoking weakens the heart and increases blood pressure - CVD

• Smoking causes different types of cancers

• Smoking is the main cause of COPDs

• Smokers with diabetes have higher risks for serious complications including:

– Heart and kidney disease

– Retinopathy

– Peripheral neuropathy

– Poor blood flow