Chronic diseases

in Malaysia

Dr. Rashidi Ahmad

MD(USM), MMed(USM), FADUSM, AM
24th August 2008
Pantai Batu Buruk, KT
 Objectives

• Understanding chronic diseases

• Understanding risk factors
• Understanding methods of
prevention
 Outline
 Definition
 Significance epidemiological data
 Overview chronic diseases in Malaysia
and its risk factors
 Discussion on few chronic diseases
 Introduction

• Broad definition of chronic disease: Illnesses

that are prolonged, do not resolve
spontaneously, and are rarely cured
completely.
• CDC's National Center for Chronic Disease
Prevention and Health Promotion: … and
that are preventable, and that pose a
significant burden in mortality, morbidity,
and cost.
Chronic Disease Epidemic
 Chronic Disease in US

• > 90 million Americans live with chronic dz

• Account for 70% of all deaths
• Account for > than 60% of the nation's
medical-care costs.
• Account for one third of the years of
potential life lost before age 65

The Robert Wood Johnson Foundation, Annual Report 1994;

Health, United States, 1994
 Chronic Dz in M’sia

• Total deaths in Malaysia, 2002 =

119,000.
• Total deaths related to chronic disease
in Malaysia, 2002 = 85,000.
• Chronic diseases accounted for 71% of
all deaths in 2002
 Malaysia NCD Surveillance 2005/06: CD among
Malaysian Adult Aged 25-64

• The data was obtained from 2.572 subjects,

with total response rate of 84.6%.
• ~ 11.6 million adults aged 25-64 years were
having at least one NCD risk factor.
• Only about 3% of Malaysian adults did not
have risk factor.
Common Risk Factors
 Overweight & obesity

• Prevalence: overweight (31.6%); obesity (16.3%).

• Men (30.9%), women (32.4%) were overweight
• Men (13.9%), woman (18.8%) were obese.
• 1 in 2 adults aged 25 to 64 years were either
overweight or obese.
• Indians > Malays and Chinese.
Prevalence of Obesity
 •Prevalence of overweight in Malaysia is expected to increase in
women over the next 10 years, but remain relatively constant in men
 Overweight and obesity

• Raised body mass index is a/w the

possibility of early death.
• High Tg & LDL-cholesterol, low HDL-
cholesterol.
• 3 x more likely to have HPT
• 50% of Type 2 diabetics are obese.
• Risk of breast and prostate cancer
 Hypercholesterolemia

• Prevalence: 53.5%.
• About 53.1% of men and 53.9% of women
• 1 in 2 adults aged 25-64 years had
hypercholesterolemia.
• Indians (61.3%), followed by Malays (54.7%)
and Chinese (52.9%).
Prevalence of Hypercholesterolemia
 Unhealthy diet

• The prevalence of non-meeting of dietary

guideline for vegetables and fruits intake
was 72.8%.
• About 70.3% of men and 75.5% of women
did not meet the dietary guideline.
• ~ 8.7 million or most adults aged 25-64
years did not meet the dietary guideline
for vegetables and fruits intake.
Prevalence of Unhealthy Diet (Not
enough vegetables and fruits)
~ 3.1 million Malaysian (1 in 2 men and 1 in 33 women),
aged 25-64 years were current smokers
 Smoking habit

• Prevalence of current smokers was

25.5%.
• Men (46.5%), women (3.0%) were current
cigarette smokers.
• ~ 3.1 million (1 in 2 men and 1 in 33
women), aged 25-64 years were current
smokers.
Prevalence of Current Smoker
 Physical inactivity

• Prevalence: 60.1%.
• About 55.4% of men and 65.1% of
women were physically inactive.
• ~ 7.2 million or 1 in 2 for both men and
women, aged 25-64 years were
physically inactive.
Prevalence of Physical Inactivity
 Diabetes mellitus

• Diabetes is a lifelong disease.

• DM is a disease of the pancreas (an organ
behind your stomach).
• DM occurs when the pancreas does not
produce any insulin or pancreas produces
very little insulin or when the body does
not respond appropriately to insulin
Diabetes mellitus in Malaysia

• Prevalence: 11.0%.
• 1 in 10 men and 1 in 8 women had high
blood glucose.
• Known diabetes: 543,385
• Newly diagnosed: 781,798
• Indians (20.0%), Malays (11.1%) and
Chinese (7.5%).
Prevalence of Raised Blood Glucose
 Manifestations of DM
• IDDM (type 1)
*Increased thirst
*Increased hunger (especially
after eating)
*Dry mouth
*Frequent urination
*Unexplained weight loss
*Fatigue (weak, tired feeling)
*Blurred vision
*Labored, heavy breathing
*Loss of consciousness (rare)
• NIDDM (type 2)
*Slow-healing sores or cuts
*Itching of the skin (usually
in the vaginal or groin area)
*Yeast infections
*Recent weight gain
*Numbness or tingling of the
hands and feet
*Low blood glucose levels
*Impotence or erectile
dysfunction
Complications of DM
 Risk factors
• A family history
• Race or ethnic background
• Being overweight & abnormal cholesterol levels
• Hypertension
• Age
• Drugs: thiazides, Steroid medicines
• Alcohol & Smoking
• History of gestational diabetes
• Autoimmune disease
• Viruses 
 If you are diabetic
• Balanced diet
• Exercising regularly.
• Maintain your blood cholesterol and triglyceride
levels as near normal ranges
• BP should not go over 130/80.
• Taking medicine, if prescribed, and closely
following the guidelines on how and when to take it.
• Monitoring blood glucose and BP levels at home.
• Keep to the appointments
Hypertension
 What is hypertension?

• BP > 140 mm Hg / 90 mm Hg, measured

while at rest.
• Causes: essential or secondary HPT (10%)
• Mostly asymptomatic.
• The most well known symptoms are
headache felt at the back of the head,
dizziness, fatigue and ringing in the ears.
Hypertension in Malaysia

• Prevalence: 25.7%.
• Men vs women - 26.3% vs 25.0%.
• 1 in 4 adults aged 25-64 years had HPT.
• Known hypertensives: 1.4 million
• Newly diagnosed:1.7 million.
• Chinese (31.0%), Malays (23.4%) and
Indians (21.6%).
Prevalence of Raised Blood Pressure
Hypertension risk factors
Complications
of HPT
 How can high BP can be
prevented?
• Control body weight
• Exercise regularly - 30 minutes a day
• Limit daily intake of sodium (about 1 teaspoon of
salt).
• Take more fruits and vegetables and low fat
products
• Eat food that is rich in potassium (3,500 mg)
potassium per day.
• SAY NO to alcohol or tobacco.
• Relaxation treatment: slow breathing exercise
 Reduce high sodium food

• Processed foods such as lunch meats, sausage,

bacon, and ham
• Canned soups, bouillon, dried soup mixes
• Condiments (ketchup, soy sauce, salad dressings)
• Frozen and boxed mixes for potatoes, rice, and
pasta, snacks (pretzels, popcorn, peanuts, chips),
pickled or marinated food.
• AJINIOMOTO (monosodium glutamate)
Increase high potassium diet
Heart attack
Risk factors
Stroke
Prevention
 Cancer

World Health Organization (WHO) International Agency for Research on Cancer:

World Cancer Report 2003)
 Who is at risk for cancer?
• Everyone
• In the US, cancer is likely to affect 1 in 2
men and 1 in 3 women
• The amount of risk you have depends on a
few factors (tobacco use, lifestyle choices
(such as diet and exercise), family history,
and factors in your workplace and
environment)
 Workplace or environment factors?

• Exposure to the sun can cause skin cancer, and

breathing tobacco smoke puts you at risk of
lung cancer and some other types of cancer.
• Carcinogenic: asbestos, solvents and
chemicals used for manufacturing or cleaning,
smoke or fumes from burning materials, and
many others.
Cancer of prostate
Prostate cancer manifestations

• Weak or interrupted flow of urine.

• Frequent urination (especially at night).
• Trouble urinating.
• Pain or burning during urination.
• Blood in the urine or semen.
• A pain in the back, hips, or pelvis that doesn't go
away.
• Painful ejaculation
How to detect?
 Transrectal USG

Prostate-specific antigen (PSA) level: PSA is a

substance produced by the prostate and some other
tissues in the body
Breast cancer
How to detect?

Techniques for breast

examination.
• The New Zealand Breast Cancer Foundation recommends women
between 40 and 50 have a yearly mammogram and twice yearly
from 50 years.
 Conclusions
• Chronic diseases is a major problem for
Malaysia
• At least 80% of premature heart disease,
stroke and type 2 diabetes, and 40% of
cancer could be prevented by reversing
a common factors.
Common Risk Factors