TABLE OF CONTENTS
WHAT WILL KILL YOU FIRST: SMOKING, A HIGH FAT DIET OR ALCOHOL ABUSE 1
SMOKING 1
COMPLICATIONS: 2
PATIENT PRESENTATION WITH COMPLICATION OF SMOKING 4
IMPACT OF SMOKIING ON MORBIDITY AND MORTALITY 5
PRE-HOSPITAL MANAGEMENT TO AVOID RISKS ASSOCIATED WITH SMOKING 6
COMPLICATIONS OF A HIGH FAT DIET: 7
IMPACT OF EACH RISK FACTOR ON MORBIDITY AND MORTALITY 10
COMMON PATIENT PRESENTATION 11
PRE_HOSPITAL MANAGEMENT TO AVOID RISKS ASSOCIATED WITH HIGH FAT DIET: 11
COMPLICATIONS OF ALCHOHOL ABUSE: 12
IMPACT OF EACH RISK FACTOR ON MORBIDITY AND MORTALITY 13
COMMON PATIENT PRESENTATION: 14
PREHOSPITAL ANAGEMENT : 14
COMPPARISON OF OVERALL IMPACT OF RISK FACTOR: 14
What will kill you first: smoking, a high fat diet or alcohol abuse
All these three are associated with modifiable non-communicable diseases. Non-communicable diseases are diseases that are not transferable from one person to the other. These are slowly progressive diseases. Modifiable diseases are those diseases which can be cured by changing sedentary lifestyle, poor dietary habits, lack of exercise or low physical activity, consumption of saturated or hydrogenated fat and etc.
SMOKING
Smoking is one of the prominent and single most preventable causes of death worldwide. This means that thousands of deaths worldwide due to smoking can be prevented by cessation of smoking. Smoking does not affecting the person who smokes but also affect others in the surrounding area indirect smoke inhalation known as secondhand smoke. Tobacco in cigarette contains thousands of compounds that hastoxic effect on the human body. Smokers die at a relatively younger age when compared to the non-smokers. Smokers are more likely to develop heart diseases, lung cancer and stroke when compared to the non-smokers(Ahmad, Selvaraj, & Meenakshisundaram, 2015).
COMPLICATIONS:
Smoking usually decreases some years of life time between 10 to 12 years. Smokers die earlier due to the impact of nicotine and other toxins from smoke on every body system. Major cause of death in smokers is due to respiratory and cardiovascular diseases (including coronary artery diseases, bronchitis, emphysema, CA of trachea/lungs/bronchus /colon, etc.)(Balter, Good, & Barrett, 2015). Tobacco affects the entire body from head to toe. Prolong smoking has the following impact on the body systems:
1) EYE: In the eyes, smoking can cause cataract, poor vision, dry eyes, uveitis, diabetic retinopathy and blindness.
Smoking causes 3 fold increase in the risk of developing “age related macular degeneration” (ARMD) that basically affects the part of central retina which is responsible for the central field of vision. This macular degeneration causes blind spots in the retina that leads to vision impairment(Chaiton, Cohen, Rehm, Abdulle, & O’Loughlin, 2015)
2) GIT: In GIT, nicotine causes appetite suppression, GERD, peptic ulcer, colon polyps, liver diseases (cirrhosis, fatty liver disease), Crohn’s disease, pancreatitis, gallstones gingivitis, periodontitis, tooth decay, mouth CA.
Smoking weakens the lower esophageal sphincter that leads to GERD. Smoking also increases the risk of H. Pylori infection and ulcer formation. Smokers have 0.82 fold greater risk of acquiring H.pylori infection as compared to the non-smokers
3) RESPIRATORY SYSTEM: smoking affects each part of the respiratory system from the mouth to the alveoli. Cigarette smoking causes infections, emphysema, COPD, bronchitis, pneumonia.
Smoking impairs the action of cilia of respiratory epithelium that usually assist in sweeping mucus, debris and other pathogens out. When the function of cilia is impaired, there is no proper removal of mucus, consequently this mucous clog the normal airway and become a favorable site for the pathogenic organisms to excess body. Coughing leads bronchitis that further destruct respiratory epithelium and causes bronchial epithelial hypertrophy, bronchial elasticity is also lost and alveolar walls are ruptured. These structural changes lead to emphysema(Espada et al., 2015).
Smoking has also a strong association with respiratory cancers, including LUNG and Larynxcancer. Basically inhaled smoke contains hundreds of toxic substances (like benzene, pyrene, polonium, nitrosamines) that enter the lungs and spread into the body via absorption through lung capillaries. These toxic substances when come into circulation can damage DNA and can bring modification in normal genes which can alter cell cycle. This alteration in cell cycle leads to abnormal cell growth. The most common gene mutations involve p53, p16, EGFR, c-MYC, HER-2/neu and KRAS(Gamble, Grant, & Tsourtos, 2015).
Classification of Lung CA is: 1) adenocarcinoma, 2) Broncho alveolar carcinoma, 3) small cell carcinoma and 4) squamous cell carcinoma
4) CVS: In the cardiovascular system, smoking causes Vasoconstriction, hypertension, peripheral artery disease, atherosclerosis, stroke, coronary heart disease, and angina. Arrhythmias, Blood CA, too much clotting.
Smoking leads to the sub-intimal accumulation of LDL that leads to atherosclerotic plaque formation. Due to this atherosclerosis there are various complications, including MI, stroke, etc. Smoking also causes elevated blood pressure that leads to increase heart rate and decrease cardiac output(Massey et al., 2015).
5) CNS: Effects of cigarette smoking on CNS includes anxiety, irritability, mood alteration, nicotine craving, cognitive impairment, irritation, depression.The effect of nicotine on brain tissue is neuroregulatory as the level of epinephrine and norepinephrine rises. There is also release of beta-endorphin, arginine vasopressin, cortisol and adrenocorticotrophic hormone(Rohsenow et al., 2015).
6) REPRODUCTIVE SYSTEM: Smoking causes infertility, cervical CA, early menopause, erectile dysfunction, low sperm count, gonadal dysgenesis, complications of pregnancy, ectopic pregnancy, LBW (low birth weight) babies, SIDS (sudden infant death syndrome) neural tube defects.
Smoking affects the uterine receptivity and reduces the number of germ cells in an ovary. In males, smoking can affect motility of sperms by interfering action of protamine
7) INTEGUMENTRY SYSTEM: Nicotine has a great impact on integumentary system in terms of skin discoloration, wrinkles, pale teeth
Skin has nicotinic receptors that respond to the nicotine in cigarette. Ability to smell and taste is also impaired due to nerve ending damage with the rise in blood carbon m0nooxide level.
Patient presentation with complication of smoking
The patient can present with the following symptoms:
Tachypnea, Cough, Dyspnea (shortness of breath), Fatigue, decreased in stamina, cold hands and feet, aging and skin wrinkling, tooth and gum disease, asthma, Wheezing, Decrease breath sounds, Rhonchi, Hypoxia, Nausea, Vomiting, Sleepiness or confusion, Teflon particles, Inhalation injuries, Carbonaceous sputum, Respiratory distress syndrome, Burns or thermal injuries, Carbon monoxide poisoning, Loss of consciousness or death and Renal tubular acidosis(Tabuchi & Fujiwara, 2015).
IMPACT OF SMOKING ON MORBIDITY AND MORTALITY
• The risk of dying from smoking has increased over last 50 years. The mortality rate is 3 times higher in smokers than in non-smokers
• The risk of dying from lung cancer due to smoking before 85 years of age is almost 22.1% in males and 11.9 % in females (life expectancy is 10 to 12 years less in smokers)
• Deaths from smoking are more than 480,000 per year (278,544 men’s deaths and 201,773 women death). Deaths from secondhand smoke is 7,400 per year
• Due to smoking, the quality of life is decreased significantly. About 70 % HIV patients have a positive smoking history(Veilleux & Skinner, 2015).
• Cessation of smoking can reduce risk of lung CA. Smoking of one pack of cigarettes daily can double the death rate from ischemic heart diseases
• Smoking causes more deaths each year than the combined deaths from alcohol, HIV, accidents and firearm injuries
• The major cause of death is cance as a result of smoking
• The risk of inhalation injury is estimated by knowing the amount of smoke inhaled, its duration and toxins in the smoke
• Patient with Diabetes mellitus, Myocardial Infarction and Cancer have more than 50 % a history of smoking
PRE-HOSPITAL MANAGEMENT to avoid risks associated with smoking
• Primary prevention and control through health education and anti-smoking campaigns
• Treatment guidellines with global standards
• Technical support to implement guidelines along with analysis
• Quitting smoking before the age of 40 years can reduce the risk and complications by 90%
• Diet modification ( low intake of alcohol and saturated fats that can worsen complications)
• Increase physical activity
• Behavioral modification
NICOTINE withdrawal is the primary prevention. For thosewho can not stop from nicotine comsuptionfor whom it’s impossible to withdraw nicotine, there are several other means, including “NICOTINE PATCHES, NICOTINE GUMS< INHALARS, NASAL SPRAYS. Sometimes non-nicotine treatment is also prescribed; like the use of CHANTIX.
Anti-smoking campaigns are designed to avoid complications of smoking. This campaign includes following steps:
1) Cessation of smoking at once
2) Increase the time interval between each cigarette if patients unable to quit at once
3) Taper off number of cigarettes per day
4) Use of nicotine gums or patches instead of cigarette
5) Bupropion is effective to quit smoking
A HIGH FAT DIET
Poor dietary habit is killing more people than anything else. Diet is a modifiable risk factor for various heart diseases. There are following types of dietary fats:
1) GOOD FATS: Unsaturated, polyunsaturated and monounsaturated fats. Omega 3, omega 6 fish oil, vegetable oil and seed oil are beneficial for health
2) BAD FAT: This includes saturated fats, trans-fats, hydrogenated fats ( present in cakes ,cheese, fast food,margarine, cream, etc.)
COMPLICATIONS OF A HIGH FAT DIET:
Increase fat in the body increases the risks of cardiovascular diseases.
1) ATHEROSCLEROSIS:High fat in blood is termed as HYPERCHOLESTROLEMIA which is the most important risk factor in developing atherosclerosis. Atherosclerosis is basically hardening of the arteries ranging from small size arteries to arterioles and is characterized by the sub intimal lesions. Diet is a modifiable risk factor that plays central role in developing atherosclerosis. In the past atheromatous plaque formation was termed as cholesterol storage disease
PATHOPHYSIOLOGY: The major component of serum cholesterol associated with increased risk of developing atherosclerosis is LDL (low density lipoprotein). LDL is regarded as poor or bad cholesterol. LDL is the form of cholesterol that is delivered to the peripheral tissues. HDL (high density lipoprotein) is the best cholesterol. Increasedlevel of LDL in blood and decreasedlevel of LDL IN BLOOD l relates directly to the increased risk of atherosclerosis.
Mechanism of atheromatous plaque formation includes the following steps:
• Injury to the arterial endothelial layer causes increasein vascular permeability that leads to the accumulation of LDL in vessel wall ensuring atheroma formation. There is intimal thickening
• monocyte adhesion and the transformation is refered to macrophages, which are also termed as foam cells.
• Furthermore, platelet adhesions and a release of some factors that causes recruitment of smooth muscle cell. These factors include platelet derived growth factor (PDGF), TFG, FGF, etc.
• A proliferation of smooth muscle and production of extracellular matrix along with lipid deposition
• COMPLICATIONS: There are various complications of atherosclerosis depending upon the involvement of arteries. Atherogenic stenosisis arterial vessel lumen occlusion due to atheromatous plaque in the arterial wall that cause ischemic injury of organs or tissue distally to the lesion. This atheroma impedes blood flow
• CORONARY ARTARY DISEASE: Atheroma formation causes narrowing of the coronary artery vessel lumen that impedscoronary blood flow. The mortality rate due to ischemic heart disease is the highest in the world. The most commonly involved artery is anterior descending coronary artery
• PERIPHERAL ARTERY DISEASE: In this condition, atheromatous plaque is formed in the arteries of the arms or legs. Due to this disease, limbs become less sensitive to heat and cold, so the risk of burns and frostbite is enhanced that can lead to gangrene formation
• CAROTID ARTERY DISEASE
• ANEURYSMS: Atheroma basically weakens the underlying media that consequently weakens the arterial wall leads to the dilation of a segment of the vessel wall. This dilation in arterial walls is termed as aneurysm, which is prone to rupture. The most common site of an aneurysm is descending aorta
• 2)CHRONIC PANCREATITIS: The diet rich in fat is the major risk factor for causing chronic pancreatitis due to pancreatic exocrine insufficiency
• 3) CONSTIPATION: persons who take high fat diet easily gets constipated and also experience abdominal bloating
4) OESITY: High fat intake is related to obesity and obesity in turn is related to various chronic disorders like diabetes mellitus, cardiovascular problems, etc. Obesity is a serious health problem that is linked to various other health conditions. It is associated with various cancers like breast cancer, kidney cancer, colon cancer and esophageal cancer
Fat carries the more amount of calories (9 calories per 1 gram) as compared to the calories in proteins and carbohydrates (4 calories per 1 gram). Excessive fat intake leads to consumption of more calories per day and there is deposition of central fat initially than peripheral fat is deposited later on
Obesity is measured by BMI. A person with a BMI between 18.5 to 24.5 is normal.and Person with BMI more than 30 is obese, while the person having BMI between 25 o 29.9 is overweight and a person having BMI below 18.5 is underweight
Fat tissues increases estrogen level that leads to increased risk of breast CA. Obesity is also related to increased levels of insulin like growth factor
5)TYPE 2 DIABETES: Diet rich in fat causes type 2 diabetes indirectly by inducing inflammation
The diet rich in fat can interfere with the enzyme known as GnT4a glycosyltransferase. GnT4a glycosyltrasferase is required for the retention of glucose transporters in beta cells of the pancreas. When the function of this enzyme is disturbed due to high fat diet then insulin resistance emerged
6)GALL BLADDER DISEASE: People who have high intake of fat rich food are at great risk of having cholysystitis
7)HYPERTENSION: High fat intake is also related to secondary hypertension
8)BREAST CANCER: high fat diet increases blood estrogen level secondary to obesity that leads to increase incidence of breast cancer
IMPACT OF EACH RISK FACTOR ON MORBIDITY AND MORTALITY
• Persons who have high fat intake will experience hypertryglyceryemia, low HDL level, high LDL level and metabolic syndrome
• Epidemiological evidence supports that high fat diet is promoting health related issues day by day
• In non-communicable diseases, unhealthy diet contribute to 30% of preventable mortality and morbidity rate
• There is an association between high fat dietary consumption and risk of cancers, especially of prostate, breast, colon and ovary.
• The supstances in fruit, fishs and vegetables can lower the risk of having cholycystitis (gall bladder inflammation)
COMMON PATIENT PRESENTATION
1) OnCARDIC VASCULAR system, the patienrt will present with:
Chest pain, headache, high blood pressure,vision impairment,tachycardia and palpitations
2) Patient with pancreatic complication will present with:
Sudden onset of abdominal pain. Pain radiates towards the back, Nausea and vomiting, Anorexia, Fever, Achycardia, Jaundice, Hypotension, Abdominal tenderness and dyspnoea
PRE_HOSPITAL MANAGEMENT to avoid risks associated with high fat diet:
• Intake of food that with low in saturated fats like brown rice, whole grain bread, cereals and oats
• Intake of less calories to reduce body fat
• More intake of fresh fruits and vegetables
• Intake of lean meats like fish and chicken
• intake of low fat dairy products like margarine, butter, cream, cheese, cakes, cookies, etc.
• No matter either it’s a good or bad fat, the daily fat consumption should not exceed more than 37% of the total food intake
• Exercise. This can lower the levels of inflammation in the body and also lowers elevated levels of IGE-1 (insulin like growth factor 1
• Cessation of smoking
• Increase physical activity in persons aged between 45 and 85 can lower the oveall risk of mortality rate by high fat diet to 18 %
• Dinking more water will reduce the accumulation of toxic substances in the body
ALCOHOL
The danger of alcohol is on the national agenda for years. This is classified as central nervous system depressant as it slows down various body functions. Drinks that contain alcohol are:
Beer contains 2-6 % alcohol, cider contains 4- 8 % alcohol, liqueurs contains 15 to 60 % alcohol, wine contains 8 to 20 % alcohol, rum contains 40 % alcohol and gin contain 47 % alcohol
COMPLICATIONS OF ALCOHOL ABUSE:
Alcohol is adversely affects our body. the effects of excessive alcohol consumption on the body as follows:
CNS: Alcohol disrupts the brain’s communication pathway. This interference can lead in behavioral and mood changes. Body movement ordination is also lost . There can be unipolar major depression or epilepsy associated with alcohol drinking. Alcohol also disturbs perception slurred, speech and ability to react readily
If pregnant womenconsume alcohol, this will bring dangerousimpact on fetus in during fetal development. Alcohol can pass from the mother’s blood to the fetus. Alcohol has a devastating effect on fetal growth by affecting brain and spinal cord. The effects of alcohol on fetus include birth defects, facial abnormalities such as microcephaly, narrow eyes, growth problems, learning and behavioral problems
LIVER: Heavy drinking leads to various liver problems, including alcoholic hepatitis, fatty liver, steatosis, cirrhosis and fibrosis
CVS: Alcohol consumption has numerous effects on the cardiovascular system, including cardiomyopathy, cerebrovascular disease, elevated blood pressure, arrhythmias, hemorrhage stroke and ischemic stroke
PANCREAS: Alcholol use causes acute and chronic pancreatitis
IMMUNE SYSTEM: drinking too much can weaken our immune system and make our body more prone to infections. Chronic drinkers are more liable to communicable diseases like tuberculosis and pneumonia
CANCER: Alcohol can increase the risk of developing cancer of throat, mouth, breast, liver and esophagus
Other complications of alcohol consumption include hepatic encephalopathy, variceal hemorrhage, ascities, thrombocytopenia, iron overload, peritonitis
INJURIES: Due to impaired psychomotor abilities, secondary injuries caused bydrowning, falls or poisoning
IMPACT OF EACH RISK FACTOR ON MORBIDITY AND MORTALITY
Alcohol is related to wide mortality, morbidity and disability. Mortality rate depends upon the volume of alcohol consumption. Most of the alcohol related deaths are due to the complication of coronary artery disease. Alcohol is the 3rd leading cause of disability after malnutrition.
COMMON PATIENT PRESENTATION:
Alcoholic patient is usually lethargic with uncoordinated body movement and impaired vision. Other presentations depends on the underlying complication. If an alcoholic person has underlying liver complication then he/she will present with non-specific symptoms like low grade ever, malaise, nausea, GI bleeding,seizures and delerium
PREHOSPITAL MANAGEMENT :
PRIMARY PREVENTION: Cessation of alcohol intake
SECONDARY PREVENTION: Early diagnosis and prompt treatment given to the patient. The thrombolytic therapy should be initiated in case of stroke. Tissue plasminogen activator (t-PA) is the most commonly used.
COMPARISON OF OVERALL IMPACT OF RISK FACTOR:
According to IHME, the annual death rate due to smoking, alcohol and high fat diet is as follows:
A HIGH FAT DIET: 678,283 deaths per year
SMOKING: 465,661 deaths per year
ALCOHOL: 88,590 deaths per year
CONCLUSTIONCONCELUSION:
Smoking, alcohol consumption and a high fat diet are all related to metabolic syndrome. Metabolic syndromes include obesity, hypertension, diabetes and elevated triglyceride level. Smoking, alcohol and high fat intake are also related to hypertension and cardiovascular diseases. Cardiovasular diseases still the major one cause of death worldwide. Both cigarette, smoking and alcohol consumption are related to cerebrovascular diseases, abdominal arteryaneurysm, pre-term delivery,So now days, it is still assumed that smoking cigarette is stilla mainkill t due to its toxic effects on every part of the body. Life expectancy can be improvedif smoking, alcohol consumption and a high fat dietl are reduced from our lives
REFRENCE: J. PARK (community medicine)
Robbins and Cortan (pathology)
References
Ahmad, M., Selvaraj, E., & Meenakshisundaram, R. (2015). Chapter 14 – The Effects of Active and Passive Smoking and Cardiovascular Disease. In M. Ramachandran (Ed.), Heart and Toxins (pp. 437-457). Boston: Academic Press.
Balter, L. J. T., Good, K. P., & Barrett, S. P. (2015). Smoking cue reactivity in current smokers, former smokers and never smokers. Addictive Behaviors, 45(0), 26-29. doi: http://dx.doi.org/10.1016/j.addbeh.2015.01.010
Chaiton, M., Cohen, J. E., Rehm, J., Abdulle, M., & O’Loughlin, J. (2015). Confounders or intermediate variables? Testing mechanisms for the relationship between depression and smoking in a longitudinal cohort study. Addictive Behaviors, 42(0), 154-161. doi: http://dx.doi.org/10.1016/j.addbeh.2014.11.026
Espada, J. P., Gonzálvez, M. T., Orgilés, M., Guillén-Riquelme, A., Soto, D., & Sussman, S. (2015). Pilot clinic study of Project EX for smoking cessation with Spanish adolescents. Addictive Behaviors, 45(0), 226-231. doi: http://dx.doi.org/10.1016/j.addbeh.2015.02.009
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Massey, S. H., Bublitz, M. H., Magee, S. R., Salisbury, A., Niaura, R. S., Wakschlag, L. S., & Stroud, L. R. (2015). Maternal–fetal attachment differentiates patterns of prenatal smoking and exposure. Addictive Behaviors, 45(0), 51-56. doi: http://dx.doi.org/10.1016/j.addbeh.2015.01.028
Rohsenow, D. J., Tidey, J. W., Kahler, C. W., Martin, R. A., Colby, S. M., & Sirota, A. D. (2015). Intolerance for withdrawal discomfort and motivation predict voucher-based smoking treatment outcomes for smokers with substance use disorders. Addictive Behaviors, 43(0), 18-24. doi: http://dx.doi.org/10.1016/j.addbeh.2014.12.003
Tabuchi, T., & Fujiwara, T. (2015). Are secondhand smoke-related diseases of children associated with parental smoking cessation? Determinants of parental smoking cessation in a population-based cohort study. Preventive Medicine, 73(0), 81-87. doi: http://dx.doi.org/10.1016/j.ypmed.2015.01.028
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