By Dr Biji Anilkumar
 

Health is securely placed atop the invaluable hierarchy and we all know the reason why. Once health is lost, we become a burden to ourselves, to those around and to the society at large. Therefore we owe it to ourselves to safeguard our health. Modern science, through improved sanitation, vaccination, antibiotics and medical attention has eliminated the threat from most infectious diseases which were once the leading cause of death globally. However as world becomes more industrialised, a new breed of diseases has developed called lifestyle diseases, the modern day big silent killer.
 
How lifestyle causes diseases
Lifestyle diseases are those usually related to our urban style of life. The factors contributing to these disorders are: too much work with too much stress and tension, very less sleep, bad eating habits, sedentary life with little or no exercise, tobacco and alcohol addiction and so on. There’s an ever increasing list of lifestyle diseases, the most common being heart diseases especially coronary heart disease, diabetes, hypertension (high blood pressure), hyperlipidemia (high cholesterol), obesity, chronic obstructive pulmonary diseases and some cancers like lung, oral cavity etc. Globally 14.2mn people between the ages of 30-69 years die each year prematurely from these diseases. Hence the population at risk shifts from 40+ to may be 30+ or even younger.
 
Why is lifestyle disease screening important?
Lifestyle diseases like diabetes, hypertension, hyperlipidemia do not cause any symptoms in the initial stages and may be diagnosed only when complications set in. Screening essentially helps in identifying diseases in people who do not yet have symptoms or a sign of it and as we all know, ‘Prevention is better than cure’. It helps to understand one’s health and make lifestyle changes whenever necessary. As the list of lifestyle diseases is so vast we will consider the most simple and basic screening tests here.
 
Diabetes screening:
Diabetes mellitus or simply diabetes is a group of metabolic diseases with high levels of sugar in the blood resulting from defects in insulin secretion from pancreas. Long term diabetes is associated with damage and failure of various organs especially the eyes, kidneys, nerves, heart and blood vessels. Early detection and prompt treatment may reduce the burden of diabetes and its complication. Screening for diabetes should start from the age of 30 years and then retesting every two years. Depending on risk factors like overweight or a family history of diabetes, start screening early and should have more frequent checks for diabetes.
The best screening test for diabetes is the Fasting Blood Sugar (FBS) test. FBS measures blood glucose after you have not eaten for at least 8 hours.
Two-hour Post Prandial Blood Sugar (PPBS) — measures blood sugar level exactly two hours after you start eating a meal. Fasting blood sugar (FBS) level range between 70 and 100mg/dL (3.9-5.6 mmol/L) and Postprandial Blood Sugar (PPBS) level below 140mg/dL (7.8 mmol/L) is considered normal.
HbA1C testing is another popular blood sugar test which measures average blood glucose levels for a period of up to 3 months prior to the test. It is not a screening test but shows how well you are controlling your diabetes. Normal value is less than 6% and the ranges may vary slightly among different laboratories.

Blood pressure screening:
Hypertension or high Blood Pressure (BP) is a major health problem, accounting for nearly 6% deaths worldwide. Though hypertension by itself does not cause any symptoms, unrecognised and hence untreated high blood pressure can result in complications like stroke, heart attack, kidney failure etc. BP is checked using an instrument called sphygmomanometer or BP apparatus. It can be done by a doctor or healthcare personnel.
Automated BP devices are now available that permit self-recording at home. People over the age of 18 years are recommended to get their BP checked once in  two years and every three months if it is detected to be high. Normal blood pressure is when your blood pressure is lower than 120/80 mmHg and high blood pressure (hypertension) is when your blood pressure is 140/90 mmHg or above most of the time.
Persons with systolic blood pressure between the ranges 120 to 139 or diastolic blood pressure 80-89mm of Hg, called pre-hypertension should be encouraged to adopt lifestyle modifications to prevent the development of hypertension.
 
Lipid profile screening:
Lipids are substances like cholesterol and triglycerides that are derived from fats. Triglycerides store unused calories and cholesterol is used to build cells and certain hormones. Excessive lipids in blood deposit in the lining of blood vessels and lead to a condition called atherosclerosis which can result in a number of complications like heart diseases, stroke, kidney diseases etc.
Under lipid profile we check different lipid parameters like total cholesterol, triglycerides, HDL, LDL and VLDL. Lipid profile test is done preferably after overnight fasting and should be done at least once in two years from the age of 20 years. People less than 20 years may be screened if there is obesity, hypertension or any history of premature heart disease or very high cholesterol level in immediate family.
•Total Cholesterol: measures HDL, LDL and VLDL together in the blood. A level of less than 200mg/dl is desirable
•HDL: High Density Lipoprotein (HDL) is called the Good Cholesterol as it helps remove cholesterol from the arteries and so protect us from dangerous plaques or blockages in the arteries. More than 35mg/dl is preferred.
•LDL: Low Density Lipoprotein (LDL) carries majority of cholesterol through your blood stream. It readily oxidises and gets deposited as plaques on the arterial wall likely to clog arteries. So it is called Bad Cholesterol. Normal range is less than 130mg/dl.
•VLDL: Very Low Density Lipoprotein is a form of cholesterol that helps distribute triglycerides in the blood. It is converted to LDL in the blood stream. Hence high VLDL is also considered as bad to our body. Desirable level is less than 50mg/dl.
•Triglycerides: If you regularly eat more calories than you burn, you may have high triglycerides (hypertriglyceridemia). A high triglyceride level along with high LDL cholesterol levels increases the chances of heart disease. Normal is less than 150mg/dl.
 
Cancer screening:
The ACS (American Cancer Society) has put out a simple ‘C-A-U-T-I-O-N’ remainder to recognise the seven signs of cancer. C: Change in bowel or bladder habits A: A sore that does not heal U: Unusual bleeding or discharge T: Thickening or lump in the breast or elsewhere I: Indigestion or difficulty in swallowing O: Obvious change in a wart or mole N: Nagging cough or hoarseness.
Some other symptoms that may also signal the presence of some types of cancer are: persistent headaches, unexplained weight loss or loss of appetite, chronic pain in bones or any other areas of the body, persistent fatigue, nausea or vomiting, persistent low grade fever either constant or intermittent and repeated infections. These aren’t a cancer diagnosis, but only warning signs that you may want to get checked out with a healthcare professional to see if you have the condition.
 
Lifestyle modifications:
Lifestyle diseases are usually attributed to dramatic shifts in the way human live their life. Along with these screening, modest but achievable adjustments to lifestyle behaviours are likely to have considerable impact at the individual and population levels. The combination of healthy lifestyle factors like — maintaining healthy weight, exercising regularly, following a healthy diet, cessation of tobacco consumption and other addictions, learning to cope up with stress and enough sleep — seem to be associated with as much as an 80% reduction in the risk of developing lifestyle diseases.
 
• Maintain a healthy weight: When we put on weight, the gain is mostly fat especially abdominal fat rather than muscle. Waist circumference is a useful simple tool to measure abdominal fat. Men are considered overweight if the waist measurement is greater than 40 inches (101.6cm) and women if it is greater than 35 inches (88.9cm). Reducing weight by just 10% can decrease your blood pressure, lower blood cholesterol level and reduce your risk of diabetes.
 
• Exercise regularly: Doing some regular daily exercise can reduce chances of developing high blood pressure, high cholesterol and diabetes. It also reduces stress which may be a factor in heart diseases. Try getting at least 30 minutes of moderately intense physical activity most days of the week.
 
• Follow a healthy diet: The World Health Organisation (WHO) makes the following five recommendations with respect to both populations and individuals.
(1)Try to burn as much energy as you eat, and try to eat as much energy as you burn, as a healthy weight is a balance between those two.
(2) Increase consumption of plant foods, particularly fruits, vegetables, legumes, whole grains and nuts.
(3) Limit intake of fat and oil, and avoid saturated fats, which are those that become solid at room temperature such as coconut oil and most animal fats including those found in red meat, dairy and eggs. Prefer unsaturated fats, which remain liquid at room temperature, and are predominant in most plant-based oils and foods. Eliminate trans fats which are seen in deep fried fast foods, bakery products, packaged snack foods.
(4) Limit the intake of granulated sugar
(5) Limit salt/sodium consumption from all sources and ensure that salt is iodised.
 
• Stop smoking and other addictions: Smoking is a major risk factor for heart attacks, Chronic Obstructive Pulmonary Disease (COPD), emphysema, and cancer, particularly lung cancer, cancers of the larynx and mouth, and pancreatic cancer. If someone stops smoking, then these chances gradually decrease as the damage to their body is repaired. A year after quitting, the risk of contracting heart disease is half that of a continuing smoker. High levels of alcohol consumption are associated with an increased risk of alcoholism, malnutrition, chronic pancreatitis, alcoholic liver disease — cirrhosis, and cancer.

Stress management:There will never be more hours in the day and your career and family responsibilities will always be demanding. In fact, the simple realisation that you’re in control of your life is the foundation of stress management. Adequate sleep is also important; it fuels your mind, as well as your body. Feeling tired will increase your stress because it may cause you to think irrationally. A good night’s sleep not only makes one alert and energetic throughout the day but also keeps away some lifestyle diseases like hypertension, arthritis and heartburn.
Children are increasingly falling victim to lifestyle diseases with incidence of diabetes, hypertension, depression, obesity, thyroid and joint problems in under 18 years are rising considerably in recent past. Indulging in junk food, addiction to television and aversion to outdoor activities are reasons why they are developing these disorders.
You have the power to change your lifestyle and you should consider this while you are young and healthy. Remember the quote by Jim Rohn, the American personal development legend, ‘Take care of your body; it’s the only place you have to live’!
 
*** The author is MBBS, DCP, DNB, Anatomical and Clinical Pathology, Aster Medical Centre, Industrial Area.