Experts at First Abelson Seminar Ponder
The Global Rise Of Chronic Disease
A growing global epidemic of chronic disease, such as heart disease,
stroke, cancer and diabetes, will cause at least 35 million deaths
this year, costing the world economy billions of dollars, even though
medical science has identified the principal causes and knows ways
to prevent it, experts said at a AAAS seminar in Washington, D.C.
Speakers at the first Philip Hauge Abelson Advancing Science Seminar
said that twice as many premature deaths are caused worldwide by chronic
diseases as by all infectious diseases, maternal and perinatal conditions
and nutritional deficiencies combined. And while the toll from infectious
diseases is declining globally, deaths from chronic disease are expected
to increase by 17 percent in the next 10 years.
The 8 December seminar included speakers from the World
Health Organization (WHO), from pharmaceutical and medical
device manufacturers and from university research labs.
It was the inaugural event in a series named for Abelson,
a researcher in physics, biology and other sciences,
and the editor for 22 years of Science,
which is published by AAAS. Abelson died last year at
the age of 91.
Alan I. Leshner, AAAS chief executive officer and executive publisher
of Science, said the seminar series would address major
societal challenges and focus on the frontiers of science and technology.
Director of Chronic Diseases and Health Promotion,
Robert Beaglehole, WHO’s director of Chronic
Diseases and Health Promotion, said in the keynote
address that the toll of premature death from chronic
disease is increasing worldwide principally because
of unhealthy diets, physical inactivity and the use
of tobacco and the aging of populations in almost all
Diet and the lack of physical activity is contributing to a growing
pattern of obesity, a key risk factor for diabetes and early heart
disease. And it’s not just happening in the rich countries,
such as the United States and South Africa, where recent reports show
that 75 percent of women aged 30 and over are overweight. A “very
frightening statistic,” said Beaglehole, is that in countries
both rich and poor, about 22 million children worldwide under the
age of five are already obese.
“We’ve done a lot to observe the emergence of this problem,”
he said. “We have done practically nothing to solve it.”
Beaglehole said that common misunderstandings about chronic disease
have affected policy decisions and slowed the worldwide response to
the emerging epidemic.
For instance, he said it’s widely believed that premature heart
disease, stroke, diabetes and other chronic diseases are mostly a
plague among the elderly and among the rich in high-income countries.
Actually, said Beaglehole, 80 percent of deaths from chronic diseases
are in low- and middle-income countries. A WHO report found that poor
people, in all but the least developed countries, are more likely
than the rich to develop chronic diseases and are more likely to die
early. And it is not just the elderly who are victims. The WHO report
found that almost half of the deaths from chronic diseases occur in
people under 70 years old.
“A very dangerous misunderstanding is that chronic disease
is the result of unhealthy lifestyles under the control of individuals,”
Beaglehole said. “The reality is that poor people and children
have very limited choices, and it is unfair to blame them for the
environmental conditions in which they suffer.”
There’s also the belief by many that chronic diseases and premature
deaths cannot be prevented.
“The reality is that approximately 80 percent of premature
heart disease, stroke and type 2 diabetes is preventable, as are 40
percent of all cancers — many of which result from tobacco consumption,"
said Beaglehole. “A few known risk factors explain the vast
majority of premature chronic disease deaths.”
A global effort to attack the causes of chronic disease could reduce
death rates by 2 percent a year and save 36 million lives within a
decade, he said. Ninety percent of the lives saved, said Beaglehole,
would be in low- and middle-income countries.
Slowing the epidemic of premature death from chronic diseases will
have to involve policy issues beyond the health field, he said. For
instance, farm subsidies often affect the type of food available in
some countries. An example: The consumption of full fat milk is encouraged
in schools in some European countries because of subsidies, said Beaglehole.
Excessive fat, sugar and salt in the diet lead to obesity, type 2
diabetes, heart disease and stroke.
Other specialists at the Abelson seminar reported recent findings
that offer new hope for treatment and management of heart disease,
high blood pressure, obesity, diabetes and cancer.
J. Topol, provost of the Cleveland Clinic Lerner College of Medicine,
said studies of families with heart attack have demonstrated specific
genes that are causative or induce susceptibility. This will allow
strategies of lifestyle and individualized therapy early in life to
prevent heart attacks decades later.
The battle against the growing epidemic of obesity will require fundamental
changes in attitudes toward food and exercise, said Holly
Wyatt, the program director at the Centers for Obesity Research
and Education at the University of Colorado Health Sciences Center.
In American society, she said, “we’ve had a lot of pressures
to not expend more energy than we have to and we had a lot of pressure
to eat more than we need.”
To change the behaviors that lead to obesity will require encouragement
from virtually every element in society — employers, schools,
churches, community centers and retail stores, she said. Such programs
have worked in the past to discourage tobacco use and encourage using
seat belts in cars. Without such an effort, Wyatt said that by 2008
about 75 percent of Americans will be at a body weight that negatively
Basic research on how the kidneys regulate salt in the body has given
medical science a new understanding of the causes of high blood pressure,
a major risk factor for heart attack, stroke and kidney failure, said
Lifton, Sterling Professor and chairman of Genetics atYale University
School of Medicine. He said there are biological pathways and gene
mutations that cause the kidneys to sequester sodium, leading to increases
in blood pressure. Drugs to counter these effects could lead to dramatically
improved treatments for hypertension, a disorder that affects a billion
people world wide and is linked to about 5 million deaths annually.
I. Shulman, an investigator of the Howard Hughes Medical Institute
and professor of internal medicine and cellular & molecular physiology
at Yale University, said that new, non-invasive studies using magnetic
resonance spectroscopy have demonstrated that the development of insulin
resistance in type 2 diabetes is directly related to the build-up
of fat inside muscle and liver cells where it disrupts normal insulin
signaling and action in these organs. Studies in transgenic and knockout
mice as well as in humans have shown that removing this excess intracellular
fat can restore insulin sensitivity and cure type 2 diabetes. The
results from these studies provide new targets for novel therapies
that might be developed to reduce intracellular fat levels and reverse
insulin resistance in patients with type 2 diabetes, said Shulman.
21 December 2005