Management of Risk Factors and NCDs

The following sections outline the developed and proposed strategies to manage
NCDs and their risk factors from several perspectives.

Management of Risk Factors

The most common causes of NCDs are metabolic and behavioral risk factors and
can be largely preventable by several available means. Most global discussions
concern the risk factors of self–management (tobacco and alcohol consumption,
physical activity, weight, food, and dental health care) and focus on the role of
individual responsibility to manage the risk factors of NCDs. Health care specialists
should educate patients about their nutrition value and raise the profile of didactics,
practicums, and workshops in daily practice (68). Further, the management of NCDs
is the priority of the public health sector in most countries, because management in
society is the main direction of NCD prevention strategies. Interventions are used in
public health management in an effort to promote good health behavior. For
example, India, with its wide sociocultural, economic, and geographical diversity, is
implementing multi-sectoral (partnership between different sectors) actions to
prevent NCDs, including school health programs, initiatives of National Cancer
Control Programme, National Trauma Control program, National Program for Control
of Blindness, National Mental Health Programme, the National Tobacco Control
Program, and the National Program for Control of Diabetes, Stroke, and
Cardiovascular Diseases initiatives (69). From another approach, researchers also
highlight the environmental factors (air pollution, climate changes, sunlight) and their
impact on NCD development. Air pollution will be an important challenge in the future
and new technologies, such as microchips, will have more of an impact in air
monitoring (27).

Since diet is a common risk factor among most NCDs, it attracts more attention in an
effort to find effective strategies to provide healthy food to the community and at all
stages of life. Evidence-based nutrition interventions should be a global health
priority and the role of the dietary fat studied should be a modifiable variable in the
prevention of NCDs (29). Recent evidence suggests that a diet that is high in healthy
fat and rich in unsaturated fatty acids prevents the development of metabolic
diseases and reduces cardiovascular events (29). Many interventions addressing
poverty and development have an impact on NCD prevalence and risk (69). The
current evidence is limited to diets, and a positive effect of agricultural-based food
security programs on diet indicators has been suggested (7). A suboptimal diet is the
leading risk factor for NCDs and consumption of specific foods, rather than
macronutrients or micronutrients; it may be the most significant risk factor for NCDs
(70). Strategic health communication in the population-wide intervention includes
engaging the food industry in order to reduce the salt content in foods (71). The
concept of a sustainable diet combines health and environmental concerns and
includes the abovementioned risk factors as part of the recommendations to reduce
processed meat consumption and to increase whole-grain consumption (72).
Lifestyle activities include healthy diets and focus on limiting the use of salt, sugar,
and saturated fats (73). While our body can synthesize many of the molecules
required to function properly, essential nutrients are obtained from food.
Carbohydrates, proteins, and fats are the primary components of food. Minerals are
inorganic essential nutrients that must be obtained from food. The omega−3 alpha-
linolenic and the omega−6 linoleic acids are essential fatty acids that are needed to
make some membrane phospholipids. Vitamins (B, C, A, D, E, and K) are the
classes of essential organic molecules (such as cofactors) that are required in small
quantities for most enzymes to function properly. The absence or low levels of
vitamins can have a dramatic effect on health. A focus on the need to meet adequate
dietary intakes of essential nutrients (74) through a healthy diet is considered to be
very significant for the aging society (74). Food supplements are concentrated
sources of nutrients (minerals and vitamins) or other substances with a nutritional or
physiological effect, which are marketed in the form of pills, capsules, and/or liquids
(Table 1). These dietary supplements offer many benefits, including the maintaining
of an adequate intake of certain nutrients, to correct nutritional deficiencies, or to
support specific physiological functions. Recently, researchers have been looking for
new solutions to implement an efficient food production process and to discover the
benefits of starch waste on human health.

Management of NCDs
NCDs are the silent killers threatening health without showing any symptoms until
the problem progresses to an advanced stage. Patients with NCDs, or people with a
susceptibility to develop one, need long-term care that is personalized, proactive,
and sustainable. Primary health care can organize and deliver healthcare strategies
to manage NCDs in each community and to detect diseases at early stages. Thus,
they can significantly overcome the challenges linked to a high cost in the health
sector. For example, several studies have proved that lifestyle factors have direct
links to cancer risk and changing lifestyles, in a positive approach, can considerably
minimize the cancer burden. The main risk factors of cancer are age, gender,
alcohol, smoking, family disease history, and food (90–92). Cancer can be prevented
by changing behavior: dietary improvements, physical activity, weight control, obesity
management, tobacco prevention, safe sex and control of oncogenic viruses, sun
protection, medications, and lower alcohol consumption (26).

A dramatic decrease in all cardiovascular disease-related deaths has been recorded

in high-income countries, whereas a significant increase was registered in low and
middle-income countries (93, 94). Checkley et al. reported on NCDs' management in
low and middle-income countries (95). While some people in these countries can
access the same treatments that are available in high-income countries, the majority
of the population lacks access. The main obstacle causes an increase in the number
of patients with NCDs in low and middle-income communities is the absence of a
well-designed plan to stop disease occurrence and spreading. Each country needs
to prepare its management plan, not just with coping models from high-income
countries. Several successful models have been verified, taking into consideration
the low-cost strategies to prevent, diagnose and treat NCDs. For example, a cost-
effective strategy has been developed in Kenya to diagnose diabetes and
hypertension in the early stages of life. While health workers are visiting homes to
examine human immunodeficiency virus (HIV) infection, they also measure blood
glucose levels and blood pressure. Further, type 2 diabetes is a global pandemic that
highly affects human health and global economic development (96). The
International Diabetes Federation reported that there were 415 million people living
with type 2 diabetes in 2015, and estimated that the number by 2040 might increase
to 642 million, which is attributable to genetic and environmental factors (96). The
genetic–environmental interaction induces insulin resistance and β-cell dysfunction
(96). The epidemic of type 2 diabetes in recent decades has not only attributed to the
alteration of the gene pool, but environmental changes also play significant roles in
the rapid increase in the prevalence of type 2 diabetes (96). However, global
diabetes mellitus epidemics require the looking for innovative approaches to
prevention (7).

Contemporary Prevention Strategy of NCDs

The prevention strategies of NCDs can include small and large-scale human
cooperation (Figure 3). The importance of preventing NCDs arises from the direct
impact of NCDs on the decreasing rate of national income. Loss productivity on a
large-scale is the result of the inability to work and the frequent absence threats to
the national economy. The management strategy to prevent NCDs is based on risk
factor management that addresses individual, society, country, and global levels,
with actions, such as resource allocation, multi-sectoral partnership, knowledge and
information management and innovations. The most critical dimension of the
prevention strategy is lifestyle management at the individual level and with a focus
on actions, such innovations, which can help the society to increase the awareness
of risk factors management, to take health policy decisions at a country level and to
develop a health strategy at the global level. The importance of leadership for the
change management process is underscored and requires the creation of new
approaches to the prevention of NCDs (96, 97).

FIGURE 3
At the global level, WHO and UN agencies can work together to design policies and
strategies to reduce the risk of NCDs (98, 99). It is important to monitor NCDs and to assess
their progress at the national, regional and global levels. These organization can support
research and encourage collaborations among national and international health agencies
and academic institutions. Further, tobacco smoke, as a common factor of the four main
types of NCDs, must be put under control. The WHO offers help to smokers who have the
desire to stop using tobacco products and to implement rules to propose a smoke-free
environment. Further, WHO can, by law, protect tobacco control policies from the
commercial interests of the tobacco industry. At the country level, each government needs to
design its plan based on its economy. Several low-cost and highly effective strategies are
available to prevent and manage NCDs (100–103). For example, encouraging people to play
sports for physical activity is the most effective factor that can easily influence the prevention
of NCDs, and at the same it is time and cost-effective. Moreover, improved budgetary
allocations to support primary health care systems should be put in place in order to provide
health services to all community members. To achieve large-scale progress, collaboration
between governments and various non-governmental organizations, schools, and
universities, to provide advice on lifestyle modifications and to warn people about the risks of
NCDs, is in high demand. At the society level, research centers and institutes can
significantly contribute to the prevention of NCDs by conducting research projects and
programs. Focusing research on food biotechnology and agriculture has a direct influence
on NCDs risk (7, 104). The development of diagnostic tools allows for the rapid detection of
NCDs biomarkers with high sensitivity to help detect diseases at their early stages, which
subsequently contributes to easier treatment and fast cures (105–107). However, in order to
reach the highest attainable standard of health, it is important to encourage individuals and
families to follow a healthy lifestyle in order to get an effective response for prevention and
the control of NCDs and to improve health outcomes (100, 108).
Conclusions
In modern society, NCDs are the main challenge in health systems. Risk factor
management is essential in NCDs' management. The management of NCDs
requires many strategies from several perspectives and on different levels, including
the individual and country levels. Based on the hypotheses that were raised during
the above scientific discussion, it can be concluded that modern strategies for the
management of NCDs should be oriented toward the individual level, where the
individual is responsible for their health by simply following a healthy lifestyle. It is
important to combine modern scientific achievements and innovative decisions, with
regard to the rationality of nutrition and positive effects on human health.
Governments and international organizations should make people aware of their
health and their environment to make the world a safe and healthy place. From
another perspective, support research to find new techniques to improve food
biotechnology is in high demand. Further, finding rapid and sensitive diagnostic
platforms to detect NCDs at the point-of-care offers huge benefits to personnel and
the healthcare system. The innovations are vital to address the growing crisis of
NCDs successfully, and most often use lifestyle projects, the promotion of healthy
eating behaviors and smoking cessation. We believe that there is a need to look for
further innovations to build better lives in society.