Please summarise all the non communicable diseases take refrence from parks textbook

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I now have comprehensive material from Park's textbook covering all major NCDs. Let me compile the full summary now.

Non-Communicable Diseases (NCDs) - Summary from Park's Textbook of Preventive and Social Medicine

Overview of NCDs

Non-communicable diseases (NCDs) are chronic diseases that are not transmitted person to person. They include cardiovascular diseases (CVDs), cancers, chronic respiratory diseases, diabetes, and mental health disorders. India is undergoing rapid epidemiological transition, with NCDs estimated to account for 63% of all deaths in 2016. The WHO SDG Target 3.4 calls for a one-third reduction in premature NCD mortality by 2030, defining premature death as dying from NCDs between the ages of 30 and 70 years.

The four main shared risk factors driving NCDs are: tobacco use, physical inactivity, harmful alcohol use, and unhealthy diet.

1. Coronary Heart Disease (CHD) / Ischaemic Heart Disease

Definition: Impairment of heart function due to inadequate blood flow caused by obstructive changes in the coronary circulation.

Presentations:

Angina pectoris
Myocardial infarction
Cardiac arrhythmias
Cardiac failure
Sudden death

Burden: CHD causes 25-30% of deaths in most industrialized countries. About 25-28% of patients who suffer a heart attack die suddenly; ~55% of cardiac deaths occur within the first hour.

Risk Factors (multifactorial):

Not Modifiable	Modifiable
Age	Cigarette smoking
Male sex	High blood pressure
Family history	Elevated serum cholesterol
Genetic factors	Diabetes
	Obesity, Sedentary habits, Stress

Key points on risk factors:

Smoking accounts for 25% of CHD deaths under age 65 in men in countries with widespread smoking. Risk declines after cessation and returns to non-smoker level after 10-20 years.
Hypertension and elevated serum cholesterol act synergistically with smoking - their effects are more than additive.
Trends: The "epidemic" of CHD began in the US in the 1920s; developing countries are now catching up. Developed countries showing a decline due to lifestyle changes, diet modification, and better BP control.

(Park's Textbook, block5, lines 8322-8540)

2. Hypertension

Definition: Hypertension has no strict biological threshold; blood pressure is distributed on a continuous bell-shaped curve in populations. It is defined operationally.

Classification (WHO/ESH):

Category	Systolic (mmHg)	Diastolic (mmHg)
Optimal	< 120	and < 80
Normal	120-129	and/or 80-84
High Normal	130-139	and/or 85-89
Grade 1 HTN	140-159	and/or 90-99
Grade 2 HTN	160-179	and/or 100-109
Grade 3 HTN	≥ 180	and/or > 110
Isolated Systolic HTN	≥ 140	and < 90

Significance: Hypertension is the commonest cardiovascular disorder and a major risk factor for stroke and CHD. It accounts for 20-50% of all deaths through cardiovascular mortality. Organ damage affects the heart, kidneys, brain, and eyes.

Prevention: Lifestyle modifications - dietary salt reduction, weight reduction, regular exercise, limiting alcohol, smoking cessation.

(Park's Textbook, block5, lines 8977-9016)

3. Stroke (Cerebrovascular Disease)

Definition (WHO): "Rapidly developed clinical signs of focal disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than vascular origin."

Types:

Ischaemic stroke - lacunar infarct, carotid circulation obstruction, vertebrobasilar obstruction
Haemorrhagic stroke - intracerebral haemorrhage, subarachnoid haemorrhage, intracranial aneurysm, arteriovenous malformations

Burden:

In 2016, cerebrovascular disease caused 5.78 million deaths worldwide (10.2% of all deaths)
Leading cause of disability in adults; 20-50% die within the first month
Cerebral thrombosis is the most frequent form in clinical studies; haemorrhagic stroke is more common in Japan

Risk factors: Hypertension (most important), smoking, atrial fibrillation, diabetes, obesity, physical inactivity

(Park's Textbook, block6, lines 216-255)

4. Cancer

Definition: A group of diseases characterized by abnormal cell growth, ability to invade adjacent tissues and distant organs, and eventual death if untreated.

Major categories:

Carcinomas - from epithelial cells (oral cavity, oesophagus, intestines, uterus, skin)
Sarcomas - from mesodermal/connective tissue cells (fibrous, fat, bone)
Lymphomas, myeloma, leukaemias - from bone marrow and immune system cells

Global burden (2020):

19.29 million new cases; 9.96 million deaths
Most common cancers: breast, lung, prostate, colon, stomach
Most common causes of cancer death: lung, liver, stomach, breast

India: ~1.1 million new cases per year; ~3.9 million cases at any time. Tobacco-related cancers = ~50% in men, ~20% in women. About 1 million tobacco-related deaths annually.

Causes of cancer (multifactorial):

Environmental factors (responsible for 80-90% of all human cancers):
- Tobacco - cancers of lung, larynx, mouth, pharynx, oesophagus, bladder, pancreas, kidney
- Alcohol - oesophageal and liver cancer (~3% of cancer deaths)
- Dietary factors - smoked fish (stomach), dietary fibre deficiency (intestinal), high fat (breast)
- Occupational exposures - benzene, arsenic, asbestos, vinyl chloride (~1-5% of cancers)
- Viruses - HBV/HCV (hepatocellular carcinoma), EBV (Burkitt's lymphoma, nasopharyngeal carcinoma), HIV (Kaposi's sarcoma, NHL)
Genetic/host factors
Hormonal factors
Age

Common patterns in India: Uterine cervix (women), oropharynx (both sexes) account for ~50% of all cancer cases. Both are environment-related, amenable to early diagnosis, and highly curable at stages I and II.

Cancer Control - Three levels:

Primary prevention - remove carcinogens/modify lifestyle (anti-tobacco, diet changes)
Secondary prevention - early detection (screening for cervical, breast, oral cancers)
Tertiary prevention - treatment, rehabilitation, palliative care

(Park's Textbook, block6, lines 552-793)

5. Diabetes Mellitus

Definition: A group of metabolic disorders characterized by hyperglycaemia in the absence of treatment, due to defects in insulin secretion, insulin action, or both.

Classification (WHO 2019):

Type	Description
Type 1	Beta-cell destruction (mostly immune-mediated), absolute insulin deficiency; onset in childhood/early adulthood
Type 2	Most common; variable beta-cell dysfunction + insulin resistance; associated with overweight/obesity
Hybrid forms	Slowly evolving immune-mediated (LADA-type); Ketosis-prone type 2
Monogenic diabetes	Caused by specific gene mutations (MODY, neonatal)
Gestational diabetes	Diagnosed first during pregnancy
Other specific types	Exocrine pancreas diseases, endocrine disorders, drug-induced

Complications:

Microvascular: retinopathy, nephropathy, neuropathy
Macrovascular: coronary heart disease, peripheral arterial disease, cerebrovascular disease
Other: obesity, cataracts, erectile dysfunction, NAFLD, increased susceptibility to TB

Burden:

Age-adjusted mortality in diabetics is 1.5-2.5 times higher than general population
Lower limb amputations are 10 times more common in diabetics; >50% of non-traumatic amputations are due to diabetes
India: Indians have increased genetic susceptibility to T2DM. India is rapidly becoming the "diabetes capital of the world"

(Park's Textbook, block6, lines 1512-1660)

6. Obesity

Definition: Abnormal growth of adipose tissue due to enlargement of fat cell size (hypertrophic obesity), increase in fat cell number (hyperplastic obesity), or both.

Measurement - BMI (Body Mass Index):

BMI	Classification
< 18.5	Underweight
18.5-24.9	Normal
25.0-29.9	Overweight
30.0-39.9	Obese
≥ 40	Morbidly obese

Health consequences: Obesity is a major risk factor for type 2 diabetes, cardiovascular disease, hypertension, dyslipidaemia, certain cancers, sleep apnoea, osteoarthritis, and reduced quality of life. It is recognized as a chronic disease in its own right.

Prevention and management: Dietary modification, increased physical activity, behavioural therapy, and in severe cases, pharmacological or surgical intervention.

(Park's Textbook, block6, lines 1882-1884+)

7. Mental Health Disorders

Mental health disorders are an important category of NCDs and are included within the NCD framework in the SDGs (Target 3.4 and 3.5).

Key points:

Mental disorders contribute substantially to the global burden of disease; depression is a leading cause of disability worldwide
Strong bidirectional link between mental health and physical NCDs - depression worsens diabetes control; chronic pain drives depression
Substance use disorders (alcohol, drugs) are included in the NCD mental health cluster
SDG Target 3.5 specifically addresses substance abuse, including harmful use of alcohol, alongside mental health

National Mental Health Programme (NMHP) - India:

Launched to provide community-based mental health services at district level
Aims for integration of mental health into primary health care
Focus areas: treatment of severe mental disorders, prevention, suicide prevention, and social reintegration

(Park's Textbook, block7 lines 4282-4337, block11 lines 6750-6894)

8. Chronic Respiratory Diseases (COPD / Asthma)

While not presented as a separate full chapter at the same level, Park's textbook includes COPD and chronic respiratory diseases in the NCD framework. They are among the "Big 4" NCDs along with CVD, cancer, and diabetes. Key risk factors include tobacco smoking, indoor air pollution (biomass fuel combustion), outdoor air pollution, and occupational dust/chemical exposure.

Shared Risk Factors for NCDs

Park's textbook consistently emphasizes that NCDs share common risk factors and that an integrated prevention approach is most cost-effective:

Behavioural Risk Factor	NCDs caused
Tobacco use	Cancer (lung, oral, bladder, etc.), CHD, stroke, COPD
Physical inactivity	CHD, stroke, diabetes, obesity, cancer
Unhealthy diet	CHD, stroke, diabetes, obesity, cancer
Harmful alcohol use	Liver disease, cancer (oesophagus, liver), stroke

Common biological risk factors: Raised blood pressure, raised blood glucose, dyslipidaemia, overweight/obesity - all intermediaries linking behavioural risk factors to disease.

Prevention of NCDs - WHO/Park's Framework

Primary prevention (most important):

Anti-tobacco legislation, clean air policies
Promote healthy diet (reduce salt, fat, sugar)
Promote physical activity
Reduce harmful alcohol use

Secondary prevention:

Screening programs (cancer cervix - Pap smear; breast - mammography; diabetes - fasting glucose; hypertension - BP measurement)
Early detection and treatment

Tertiary prevention:

Rehabilitation, palliative care, management of complications

Integrated approach: Monitoring BP, blood sugar, and cholesterol together is more effective than treating each in isolation. A "total cardiovascular risk approach" is more cost-effective than individual risk factor thresholds.

India's National Programmes for NCD Control

National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS) - covers the main 4 NCDs
National Cancer Control Programme
National Mental Health Programme (NMHP)
National Programme for Control of Blindness (NPCB)
National Tobacco Control Programme

All content referenced from: Park's Textbook of Preventive and Social Medicine (ISBN: 9789382219163), Chapters on NCDs - Stroke (block6), Cancer (block6), Diabetes (block6), Obesity (block6), CHD (block5), Hypertension (block5), NCDs and Mental Health (block7), and Epidemiological Transition/India NCD burden (block12).

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