Posts Tagged ‘world health organization’

The importance of nutrition in smoking cessation in women

26 de março de 2013 Comentários desligados



The importance of nutrition in smoking cessation in women


                                                                                                                     Marcia M.T.LOBO1

                                                                                                                                                        MARCOS HS NASCIMENTO 2

  1. Masters Degree in Nutritional Safety at Federal University of Paraná – UFPR – Brazil
  2. Medical Editor of PULMAOSA Website

The strategy in stimulating smoking cessation in women should be priorized ahead of the growing exposure to tobacco promotional campaigns associated with the tobacco industry for this population group.

Smoking nowadays is the leading cause of preventable death in the world, and is considered a disease with its own ICD (International Classification of Diseases) to designate it: the F17.2. Smoking by itself, is capable of generating 50 other diseases, being the huge star among the non communicating diseases, as it is responsible by 30%  of all cancer deaths, including lung cancer that presents a clear link with smoking and is the current leader of deaths from this disease in both men and women in the United States and  also in Brazil (1).

Data obtained from the World Health Organization (WHO), attributed approximately 5.4 million deaths per year to tobacco, with Brazil accounting for 200,000 of these deaths (2,3).

Although the prevalence of smoking in Brazil have declined over the past years (17.5% of adults (over 15 years), 22% male and 13% female), however, in  the main cities  of the Southern region of the country presented high prevalence of smoking among women, with 17.5% in Porto Alegre (Rio Grande do Sul State); 15.5% in Curitiba (Paraná); and Florianópolis (Santa Catarina) 15.3%. This may indicate a need to prioritize health promotion and tobacco control focuses primarily on women (4.5).

The control and reduction of smoking prevalence are of fundamental importance since it can provide gains in both health and in financial resources (6). About this context, the Brazilian Thorax Society guidelines for smoking cessation (BTS) suggested that the presence of a dietitian in the multidisciplinary team is of great importance (7).

Regarding specifically to women and their body image, this fact represents a significant issue in this group’s behave, where the fear of weight gain is the great factor relationed with  women’s noncompliance about smoking cessation treatment, even when the health benefits are known,  and also combined with other factors such as stress relief and anxiety (8).

It is crucial that the frequent eating habits or acquired ones be rating after such treatment, as well as monitoring body weight, ir order to be establish behaviors that contribute for the  real success of smoking quit process. The weight gain factor is responsible by non-adherence for the treatment to quit tobacco derivatives and cigarettes, just because the large variation in weight gain and its mechanism constitute the major cause for the increased caloric intake and decreased resting metabolic rate (9).

There is evidence that nicotine causes an increase in energy expenditure. This is explained by the fact that consumption of a single cigarette induce about 3% increase in energy expenditure of the organism of in a period of 30 minutes. Concomitantly nicotine promotes an apetite decrease, caused by the rapid arrival of smoke nicotine in the brain (about 6 to 10 seconds). It allows some increase in the concentration of neurotransmitters, such as dopamine and serotonin, which are inhibitors intake food. It would explain the fact that smokers tend to have lower body weight when compared to nonsmokers, instituting a belief that smoking is an efficient way to control body weight (10,11).

Therefore obtain better results in tobacco control policies, aimed at women, duty would consider the influence of body weight control appropriate and compulsory through nutritional intervention assertive. The objectives of this strategy is to achieve higher success rates in smoking cessation, justifying the control of food intake, that more than an addendum to the treatment, it must be presented as a condition “si ne qua non” in the process of smoking cessation treatment for women.



  1. NASCIMENTO, M.H.S. Doenças Crônicas: Pedágio caro para o Brasil, os USA e o Mundo. Available from: pedágio-caro-para-o-brasil-os-usa-e-o-mundo/.Acesso em 12/03/2012.


  1. World Health Organization (WHO). The World Health Report 2002: Reducing risks, promoting healthy lifestyles. Geneva: WHO, 2002.


  1. Instituto Nacional do Câncer (INCA). Tabagismo no Brasil:

Dados e Numéricos. Brasilia: Ministério da Saúde, INCA. Available from: em 20/03/2012.


  1. Instituto Brasileiro de Geografia e Estatística (IBGE).Global Adult Tobacco Survey(GATS):Brasil,2008.IBGE;2009.


  1. Ministério da Saúde. Secretaria de Vigilância em Saúde; Secretaria de Atenção à Saúde. Diretrizes e Recomendações para o Cuidado Integral de Doenças Crônicas Não-Transmissíveis: Promoção da Saúde, Vigilância, Prevenção e Assistência. Brasília,2008.


  1. PISINGER, C.; GODTFREDSEN,N.S. Is there a health benefit of reduced tobacco consumption? A systematic review. Nicotine To Res.9(6):631-46, 2007.


  1. REICHERT, al ,Diretrizes para cessação do tabagismo, Sociedade Brasileira de Pneumologia e Tisiologia (SBPT). J Bras Pneumol. 34(10):845-880, 2008.


  1. SCARINCI, al.Sociocultural factors associated with cigarette smoking among women in Brazilian worksites:a qualitative study.Health Promotion international,v.22,n.2,p.146-154,2007.


  1. FILOZOF,C.;FERNANDEZ,P.M.C.;FERNANDEZ,C.A. Smoking cessation and weight gain. Obes Rev,5:95-103, 2004.


  1.  CHIOLERO,A., FAETH.D., PACAUD, F., CORNUZ, J. Consequences of smoking for body weight, body fat distribution, and insulin resistance. Am J Clin Nutr ;87:801–9,2008.

Australia: the country that became a synonym of Public Health

1 de abril de 2012 Comentários desligados

Australia: the country that became a synonym of Public Health

Even facing lawsuits filed by the tobacco industry in international courts, Australia decided to definitely enter the
forefront of public health and must become, in late 2012, the first country to remove the logos on cigarette packets.

As already discussed in a recent article by PULMAOSA, entitled “The Bat Signal from Australia,” the country will adopt a standardized packaging for cigarette packets, thus eliminating the colors and attractants for young people and children.

This is the role of one who cares for the health of its people, says the physician editor of  PULMAOSA, Dr. Marcos Nascimento. “However, for the success of this measure, worthy of applause, the World Health Organization (WHO) and the 170 countries that have ratified the Framework Convention on tobacco control (FCTC), as Brazil and Uruguay should support Australia, and not be passively watching, and waiting for the results of trials of lawsuits filed by the tobacco industry against Australia. Undoubtedly, given the magnitude and extent of the Australian example, the WHO should advise the other countries to follow the example of Australia,” adds Dr.Nascimento.



The Framework Convention on Tobacco Control, WHO – World Health Organization Treaty

The toll charged for Chronic Diseases in Brazil, USA and the World

16 de março de 2012 Comentários desligados

The toll charged for Chronic Diseases in Brazil, USA and the World

If an exercise or do a search on the most comprehensive reported by national and international media in mid-march 2012, we came coincidentally with a few facts that concern so urgent and so immediate society (or the media itself) : Economic Crisis in Europe and the United States, the Afghanistan crisis, the Brazilians travel abroad, a record of tax incessantly beaten by the government in Brazil, and violence both real life and virtual …
Very rarely has been observed that news will affect our daily life in 5 or 10 or 50 years.
There is an automatic search for media events that have impacted or will impact in the coming seconds, minutes, days, and would risk a maximum in the coming months.
The exploration of events that will occur in larger ranges become increasingly rare, except perhaps the 2014 World Cup and the Olympics in London in 2012 and the Election of the next president of the United States among a few others .. .

Although the World Health Organization (WHO) has made numerous warnings, a fact that has gone slightly unnoticed are the impacts and consequences caused by chronic diseases today and in the next 20 years.

But what is Chronic Disease?

Chronic diseases are prolonged conditions that often do not improve and are rarely cured completely.
There are those that are transmitted as tuberculosis, Chagas disease, hepatitis, AIDS, etc.., And those who are called non-communicable diseases (also called non-communicating) and among which include diabetes, dementia, cancer, congestive heart failure, COPD (Chronic Obstructive Pulmonary Disease) bronchial asthma.
The increasing incidence of chronic disease is a challenge for health services in Brazil and worldwide.

Chronic diseases are by far the leading cause of death worldwide, accounting for 63% of all deaths. Of the 36 million people who died from chronic diseases in 2008, nine million were under 60 years and ninety percent of these premature deaths occurred in low and middle income.

In Brazil 72% of all deaths were attributed to non-communicable diseases in 2007.

Over the next 10 years the WHO projects an increase of 22% to 10 million deaths from chronic noncommunicable diseases in Brazil, and cardiovascular disease as the major cause. Morbidity and mortality from noncommunicable diseases are greater in the poor. The most common causes associated with chronic diseases in Brazil are listed in Figure 1.

Fig 1 – Deaths designed for chronic diseases in Brazil. Adapted from WHO NCD Country Profiles 2011.

  • Why are chronic diseases have such an impact on health?

The Chronic diseases have a profound effect on the physical, emotional and mental well-being of individuals, often making it difficult to continue with normal daily activities and relationships. This implies severe personal cost with high impact on health that is associated with economic costs, since labor is associated with absenteeism, sick leave involving lead removal in temporary or even permanent job generating early retirement and therefore drop the index productivity of the country.

  • What are the risk factors? How to reduce the risk of chronic diseases?

Risk factors for chronic diseases are associated with both genetic and acquired the criteria as dietary habits and the amount of vegetables and fruit (fiber) consumed, the concentration of sodium (salt), fat, trans fat (industrialized) and behavioral as the use of tobacco and its derivatives.
Remember that all food processing industry that generated gains in scale adopted in the 19th and 20th centuries, have adopted practices that have raised since the quantities of pesticides and agrochemicals for food production to the levels of fat, salt, sugar, and other food preservatives, many of artificial origin. Sweeteners and artificial flavorings followed more recently by the introduction of the food industry’s use of modified fats called trans fats that increase not only the food durability, but are closely associated with the development of cardiovascular disease – There is therefore, a total prohibition of its use in Scandinavian countries and Canada for example.
However, we must clarify that in many cases, health outcomes can be improved, depending on access to preventive and early diagnosis and appropriate medical services, guarantee of therapeutic treatment, access to information and the possibility of individual choices ranging from the daily exercise, the protection of public smoke-free places (chronic lung diseases, cancers) and a healthier diet, with such low levels of sodium, total absence of trans fats in foods (CVD) and the creation of suitable institutions indexes that measure the amount of pesticides (associated with cancers), in parts per billion or trillion (ppb. or ppt.) compatible with the requirements of FAO (the UN body responsible for controlling the food production) and other European regulators and the U.S.D.A. and also the Food and Drugs Administration (FDA).

  • The toll charged for Tobacco in Brazil and the World

Among the chronic diseases, it is noteworthy that among the three major preventable causes, two are occupied by the use of tobacco products. The first and foremost active smoking in second place followed by traffic accidents and in third place by passive smoking or secondary.

You have to remember that smoking itself is considered a pathology that has its own  ICD (International Classification of Disease)  to designate it, the F17.2.

Smoking is responsible for the generation of 52 other diseases, so that you can illustrate your power to see damage to be the main cause of disease is not communicating, causing 30% of all cancer deaths, including Lung cancer, head of the pathology of deaths among both men and women in the United States and Brazil, and be responsible for 80% of deaths from chronic obstructive pulmonary disease (COPD), popularly known as emphysema and chronic bronchitis.

The US Toll Charged for Chronic Diseases

Just to compare the US proportionally mortality is:

Cardiovascular Diseases answers for 35%; Cancers for 23%; Respirtory Diseases 7%; Diabetes 3%; Injuries 7%; Communicable, maternal, perinatal and nutritional comditions 6%; Other NCDs 19%;

  • Toll Charged in Lives:

Tobacco use unfortunatelly killed 100 million people in the 20th century. If current trends continue, tobacco will kill a billion people in the 21st century.

• Tobacco kills in the world more than 5 million people per year and accounts for one in 10 deaths among adults.
• The tobacco will kill more than 8 million people worldwide each year until the year 2030, with 80 percent of those deaths in low and middle income.
• Secondhand smoke kills more than 600,000 people worldwide each year, including 165,000 children.
• Tobacco production damages the environment by using too many pesticides, pollute groundwater and disposal, in addition to diverting agricultural land that could be used to produce food.
Toll in Brazil:
The costs of tobacco in Brazil, according to World Bank study carried out taking into account the tobacco-related hospitalizations occurred in the Public Service named SUS from 1996 to 2005, revolve around Us $ 500 million.

In Brazil, approximately R$ 340 million (Real$) is spent on hospitalization only for cases of cancer, cardiovascular and respiratory diseases attributable to smoking. Sum equivalent to almost 30% of total hospital costs for health care to treat these diseases.
Remember: This follows from the fact that smoking be related to different types of conditions, generating another 52 international code of diseases. Therefore, smoking leads to a number of deaths of about 200,000 people per year in Brazil, killing more than Malaria, Smallpox, and AIDS combined, according to the Brazil’s National Cancer Institute and the Ministry of Health.
The Brazilian National Institute of statistics (IBGE) has recently revealed that the number of smokers in Brazil is 24.6 million, of which 81.3% (20 million) are over 18 years. And according to the Datafolha there in relation to smoking a favorable opinion to the tax increase, with 63% of the population in favor of waving, and 88% agree that taxes paid by the industry should go to the health sector and can provide a solution to the non-return the CPMF unpopular, while balancing the government budget.
In 2011 the Brazilian government finally adopted a historic measure to protect public health from more than 190 million Brazilians to enact a comprehensive law on tobacco control. Signed by the president Rousef, the new law has made Brazil the largest country in the world completely free of active and secondhand smoking.
Meanwhile, it is noteworthy that further adjustments are still needed as the proposition to ban sale of cigarettes at school perimeter, popularize the spirometry test – to assess lung function and allows earlier diagnosis of COPD (the popular test of breath”) as well as increased surveillance to curb the sale of spare product, which could greatly improve the protection among children and adolescents.  After all, nicotine is a proven drug that causes more deaths worldwide and is directly responsible for more than 90% of cases of lung cancer, a disease with poor prognosis and extremely lethal.
Regarding chronic diseases some solutions can be identified as suggestions and are adopted not only by public power, but that due to the gain that can provide both health and in terms of economic productivity, would be required knowledge and persecuted by administrators private insurers and the companies and industrialists such as OGX, Gerdau, Embraer, Azul Airlines,  Jet Blue, Boeing, Apple, Walgreens, Ford, General Eletric, etc..

  1. That at least 80% of cardiovascular disease, stroke and type 2 diabetes and 40% of cases of cancers could be preventable when encouraging a healthy diet, regular exercise, and avoiding the use of all derivatives such as tobacco or cigarettes Nargileh;
  2. WHO estimates that if there was an additional reduction of 2% in the number of deaths from chronic diseases in Brazil over the next 10 years, this would allow the country to an economic gain of $ 4 billion – money that could be applied in Health and education. Thus eliminating the worst weight that a land can support… which is ignorance!

WHO – World Health Organization: NCD Country Profiles, 20011

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Ethics Must Be Global, Not Local

11 de março de 2012 Comentários desligados


Ethics Must Be Global, Not Local

Marcos Nascimento, MD.

This week will be a board meeting of the Brazil’s regulatory agency ANVISA- in that will address the issue of prohibition / restriction of added sugars, and other substances that give flavor to tobacco and its derivative-products such as cigarettes.
Briefly there are three spots to be discussed at this meeting:
1. The Smoking and its consequences for public health:

→ The Smoking to be associated with more than 50 diseases, is considered the biggest concern of the World Health Organization, causing personal ruin and death on a global scale of the order of 200,000 per year in Brazil and six million people worldwide. 1
→ The addition of sugars and any additives or based mint and other flavors, both known to increase the power of addition of nicotine, by the release of various toxins such as alcetaldeído 2, thereby stimulating the initiation of young and adolescents to tobacco products, especially cigarettes, but also used to smoke cigars, pipes and Narguilé water pipe for example.

2. The version of the Smoking Cessation Industry:

→ The international tobacco industry acts as expected for a company that owns shares in the stock market justifying the profit of your business before their shareholders. For this reason, denies the scientific evidence that sugar increases the addictive power of nicotine.
Moreover, the tobacco industry tries to turn the discussion focus only the economic question about an international commodity and the resulting consequences in the local and international tobacco, haggling over how much the ban on flavorings and sugar can affect Brazilian exports, and concomitantly … The Tobacco Industry’s profit!

3. The Role of the Brazil’s National Sanitary Surveillance Agency-ANVISA:

→ By definition, the regulatory agency was created to defend the interest of the population, ie. the interest of all citizens who pay their taxes and trust that the matters will be always discussed through the ethical stances, taken in the interests of public health, as described in virtual page on the Internet’s own ANVISA (The image below).

ANVISA Mission/ Missão da ANVISA

By involving the damage caused by smoking, the discussion of the Next Tuesday, March 13 address an issue of worldwide concern about human life, and will be mainly on Ethics. But the question here are: what is Ethics?  Can the Ethics of business be adapted according to local rules or should be globally the same ?
Evaluating the arguments of the tobacco industry, it can not figure out how leaders of business organizations can act with a set of principles in their homeland and a different one overseas. In terms of principles, ethics MUST be global and not local!

So what we are discussing here, and what will be discussed in Brasilia next Tuesday (March 13), is whether or not ethics works in the real world.

Ethics in a simple definition of Paulo Coelho: “It is the concern for your neighbor, It’s about how you must to think twice before acting on your own benefit.”

And especially when we are called upon to defend the ethics and rebuild the ruins of the system, we can replace the Human Health values close to the heart and not next to the money.
In short, it is expected that the Ethics attend  at the board meeting of the Brazilian Regulatory Agency -ANVISA, and not just summarize a virtual setting in its’ web page, but that is actually aligned with the real world.

1. WHO – World Health Organization
2. Talhout et al, 2007: sugars in tobacco
3. ANVISA – Web Page
4. Paulo Coelho, free YouTube Video

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