Chapter 6

specifically, factors related to lifestyle habits such as diet and exercise, rest, and labor, and abnormal
health conditions (e.g. smoking, diet, alcohol use, obesity, occupational risks, fasting hyperglycemia,

Prevention of lifestyle diseases

hypertension, and high cholesterol) have become problematic (Figure 6.3)2.
2007 ranking

Learning objectives
You will be able to gain proper understanding and explain:- The current situation surrounding lifestyle diseases in Cambodia.
- How obesity affects a person’s health.
- The importance of diet/nutrition in the prevention of lifestyle diseases.
- Factors to help one acquire healthy lifestyle habits.
- Health problems that stem from an improper diet.
In this chapter, you will learn about the relationship between lifestyle diseases and lifestyle habits.
Specifically, we will cover lifestyle diseases that are common in Cambodia, and basic lifestyle habitsand diet/nutrition as contributing factors to the diseases.

1. Common lifestyle diseases among Cambodians
Around 30 years ago, Cambodia had a high mortality rate caused by infectious diseases. While thecountry has since seen declines in the proportion of infectious diseases-related mortality thanks to

Lower respiratoty infection

1

1StrokeStroke22Lower respiratoty infection

Cirrhosis

33

Cirrhosis

Ischemic heart disease44Ischemic heart disease

Neonantal disorder

55Neonantal disorder

HIV/AIDS

6

6

Road injuries

Tuberculosis

7

7

Mechanical forces

Road injuries

8

8

COPD

Mechanical forces

99Tuberculosis

Congenital defects

10

10 Diabetes

Communicable,maternal, neonatal,
and nutritional diseases

COPD

12

13 Congenital defects

Non-communicablediseases

Diabetes

13

18 HIV/AIDS

Injuries

Source: Institute for Health Metrics and Evaluation. Cambodia -What causes the most deaths? http://www.healthdata.org/cambodia

Figure 6.2 Changes in causes of deaths over time in Cambodia (2007–2017)2

improved hygiene and nutrition, the proportion of non-communicable diseases (NCD)-related

2007 ranking

mortality has surpassed 60% (Figure 6.1)1. In particular, what are known as lifestyle diseases, such as

Malnutrition

1

1

Malnutrition

stroke, liver disease, heart disease, cerebrovascular disease, malignant neoplasms (i.e. cancer), andAir pollution

2

2

Tobaccodiabetes, are now among the leading causes of death (Figure 6.2). Among the risk factors for death andTobacco3

3

Dietary risks

disability due to such diseases, factors related to human behaviors and metabolism figure largely;

Dietary risks

44

Air pollution

Alcohol use

55High fasting plasma glucose

High fasting plasma glucose

66

Alcohol use

High blood pressure

77High blood pressure

Unsafe sex

88

Occupational risks

WaSH

9

9

High body-mass index

Occupational risks

10

10 High LDL

1990

2017
Non-communicablediseasesAccidents, etc.

8.3%

Non-communicablediseasesAccidents, etc.

10.7
34.8%

56.9%

Infectious diseases

%

26.6%

62.7%

Infectious diseases

Source:Ministry of Economy, Trade and Industry. “International Healthcare Development Country Report: Cambodia”1

Figure 6.1 Changes in causes of deaths over time in Cambodia (1990–2017)

962017 ranking

2017 ranking

High LDL

11

12 WaSHHigh body-mass index

13

13 Unsafe sex

Metabolic risks

Environmental/
occupational risks
Behavioral risks

Source: Institute for Health Metrics and Evaluation. Cambodia - What risk factors drive the most death and disability combined?
http://www.healthdata.org/cambodia

Figure 6.3 Changes in risk factors for death and disability over time in Cambodia(2007–2017)2

Chapter 6

Prevention of lifestyle diseases97

2. Lifestyle diseases and other conditions related tolifestyle habits

Normal blood vessel

1) Lifestyle diseases

Buildup of cholesterol forms due tosmoking or obesity

Table 6.1 shows a list of common lifestyle diseases and their symptoms. Cerebrovascular disease is a
Buildup in inner walls causes narrowingof the vessel, reducing blood flow

collective term for diseases caused by abnormality of arteries in the brain, with stroke being a commonly
known form. Liver disease (hepatitis) involves inflammation of the liver, and possible causes include
hepatitis virus infection, alcohol use, and obesity. Heart disease includes angina and myocardial

A blood clot blocks blood vessel

infarction, which are caused by reduced blood flow or the formation of a blood clot in coronary arteriesof the heart. A malignant neoplasm is an out-of-control growth of diseased cells (cancer cells) withina human body. Cancer cells are a mass of diseased cells, which were originally normal cells that turn into

Figure 6.4 Development and progression of arteriosclerosis

cancerous cells when their genes are damaged. Diabetes is a disease in which the bodily function that
Normal cells

Table 6.1 Common types of lifestyle diseases and their symptoms

Type of lifestylediseaseSymptoms

CerebrovasculardiseaseA collective term for diseases caused by abnormality of arteries of the brain. Stroke is acommonly known form. Stroke has two main types: diseases caused by a blockage or
rupture of the brain blood vessels. The former refers to cerebral infarction, in which a
blockage of a blood vessel prevents blood from flowing into the brain, depriving the brainof oxygen and nutrients. This leads to the necrosis of neurons in the brain, which may cause
a range of damage. The latter form of cerebrovascular disease includes subarachnoid
hemorrhage and brain hemorrhage, in which a rupture of an artery in the brain causes
bleeding into the brain. The blood that leaks out puts pressure on the neurons in the brain
and causes damage. Symptoms include headache, paralysis of limbs, speech difficulty, anddecreased level of consciousness.

Liver disease(hepatitis)

Liver disease (hepatitis) involves inflammation of the liver. Its possible causes are hepatitis
virus infection, alcohol use, and obesity. Symptoms include loss of appetite, malaise,nausea, vomiting, and jaundice.

Ischemic heartdiseaseIschemic heart disease includes angina and myocardial infarction. Angina is a condition
where arteriosclerosis narrows the coronary arteries of the heart and obstructs the bloodflow (Figure 6.4), resulting in repeated seizures accompanied by transient pain.
Myocardial infarction refers to a condition where formation of clots in a blood vessel of theheart due to arteriosclerosis causes occlusion of the blood vessel, resulting in necrosis of
myocardial cells. Delays in treatment can be fatal, and prompt medical attention is required.

A malignant neoplasm (cancer) is a disease in which normal cells turn into diseased cells(cancer cells) and grow in an out-of-control manner (Figure 6.5). Cancer cells may form in
Malignantdifferent organs including the lungs, liver, uterus, and breast, and may grow, expand andneoplasm (cancer)
spread to other organs, a process called metastasis. Symptoms vary depending on the site of
the cancerous organ.

Diabetes

98

Diabetes is a disease in which the insufficiency or impaired action of insulin, which
reduces blood sugar, causes a decline of the bodily function that suppresses the elevation ofblood sugar levels, leading to chronic high blood sugar. There are type 1 and type 2
diabetes. Type 1 diabetes involves destruction of insulin producing cells due toautoimmune diseases and requires self-injection of insulin. Type 2 diabetes develops due tocertain genetic factors combined with certain lifestyle habits such as overeating andphysical inactivity. It may worsen without subjective symptoms, and raise risks for thethree main complications, namely retinopathy, nephropathy, and neuropathy, as well as for
progression of arteriosclerosis in larger vessels which may lead to heart diseases or stroke.

Cancer cells form

Normal cells destructed

Cancer cell growCancer develops

Figure 6.5 Process of carcinogenesis

suppresses the elevation of blood sugar levels is reduced, leading to chronic high blood sugar and causing
a number of complications.
Another lifestyle disease is periodontal disease. Periodontal disease is an inflammatory diseasecaused by bacterial infection of the gums (Figure 6.6). When the gap between the teeth and gums iscleaned insufficiently, plaque may build up, allowing numerous bacteria to linger. The margins of thegums may be reddened or swollen due to inflammation, although pain is absent in many cases. If it
progresses, the gap between the teeth and gums, called a periodontal pocket, becomes deeper, and thefoundation of the teeth (alveolar bone) breaks down, ultimately requiring tooth extraction. Furthermore,
toxic substances that form as a result of inflammation can enter into general circulation via blood vesselsof the gums, causing various diseases or worsening pre-existing conditions.
Risk factors for periodontal disease include oral environments such as plaque, tartar, misaligned
teeth, and smoking, as well as lifestyle habits that may decrease the body’s resistance to diseases suchas poor eating habits, stress/fatigue, physical inactivity, and lack of sleep. To prevent periodontal disease,
Chapter 6

Prevention of lifestyle diseases

99

Healthy

Periodontal disease2) Other health issues related to lifestyle habits

PlaquePocket

Healthy gum

TartarInflammation of gum

Healthy bone
Bone destruction

Figure 6.6 Periodontal disease(1) BMI-mortality relationship
In all causes of death, the BMI-mortality relationship among Japanese men demonstrates a reverse
J-shaped curve when plotted on a graph (Figure 6.7.1).3 This graph shows that when men whose BMI
are between 23 and <25, their mortality risk is assumed to be 1.0 (the reference value), and then shows
how many times the mortality risk increases for those who have lower or higher BMI than the reference
value. For example, the mortality risk of men with BMI of 30 or higher is 1.42 times higher than thosewith BMI of 23 and <25. Japanese men whose BMI are between 23 and less than 30 are shown to have
low risk of mortality from all causes compared those with other ranges of BMI. That is the optimal range

it is therefore important for one to reduce or refrain from alcohol and tobacco use, keep regular hours,of BMI for Japanese men.

avoid stress, and keep a balanced diet, as well as brushing one’s teeth properly every day to keep the

The BMI-mortality relationship among Japanese women demonstrates a U-shaped curve (Figure

surface of the teeth clean and free of plaque. It is also effective to have one’s teeth cleaned by a dental

6.7.2).3 This graph indicated that, taking into account mortality risk from all causes, the optimal range

specialist on a regular basis to maintain the health of one’s teeth, as it will remove tartar completely, evenof BMI for Japanese women is between 21 and less than 27.

inside the gums, and clean the dental root, making the surface smooth and ridding it of bacteria that

It should be noted, however, that BMI, or body mass index, is calculated based on a person’s heightcause inflammation. In addition, the treatment of damaged gums and bone will help restore the gums

and weight, and does not tell whether the person is muscular or has excessive fat. “Latent obesity,” orclose to a healthy state. For details on dental health, see Chapter 8.

normal BMI combined with a high body fat percentage, is found among young women. Although there
are body fat scales available for purchase, different models may employ different methods of estimation

Column: What is inflammation?

or criteria, which makes it difficult to take an accurate measurement of body fat percentage. You can use
trends in body fat percentage as one indicator for obesity, keeping in mind that it has a margin of error.

Inflammation is a bodily reaction to damage to biological tissues or cells caused by an injury, disease,or noxious stimulation, as a means of removing the damaged parts and helping regeneration. It is areaction necessary for a human body to restore its health. Major stimuli (causes) of inflammation
1.8

1.5

BMI with
low risk for
mortality

1.4
1.3
1.2
1.1
1.0
0.9

Plaque is a sticky substance, white or yellowish white in color, that is found on the surface of a tooth.

0.7

It is a mass of numerous bacteria, as many as 100 million per 1 mg. A cavity-causing bacterium

14-<

Tartar is a calcified form of plaque. It is a mass that is hard as a stone and tends to form between
teeth and the gum ridge. It often contributes to the development of cavities, halitosis, and periodontal
disease.

1.4

BMI with
low risk for
mortality

1.3
1.2
1.1
1.0

Reference

Column: Plaque and tartar

Reference

0.9

0.8

BMI

BMI

Figure 6.7.1

Figure 6.7.2

40

30

30
-<

27

27
-<

25

25
-<

23

23
-<

21

21
-<

40

30

30
-<

27

27
-<

25

25
-<

23
-<

23

21

21
-<

19

0.8

19
-<

called Streptococcus mutans is prone to adhere to teeth, forming stiff plaque.

Hazard ratio

Hazard ratio

pain, and the inability to move the affected part. Inflammation may be acute, meaning it subsides inare at play in the chronic phase (See Chapter 7).

1.5

1.6

19

chemical stimuli such as acid and alkali. Common symptoms include reddening, swelling, fever,is dominated by a type of white blood cell called neutrophils, while lymphocytes and macrophages

1.6

1.7

19
-<

Chapter 7); physical stimuli such as ultraviolet, light radiation, or high or low temperatures; andJapanese Women

1.7

14
-<

include: biological stimuli due to the invasion of a pathogen (bacteria, viruses, parasites, etc.; seea short period of time, or chronic, when the symptoms are prolonged. The acute phase of inflammation

Japanese Men

1.9This figure is created using the data published in Sasazuki S. et al. Body Mass Index and Mortality From All Causes and Major
Causes in Japanese: Results of a Pooled Analysis of Large-Scale Cohort Studies. Journal of Epidemiology. 21(6) 417-430. 2011.
http://doi.org/10.2188/jea.JE20100180

Figure 6.7 Association between Body-Mass Index and Risk of mortality from all causes3

100

Chapter 6

Prevention of lifestyle diseases

101(2) Obesity and underweight(3) Anemia

Obesity is a condition in which a person’s body has an excessive accumulation of body fat. Because it

Anemia is a condition in which the amount of hemoglobin and the number of red cells in a given volume

constitutes a risk factor for respiratory, cerebrovascular, liver, and heart diseases, as well as for diabetes,of blood fall below standard levels. When one has anemia, they may experience symptoms such as facial

prevention and control of obesity plays an important role in building health. Body mass index (BMI) is

pallor, fatigue, general malaise, headache, palpitation, shortness of breath, loss of appetite, and in theused to determine the level of obesity.

cases of children, the impairment of intellectual development as well as learning or motor problems due

Being underweight, meanwhile, is a condition in which a person’s body has low body fatness. Manyto poor concentration. This is because a primary role played by red blood cells, which are a component

young women may have an unbalanced diet or repeat extreme dieting despite the fact that they do notof blood, is to transport oxygen and nutrients throughout the body, and any impairment to this functionneed to lose weight, and this raises health risks associated with dieting. An unbalanced diet owing to theaffects the brain the most out of all organs. A key to the delivery of oxygen is hemoglobin, which is a

wrong eating habits, in particular, may cause iron deficiency anemia or osteoporosis, which arecomponent of red blood cells. Hemoglobin is rich in iron, and it carries oxygen when iron binds todetrimental to one’s health. When it becomes serious, it may lead to anorexia or bulimia. Both anorexia

oxygen.

and bulimia are forms of eating disorders. The former is estimated to affect in many cases people in

Adolescence in particular is a phase when one’s consumption of iron increases as one goes throughtheir adolescence and early adulthood, when they avoid eating for fear of becoming fat, which causes

growth or menstruation, which often causes iron deficiency anemia due to a lack of iron as a component

them to become extremely thin. The latter involves repetitive episodes of overeating a few times a weekof hemoglobin. Poor nutrition also causes iron deficiency anemia. Dietary iron is found in two forms:

over a period of months combined with inappropriate compensatory behaviors to avoid gaining weightheme iron, which is present in large amounts in animal-based products such as meat, and fish, and non-(i.e., vomiting, use of a laxative). If such eating disorders become chronic, they may cause a number ofheme iron, which is present in vegetables and grains (Figure 6.8). Heme iron is known to be more well-forms of health disturbance, including amenorrhea, hypotension, and arrhythmia.

absorbed than non-heme iron. For the prevention of iron deficiency anemia, it is recommended that one
takes animal products that are rich in heme iron. Vegetables, legumes, and other common plant-based

Column: Health information obtained based on body height and weight

BMI is calculated based on a person’s height and weight. According to the WHO standards, aproducts that are rich in non-heme iron, meanwhile, can also have better iron absorption when combinedwith vitamin C-rich vegetables and fruits. One therefore needs to take both heme and non-heme iron ina balanced manner.

normal BMI is 22.0 for both men and women, and those with a BMI of below 18.5 are classified as
being underweight, and 30 and above, obese (Table 6.2). BMI is an indicator meant for adults; theHeme ironNon-heme iron

Kaup index and the Rohrer index are used for infant and school children, respectively (See Chapter
9 to learn about the calculation).

BMI = weight (kg) / height (m) 2

Meat

Liver

Green/yellow vegetables

Chicken eggs

Fish

Shellfish

Legumes

SeaweedTable 6.2 BMI and Nutritional status

BMI
Below 18.5

Nutritional status

18.5–24.9

Normal weight

25.0–29.9

Pre-obesity

30.0–34.9

Obesity class I

35.0–39.9

Obesity class II

Above 40

Obesity class III

Underweight4

Source: WHO region office for Europe, Body mass index-BMI.
https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi

Figure 6.8 Main dietary sources of iron

Column: Cambodians and anemia

Anemia represents a serious health issue in Cambodia. Prevalence of anemia in the country isapproximately 56% among children under 5 years of age, and approximately 45% among women
15-49 years of age5. Possible causes of anemia in Cambodians, other than simple iron insufficiency,
may include deficiencies of zinc or folic acid deficiency, parasite or malaria infection, and pregnancy.
Anemia caused by these factors may not be improved by the intake of dietary iron or iron102

Chapter 6

Prevention of lifestyle diseases

103supplementation alone (Table 6.3)6. While use of the Lucky Iron Fish7 and fish sauce fortified with
8

A balanced diet is a diet that allows one to take in just the right amounts of nutrients they need toan iron compound have been known to improve dietary iron deficiency anemia, the Lucky Iron Fish

maintain their health. To maintain homeostasis, it is important for one to acquire a habit of eating a

was reported to have been ineffective in the cases of anemia due to non-dietary causes such asbalanced diet. However, it takes some time for us to see whether or not our diet is right as the latter9

genetic hemoglobin disorder . It is therefore important that one keep a balanced diet. Other possible

manifests in the form of abnormal physical conditions. In other words, people are not quick to realize it

approaches to alleviate or prevent anemia include parasite control using vermicides, proper malaria

when their diet is not appropriate. This is what makes dietary habits one of the factors for lifestyle

prevention and treatment measures, and family planning that suits individuals.

diseases. Continuation of an inappropriate diet exposes a human body to an inadequate supply ofnutrients for a prolonged period of time. Many cases of type 2 diabetes, dyslipidemia, and hypertension,

Table 6.3 Non-iron-related causes of anemia in Cambodia

for instance, are attributable to inappropriate dietary habits. Development of these diseases constitutes

Deficiency of zinc makes the erythrocyte membrane more
vulnerable to damage, which causes the red cell count to
decline.

risk factors for ischemic heart diseases and cerebrovascular diseases.

Folic aciddeficiency

Folic acid is essential for hematopoiesis, and its deficiency
inhibits production of normal red blood cells.

different groups according to their characteristics. When using the Cambodian Food Pyramid to track

Parasite infection

If hookworms are attached to the intestinal mucosa for a
prolonged period of time, it causes chronic blood loss,
resulting in anemia.

Zinc deficiency

Malaria

Pregnant women

To help one take in the right amounts of necessary nutrients, it is effective to use the Cambodian
Food Pyramid (see Chapter 5) as a guide to appropriate food intake. The pyramid classifies foods into
one’s dietary nutrient intake, it is preferable to do so over the span of one week or similar, rather thanjudging whether or not the intake is appropriate based on a meal-by-meal or day-by-day basis.
In addition, it is critical to have children acquire good dietary habits in their infancy and earlychildhood, and children need to learn about the Cambodian Food Pyramid and the Seven Key
Messages during their school-age years (see Chapter 5). Since lifestyle habits of school-age children

Malaria parasites proliferate inside the body and infect andeventually destroy red blood cells. (See Chapter 7 to learn
more about malaria)

depend largely on parent education, it is also important to communicate with parents and guardians. In
school education, it is desirable to have students/pupils gain understanding of the characteristics offoods that are consumed frequently in each region of Cambodia, and have them acquire knowledge on

Expecting mothers require iron and other nutrients in greater
amounts than normal. Short inter-pregnancy interval puts
greater strain on a mother, raising the risk for anemia.
Pregnancy and delivery by a teenager, who is still in a periodof growth herself, can also be more susceptible to anemia.

nutrition, such as what to eat and how much to eat to maintain an appropriate nutrition status. To thisend, it is effective to provide opportunities to try actual food and meals by offering experiences such as
observing foods being sold at a market or store, eating at a restaurant, growing crops at school or home,and cooking the crops they have grown by themselves, or making use of audiovisual learning materials.

3. Prevention of lifestyle diseases and diet/nutrition

2) Importance of healthy proteins

10-121) Acquiring desirable lifestyle habitsProteins are found in nearly all foods, regardless of whether they are plant- or animal-based. They are
degraded by multiple digestive enzymes in the digestive tracts into amino acids for absorption. Onceabsorbed, the amino acids are converted into a variety of different substances based on genetic information

A normal rhythm of everyday life often means that one eats three times a day. It is desirable that one

and biological state, and serve as an energy source or building material for biological structures. In

acquires a habit of eating a regular and balanced diet, keeping lifestyle disease prevention in mind as aaddition, amino acids play important roles to synthesize proteins, which produce enzymes, hormones,

part of daily life. Being mindful of one’s every meal every day helps maintain healthy lifestyle habits.

neurotransmitters, immune cells and antibodies, various receptors, or transporters. Thereby, the proteins

The human body is inherently equipped with a system that works to maintain homeostasis. For

regulate bodily functions and maintain immune function, contributing to preserve bodily resistance (seeinstance, if one eats snacks that are high in sugar and fat, levels of sugar and triglyceride or cholesterol

Chapter 5).

in the blood increase. Such increases are a normal bodily response, and they return to the levels before

While there are 20 amino acids that are body constituents, nine of them cannot be synthesized in thethe intake of such snacks. If undesirable lifestyle habits or disturbance to a rhythm of everyday life

body. These nine are called essential amino acids, and humans must take them in the form of dietary

harms the system that maintains homeostasis, however, it may cause a situation where the blood sugar

protein. If one’s diet consists predominantly of a single type of food, it is difficult for them to cover allor triglyceride levels elevated by food intake take much longer to return to normal, with these levels

essential amino acids. It is therefore necessary for one to maintain a balanced intake of meat, seafood,remaining high even when one has not eaten.

eggs, and legumes, in addition to grains as a staple food.

104

Chapter 6

Prevention of lifestyle diseases

105

4. Acquiring a better rhythm of everyday life2) Biological clocks

1) Maintenance of biological homeostasis

The earth rotates once every 24 hours approximately. Living organisms on earth have bodily systems
that reflect changes in photoenvironment that repeat in a 24-hour cycle. This is called a circadianHomeostasis is a bodily function, or a process of biofeedback, with which a living body maintains arhythm, in which their biological clocks regulate sleep, hormone release, body temperature, blood

constant internal environment and sustains life activities by responding to environmental changes (seepressure, and enzymatic reactions (i.e., chemical reactions such as digestion, degradation, absorption,

also Chapter 2). A living body has mechanisms that maintain homeostasis, such as regulation of bodyand metabolism induced by enzyme activity). If a circadian rhythm is out of form or is disrupted, it has

temperature, body fluid osmolality and pH, the concentration of glucose in blood, and blood pressure.

mental and physical consequences; if the rhythm is not restored, it may induce sleep disorders, lifestyle

For instance, the body temperature of a healthy human being is maintained at 36–37 degrees Celsius

diseases, or psychiatric illness (see also Chapter 2).

regardless of external temperatures. Likewise, a person’s concentration of glucose in blood is maintained

Humans eat and are active during the light period (i.e., when it is light during daytime) and sleep

within the normal range even right after meals or when they have not eaten. By having these mechanisms

during the dark period (i.e., when it is dark during nighttime, etc.). The chemical reactions and hormone

work in concert to keep an optimal condition for the individual, a living body is able to sustain life

releases in the body are regulated according to this shift of behaviors. Regular hours and desirable

activities.

lifestyle habits accord with this innate biological rhythm and play a role in preventing diseases.

Figure 6.9 shows the main composition of a human body. Approximately two-thirds of a humanbody is water, of which two-thirds is the intracellular fluid and the remaining one-third extracellular
fluid. Intracellular and extracellular fluids normally have the same fluid density because homeostasis is3) Lifestyle habits to maintain a normal biological rhythm

at work to induce osmotic transport of water. In addition, intracellular and extracellular fluids contain anumber of substances required for a living body to sustain life, and they exchange substances via cell

To maintain the inner environment of a living body, many organs work in coordination, including themembrane to ensure the cells work properly. For instance, key substances found in extracellular andimmune autonomic, and endocrine systems. For instance, the concentration of glucose in blood is

intracellular fluids are electrolytes, including sodium ions (Na ), chloride ions (Cl ), and phosphate ions

regulated to be always within the normal range. This is achieved by the pancreas releasing insulin in(HPO42‒) in the former, and potassium ions (K+), calcium ions (Ca2+), and magnesium ions (Mg2+) in the

response to elevation of blood sugar, with insulin promoting the cellular uptake of glucose. Diabetes islatter.

a condition in which insulin fails to work properly, leaving the blood sugar level out of control and+–increasing beyond the normal range, which results in an excessive amount of glucose in urine. There are
LipidsProteins

30%

Elderly (age 75 years)

Minerals

Intracellular
fluid

Extracellular
fluid

5%

33%

20%

12%

two causes for insulin to fail to work: reduced insulin secretion, and insulin resistance. The former may
occur when insulin output by the pancreas is already low to begin with, or it becomes lower as a resultof aging or genetic reasons. The latter means that insulin has become less active even when its output issufficient. If a person becomes obese due to irregular dietary habits and physical inactivity, insulin
becomes less active.

15%

Adult male (age 25 years)

17%

6%

42%

To maintain homeostasis, daily lifestyle habits play an important role. Not only does eating at regular

20%

hours sate one’s hunger and supply the body’s need for nutrients, but it is also an activity that is necessary
to regulate enzymatic reactions and maintain homeostasis. Besides diet, regular bowel movements and15%

Infant (age 3 months)

11% 4%

40%

desirable sleep habits are also important. Some hormone release and enzymatic reactions may subside

30%

when the body is resting and energy consumption is low, while others may increase. Growth hormones
are important during periods of growth, and their secretion is promoted during sleep at night. While

0

20

40

60

80

100 (%)

sleeping, one’s hormone release and enzymatic reactions associated with the digestion and absorption ofThis figure is a modification of the original in “Oku T, & Yamada K (Eds.), Badic biochemistry, 2nd ed. Nankodo, 201410 and its
3rd ed. published in 201911.”

nutrients are reduced, so that the body stores the nutrients and saves energy. This well-orchestrated

Figure 6.9 Composition of the Human body

habits are important activities in order for a living body to maintain a normal biological rhythm andregulation allows a living body to sustain life activities without running out of energy. Regular lifestyle
maintain biological homeostasis.

106

Chapter 6

Prevention of lifestyle diseases

107Column: Environmental stimuli, homeostasis, and autonomic function

enzymes, and hormones.
Overweight and obesity, meanwhile, were observed in 3.2% of students. Prevalence of overweight

Humans are exposed to various environmental stimuli, including physical stimuli such as heat,was 2.1% among urban students13. Among students, 86.6% consumed junk food at least once a week andultraviolet light, and noise, biological stimuli such as those caused by bacterial infection, chemical

21.9%, every day; 84.3% consumed soft drinks at least once a week and 11.8%, every day. One of thestimuli caused by drugs, and psychological distress such as stress from peer relationships, hardships

Seven Key Messages advises against excessive intake of salt or fat, and this helps prevent non-of life due to financial reasons, and violence (see also Chapter 12). When one is exposed to such

communicable diseases from developing. While child overweight and obesity are not an issue of highstimuli for a prolonged period of time, their biological homeostasis may become imbalanced, putting

priority in Cambodia at present, it will become important to educate students on what diets help prevent

their health at risk. As discussed in Chapter 2, the autonomic nervous system has two divisions,non-communicable diseases.

namely the sympathetic and parasympathetic nervous systems, and they control the blood pressure,heart rate, body temperature, digestion, metabolism, perspiration, excretion, sexual arousal

Table 6.4 Comparison of nutrition statuses (age 6–17 years)

processes. When the body is continuously subjected to environmental stimuli, this autonomic

Urban

Rural

Stunting

20.4%

36.4%

Wasting

10.4%

16.1%

Underweight

22.1%

38.1%

regulation may be disturbed, potentially resulting in homeostatic imbalance. This causes certain
symptoms to manifest in mental and physical ways, such as tiredness, constipation or diarrhea,
headache, dizziness, palpitation, and feeling of depression. It is therefore necessary to pay ample
attention to stimuli from the environment in addition to keeping regular lifestyle habits, in order tomaintain homeostasis and good health.

Source: FIDR, 201713

5. Improper diets and health problems
In many cases, the health impact of a proper or improper diet may only be noticed when one is aware of
subjective symptoms and the illness is advanced. Where infants are concerned, a mother may experiencea low milk supply or become unable to breastfeed a child at all due to poor nutrition or health, or childneglect. In their early childhood and school-age years, children may experience an imbalance in energy
and nutrition intake that is necessary for them due to picky eating, unbalanced eating, or allergy.

Egg
Legumes,
nuts and seeds

According to an FIDR report13, the prevalence of stunting in Cambodia was approximately 20%
among children of age 6 years, peaked at over 40% in those of age 10–12 years, and was still higher than
30% in 13–15 years. Wasting accounted for 10% in age group 7–9 years and approximately 20% in
10–15 years. As for malnutrition, the prevalence increased significantly at the age of 10–12 years. In a
comparison of children’s nutrition status between urban and rural areas, malnutrition was severe among
rural children (Table 6.4). See Chapter 9 to learn about the definitions of stunting, wasting, andunderweight as indicators of malnutrition.
For normal growth of children, intake of protein as well as energy is important. In Cambodia, theMeat andmeat products

Others5%

16%

Cereal

37%

5%
16%

Fish andshellfish

21%

Source: FIDR13

Figure 6.10 Sources of protein for children

largest source of students’ protein intake was cereal, followed by fish, meat, eggs, and legumes (Figure6.10)13. The most common meal pattern in Cambodia was “rice with soup or sweetened soup,” followedby “rice with soup and deep-fried/grilled dish.” To ensure normal growth of children, it is important toimprove nutrition status through a smart approach to supplying good-quality protein. Meat and eggs, forinstance, contain iron on top of quality proteins, which helps prevent anemia. In Cambodia, people
consume more soy milk than regular milk, and soy milk serves as their source of protein intake. Proteins,which are an important composition of a human body, are building blocks of the immune system,
108

Chapter 6

Prevention of lifestyle diseases

109Column: Dietary habits that prevent lifestyle diseases will also help prevent infectious

diseases

they content to remain as they are? And what are their reasons? Explore answers to these questions.
[6-4] Examine dietary habits of people who are very thin. Explore the reasons behind them and discuss
what may be done to improve them.

Dietary guidelines implemented in Cambodia including the Cambodian Food Pyramid not only help

[6-5] Cases of eating disorders are on the rise among young women in Western countries as well as

prevent lifestyle diseases but infectious diseases as well. WHO has published “Nutrition advice forsome Asian countries, including Japan and South Korea. Discuss if there are women who suffer

14

from anorexia or bulimia in Cambodia.

adults during #COVIT-19 ” (Table 6.5), emphasizing the importance of food: “Proper nutrition isvital. Eat a well-balanced diet every day to get the vitamins, minerals, dietary fiber, protein and[6-6] Identify health problems among children and young people around you that are likely to be a

antioxidants your body needs to be healthier with a stronger immune system and to lower your risk

result of an improper diet, and discuss as many factors as possible that may explain why they eatof chronic illnesses and infectious diseases.”as they do.
[6-7] Discuss what health impacts there may be when the body fails to maintain homeostasis.
14

Table 6.5 Nutrition advice for adults during the COVID-19 outbreak

Eat fresh and unprocessed food such as dark green leafy vegetables, orange/yellow colored fruit andvegetables, legumes (e.g., lentils, beans), nuts and whole grains (e.g., unprocessed maize, millet, oats,
wheat, brown rice or starchy tubers or roots such as potatoes), and proteins (e.g., meat, fish, eggs,milk).
Drink 8-10 cups of water every day. Water is the best choice, but you can also consume other drinks(e.g., lemon juice diluted in water and unsweetened, tea and coffee – not too much), and eat fruits andvegetables that contain water (e.g., cucumber, tomatoes, spinach, mushroom, melon, broccoli, Brussels
sprouts, oranges, apples, blueberries).
Eat healthy fats found in white meat (e.g., poultry), fish, avocado, nuts, olive oil, soy, canola,
sunflower and corn oils, rather than fats found in fatty meat, butter, coconut oil, cream, cheese, ghee
and lard. Avoid fats found in processed food, processed meats, fast food, snack food, fried food, frozen
pizza, pies, cookies, margarines and spreads.
Limit your salt intake. When cooking and preparing food, limit the amount of salt and high sodium
condiments (e.g., soy sauce, fish sauce). Limit your daily salt intake to less than 5 g (approximately 1
teaspoon), and use iodized salt. Avoid snack foods that are high in salt.
Limit your sugar intake. Choose fresh fruits instead of sweet snacks (e.g., cookies, cakes, chocolate).
Limit your intake of soft drinks or sodas, still drinks and other drinks that are high in sugar (e.g.,sweetened fruit juices, fruit juice concentrates and syrups, flavored milks, yogurt drinks).
Avoid eating out. Eating out during this COVID-19 pandemic increases your contact with otherpeople and your chance of being exposed to the virus. So eat at home. Home-cooked food is the best
choice, and is healthier and more nutritious for you than calorie-filled food from outside the home.
Reach out for help. During this COVID-19 pandemic, you may need support with your mental healthand diet to ensure you keep in good health, especially if you are living with a chronic illness and havesuspected or confirmed COVID-19. If you feel overwhelmed, seek help from trained professionals andthrough other trusted sources (e.g., digital, social, print and broadcast).

References
1

Ministry of Economy, Trade and Industry. International Healthcare Development Country Report: Cambodia. https://www.meti.
go.jp/policy/mono_info_service/healthcare/iryou/downloadfiles/pdf/countryreport_Cambodia.pdf

2

Institute for Health Metrics and Evaluation. Cambodia. http://www.healthdata.org/cambodia

3

Sasazuki S, Inoue M, Tsuji I, Sugawara Y, Tamakoshi A, et al. Body Mass Index and Mortality From All Causes and Major Causes inJapanese: Results of a Pooled Analysis of 7 Large-Scale Cohort Studies. Journal of Epidemiology. 21(6): 417–430. 20114

WHO. Body mass index - BMI. https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/bodymass-index-bmi

5

USAID, Strengthening Partnerships, Results, and Innovations in Nutrition Globally(SPRING), Cambodia National Anemia Profile.
https://www.spring-nutrition.org/sites/default/files/publications/anemia-profiles/spring_nap_cambodia.pdf

6

Wieringa FT, Dahl M, Chamnan C, Poirot E, Kuong K, et al. The High Prevalence of Anemia in Cambodian Children and Women
Cannot Be Satisfactorily Explained by Nutritional Deficiencies or Hemoglobin Disorders, Nutrients 2016, 8, 348; doi:10.3390/
nu8060348. https://www.mdpi.com/2072-6643/8/6/348

7Charles CV, Dewey CE, Hall A, Hak C, Channary S, et al., A Randomized Control Trial Using a Fish-Shaped Iron Ingot for the
Amelioration of Iron Deficiency Anemia in Rural Cambodian Women. Tropical Medicine & Surgery 3(3):2015.
https://www.longdom.org/open-access/a-randomized-control-trial-using-a-fishshaped-iron-ingot-for-the-amelioration-of-irondeficiency-anemia-in-rural-cambodian-women-2329-9088-1000195.pdf

8Longfils P, Sowath S, Nakanishi Y, Chavait V, Monchy D, et al., Daily Consumption of Iron Fortified Fish Sauce Improved Iron
Status of Iron Deficient Anemic School Children in Cambodia. Trace Nutrients Research 24:59-64 2007. http://www.jtnrs.com/
sym24/24_059.pdf

9Rappaport AI, Whitfield KC, Chapman GE, Yada RY, Kheang KM, et al., Randomized controlled trial assessing the efficacy of areusable fish-shaped iron ingot to increase hemoglobin concentration in anemic, rural Cambodian women. The American Journal of
Clinical Nutrition, 106(2), 667–674, 2017. https://academic.oup.com/ajcn/article/106/2/667/4557630

Exercises for further thought and research[6-1] Review and assess your own lifestyle habits.
[6-2] Discuss issues of lifestyle habits with your group members, and offer advice to one another.
[6-3] Examine lifestyle habits of people who are obese. What makes them different from those of people
who are not obese? Do they wish to change their lifestyle habits and overcome obesity? Or are110

10 Oku T, & Yamada K (Eds.), Basic biochemistry, 2nd ed. Tokyo: Nankodo, March 30, 2014.
11 Oku T, and Yamada K (Eds.), Basic biochemistry, 3rd ed. Tokyo: Nankodo, August 20, 2019.
12 National Institute of Health and Nutrition, Oku T, and Shibata K (Eds.), Basic Nutrition, 3rd ed. Tokyo: Nankodo, February 25,
2010.
13 Federation for International Development Relief, Development of recommended dietary allowance and food-based dietary guidelines
for school-aged children in Cambodia. 2017.
14 WHO, Nutrition advice for adults during #COVIT-19. http://www.emro.who.int/nutrition/nutrition-infocus/nutrition-advice-foradults-during-the-covid-19-outbreak.html
Chapter 6

Prevention of lifestyle diseases

111