SEEDi1.0-3.0 strategies for major noncommunicable diseases in China

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SEEDi1.0-3.0 strategies for major noncommunicable diseases in China Chun-song Hu1, Tengiz Tkebuchava2 1. Department of Cardiovascular Medicine, Nanchang University, Nanchang 330006, Jiangxi Province, China 2. Boston TransTec, LLC, Boston, MA 02459, USA ABSTRACT The purpose of this article is to briefly introduce the status and challenges of major noncommunicable diseases (mNCDs), which include cardiovascular disease, diabetes and cancer, as well as related risk factors, such as environmental pollution, smoking, obesity and sleep disorders. “S-E-E-D” rules or the strategies of “S-E-E-D” intervention (SEEDi) consist of four core healthy elements: sleep, emotion, exercise and diet. The history of SEEDi1.0–3.0 is also introduced, which includes versions 1.0, 1.5, 2.0 and 3.0 of the program. These guidelines are suitable for prevention and control of mNCDs. Not only the “Healthy China” initiated in China’s “13th Five-year Plan,” but also the “Healthy World” philosophy needs SEEDi1.0–3.0 strategies for control of mNCDs. Keywords: noncommunicable diseases; cardiovascular disease; diabetes mellitus; cancer; lifestyle Citation: Hu CS, Tkebuchava T. SEEDi1.0–3.0 strategies for major noncommunicable diseases in China. J Integr Med. 2017; 15(4): 265–269.

1 Introduction According to World Health Statistics 2016: Monitoring Health for the SDGs, [1] the average life expectancy increased by 5 years between 2000 and 2015, and global life expectancy for children born in 2015 was 71.4 years (73.8 years for females and 69.1 years for males). However, healthy life expectancy was only 63.1 years globally. According to the report on cardiovascular disease (CVD) in China, 2015,[2] CVD remains the leading cause of death. The large epidemic of major noncommunicable diseases (mNCDs), due to unhealthy lifestyles, including environmental pollution, has become a heavy burden and a tremendous challenge,[2–4] seriously affecting the healthy development of the economy and society in China and the rest of the world. Currently, mNCDs remain the leading

cause of death in most countries.[5] How to prevent and effectively manage mNCDs for the health of China and the world has become an important topic and research subject. 2 Current status and challenge in mNCDs According to the latest data from the World Health Organization, a quarter of global deaths are caused by pollution in air, water, soil and other environmental factors.[6] As many as 8.2 million deaths can be attributed to air pollution; for example, exposure to secondhand smoke may result in atherosclerotic cardiovascular disease (ASCVD), diabetes, cancer and chronic respiratory diseases. According to the 2015 adult survey report of tobacco in China,[7] the smoking rate was 27.7% in older

http://dx.doi.org/10.1016/S2095-4964(17)60355-8 Received January 7, 2017; accepted May 2, 2017. Correspondence: Chun-Song Hu, MD; E-mail: [email protected]

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adults. It was 52.1% in men and 2.7% in women, with the total number of smokers reaching 316 million. China and the United States have the largest populations dealing with obesity. According to The Lancet, [8] obesity is a health problem affecting 4 320 million men and 4 640 million women in China. Since obesity is a major risk factor for mNCDs, it is a serious public health concern. For example, every year obesity places a 60 billion pound burden on the UK.[8] If the present trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 9% in women and 6% in men.[8] Sleep disorders are also important risk factors of mNCDs; 38.2% of Chinese adults have insomnia. Long-term sleep disorders, such as obstructive sleep apnea and insomnia, are closely related to hypertension, arrhythmia, myocardial infarction and even sudden cardiac death, as well as diabetes and cancer. In addition, modern electronic devices and entertainment have also contributed to a surge in mNCDs, due to a sedentary lifestyle and lack of exercise. There are more than 300 million people suffering from CVD in China. More than four-fifths of young people do not get enough physical activity, and nearly one in four (25.2%) adults, aged 18 years old and above, in China have hypertension.[2,9] Further, more than 100 million people suffer from diabetes in China; of these, the prevalence of adult-onset diabetes increased from 0.9% in 1980 to 11.6% in 2010.[3] Spending on diabetes is expected to reach 360 billion yuan by 2030, [10] becoming a sizable economic burden. Besides obesity, long working hours, reduction of sleep, mental stress and other unhealthy lifestyles are also important risk factors for diabetes. Obesity and unhealthy lifestyles may also increase the risk of cancers. According to the report Cancer Statistics in China 2015,[4] there were estimated 4 292 000 new cancer cases, and 2 814 000 deaths in China in 2015. CVD, diabetes and cancer are just like “the three big mountains” of human health, and they are often linked to each other resulting in deadly comorbidities or strips, due to shared risk factors among mNCDs.[11,12] Major risk factors are variable, and related mNCDs are preventable. Just as “the foolish old man” slowly removes “the three big mountains” (Figure 1), people need to continuously develop fresh programs,[15] new platforms[16,17] and novel strategies to help in the prevention and control of mNCDs. 3 History of SEED intervention In 2005, “S-E-E-D” rules (SEEDRs) for healthcare were creatively proposed. They consist of four core healthy elements, which are sleep, emotion, exercise, and diet. SEEDRs included “Sleep Rule”: a reasonable sleep and rest at midday; “Emotion Rule”: emotional stability and peace July 2017, Vol. 15, No. 4

of mind; “Exercise Rule”: aerobics, static and dynamic binding; and “Diet Rule”: scientific diet, balanced and consistent nutrition including smoking cessation and alcohol limitation. SEEDRs or SEED intervention (SEEDi) are suitable for everyone’s health, especially for the prevention of unhealthy lifestyle-related mNCDs, which also include ASCVD.[18] Whoever has a good “SEED” will have good health. Considering a major impact of the environment on health, SEEDi was further developed into E(e)SEEDi. Here, E(e) signifies big and small environments, as well as internal and external environments, and is represented by the “Environment Rule”: a suitable environment, away from pollution. While SEEDi is known as the 1.0 version or “SEEDi1.0,” E(e)SEEDi is the 1.5 version of SEEDi known as “SEEDi1.5.” As an early strategy of prevention, SEEDi or E(e)SEEDi is especially suitable for mNCDs related to unhealthy lifestyles (Table 1). In 2009, the E(e)SEED-BasED healthy lifestyle was further summarized and named “Hu’s healthy lifestyles (HHL).” It contains five core health elements which are environment, sleep, emotion, exercise and diet, as well as a total of 15 core lifestyles. Therefore, HHL intervention is known as SEEDi version 2.0 or “SEEDi2.0.” Next, a general formula, named the health and longevity equation (Health and Longevity = RT-ABCDEF + E(e)SEED-BasED + 210) was set up,[13,14,16,18] and meets the latest “5P” medical model for prevention and management of mNCDs. The general formula is known as the 3.0 version of SEEDi, or “SEEDi3.0.” Can “foolish old man” remove slowly “three big mountains?” Yes!

Air pollution DM

CA

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澳

OB

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E2 D

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s 2.0

E(e) d

D

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RT-ABCDEF

E1 E2

s

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1.0–3.0 for noncommunicable disease Figure 1 SEEDi

CVD: cardiovascular disease; DM: diabetes mellitus; CA: cancer; OB: obesity; E(e): environment; S: sleep; E1: emotion; E2: exercise; D: diet; b: behavior; a: age; s: safety, sex, study; e: education, employment, ethnic; d: disease, drug; i: intervention. RT-ABCDEF is a strategy for management and prevention of human diseases, which was originated from RT-ABCDE (RT: right, routine, and reversible treatment; A: antagonistic treatment; B: biohazard control; C: change unhealthy lifestyle; D: disease and risk control; E: examination),[13] with F standing for “follow-up.” The “210” stands for a comprehensive strategy of prevention, which includes primary and secondary prevention, and “Grade-zero” prevention.[14] The latter is also called policy of prevention. 1.0: version 1.0; 1.5: version 1.5; 2.0: version 2.0; 3.0: version 3.0.

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www.jcimjournal.com/jim 1.0–3.0 strategies for major noncommunicable diseases Table 1 SEEDi

SEEDi1.0–3.0

Contents

SEEDi (SEED rules) Sleep Rule: a reasonable sleep, siesta in the noon Emotion Rule: emotional stability, peace of mind Exercise Rule: aerobics, static and dynamic binding Diet Rule: a scientific diet, balanced and constant nutrition including smoking cessation and drinking limitation SEEDi1.5 (E(e)SEEDi) Environment Rule: a suitable environment, away from pollution Others: the same as mentioned above SEEDi2.0 (HHLi) (E(e)SEED-BasED) Healthy Lifestyles (It is also called Hu’s Healthy Lifestyles, HHL) Health and Longevity = RT-ABCDEF + E(e)SEED-BasED + 210 (It is also named health and longevity equation) SEEDi3.0 1.0

SEEDi1.0–3.0 strategies are versions 1.0, 1.5, 2.0, and 3.0 of SEEDi or SEED rules, respectively. RT-ABCDEF is a strategy for management and prevention of human diseases, which was originated from RT-ABCDE (RT: right, routine, and reversible treatment; A: antagonistic treatment; B: biohazard control; C: change unhealthy lifestyle; D: disease and risk control; E: examination),[13] with F standing for “follow-up.” The “210” stands for a comprehensive strategy of prevention, which includes primary and secondary prevention, and “Grade-zero” prevention.[14]

4 Healthy China needs SEEDi1.0–3.0 for mNCDs Since the occurrence and development of mNCDs are closely related to unhealthy lifestyles, strategies for therapeutic lifestyle modification, SEEDi1.0–3.0, may help us effectively prevent and control mNCDs. Recently, the American College of Physicians strongly recommended that all adult patients receive cognitive behavioral therapy for insomnia, as the initial treatment for chronic insomnia disorder.[19] Primary and secondary prevention by SEEDi1.0–3.0 strategies is very important for reducing the mortality and morbidity of mNCDs; the key is to adhere to these strategies through healthy lifestyles, which also include rational drug selection. At the same time, strengthening the ability to predict ASCVD and major adverse cardiovascular events may help us learn how to better prevent them. Since the gut microbiome can rapidly respond to longterm or short-term altered dietary intake,[20] human dietary lifestyles may affect intestinal bacteria,[21,22] and are likely to have a strong impact on health. This reveals links between dietary patterns and gut flora among obese populations and related patients with mNCDs. Unhealthy “SEED” and “Soil” (e.g., gut flora) are linked with mNCDs and comorbidities or strips such as deadly CVD, diabetes, and cancer;[11] as a universal practice of healthy lifestyles, SEEDi1.0–3.0 may be used as core strategies for mNCDs. A new study found that a higher level of fruit consumption was associated with lower blood pressure and blood glucose levels, leading to significantly lower risks of major CVDs because phenols or polyphenols may help reduce the release of pro-inflammatory mediators.[23] Another study, in Nature, found that cancer risk is heavily influenced by extrinsic factors.[24] All in all, these studies confirm the role of SEEDi1.0–3.0 on mNCDs. Due to its strategies for containing mNCDs and their major risk factors, as well as its framework for healthy lifestyles, SEEDi1.0–3.0 are Journal of Integrative Medicine

known as the “mNCDs vaccine,” hinting at the double effect of prevention and treatment. When combined with the technologies of biological structure-editing,[25] such as RNA interference and clustered regulatory interspaced short palindromic repeats/Cas9, SEEDi1.0–3.0 may help us achieve precise prevention and control of mNCDs and their major risk factors in the future. The “Cancer Moonshot” endorsed by the United States president aims to find a new cure for cancer and alleviate the burden of morbidity and mortality. [26–28] The great plan, as a national strategy, will not only benefit the US, but also the world. The health industry will become an important pillar of domestic economic growth for China in the “13th Five-year Plan.” According to this year’s “World Health Statistics,” health expenses exceeded 25% of total household spending. According to World Bank estimates,[29] between 2010 and 2040, by reducing the mortality of CVD by 1%, China will receive an economic benefit of $10.7 trillion. SEEDi1.0–3.0 strategies are readily available to all, and make it easy to achieve the most extensive health coverage. The policy of prevention, also called “Gradezero prevention”, is very significant for the prevention and control of mNCDs. [18] Therefore, SEEDi 1.0–3.0 are expected to become a national health strategy, as the health of China and the world can benefit from SEEDi 1.0–3.0. Indeed, SEEDi1.0–3.0 will help us to reduce prescription drug costs just like the Affordable Care Act,[30] and will help to promote more traditional Chinese medicines for cancer treatment.[31] We expect progress to be achievable on the big global health challenges of mNCDs. The effective control of mNCDs requires governmental, business, scientific and public cooperation in this difficult task. 5 Acknowledgements The editors and experts are acknowledged gratefully for critical review.

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6 Competing interests There are no potential conflicts of interest. REFERENCES 1

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