Abstract 010: Population-wide Weight Loss and Regain in Relation to Diabetes and Cardiovascular Disease Mortality: Cuba 1980-2010
INTRODUCTION The Cuban economic crisis in the early 1990’s led to weight loss of about 4-5 kg in the entire population, leading to a sharp drop in diabetes and cardiovascular mortality. Following modest economic recovery (1996-2012) body weight was regained as adequate food sources became available and public transportation was restored. Our objective was to evaluate the association of these population-wide body weight changes with mortality trends from diabetes and cardiovascular disease, cancer, and all-causes.
HYPOTHESIS We hypothesize that the previously observed mortality improvements in diabetes and cardiovascular disease due to population-wide weight loss will be reversed following the population-wide weight rebound.
METHODS Changes in daily energy intake, physical activity, and body weight were tracked from 1980 to 2010 using national and regional surveys from Cuba. Body weight data was measured in four local surveys in the city of Cienfuegos in 1991(n=1657), 1995(n=1351), 2001(n=1667), and 2011(n=1492). Diabetes prevalence and incidence trends were obtained from population-based registries. Mortality trends were modeled using national vital statistics over the period 1980-2010.
RESULTS A rebound in population-wide body weight was observed starting in 1996 and by 2011 obesity prevalence had already exceeded pre-crisis levels. The upward weight trend was accompanied by a 140% increase in diabetes incidence (from 1 per 10000 in 1997 to 2.4 per 10000 in 2003), a 47% increase in diabetes mortality (from 9.3 per 10000 in 2002 to 13.9 per 10000 in 2010) and a deceleration in the rate of mortality decline in coronary heart disease.
CONCLUSIONS This unique, 30-year natural experiment demonstrates the strong association at the population level of weight reduction on diabetes and cardiovascular mortality and the contrary effect of weight regain. Moderate and healthy weight loss, affecting the totality of contemporary populations, could yield significant public health benefits.
- © 2013 by American Heart Association, Inc.