American Journal of Epidemiology Advance Access originally published online on September 19, 2007
American Journal of Epidemiology 2007 166(12):1374-1380; doi:10.1093/aje/kwm226
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ORIGINAL CONTRIBUTIONS |
Impact of Energy Intake, Physical Activity, and Population-wide Weight Loss on Cardiovascular Disease and Diabetes Mortality in Cuba, 1980–2005
1 Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
2 Hospital Universitario "Dr. Gustavo Aldereguia Lima," Cienfuegos, Cuba
3 Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
4 Institute of Labor and Industrial Relations and School of Social Work, University of Michigan, Ann Arbor, MI
5 Department of Epidemiology, Centro Nacional de Investigacion Cardiovascular, Madrid, Spain
6 Department of Preventive Medicine and Epidemiology, Stritch School of Medicine, Loyola University, Maywood, IL
Correspondence to Dr. Manuel Franco, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205-2223 (e-mail: mfranco{at}jhsph.edu).
Received for publication June 1, 2007. Accepted for publication July 16, 2007.
Cuba's economic crisis of 1989–2000 resulted in reduced energy intake, increased physical activity, and sustained population-wide weight loss. The authors evaluated the possible association of these factors with mortality trends. Data on per capita daily energy intake, physical activity, weight loss, and smoking were systematically retrieved from national and local surveys. National vital statistics from 1980–2005 were used to assess trends in mortality from diabetes, coronary heart disease, stroke, cancer, and all causes. The crisis reduced per capita daily energy intake from 2,899 calories to 1,863 calories. During the crisis period, the proportion of physically active adults increased from 30% to 67%, and a 1.5-unit shift in the body mass index distribution was observed, along with a change in the distribution of body mass index categories. The prevalence of obesity declined from 14% to 7%, the prevalence of overweight increased 1%, and the prevalence of normal weight increased 4%. During 1997–2002, there were declines in deaths attributed to diabetes (51%), coronary heart disease (35%), stroke (20%), and all causes (18%). An outbreak of neuropathy and a modest increase in the all-cause death rate among the elderly were also observed. These results suggest that population-wide measures designed to reduce energy stores, without affecting nutritional sufficiency, may lead to declines in diabetes and cardiovascular disease prevalence and mortality.
cardiovascular diseases; Cuba; diabetes mellitus; energy intake; exercise; mortality; weight loss
Abbreviations: ICD-10, International Classification of Diseases, Tenth Revision
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