Weight loss and regain in relation to diabetes and cardiovascular disease mortality: Cuba 1980-2010

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cardiovascular disease and diabetes are currently two of the most important diseases worldwide but population science has given us the tools to combat these epidemics we control of their major risk factors and healthy diet physical inactivity means overweight obesity we can greatly reduce the disease burden therefore it is critical that we put into action strategies to prevent uncontrolled cardiovascular disease and diabetes on a global scale the population prevention strategy described by jeffrey rose seeks to affect the underlying causes that make these conditions common the population approach to preventing caravan spur disease and diabetes requires a shift of the whole distribution from physical activity and diet in the favorable direction our hypothesis is that changes in the whole human population in terms of physical activity dietary energy intake and body weight that directly to changes in cardiovascular disease and diabetes for the period of 1980 through 2010 in order to test this hypothesis we examined public health trends during an unusual historical period of Cuba this analysis is unique for the following reasons first Cuba has a homogenous population of around 11 million people with minor health differences in terms of race income and education levels second the Cuban population has undergone large economic changes in the last three decades that is the loss of the Soviet Union as a trading partner in 1989 Cuba entered the economic crisis known as the especial period that worsened continuously over the next five years sustained shortages in the food rationing system led to reductions in per-capita daily energy intake in response Cuba implemented several new green policies like commercial neighborhood gardens and use of draft animals in agriculture the lack of public transportation resulted in increased energy expenditure from active forms of transportation and walking and cycling the Cuban government imported 1.5 million bicycles from China at that point and produced another half needed complete economic recovery took not a core until the year 2000 since then economic growth has occurred until now the final reason to conduct a study in Cuba with the amount of high-quality health research data that we could analyze in collaboration with Cuban researchers at the University of employers we analyzed cardiovascular health data for over 20 years within the Carmen initiative the same time primary care chronic disease registries offered extremely valuable data on the burden of diabetes for the three decades of this time finally mortality data are publicly available in the Ministry of Public Health website during the worst years of the economic crisis Dietary energy intake fell slowly and consistently at the same time that physical activity due to walking and bicycling increased too consequently obesity prevalence that was already low around 12% soviet-era reached a nadir of 7% in 1995 and rebounded promptly to reach 19.7% in the year 2010 focusing on the changes in the distribution of body weight in the city of the m4 goes over time we can observe a whole population body weight loss of an average of 5 kilos from the pre-crisis year 1991 until 1995 peak of the crisis from 1995 on we can follow a whole population weight regain phase through the years 2001 and 2010 this population wide weight loss and regain over time follows perfectly Jeffrey roses idea of shifting the whole distribution of chronic diseases risk factors coronary heart disease mortality that had declined sharply after the years of obesity reductions halted its decline as obesity prevalence continued increasing the burden of diabetes has been wildly affected by these body weight changes diabetes prevalence increased hand-in-hand with obesity diabetes incidence shows a decline and increase following OTC patterns and finally the big mortality that had decreased dramatically after the crisis rebounded in the way it came period so what is the relevance of these results for clinicians we should not disregard that population approach in the efforts of chronic disease prevention and individual behavior change recommendations and programs in the clinical settings are complementary following the results of our research two burning questions arose what can we learn from our study in order to prevent cardiovascular disease and diabetes in countries like the UK the u.s.

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Or Spain where more than half of their adults are overweight or obese one important lesson is that transportation policies are fundamental therefore we should encourage walking and bicycling as means of transportation these results also highlighted the need for physical activity and diet changes to happen at the same time and most importantly affecting the whole population the next question would be can we compare the circumstances of the special period in Cuba with the current economic crisis in many European countries in terms of its population health consequences this comparison is problematic since all segments of the Cuban population live under various similar social and economic conditions populations of European countries are very heterogeneous in regard to the levels of physical activity and diet of a different population straighter no clear shift of the whole distribution of Kalavati risk factors physical activity diet or body weight is currently apart as final remarks the author's we would like to highlight the fruitfulness of international scientific collaboration researchers in Cuba Spain and the u.s. in our team have worked together for the last 20 years in public health and medicine research this is more than a story about statistics it is also a story about people in conclusion therefore we would like to acknowledge our great respect and admiration for the Cuban people faced extremely difficult social and economic challenges during the special period and by making common cause against this tragedy held up with courage and dignity this tragedy was man-made by international politics and should never happen again to any population in the world

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