Date: September 28, 2007
Population-Wide Weight Loss In Cuba Resulted In Fewer Deaths From
Diabetes And Heart Disease
Science Daily — Researchers from the Johns Hopkins Bloomberg School of
Public Health, Cienfuegos, Cuba and Loyola University had a unique
opportunity to observe the impact of population-wide weight loss due to
sustained reductions in caloric intake and an increase in energy output.
This situation occurred during the economic crisis of Cuba in 1989-2000.
As a result, obesity declined, as did deaths attributed to diabetes,
coronary heart disease and stroke.
"This is the first, and probably the only, natural experiment, born of
unfortunate circumstances, where large effects on diabetes,
cardiovascular disease and all-cause mortality have been related to
sustained population-wide weight loss as a result of increased physical
activity and reduced caloric intake," said Manuel Franco, MD, a PhD
candidate in the Bloomberg School of Public Health's Department of
"Population-wide approaches designed to reduce caloric intake and
increase physical activity, without affecting nutritional sufficiency,
might be best suited for the prevention of cardiovascular disease and
The study authors gathered data on energy intake, body weight and
physical activity using previously published literature from the Cuban
National Institute of Hygiene, Epidemiology and Microbiology, the Food
and Agriculture Organization of the United Nations, the Cuban First and
Second National Surveys on Risk Factors and Chronic Diseases and the
Cuban Ministry of Public Health.
There was a drop in the daily per capita food availability from the late
1980s to 1995, resulting in a daily energy intake decline from 2,899
kcal in 1988 to 1,863 kcal in 1993. In 1987, 30 percent of Havana
residents were physically active. From 1991 to 1995, 70 percent of
Cubans were physically active as a result of widespread use of bicycles
and walking as means of transportation. Obesity prevalence in
Cienfuegos, Cuba, decreased from 14.3 percent in 1991 to 7.2 percent in
During the end of the Cuban economic downturn and the years following
it, there were substantial declines in cardiovascular disease, type 2
diabetes and all-cause mortality. The researchers report a plateau in
the number of deaths from diabetes during the food shortage of
1988-1996, when physical activity increased and obesity decreased.
"Future steps towards prevention of cardiovascular disease and diabetes
should focus on long-term population-wide interventions by encouraging
physical activity and the reduction of caloric intake," explained
Franco, who is also affiliated with the Johns Hopkins Welch Center for
Prevention and Epidemiology.
Johns Hopkins researchers Manuel Franco, Benjamin Caballero, Mariana
Lazo and Eliseo Guallar co-authored "Impact of Energy Intake, Physical
Activity and Population-wide Weight Loss on Cardiovascular Disease and
Diabetes Mortality in Cuba, 1980-2005". Additional co-authors are Pedro
Orduñez, Jose A. Tapia Granados, Jose Luis Bernal and Richard S. Cooper.
The study was published September 19, 2007, as an Advance Access study
by the American Journal of Epidemiology.
Dr. Manuel Franco was funded by grants from the Fulbright Commission and
the Welch Center for Prevention, Epidemiology and Clinical Research.
Note: This story has been adapted from material provided by Johns
Hopkins Bloomberg School of Public Health.