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| English: Prevalence of diabetes worldwide in 2000 (per 1000 inhabitants). World average was 28.23‰. no data less than 7.5 7.5-15 15-22.5 22.5-30 30-37.5 37.5-45 45-52.5 52.5-60 60-67.5 67.5-75 75-82.5 more than 82.5 Note: I interpreted France in the data as including the overseas departments of Reunion, Guadeloupe, Martinique, and French Guiana as they are integral parts of France. China includes the SARs of Hong Kong and Macao. (Photo credit: Wikipedia) |
Abstract
Objective To evaluate the
associations between population-wide loss and gain in weight with
diabetes prevalence, incidence, and mortality, as well as cardiovascular
and cancer mortality trends, in Cuba over a 30 year interval.
Design Repeated cross sectional surveys and ecological comparison of secular trends.
Setting Cuba and the province of Cienfuegos, from 1980 to 2010.
Participants Measurements in
Cienfuegos included a representative sample of 1657, 1351, 1667, and
1492 adults in 1991, 1995, 2001, and 2010, respectively. National
surveys included a representative sample of 14 304, 22 851, and 8031
participants in 1995, 2001, and 2010, respectively.
Main outcome measures Changes in
smoking, daily energy intake, physical activity, and body weight were
tracked from 1980 to 2010 using national and regional surveys. Data for
diabetes prevalence and incidence were obtained from national population
based registries. Mortality trends were modelled using national vital
statistics.
Results Rapid declines in diabetes
and heart disease accompanied an average population-wide loss of 5.5 kg
in weight, driven by an economic crisis in the mid-1990s. A rebound in
population weight followed in 1995 (33.5% prevalence of overweight and
obesity) and exceeded pre-crisis levels by 2010 (52.9% prevalence). The
population-wide increase in weight was immediately followed by a 116%
increase in diabetes prevalence and 140% increase in diabetes incidence.
Six years into the weight rebound phase, diabetes mortality increased
by 49% (from 9.3 deaths per 10 000 people in 2002 to 13.9 deaths per 10
000 people in 2010). A deceleration in the rate of decline in mortality
from coronary heart disease was also observed.
Conclusions In relation to the
Cuban experience in 1980-2010, there is an association at the population
level between weight reduction and death from diabetes and
cardiovascular disease; the opposite effect on the diabetes and
cardiovascular burden was seen on population-wide weight gain.
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