Nutrition: An Up Side to Hard Times
By NICHOLAS BAKALAR
Published: October 9, 2007
Cuba’s economic crisis in the 1990s had a silver lining, scientists are reporting: a decrease in the rates of obesity, diabetes, coronary heart disease and stroke.
And no wonder. Average calorie consumption dropped more than a third, to 1,863 calories a day in 2002 from 2,899 in 1989. Cubans also exercised more, giving up cars for walking and bicycling.
Using national vital statistics and other sources, the researchers gathered data on energy intake, body weight and physical activity in Cuba from 1980 to 2005. In Cienfuegos, a large city on the southern coast, obesity rates decreased to less than 7 percent in 1995 from more than 14 percent in 1991. As more food became available, obesity increased to about 12 percent again by 2002.
Nationwide, coronary heart disease mortality declined 35 percent from 1997 to 2002. Diabetes mortality was down to less than 10 per 100,000 in 2003 from 19 per 100,000 in 1988. The death rate from all causes declined to 4.7 per thousand in 2002 from 5.9 per thousand in 1982.
“No one is recommending an economic crisis as a health measure,” said Dr. Manuel Franco of the department of epidemiology at Johns Hopkins. “What we are saying is that changes at the population level designed to reduce caloric intake and increase physical activity might be best suited to prevent obesity and its related conditions.”
The article was published online in The American Journal of Epidemiology.
http://www.nytimes.com/2007/10/09/health/09nutr.html?_r=1&partner=rssnyt&emc=rss&oref=slogin~~~~~~~~~~~~~~~~~~~~~~Population-Wide Weight Loss In Cuba Resulted In Fewer Deaths From Diabetes And Heart Disease
ScienceDaily (Oct. 1, 2007) — 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 Epidemiology.
"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 diabetes."
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 1995.
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.
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