Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality in Cuba 1980-2010: repeated cross sectional surveys and ecological comparison of secular trends. BMJ 346:f1515

Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain.
BMJ British medical journal (Impact Factor: 16.3). 04/2013; 346:f1515. DOI: 10.1136/bmj.f1515
Source: PubMed


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.
Repeated cross sectional surveys and ecological comparison of secular trends.
Cuba and the province of Cienfuegos, from 1980 to 2010.
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.
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.
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.
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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Available from: Pedro Orduñez, Jan 06, 2014
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    • "Data from population-based cohort studies demonstrate that overweight and obese adults who lose weight benefit from improvements in cardio-metabolic risk [5], [6] similar to the effects reported in weight loss trials [7]–[9]. Recent events in Cuba illustrate the dramatic reductions in diabetes incidence and mortality during a period of economic crisis that produced an average 5.5 kg weight loss over the whole population; which reversed just as dramatically when economic conditions improved and population weights rebounded [10]. "
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    ABSTRACT: Background: Participation in weight loss programs is often associated with improved wellbeing alongside reduced cardio-metabolic risk. In contrast, population-based analyses have found no evidence of psychological benefits of weight loss, but this may be due to inclusion of healthy-weight individuals. We therefore examined cardio-metabolic and psychological changes following weight loss in a cohort of overweight/obese adults. Methods: Data were from 1,979 overweight and obese adults (BMI $25 kg/m 2 ; age $50 y), free of long-standing illness or clinical depression at baseline, from the English Longitudinal Study of Ageing. Participants were grouped according to four-year weight change into those losing $5% weight, those gaining $5%, and those whose weight was stable within 5%. Logistic regression examined changes in depressed mood (eight-item Center for Epidemiologic Studies Depression score $ 4), low wellbeing (Satisfaction With Life Scale score ,20), hypertension (systolic blood pressure $140 mmHg or anti-hypertensives), and high triglycerides ($1.7 mmol/l), controlling for demographic variables, weight loss intention, and baseline characteristics. Results: The proportion of participants with depressed mood increased more in the weight loss than weight stable or weight gain groups (+289%, +86%, +62% respectively; odds ratio [OR] for weight loss vs. weight stable = 1.78 [95% CI 1.29– 2.47]). The proportion with low wellbeing also increased more in the weight loss group (+31%, +22%, 24%), but the difference was not statistically significant (OR = 1.16 [0.81–1.66]). Hypertension and high triglyceride prevalence decreased in weight losers and increased in weight gainers (228%, 4%, +18%; OR = 0.61 [0.45–0.83]; 247%, 213%, +5%; OR = 0.41 [0.28–0.60]). All effects persisted in analyses adjusting for illness and life stress during the weight loss period. Conclusions: Weight loss over four years in initially healthy overweight/obese older adults was associated with reduction in cardio-metabolic risk but no psychological benefit, even when changes in health and life stresses were accounted for. These results highlight the need to investigate the emotional consequences of weight loss.
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