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Population-wide weight loss in relation to diabetes and cardiovascular mortality

This week's issue of the British Medical Journal investigates population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality.

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Dr Franco and colleagues from Spain evaluated 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.

The team performed repeated cross sectional surveys, and ecological comparison of secular trends in 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.

Population-wide increase in weight was followed by a 116% increase in diabetes prevalence
British Medical Journal

The team's main outcome measures included 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.

The research team modelled mortality trends 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, and exceeded pre-crisis levels by 2010.

The researchers found that population-wide increase in weight was immediately followed by a 116% increase in diabetes prevalence, and 140% increase in diabetes incidence.

The team observed that 6 years into the weight rebound phase, diabetes mortality increased by 49%.

A deceleration in the rate of decline in mortality from coronary heart disease was also observed.

Dr Franco's team concludes, "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."

BMJ 2013; 346: f1515
15 April 2013

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