CCBYNC Open access

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 2013; 346 doi: (Published 09 April 2013) Cite this as: BMJ 2013;346:f1515
  1. Manuel Franco, associate professor1, adjunct associate professor2, visiting researcher3,
  2. Usama Bilal, research assistant1, visiting researcher3,
  3. Pedro Orduñez, regional adviser4, professor5,
  4. Mikhail Benet, professor5,
  5. Alain Morejón, assistant professor5,
  6. Benjamín Caballero, professor6,
  7. Joan F Kennelly, research assistant professor7,
  8. Richard S Cooper, professor and chair8
  1. 1Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
  2. 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  3. 3Department of Epidemiology, Atherothrombosis and Cardiovascular Imaging, Centro Nacional de Investigaciones Cardiovasculares Madrid, Spain
  4. 4Project for Chronic Disease Prevention and Control, Pan American Health Organization, Washington, DC, USA
  5. 5Centro de Estudios sobre Enfermedades Crónicas, Universidad de Ciencias Médicas, Cienfuegos, Cuba
  6. 6Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA
  7. 7Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
  8. 8Department of Public Health Sciences, Loyola University Stritch School of Medicine, Maywood, IL, USA
  1. Correspondence to: M Franco mfranco{at}
  • Accepted 11 February 2013


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.


  • We would like to acknowledge our great respect and admiration for the Cuban people who faced extremely difficult social and economic challenges during the special period—and by making common cause against this tragedy held up with courage and dignity. This tragedy was “man made” by international politics and should never happen again to any population.

  • Contributors: MF and RC contributed to the original design. PO, MB, and AM organised and conducted data collection. UB conducted the statistical analyses. MF, UB, and RC carried on the systematic literature research. MF, UB, PO, BC, JFK, and RC were active in the interpretation of results. The manuscript was drafted by MF, UB, JFK, and RC, and reviewed by all authors. All authors have approved the final report. All authors had full access to the data in the study and take responsibility for its integrity and the accuracy of the data analysis. MF is the guarantor for this study.

  • Funding: No funding sources had any role in the decision to submit this manuscript or in its writing.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The ethics committee of the University of Medical Sciences, Cienfuegos, approved protocols.

  • Data sharing: No additional data available.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text