During the 1990s in Cuba, food was sparse and gasoline was nearly unavailable because of the US embargo and loss of Russian support; one of the positive consequences of that situation was a reduction in rates of diabetes and heart disease.

The “special period” (as it became known) was between 1991 and 1995 and consisted of people using donkeys to move loads, as well as the government importing 1.5 million bicycles from China for modes of transportation. The current study, published in BMJ, aimed to determine whether eating less, cycling, walking, and manual labor contributed to the health of the nation as a whole. In other words, might a change in whole nation’s dietary intake plus increased physical activity caused by transportation policies impact on the incidence of type 2 diabetes and cardiovascular disease?

The shortage of food and fuel in Cuba produced a reduction in dietary energy intake and a large increase in physical activity. These changes produced a population-wide weight loss of 4-5kg (8-11 lbs.) Significant decreases in death rates from coronary heart disease and diabetes were seen shortly after.

A team of investigators from Cuba, Spain, and the U.S. analyzed..:

  • ..link between diabetes prevalence and population-wide body changes
  • ..incidence and death rates from type 2 diabetes and cardiovascular disease
  • ..cancer and all-causes

Cuba is a nation with a long history of public health and cardiovascular research, which provided the data needed from primary chronic disease registries, cardiovascular studies, and national health surveys. The Cuban population has seen economic and social changes directly associated with physical activity and food intake from 1980 to 2010.

The data used for the analysis included participants between the ages of 15 and 74 years and information on:

  • height
  • weight
  • energy intake
  • smoking
  • physical activity

Changes in physical activity and energy intake went hand-in-hand with changes in body weight. For example, between 1991 and 1995 there was a 5kg reduction on average, while between 1195 and 2010 a weight rebound was seen of 9kg.

The incidence of smoking fell during the 1980s and 1990s and decreased even more quickly in the 2000s.

The prevalence of diabetes continued to rise from 1997 as the population started to gain weight. It then decreased during the weight loss period, followed by another increase until it peaked in the weight regain years.

A sudden downward cycle in deaths from diabetes was seen five years after the beginning of the weight loss period, in 1996. This went on for about six years during which energy consumption status slowly recovered and physical activity levels decreased. In 2002, death rates went back to pre-crisis figures and a significant increase in diabetes deaths was seen.

Stroke and coronary heart disease death rates slowly dropped from 1980 to 1996 with a bigger decrease occurring after the weight-loss phase. During the weight regain phase, these declines stopped.

The investigators concluded that the “Cuban experienced in 1980-2010” showed that within a short period, noteworthy weight loss in the whole population can greatly affect the overall burden of deaths from diabetes and cardiovascular disease.

They point out that findings show that a 5kg population-wide weight loss “would reduce diabetes mortality by half and CHD mortality by a third”, however, these findings are an unusual circumstance from this one experience. On the other hand, they do provide a “notable illustration of the potential health benefits of reversing the global obesity epidemic”.

Previous research has shown that there is a link between diabetes and heart disease. Diabetics are more likely to develop hardened arteries than non-diabetics.

A separate study demonstrated the association between sitting for long periods and developing heart disease and diabetes. Even for people who are physically active, sitting for long periods could raise the risk for both conditions.

Written by Kelly Fitzgerald