La población cubana muestra una alta prevalencia de sobrepeso y de enfermedades crónicas no transmisibles asociadas al mismo; la tendencia a ambas prevalencias comienza en la niñez.Además de los aspectos relacionados con la salud de la madre, los factores que contribuyen al aumento excesivo de peso en los niños cubanos son: reducida prevalencia de la lactancia materna exclusiva en lactantes de hasta seis meses de edad, niños que nacen a término con bajo pesoeinadecuado tratamiento nutricional dado a este grupo, alimentación complementaria incorrecta, régimen alimentario que genera obesidad, historia médica familiar y estilos de vida sedentarios. Por ello es importante adoptar estrategias integrales, multisectoriales que promuevan una alimentación adecuada y el control del peso. Esto es particularmente importante para los niños que nacen a término y con bajo peso, que son propensos a almacenar grasa corporal.

PALABRAS CLAVE Bajo peso al nacer, obesidad, diabetes, inflamación, lactancia materna, alimentación, actividad física, estilo de vida, niños, adolescentes, Cuba

The Cuban population exhibits high prevalence of overweight and associated chronic non-communicable diseases, trends that begin in childhood. In addition to factors related to the mother’s health, factors contributing to excess weight gain in Cuban children are: reduced prevalence of exclusive breastfeeding of infants up to six months of age, full-term low birth weight infants and nutritional mismanagement of this group, incorrect complementary feeding, obesogenic diet, family history and sedentary lifestyles. Thus, it is important to adopt comprehensive, multisectoral strategies that promote adequate nutrition and weight control. This is particularly important for full-term low birth weight infants, predisposed to body fat storage.

KEYWORDS Low birth weight, obesity, diabetes, inflammation, breastfeeding, diet, physical activity, lifestyle, children, adolescents, Cuba

Over one-third of Cuban adults live sedentary lives, accompanied by a not-surprising overweight and obesity prevalence of 43% by 2001, the year the last national survey was conducted.[1] Today, we can wager that figure is even more bloated. The associated climb in chronic disease is well-documented in our country and the world over, threatening to outstrip the resources at hand to manage such a burgeoning epidemic. In Cuba, in particular—a developing country where all are entitled to health care—population-wide weight gain forebodes a heavier chronic disease burden and an unbearable financial burden on the health system.

Introduction Diet is a cornerstone of comprehensive treatment of diabetes mellitus. The macrobiotic diet is low in fat and rich in dietary fiber, vegetables and whole grains, and therefore may be a good therapeutic option.

Objective Assess the influence of the Ma-Pi 2 macrobiotic diet on physical, hematologic and biochemical variables, as well as on hypoglycemic medication, in adults with type 2 diabetes mellitus.

Materials and Methods A 6-month dietary intervention was carried out in 16 adults with type 2 diabetes mellitus and poor glucide metabolism control (glycosylated hemoglobin, HbA1 >8.5%) receiving treatment at the Diabetic Care Center in Colón, Matanzas province, Cuba. The diet was prepared and served daily by macrobiotic specialists. Type and amount of food consumed and nutritional content were assessed using a weighted food-consumption survey. At onset and termination of the intervention, anthropometric and body composition variables were measured, as were biochemical (glucide and lipid metabolism) and other nutritional safety variables, and hypoglycemic drug use.

Results The diet provided sufficient energy and protein. It was low in fat, high in complex carbohydrates and dietary fiber, and provided adequate amounts of vitamins and minerals, except for vitamin B12. At 6 months, anthropometric variables were significantly lower, lean body mass was preserved, and glucide and lipid metabolism was controlled. All participants were able to eliminate insulin treatment, and 25% continued treatment with glibenclamide only. Mean total cholesterol, LDL cholesterol and triglyceride values dropped 16.4%, 22.7% and 37.0%, respectively, while mean HDL cholesterol rose 97.8%. Mean glycemia and HbA1 values also decreased 63.8% and 54.5%, respectively. According to lipid levels and ratios, cardiovascular risk was also considerably reduced. Hemoglobin, total protein, albumin and creatinin levels indicated that nutritional safety was maintained. There were no adverse events.

Conclusions In the 6-month intervention, the Ma-Pi 2 macrobiotic diet had a positive influence on weight control, body fat, and glucide and lipid metabolism in patients with type 2 diabetes mellitus. Further research is needed to validate these encouraging results, particularly a clinical trial in which a control group receives the standard diet recommended for diabetic patients.

Keywords: Type 2 diabetes mellitus, adult, macrobiotic diet, diet therapy

Recommended dietary reference intakes (DRI) for energy and nutrients for the Cuban population were first established by the Nutrition and Food Hygiene Institute (INHA, its Spanish acronym) in 1996.[1] International organizations and Cuban public health research subsequently generated a considerable volume of new information on food-based energy and nutrient requirements,[2–4] resulting in the need for a revision. Updated DRIs were therefore compiled by a multidisciplinary group of specialists and published in 2008 by INHA and the Cuban Ministry of Public Health.[5,6]