Las enfermedades crónicas no transmisibles se consideran la pandemia del siglo XXI y constituyen un desafío de alta prioridad para la salud pública; de ahí el creciente interés en la vigilancia de los factores de riesgo de las enfermedades crónicas. Cuba desarrolla la vigilancia de los factores de riesgo de forma descentralizada en cada uno de sus municipios como parte de la estrategia para enfrentar las enfermedades no transmisibles. No tiene precedentes en Cuba la vigilancia descentralizada con este nivel de detalle y diseñada expresamente para informar a los decisores en el municipio y la provincia. Se describe la metodología empleada para planificar y realizar la medición de los principales factores de riesgo en 12 municipios de 10 provincias, como parte del sistema nacional de vigilancia de Cuba. Los resultados han facilitado el uso oportuno de la información y la toma de decisiones basadas en pruebas a nivel local.

PALABRAS CLAVE: Sistema de vigilancia, factores de riesgo de enfermedades no transmisibles, encuestas de salud, métodos para la encuesta, Cuba

Introduction Prevalence of overweight and obesity is increasing worldwide in parallel with the growing burden of noncommunicable chronic diseases. According to the World Health Organization, in 2005 approximately 1.6 billion individuals aged ≥15 years were overweight and at least 400 million were obese; by 2015 these figures will almost double. Central distribution of adiposity has also been associated with higher rates of cardiovascular diseases and other conditions.

Objective Determine the prevalence of overweight, obesity and central adiposity, and their association with noncommunicable chronic diseases and related lifestyle risk factors in Cuban adults.

Methods The Second National Survey on Risk Factors and Chronic Diseases (ENFRENT II), conducted in 2000–2001, surveyed a representative sample of males and females aged ≥15 years using a stratified, multi-stage cluster sampling design. Data from a sub-sample of 19,519 individuals aged ≥20 years were analyzed and prevalence calculated for diabetes, hypertension, cardiovascular and cerebrovascular diseases, and for each of these variables in association with overweight, obesity and central distribution of adiposity, and with the presence of sedentary lifestyle, smoking, alcohol consumption, eating regular daily meals and daily breakfast.

Results Estimated prevalence of overweight and obesity in the adult population was 30.8% (CI: 30.1–31.5) and 11.8% (CI: 11.2–12.4), respectively. Obesity prevalence was twice as high in women (15.4%; CI: 14.5–16.3) as in men (7.9%; CI: 7.3–8.6). Obesity was significantly more frequent in diabetics, hypertensives and people with heart disease, while central adiposity was significantly associated with a higher prevalence of diabetes mellitus, cardiovascular and cerebrovascular diseases, hypertension, obesity and overweight. Smoking and alcohol consumption were low among overweight and obese subjects, who exhibited a higher prevalence of irregular and inadequate eating patterns.

Conclusions Prevalence of overweight, obesity and central adiposity, and comorbidity with diabetes mellitus, hypertension and heart disease, are growing public health problems in Cuba. A multi-sector strategy is needed to develop comprehensive food and nutrition policies and programs aimed at halting these trends, including interventions that encourage healthy eating patterns and regular physical activity in adults and children.

Keywords: Overweight, obesity, comorbidity, chronic disease, prevalence, nutrition disorders

Introduction Smoking is the main preventable cause of death worldwide. The World Health Organization estimates that smoking causes 5 million deaths annually, a figure that could double shortly if the present trend in tobacco product consumption continues.

 Objectives Estimate smoking-attributable mortality in the Cuban population and provide information needed to carry out effective public health actions.

 Methods This is a descriptive study using smoking prevalence and mortality data in Cuba for 1995 and 2007. Causes of death were grouped in three categories: malignant tumors, cardiovascular diseases and chronic respiratory diseases. Etiological fractions and attributable mortality were calculated by cause and sex.

 Results Of deaths recorded in 1995 and 2007, 15% and 18% of preventable deaths were attributed to smoking, respectively. In Cuba in 2007, smoking caused 86% of deaths from lung cancer, 78% of deaths from chronic obstructive pulmonary disease, 28% of deaths from ischemic heart disease, and 26% of deaths from cerebrovascular disease.

 Conclusions Smoking is responsible for high rates of preventable mortality in Cuba. There is willingness on the part of administrative and political authorities to discourage smoking, and more than half of smokers in Cuba wish to quit smoking. Given awareness that reducing smoking is the most effective means of decreasing preventable morbidity and mortality, the country is moving steadily toward concrete, sustainable steps leading to increased life expectancy and quality of life for the Cuban population.

 Keywords Smoking, preventable mortality, preventable morbidity, Cuba