Greater intake of Western fast food among Singaporean adults is associated with increased risk of diabetes and heart-disease-related death

Abstract

Commentary on: Odegaard AO, Koh WP, Yuan JM, et al. Western-style fast food intake and cardiometabolic risk in an eastern country. Circulation 2012;126:182-8. Implications for practice and research▪ Adverse associations between fast food consumption and cardiovascular health are also observed in an Eastern population.▪ The role that Western dietary behaviours play in affecting health in transitional societies needs to be articulated and addressed. ContextConsumption of fast food has increased over recent decades, accounting for as much as 40% of daily energy among certain subgroups of the US population, 1 which is typically higher in total energy, saturated fats, sodium, carbohydrates and added sugars, 2 3 and have been adversely associated with numerous health outcomes including obesity, cardiovascular disease and diabetes. 4 5 The proliferation of fast food outlets and the increased consumption of fast food globally is of particular concern in light of this knowledge. MethodsUsing more than 52 000 Singaporean adults (aged 45-74 years old) followed for 5 years, Odegaard and colleagues examined the association between the Western-style fast food consumption and the risk of incident type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) mortality. Fast food intake was defined as the consumption of 'Western-style fast food items' including hamburgers/cheeseburgers, french fries, pizza, other sandwiches, deep-fried chicken and hot dogs.Incident cases of diabetes were identified through self-reported T2DM status and validated using hospitalbased discharge databases. Deaths resulting from six International Classification of Disease codes were considered cases of CHD mortality. Fully adjusted Cox proportional hazards models for persons consuming fast food 1-3 times/month, 1 and ≥2 times/week were calculated compared with non-consumers. FindingsFrequent (≥2 times/week) Western-style fast food consumers had a significant increased risk of developing T2DM (HR 1.22, 95% CI 1.00 to 1.47, p=0.019) and an increased risk of dying from CHD (HR 1.36, 95% CI 1.04 to 1.78) compared with non-consumers. These results were strengthened in fully adjusted models, with a 27% and 56% increased risk of incident T2DM death from CHD, respectively. Extending the highest consumers to ≥4 times/ week resulted in a stronger dose-response association with CHD death (HR 1.79, 95% CI 1.09 to 2.93, p for trend=0.015). CommentaryHistorically, higher consumption of a nutritional profile similar to that observed for fast foods has been linked in clinical and epidemiological studies to obesity, CHD and T2DM, but the extent to which the consumption of fast food itself is similarly associated with health is understudied. The results reported by Odegaard and colleagues begin to fill this substantial gap in the literature. The consumption of Western-style fast foods was measured using a single dietary report. Ideally, multiple