Relative and absolute availability of fast-food restaurants in relation to the development of diabetes: A population-based cohort study

Abstract

OBJECTIVES:To determine whether residents living in areas with a high proportion of fast-food restaurants (FFR) relative to all restaurants are more likely to develop diabetes and whether the risk varies according to the volume of FFR. METHODS:The study cohort consisted of adult respondents (20-84 years) to the Canadian Community Health Survey (cycles 2005, 2007/2008, 2009/2010) who resided within walking distance (720 m) of at least one restaurant in Toronto, Brampton, Mississauga or Hamilton, ON. The development of diabetes was established by linking participants to the Ontario Diabetes Database. Cox proportional hazards models were used to estimate hazard ratios (HRs) of incident diabetes associated with relative and absolute measures of restaurant availability.RESULTS: During a median follow-up of 5 years, 347 of 7,079 participants (4.6%) developed diabetes. Among younger adults (20-65 years, n = 5,806), a greater proportion of fast-food relative to all restaurants was significantly associated with incident diabetes after adjustment for a range of individual and area-level covariates, but only in areas with high volumes of fast-food retailers (3+ outlets) (HR = 1.79, 95% confidence interval: 1.03-3.12, across the interquartile range). Adjusting for body mass index rendered this association non-significant. No significant associations were observed in areas with low volumes of FFR or among older adults (65-84 years, n = 1,273). Absolute availability (number) of fast-food and other restaurants was generally unrelated to incident diabetes. CONCLUSION:Areas with the double burden of a high volume of FFR and few dining alternatives may represent an adverse environment for the development of diabetes.KEY WORDS: Diabetes mellitus; fast food; restaurants; body mass index; cohort studies La traduction du résumé se trouve à la fin de l'article.

Environmental Risk Factors for Developing Type 2 Diabetes Mellitus: A Systematic Review

“…Of the more than 200 relationships reported and extracted, 82 showed significant association in the expected direction ( Table 2 ). Several studies including younger adults (<30 years of age) showed no strong or no statistically significant results [ 72 , 73 , 74 , 75 , 76 , 77 , 78 ]. Most [ 73 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ], but not all [ 86 , 87 , 88 , 89 ], studies conducted among ethnic groups and women also showed stronger associations.…”

“…However, the effect was significant when survey-based food measure was used. Two studies also found no significant association between T2DM and unhealthy food outlets [ 74 , 91 ]. Physical activity, diet, area-level SES and BMI appeared to attenuate the T2DM risk [ 74 , 98 , 100 ].…”

Laboratory-Assessed Markers of Cardiometabolic Health and Associations with GIS-Based Measures of Active-Living Environments

“…It is plausible that the neighborhood retail-food environment is a factor that may partly account for the associations others and we have observed with BMI and SBP. In a Canadian study of 7079 adults, younger adults who lived in a neighborhood with the greatest compared to the lowest proportion of fast-food outlets had a 79% (95% CI 1.03, 3.12) increased risk of developing diabetes over five years of follow-up [ 34 ]. Similarly, in a British study of 5958 adults, less educated adults living in the highest compared to the lowest quartile of fast-food exposure had a 2.05 (95% CI 1.08, 3.87) higher odds of being obese [ 35 ].…”

Association of Fast‐Food and Full‐Service Restaurant Densities With Mortality From Cardiovascular Disease and Stroke, and the Prevalence of Diabetes Mellitus

“…For example, a cross‐sectional study of 10 461 participants (mean age, 59 years) suggested that increased exposure to fast‐food outlets is associated with increased risk of T2D . Moreover, in another cohort consisting of adult respondents (aged 20–84 years) to the Canadian Community Health Survey, the researchers reported that among younger adults (aged 20–65 years), a greater proportion of fast food relative to all restaurants was significantly associated with incident diabetes mellitus . However, we have recently reported a minor impact of both FFRs and full‐service restaurants (FSRs) on the prevalence of obesity, which may translate to a low impact on prevalence of T2D, because obesity is the main risk factor for T2D …”

“…29 Moreover, in another cohort consisting of adult respondents (aged 20-84 years) to the Canadian Community Health Survey, the researchers reported that among younger adults (aged 20-65 years), a greater proportion of fast food relative to all restaurants was significantly associated with incident diabetes mellitus. 30 However, we have recently reported a minor impact of both FFRs and full-service restaurants (FSRs) on the prevalence of obesity, which may translate to a low impact on prevalence of T2D, because obesity is the main risk factor for T2D. 31 Although much of the focus on the increasing amount of energy consumed away from home as a driver for excess consumption has concerned FFRs, the calorie contents of meals at FSRs are generally larger than those consumed at FFRs.…”