July 4, 2012 (Minneapolis, Minnesota) — Westernized fast-food restaurants are proliferating throughout Asia leading to a substantial increase in the risk of developing diabetes and coronary heart disease, research shows. In an analysis of more than 50 000 Chinese Singaporeans, those who ate fast food twice a week or more had a 27% increased risk of developing diabetes and a 56% increased risk of dying from coronary heart disease.
"For the results with type 2 diabetes, there is more of a modest association for people who ate Western-style fast food two or more times a week compared to the people who reported not eating it," lead investigator Dr Andrew Odegaard (University of Minnesota School of Public Health, Minneapolis) told heartwire . "The real strong results are with the people who are dying from coronary heart disease. We can only speculate and hypothesize because we don't have individual patient data, but we think it might be because trans-fatty acids have never been regulated in Singapore. There is documentation that these are still widely used by fast-food companies outside of North America."
Big Macs, Whoppers, and Heart Disease
The consumption of Westernized fast food, including McDonald's, Burger King, and Kentucky Fried Chicken, has rapidly expanded in developing and recently developed countries throughout the world. With the proliferation of fast-food restaurants, there has been concern among health experts that diabetes, hypertension, dyslipidemia, and metabolic syndrome, along with an increased incidence of coronary heart disease, are exported hand-in-hand with Big Macs and Whoppers.
"In the scientific press, as well as the popular press, everybody has linked eating fast food with poor health outcomes and given the composition of fast food this makes sense," said Odegaard.
However, studies directly linking the consumption of fast food with poor health outcomes are limited. Fast food didn't really take hold until the late 1980s in Singapore; the Singapore Chinese Health Study gave Odegaard and colleagues the opportunity to study the incidence of type 2 diabetes and coronary heart disease in 52 584 participants between 1993 and 1998. For coronary heart disease mortality, 1397 deaths were recorded until the end of 2009. For type 2 diabetes, 43 176 participants were included in the analysis and 2252 cases of diabetes reported during the follow-up interview, completed at the end of 2004.
Overall, individuals who ate at fast-food restaurants twice per week or more had a significantly increased risk of developing diabetes (hazard ratio [HR] 1.27, 95% CI 1.03–1.54) and dying of coronary heart disease (HR 1.56, 95% CI 1.18–2.06).
Although the researchers state that trans-fatty acids might be one reason for the increased risk of coronary heart disease death, it is just a hypothesis at this stage. Increased consumption of fast food might simply be a prominent marker of a poor diet and lifestyle, and not causal itself, they state. Sensitivity analyses performed by the group, however, which attempted to account for the overall dietary patterns, showed the associations remained statistically significant and were not altered after adjusting for overall dietary patterns, energy intake, and body mass index.
"The consumption of Western-style fast food is really growing in Asia and south and southeast Asia, in countries where there are a lot of developing economies," said Odegaard. "When you look at the stock reports and growth reports of the holding companies [for the major fast-food chains], this is their primary engine of growth. What the companies have going on in North America is steady, the market is saturated, but the real growth is in the growing economies. From a cultural standpoint--from what I've researched on the subject--it's convenient and familiar, just like in North America, but it's more of a status thing in the developing economies. They want to experience American culture, and that's a draw."
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