Western-style fast food intake and cardiometabolic risk in an Eastern country

Abstract

Background: Western-style fast food contributes to a dietary pattern portending poor cardiometabolic health in the United States. With globalization, this way of eating is becoming more common in developing and recently developed populations.

Methods and results: We examined the association of Western-style fast food intake with risk of incident type 2 diabetes mellitus and coronary heart disease mortality in Chinese Singaporeans. This analysis included men and women 45 to 74 years of age who enrolled in the Singapore Chinese Health Study from 1993 to 1998. For CHD mortality, 52 584 participants were included and 1397 deaths were identified through December 31, 2009, via registry linkage. For type 2 diabetes mellitus, 43 176 participants were included and 2252 cases were identified during the follow-up interview (1999-2004) and validated. Hazard ratios for incident type 2 diabetes mellitus and coronary heart disease mortality were estimated with thorough adjustment for demographic, lifestyle, and dietary factors. Chinese Singaporeans with relatively frequent intake of Western-style fast food items (≥2 times per week) had an increased risk of developing type 2 diabetes mellitus (hazard ratio, 1.27; 95% confidence interval, 1.03-1.54) and dying of coronary heart disease (hazard ratio, 1.56; 95% confidence interval, 1.18-2.06) relative to their peers with little or no reported intake. These associations were not materially altered by adjustments for overall dietary pattern, energy intake, and body mass index.

Conclusions: Western-style fast food intake is associated with increased risk of developing type 2 diabetes mellitus and of coronary heart disease mortality in an Eastern population. These findings suggest the need for further attention to global dietary acculturation in the context of ongoing epidemiological and nutrition transitions.

Figure

Hazard ratio (HR) and 95% confidence interval (CI) of coronary heart disease (CHD) mortality according to intake frequency of Western-style fast food items: further dose-response evaluation, Singapore Chinese Health Study (n=52 584; 1397 deaths resulting from CHD), Respective numbers (CHD deaths) for fast food intake of 0 times a week, 1 to 3 times per month, 1 time per week, 2 to 3 times per week, and ≥4 times per week were 25 810 (784), 21 133 (503), 3006 (51), 1824 (42), and 811 (17). Results represent fully adjusted model (age, sex, year of interview, dialect, education, smoking, alcohol, sleep, physical, activity, body mass index, and nutritional factors, ie, intake of soft drinks, juice, Eastern-style snacks and dim sum, vegetables, fruit, soy, rice, noodles, other pork and red meat, and total energy).