Even relatively clean-living Singaporeans who regularly eat burgers, fries and other staples of U.S.-style fast food are at raised risk of diabetes and significantly more likely than peers to die of heart disease, according to a new study.
With globalization, fast food - widely regarded as nutritionally poor - has become commonplace in East and Southeast Asia. But there’s been little research into the effects of western junk food on the health of non-western populations, especially those transitioning to more-prosperous lifestyles.
“Many cultures welcome (western fast food) because it’s a sign they’re developing their economies,” said Andrew Odegaard, from the University of Minnesota School of Public Health, who led the new study published in the journal Circulation.
“But while it may be desirable from a cultural standpoint, from a health perspective there may be a cost,” he told Reuters Health.
Odegaard’s team, which included researchers in the school of public health at the National University of Singapore, based their study on more than 60,000 Singaporeans of Chinese descent, who were interviewed in the 1990s, then followed for about a decade.
Participants were between 45 and 74 years old at the outset, and during the study period, 1,397 died of cardiac causes and 2,252 developed type 2 diabetes.
Those who ate fast food two or more times a week had 27 percent greater odds of diabetes, and 56 percent higher risk of cardiac death, than those who ate little or no fast food, the researchers found.
Among 811 subjects who ate western-style fast food four or more times a week, the risk of cardiac death rose by 80 percent.
The findings held even after the researchers adjusted for other factors that could influence health, including age, sex, weight, smoking status and education level.
Odegaard’s team found that eastern fast foods, or dimsum, such as noodles and dumplings, were not associated with more cases of type 2 diabetes and cardiac deaths.
“It wasn’t their own snacks that was putting them at increased risk, but American-style fast food,” he said.
The Singaporeans who ate western fast food often were more likely to be younger, educated and physically active, and were less likely to smoke, than those who stuck to a more traditional diet.
That profile differs markedly from the average frequent fast-food consumer in the West, Odegaard noted.
In countries like Singapore, these patrons “are likely doing it to participate in American culture, and it is a status symbol, rather than here, where it is generally out of convenience and cost,” he explained.
These findings hold serious implications for recently developed and emerging countries, said Sara Bleich, an assistant professor of health policy at Johns Hopkins Bloomberg School of Public Health in Baltimore.
“We know (heart disease and diabetes) are very expensive because they are chronic and ongoing,” she told Reuters Health.
Research in western populations has linked the most common components of fast foods - meats, saturated fats and refined carbs - with direct heart risks and indirect health threats like weight gain, which can lead to type 2 diabetes, Odegaard’s team points out.
Those past findings and the new results suggest that public health officials need to pay “more attention to global behavioral and dietary changes that occur as cultures interact with one another,” Odegaard said.
“The big multinational fast-food companies are increasingly looking to maximize profit outside the United States, and they’re looking to emerging economies like Singapore to do that,” Bleich told Reuters Health. “So at the global level, the health implications are very strong.”
SOURCE: Circulation, online July 2, 2012.
Western-Style Fast Food Intake and Cardiometabolic Risk in an Eastern Country
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.
Andrew O. Odegaard, PhD, MPH;
Woon Puay Koh, PhD;
Jian-Min Yuan, MD, PhD;
Myron D. Gross, PhD;
Mark A. Pereira, PhD, MPH, MS