And, as you might guess, it hasn’t been a good impact.
Singapore residents who ate Western-style fast food at least twice a week were found to be 27 percent more likely to develop type 2 diabetes and 56 percent more likely to die from heart disease than those who avoided fast food and stuck with their traditional foods. For people who ate Western-style fast-food items four or more times each week, the heart disease risk increased by almost 80 percent. (There was no change in the diabetes risk.)
The study was published earlier this week in the American Heart Association’s journal Circulation.
Filling a research gap
Past investigations into an association between fast food and type 2 diabetes and heart disease have been surprisingly few, and those that have been done focused almost exclusively on U.S. populations, said Andrew Odegaard, a U of M post-doctoral researcher and the study’s lead author, in a phone interview Tuesday.
“Despite all the allusions to people having all these terrible health problems when you eat at McDonald’s, there’s really not a lot of research to substantiate that,” he said.
To help fill that research gap, Odegaard and his colleagues decided to turn to Singapore, which has recently witnessed a significant increase in diabetes and heart disease. For example, some 11.3 percent of Singapore’s adults have diabetes, according to the Diabetic Society of Singapore — a number now as high as that in the United States.
Working with researchers at the National University of Singapore, the U of M researchers analyzed 16 years of dietary and other data from 52,584 participants in the Singapore Chinese Health Study, which was launched in 1993. All the participants were Chinese residents of Singapore who by the 1990s had found themselves suddenly able to buy Western-style fast food for the first time — things like burgers, French fries, hot dogs and pizza.
The data was collected from questionnaires filled out by the participants themselves. To confirm a diabetes diagnosis, the researchers used physician records and a separate questionnaire. A national death registry was used to determine deaths from heart disease. During the study’s 16-year follow-up, 2,252 of the participants developed diabetes and 1,397 died of heart attacks or other heart-related illnesses. As already noted, eating fast food two or more times a week increased the participants’ odds of developing type 2 diabetes by 27 percent and of heart disease by 56 percent. Of the 811 participants in the study who ate Western-style fast-food four or more times a week, 17 died of heart disease. This group, therefore, had a nearly 80 percent greater relative risk of dying of heart disease than others in the study who avoided the Western food.
In additional to its major findings about the increased risk of diabetes and heart disease, the U of M study made two other interesting discoveries. One was the finding that the people in the study who were eating the most Western-style fast food tended to be younger, more educated, less likely to smoke and more physically active — just the kind of profile that is usually associated with a lower risk of type 2 diabetes and heart disease.
The other interesting finding was that the study turned up no association between cardio-metabolic risk and Eastern-style snacks and fast food, such as dim sum.
“It’s only speculation, but it may be because of the fat that those foods are cooked in,” said Odegaard. Eastern-style fast foods tend to use vegetable-based oils, he explained, while the makers of Singapore’s Western-style fast foods may be using trans fat, which has been linked to poor health outcomes.
“We have no way of knowing,” Odegaard said. “Trans fat is not regulated in Singapore, and the Western [fast-food] companies don’t share what they’re using in their foods online.”
Brazil’s fight against fast food
The U of M study has several limitations. To begin with, it’s an observational study, which means it can show only an association between fast food and health outcomes, not a cause-and-effect. In addition, as the authors themselves point out, self-reported dietary data can be unreliable. People don’t always remember (or want to report) what they eat.
Still, the study is interesting, particularly in light of another paper published this week in the journal PLoS Medicine. As part of that journal’s excellent series on “Big Food” and its impact on the world’s health, two Brazilian epidemiologists, Carlos Monteiro and Geoffrey Cannon, describe how their country is trying to protect its traditional food system from the ultra-processed products made by transnational food corporations:
All Brazilian cities have restaurants, bars, and popular canteens, where a good variety of locally sourced traditional Brazilian food is offered, often buffet-style and affordably priced on a “per kilo” basis. More importantly, meals prepared and eaten by the family at home — including the midday meal — and therefore the habit of eating together, remain an integral part of the Brazilian way of life. Notwithstanding intense pressures, which include ubiquitous television and internet propaganda designed to turn eating and drinking into constant individual snacking, food and drink consumption is not yet dislocated and isolated from family and social life in Brazil. This is probably the most important factor protecting national and regional traditional food systems.
And so far, according to Monteiro and Cannon, the Brazilian government is willing to use laws to protect the public health:
In Brazil protection of public health still remains a prime duty of government that has not eroded as it has in other countries. Thus, by law, all Brazilian children are entitled to one daily meal at school, at least 70% of the food supplied to schools must be fresh or minimally processed, and a minimum of 30% of this food must be sourced from local family farmers. Brazil also has more than 200 human milk banks, the largest such network in the world.
Two important principles used in legislation in Brazil … add to the current conventional discourse about food, nutrition, and public health. First, access to adequate healthy food in Brazil is regarded as a basic human right that needs protection by the use of law in the public interest. The right of access to adequate healthy food has been part of the Brazilian Constitution since 2010, together with the right of access to health care, education, work, and social security.
Second, many improvements in Brazilian food supplies — for example, those that benefit schoolchildren, the legal support provided to working mothers to breastfeed their babies, and the prohibition of any type of advertisement of commercial human milk substitutes — depend on sustained pressure on legislators exerted by energetic and often militant civil society organizations. Notably, in Brazil, partnership between government and civil society at all levels is a central feature of the 1988 Constitution, which was designed to ensure that Brazil would be a participatory democracy after its emergence from government by military regimes.
Right now, by the way, the prevalence of diabetes in Brazil is 5.2 percent, half of what it is in the U.S. or Singapore. But that number is climbing, especially in Brazil’s cities.