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). bsolute 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
Résumé
OBJECTIFS : Déterminer si les résidents de secteurs comptant une proportion élevée de restaurants rapides (RR) par rapport à l’ensemble des restaurants sont plus susceptibles de contracter le diabète et si le risque varie selon le volume de RR.
MÉTHODE : Cette étude de cohorte comprenait les répondants adultes (20-84 ans) de l’Enquête sur la santé dans les collectivités canadiennes (cycles 2005, 2007-2008, 2009-2010) résidant à distance de marche (720 m) d’au moins un restaurant à Toronto, Brampton, Mississauga ou Hamilton (Ontario). Nous avons établi la survenue du diabète en reliant les participants à la base de données sur le diabète de l’Ontario. Nous avons utilisé des modèles à risques proportionnels de Cox pour estimer les coefficients de danger (QD) du diabète incident associés aux indicateurs relatifs et absolus de disponibilité des restaurants.
RÉSULTATS : Au cours d’un suivi médian de 5 ans, 347 des 7,079 participants (4.9 %) ont contracté le diabète. Chez les adultes les plus jeunes (20–65 ans, n = 5,806), une proportion plus élevée de restaurants rapides par rapport à l’ensemble des restaurants présentait une corrélation significative avec le diabète incident compte tenu d’une gamme de covariables individuelles et par secteur, mais seulement dans les secteurs ayant des volumes élevés de restaurants rapides (3 ou plus) (QD = 1.79, intervalle de confiance de 95 %: 1.03–3.12, dans tout l’écart interquartile). Si l’on tient compte de l’indice de masse corporelle, cette association devient non significative. Aucune association significative n’a été observée dans les secteurs ayant de faibles volumes de RR, ni chez les personnes âgées (65–84 ans, n = 1,273). La disponibilité absolue (le nombre) des restaurants rapides et des autres restaurants était en général sans rapport avec le diabète incident.
MOTS CLÉS: diabète sucré, aliments de restauration rapide, restaurants, indice de masse corporelle, études de cohortes
Footnotes
Acknowledgements: This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent of the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. During the tenure of this study, J. Polsky was supported by the Canadian Institutes of Health Research Doctoral Research Award. R. Glazier was supported as a clinician scientist in the Department of Family and Community Medicine at St. Michael’s Hospital and at the University of Toronto. The authors sincerely thank Jonathan Weyman for creating all GIS-based measures for this work.
Conflict of Interest: None to declare.
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