The role of fast convenient food on cardiometabolic risk: should policy take away the takeaway?

By Ian. G Davies1, Toni Blackham1, Hayley Janssen1, Agnieszka Jaworowska2 and Leo Stevenson1

Faculty of Education, Community and Health, Liverpool John Moores University, Liverpool UK

Faculty of Engineering & Science, Department of Life & Sports Sciences, Greenwich University UK

Number of fast food restaurant outlets in the United Kingdom (UK) 2017, by type

Number of fast food restaurant outlets in the United Kingdom (UK) in 2017, by type

Source: MCA ID 712002

Note: United Kingdom; 2017

Further information regarding this statistic can be found on page 8.

Statista (2017)

25,885

7,962

3,1512,014

1,269

0

5000

10000

15000

20000

25000

30000

Independent fastfood inc. takeaway

Street food andmobile vans

Branded traditional Branded deliveryfocused

Brandedcontemporary

Num

ber

of outle

ts

4000,

Franchise sales of McDonald's 2006-2017McDonald's franchised restaurant sales worldwide from 2006 to 2017 (in billion U.S. dollars)*

Source: McDonald's ID 820471

Note: Worldwide; 2006 to 2017

41.38

46.94

54.1356.93

61.15

67.6569.69 70.25 69.62

66.2369.71

78.2

0

10

20

30

40

50

60

70

80

90

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Sale

s in

bill

ion U

.S. dolla

rs

Further information regarding this statistic can be found on page 8.

Nutritional composition of popular UK takeaway meals

Jaworowska et al., 2012, 2014; Davies et al., 2016

158 g

27 g

Trans fatty acids 9.9 g

Frequency/dietary patterns of takeaway food, UK (n = 1724)

17.8, 18%46.3, 46%

25.5, 26%

9, 9%

0.9, 1%

0.2, 0%

0.2, 0%

1.3, 1%

Never or less than once permonth1-3 per month

Once a weekJanssen et al., unpublished data

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

0.8

BiscuitsChocolate confectionary

Buns Cakes Pastries

Fried Potato (Chips Roasted Crisps)

Sugar Confectionary

Dairy Desserts

Refined Grains

Sugar Preserves

Pizza Home

Butter Spreads Oil

SSB

Other Potatoes (Boiled Baked Salad)

Vegetables

Salad

Fruit

WholegrainsYoghurt

EggsLegumes

Soups and Savoury Sacues

Cheese

Chinese

English

Fast Food

Kebab

Pizza Takeaway

Indian

Milk (Dairy)

Bacon Ham

Other Milk (non-dairy)

Sausages

Tea Coffee Water Diet drinks

Processed Meat (Burgers)Poultry

Western DP 1 Prudent DP 2 Takeaway DP 3 Meat and Dairy DP 4

Western diet/takeaway food Sedentary behaviour Genetic predisposition

Over nutrition, under exertion• Cultural/social

factors• Personal

choices/responsibility

• Stress

+ve energy balance

Visceral obesity

Metabolic disruption Cardiometabolic risk markers

Cardiovascualr/T2D risk

PHE, 2017, 2018; Asaria et al., 2012; Poleman et al., 2018; Hamer & Mishra., 2010; Alter & Eny., 2005.

Fast/takeaway food density, obesity, CVD?

Mazidi M, Speakman JR. Association of Fast‐Food and Full‐Service Restaurant Densities With Mortality From Cardiovascular Disease and Stroke, and the Prevalence of Diabetes Mellitus. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease. 2018;7(11):e007651. doi:10.1161/JAHA.117.007651.

CVD&

T2D?

Study type Sample Fast food/takeaway consumption

Outcome Reference

Cross-sectional Adults ≤ 1 vs. ≥2 per week глюкоза, ИК-спектр Smith et al., 2012

Cross-sectional Children ≥1 per week Serum total & LDL-cholesterol

Donin et al., 2018

Prospective (15 7) Adults ≥2 per week Weight gain, IR Pereira et al., 2005

Prospective (3 y) Adults Quartile Serum TG, TG/HDL-C. OR of metabolic syndrome

Bahadoran et al., 2013

Cardiometabolic risk markers and incidence of CVD and T2D

Policy/Intervention?

Advertising

Near schools Deprived areas??

Fast food density Wrong reformulation

Fast/takeaway food tax?

Goffe et al., 2018; PHE, 2014, 2017; Swinburn et al., 2013; Pineo et al., 2018

Conclusions

• Takeaway food has increased in UK and worldwide.

• Poor nutritional profile, but variable in key nutrients.

• Concordant with CVD, type 2 diabetes risk and incidence.

• Biochemical mechanisms for obesity and cardiometabolic risk.

• More evidence needed as likely high amount of confounding.

• Policy required for significant changes, e.g. reformulation.

References & acknowledgments

• PHE (2017) Obesity and the environment. Density of fast food outlets 31/12/2017. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/720058/Fast_Food_map.pdf. Accessed 09082018

• PHE (2018). Statistics on Obesity, Physical Activity and Diet, England 2018. https://www.gov.uk/government/statistics/statistics-on-obesity-physical-activity-and-diet-england-2018. Accessed 09082018

• Trends and inequalities in cardiovascular disease mortality across 7932 English electoral wards, 1982–2006: Bayesian spatial analysis

• Perviz Asaria, Lea Fortunato, Daniela Fecht, Ioanna Tzoulaki, Juan Jose Abellan, Peter Hambly, Kees de Hoogh, Majid Ezzati, Paul Elliott; Trends and inequalities in cardiovascular disease mortality across 7932 English electoral wards, 1982–2006: Bayesian spatial analysis, International Journal of Epidemiology, Volume 41, Issue 6, 1 December 2012, Pages 1737–1749, https://doi.org/10.1093/ije/dys151

• Hamer & Mishra (2010). Dietary patterns and cardiovascular risk markers in the UK Low Income Diet and Nutrition Survey. Nutrition, Metabolism & Cardiovascular Diseases (2010) 20, 491e497.

• Alter DA & Eny K (2005). The relationship between the supply of fast-food chains and cardiovascular outcomes. Can J Public Health 96(3):173-7.

• Davies, I. G., Blackham, T., Jaworowska, A., Taylor, C., Ashton, M., & Stevenson, L. (2016). Saturated and trans-fatty acids in UK takeaway food. International journal of food sciences and nutrition, 67(3), 217-224.

• Jaworowska, A., Blackham, T. M., Long, R., Taylor, C., Ashton, M., Stevenson, L., & Davies, I. G. (2014). Nutritional composition of takeaway food in the UK. Nutrition and Food Science, 44(5), 414-430.

• Jaworowska, A., Blackham, T., Stevenson, L., & Davies, I. G. (2012). Determination of salt content in hot takeaway meals in the United Kingdom. APPETITE, 59(2), 517-522.

• Janssen, H., Davies, I., Richardson, L., & Stevenson, L. (2018). Determinants of takeaway and fast food consumption: A narrativereview. Nutrition Research Reviews, 31(1), 16-34. doi:10.1017/S0954422417000178

• Britvic. n.d. Number of fast food restaurant outlets in the United Kingdom (UK) in 2017, by type. Statista. Accessed August 10, 2018. Available from https://www.statista.com/statistics/712002/fast-food-outlets-united-kingdom-uk-by-type/.

• McDonald's. n.d. McDonald's franchised restaurant sales worldwide from 2006 to 2017 (in billion U.S. dollars)*. Statista. Accessed August 10, 2018. Available from https://www.statista.com/statistics/820471/mcdonald-s-franchise-sales/

• Donin, A.S., Nightingale, C.M., Owen, C.G., Rudnicka, A.R., Cook, D.G. and Whincup, P.H. (2015) Consumption of takeaway meals and risk markers for coronary heart disease, type 2 diabetes, and obesity in children aged 9-10 years: a cross-sectional study. Lancet, 386, S34-S34.

• Pereira, M.A., Kartashov, A.I., Ebbeling, C.B., Van Horn, L., Slattery, M.L., Jacobs, D.R., Jr. and Ludwig, D.S. (2005) Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet, 365 (9453), 36-42.

• Bahadoran, Z., Mirmiran, P., Hosseini-Esfahani, F. and Azizi, F. (2013) Fast food consumption and the risk of metabolic syndrome after 3-years of follow-up: Tehran Lipid and Glucose Study. Eur J Clin Nutr, 67 (12), 1303-1309.

• Goffe et al (2018) The challenges of interventions to promote healthier food in independent takeaways in England. BMC Public Health 18:184

• Public Health England (2014). Obesity and the environment: regulating the growth of fast food outlets. Accessed 15th August 2018. Available from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/296248/Obesity_and_environment_March2014.pdf

• Public Health England (2017). Strategies for encouraging healthier ‘out of home’ food provision. Accessed 15th August 2018. Available from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/604912/Encouraging_healthier_out_of_home_food_provision_toolkit_for_local_councils.pdf

• Swinburn B, Vandevijvere S, Kraak V, Sacks G, Snowdon W, Hawkes C, et al. Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed Government Healthy Food Environment Policy Index. Obes Rev. 2013;14 Suppl 1:24-37.

• Pineo H, Zimmermann N, Cosgrave E, Aldridge RW, Acuto M, Rutter H. Promoting a healthy cities agenda through indicators: development of a global urban environment and health index. Cities & Health. 2018:1-19