Living near three or more bars, fast-food restaurants could raise heart failure risk
Key takeaways:
- Living in areas with three or more bars or fast-food outlets within 1 km2 was tied to increased heart failure risk.
- Factors such as education, urbanicity and access to exercise facilities further impacted risk.
Living in areas with a high density of pubs, bars and fast-food restaurants was associated with increased risk for incident HF, according to findings published in Circulation: Heart Failure.
HF risk associated with high ready-to-eat food environment density was especially high for those with lower education or those living in areas with high urbanicity or lower density of physical exercise facilities, according to researchers.
“Most previous research on the relation between nutrition and human health has been focused on food quality, while neglecting the impact of food environment,” Lu Qi, MD, PhD, professor in the epidemiology department at Tulane University, said in a press release. “Our study highlights the importance of accounting for food environment in nutrition research.”
For the present study, Qi and colleagues analyzed individual-level exposure to ready-to-eat food environments using data from the UK Biobank Urban Morphometric Platform data — a database of objectively measured built environment metrics of the residential address of each participant — to better understand the association between accessibility to three ready-to-eat food environments and incident HF: pubs or bars, restaurants or cafeterias and fast-food outlets.
The analysis included data from 478,598 participants with exposure to food environments and no HF at baseline (57 years; 54% women; 94% white).
Ready-to-eat food environments accessibility was evaluated as both distance and density. Close distance was defined as approximately 10-to-15-minute walk at a moderate pace within a 1 km street network to ready-to-eat food environments. High density was defined as the number of ready-to-eat food environments per 1 km2 around participants’ residences.
The researchers also developed a composite density score by summing the densities of all three types of ready-to-eat food environments.
The median street distances were 692.23 m to pubs and bars, 820.5 m to restaurants and cafeterias and 1,135.93 m to fast-food outlets.
The median 1-km street buffer density of pubs and bars was 1.29 U/km2, 1 U/km2 for restaurants and cafeterias, 0 U/km2 for fast-food outlets and 3.57 U/km2 for the composite density score of all three summed.
Composite density score was stratified into quintiles of ready-to-eat food environment density, with 0 U/km2 being the lowest quintile and 11.2 U/km2 to 383 U/km2 being the highest quintile.
Overall, 20% of study participants resided in the highest-density category of composite ready-to-eat food environments.
HF and proximity to ready-to-eat food
During a median of 12.23 years of follow-up, 12,956 incident cases of HF occurred.
The researchers reported that, compared with those with no exposure to composite ready-to-eat food environments, participants in the highest quintile had a 8% to 25% greater risk for incident HF (P < .0001).
Moreover, those in the highest density category for bars and pubs and fast-food outlets — defined as three or more U/km² — had greater risk for HF compared with participants with no exposure (adjusted HR for pubs and bars = 1.14; 95% CI, 1.09-1.2; P < .0001; aHR for fast-food outlets = 1.12; 95% CI, 1.07-1.18; P < .00001). In the fully adjusted model, there was no significant association between incident HF and local density of restaurants and cafeterias.
In addition, the researchers observed a significant interaction between ready-to-eat food environment density and HF risk among participants with lower educational attainment, living in areas of higher urbanicity or living in areas with lower density of physical activity facilities (P for all < .05).
“Although the mechanisms related to the development of HF with accessibility to the food environment have yet to be determined, changes in individual-level biological and behavioral risk factors in response to the context of food environments might partly contribute to the association between food environments and HF,” the researchers wrote. “An unfavorable ready-to-eat food environment with great accessibility to pubs and bars or fast-food outlets might influence eating and drinking behavioral patterns that have been related to an elevated HF risk. The adverse food environments may deteriorate reliance on energy-dense and nutrition-poor food, soft drinks, alcohol and other beverages, leading to elevated harmful cardiovascular risk factors, such as obesity and hypertension, and, in turn, might increase HF risk. Further investigations are needed to explore the underlying mechanisms.”
Food insecurity a multidisciplinary issue
In a related editorial, Elissa Driggin, MD, MS, cardiology fellow, and Ersilia M. DeFilippis, MD, advanced HF and transplant fellow at Columbia University Irving Medical Center, discussed lack of diversity in the present study as well as discussion of food insecurity in clinic.
“It is imperative to note in the current study that 94% of the patients included were white Europeans. Given the clear association between Black race and a high incidence of HF as compared with white patients, as well as associations with worse HF outcomes, attention to food environment in this high-risk population is of the utmost importance,” the authors wrote. “More detailed analyses are therefore needed in areas with more racially and ethnically diverse populations to understand the impact on the association of food environment and incident HF.
“At their core, treatment strategies need to address food insecurity and social determinants of health, which are most likely to impact those who live in high-density ready-to-eat food environments,” they wrote. “While all cardiology providers should introduce the importance of the topic, given the busy clinic environment, it is crucial to use the expertise of dietitians and other care team members to accomplish this goal.”
Reference:
- Driggin E, et al. Circ Heart Fail. 2024;doi:10.1161/CIRCHEARTFAILURE.124.011468.
- Living near pubs, bars and fast-food restaurants could be bad for heart health. https://newsroom.heart.org/news/living-near-pubs-bars-and-fast-food-restaurants-could-be-bad-for-heart-health. Published Feb. 27, 2024. Accessed Feb. 27, 2024.
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