Fast food trucks near your doorstep are not good for your heart

This editorial refers to ‘Associations between the neighbourhood food environment and cardiovascular disease: A systematic review’, by P. Meijer et al., https://doi.org/10.1093/eurjpc/zwad252. Cardiovascular disease (CVD) is the top-ranked cause of death globally,1 and the absolute number of people diagnosed with and treated for CVD is on the rise.2 Unhealthy dietary factors including consumption of fast-food are important modifiable CVD risk determinants. In addition to contributing to atherosclerosis and thereby CVD, unhealthy dietary factors contribute to CVD risk factors such as obesity, hypertension, and dyslipidemia. Improving diet could be important on an individual level, but population-level interventions based on strong evidence and brave policy and public health decisions as part of a multifactorial approach are necessary as well to prevent CVD. Food choices may be driven by the exposure to food in the environment, and variety, availability, and density of food in an area may influence behaviours. Neighbourhood food environment is the access to food in a neighbourhood or community which may again be associated with risk factors causing CVD. The food environment is part of the neighbourhood built environment which can be objectively measured regarding its relation to CVD. Systematic reviews on this relationship have shown strong evidence of a relation between increased air pollutants and CVD risk, increased residential noise and risk of CVD, and highly suggestive evidence of a relation between increased ambient temperature and risk of CVD, while data on food environment and CVD are scarce.3 Although some studies have examined the association between neighbourhood food environment and CVD, a systematic review on the association between food environment and CVD has not been performed before and is, therefore, more than welcome. In this issue of the European Journal of Preventive Cardiology, Meijer et al.4 report from a comprehensive systematic review on the associations between the neighbourhood food environment and CVD disease in adults. The authors searched three databases for studies dated 1 January 2000 to 1 May 2022. Two reviewers screened almost 6000 records, and 15 studies (cross-sectional and longitudinal studies) were included. The studies were assessed for risk of bias and relevant data were collected. The findings were summarized using a narrative synthesis method, and there were not enough suitable and comparable combinations of data to perform a meta-analysis. Most studies focused on fast-food restaurant density as exposure. The review shows that there is evidence indicating that the neighbourhood food environment, particularly fast-food restaurant density, is positively associated with CVD prevalence and incidence and CVD mortality. The relationship between food environment exposure due to a high density of fast-food restaurants and CVD may be associated with other environmental factors. It is suggested that fast-food exposure may co-locate with other environmental unhealthy factors (‘environmental bads’) such as alcohol shops, tobacco, and gambling outlets, especially in areas with low socio-economic status.5 These factors seem to be clustered together, and living in areas with lower area-level socio-economic status is associated with higher CVD risk due to unhealthy lifestyle behaviours including smoking, high alcohol consumption, physical inactivity, and diet that are independent of individual-level socio-economic status. This can be explained by a neighbourhood effect, which is referred to as characteristics and behaviours of individuals living in the same areas influencing residents’ behaviour and well-being.6,7 In such an area with a relatively vulnerable population one can imagine that even the number of fast-food restaurants would be higher and add to the risk of CVD. The European Society of Cardiology (ESC) and the European Association of Preventive Cardiology recommend diets rich in fruit and vegetables, wholegrains, legumes, nuts and fish, and low in salt, sugar, and saturated fat for CVD prevention.8,9 The ESC guideline also includes a recommendation to consider the regulation of the location and density of fast-food outlets and other catering establishments in community settings.8 To reduce the negative consequences of CVD, it is important to target the different determinants of CVD to develop sustainable prevention strategies. For individuals, interventions focusing on diet and physical activity might be as effective as pharmacological interventions.10 At the population level, working for a healthy neighbourhood food environment for socially deprived populations is a good start for this policy. Fast-food restaurants and outlets could be replaced by actions to favour the adequate availability of healthy food. The author received no financial support for the research, authorship, and/or publication of this article.