Abstract
BackgroundIn recent decades China has experienced rapid urbanization leading to a major nutrition transition, with increased refined carbohydrates, added sweeteners, edible oils, and animal-source foods, and reduced legumes, vegetables, and fruits. These changes have accompanied increased prevalence of cardiometabolic disease (CMD). There is no single dietary measure that summarizes the distinct food changes across regions and levels of urbanization.ObjectiveWe aimed to develop a diet urbanization index that would represent a dietary pattern for urbanized diet across diverse regions. MethodsUsing a sample of adults (≥18 years) in the 2015 wave of the China Health and Nutrition Survey (CHNS; n = 14,024), we selected literature-based candidate dietary variables and tested their univariate associations with overall and within-region urbanization. Using iterative exclusion of select diet-related variables, we created six potential urbanized diet indices, which we examined relative to overall urbanization to select a final urbanized diet index based on a priori considerations, strength of association with urbanization, and minimal missingness. We tested stability of the final urbanized diet index across sociodemographic factors and used mixed effects logistic regression models to examine associations between the final urbanized diet index and CMD risk factors – hypertension (HTN), overweight, and type 2 diabetes mellitus (T2DM), adjusting for sociodemographics, overall urbanization, physical activity, and including random intercepts to account for correlation at community and household level.ResultsWe identified a final urbanized diet index that captured dietary information unique to consumption of an urbanized diet and performed well across regions. We found a positive association (R2 = 0.17, 0.01 SE) between the final urbanized diet index and overall urbanization in the fully adjusted model. We found no associations between the urbanized diet index with HTN, overweight, and T2DM in fully adjusted models (OR (95% CI) = 0.94 (0.89-1.0), 1.0 (0.95 - 1.05), 1.02 (0.94 - 1.10), respectively).Conclusions We derived an urbanized diet index that captured dietary urbanization that was distinct from overall urbanization and performed well across all regions of China. This urbanized diet index provides an alternative to measures of traditional versus Westernized diet that vary across regions due to different cultural dietary traditions.