PMID- 36085037 OWN - NLM STAT- MEDLINE DCOM- 20220913 LR - 20221215 IS - 1475-2891 (Electronic) IS - 1475-2891 (Linking) VI - 21 IP - 1 DP - 2022 Sep 9 TI - Characterizing the urban diet: development of an urbanized diet index. PG - 55 LID - 10.1186/s12937-022-00807-8 [doi] LID - 55 AB - BACKGROUND: In 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. METHODS: Using 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. To examine whether our new measure reflected health risk, we 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. RESULTS: We 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 (R(2) = 0.17, 0.01 SE) between the final urbanized diet index and overall urbanization in the fully adjusted model. The new measure was negatively associated with HTN [OR (95% CI) = 0.93 (0.88-0.99)] and positively associated with T2D [OR = 1.13; 1.05-1.21] in minimally adjusted models, but not in the fully adjusted models. CONCLUSION: 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 urbanized diet that vary across regions due to different cultural dietary traditions. In addition, the new measure is best used in combination with diet quality measures, sociodemographic, and lifestyle measures to examine distinct pathways from urbanization to health in urbanizing countries. CI - (c) 2022. The Author(s). FAU - Cyr-Scully, Ali AU - Cyr-Scully A AD - Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. FAU - Howard, Annie Green AU - Howard AG AUID- ORCID: 0000-0003-0837-8166 AD - Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 123 W. Franklin Street, CB #8120, Chapel Hill, NC, 27514, USA. aghoward@email.unc.edu. AD - Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin Street, CB #8120, Chapel Hill, NC, 27514, USA. aghoward@email.unc.edu. FAU - Sanzone, Erin AU - Sanzone E AD - Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. FAU - Meyer, Katie A AU - Meyer KA AD - Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. AD - Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, USA. FAU - Du, Shufa AU - Du S AD - Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. AD - Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin Street, CB #8120, Chapel Hill, NC, 27514, USA. FAU - Zhang, Bing AU - Zhang B AD - National Institute for Nutrition and Health, China Center for Disease Control and Prevention, Beijing, China. FAU - Wang, Huijun AU - Wang H AD - National Institute for Nutrition and Health, China Center for Disease Control and Prevention, Beijing, China. FAU - Gordon-Larsen, Penny AU - Gordon-Larsen P AD - Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. AD - Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin Street, CB #8120, Chapel Hill, NC, 27514, USA. LA - eng GR - R01 DK104371/DK/NIDDK NIH HHS/United States GR - R01 AG065357/AG/NIA NIH HHS/United States GR - D43 TW009077/TW/FIC NIH HHS/United States GR - P2C HD050924/HD/NICHD NIH HHS/United States GR - R01 HL108427/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20220909 PL - England TA - Nutr J JT - Nutrition journal JID - 101152213 SB - IM MH - Animals MH - *Diabetes Mellitus, Type 2 MH - Diet MH - Humans MH - *Hypertension/epidemiology MH - Nutrition Surveys MH - Nutritional Status MH - Vegetables PMC - PMC9463720 OTO - NOTNLM OT - Cardiometabolic disease OT - China OT - Diet OT - Urbanization COIS- The authors declare that they have no competing interests. EDAT- 2022/09/10 06:00 MHDA- 2022/09/14 06:00 PMCR- 2022/09/09 CRDT- 2022/09/09 23:33 PHST- 2021/11/03 00:00 [received] PHST- 2022/08/30 00:00 [accepted] PHST- 2022/09/09 23:33 [entrez] PHST- 2022/09/10 06:00 [pubmed] PHST- 2022/09/14 06:00 [medline] PHST- 2022/09/09 00:00 [pmc-release] AID - 10.1186/s12937-022-00807-8 [pii] AID - 807 [pii] AID - 10.1186/s12937-022-00807-8 [doi] PST - epublish SO - Nutr J. 2022 Sep 9;21(1):55. doi: 10.1186/s12937-022-00807-8.