Assessing the diet quality, environmental impact, and monetary costs of the dietary transition in China (1997–2011): Impact of urbanization

Background: Increased urbanization has been linked to transitions in dietary patterns. However, evidence on the impacts of urbanization on diet quality, and environmental impact, and diet cost is limited. The aim of this study was to investigate the time trends of these three dietary sustainability in China over the period 1997–2011 and to examine their associations with urbanization. Methods: Food consumption of 8,330 participants (18–64y) of the China Health and Nutrition Survey cohort (1997, 2000, 2004, 2006, 2009, and 2011) were examined and diet quality was assessed using the Chinese Healthy Eating Index 2016 (CHEI2016). Dietary related environmental impacts on Greenhouse Gas Emissions (GHGE), Total Water Use (TWU), and Land Use (LU) were estimated using the Chinese Food Life Cycle Assessment Database. Monetary cost of diet was calculated using the community market prices of food items. Multilevel mixed-effects models were used to estimate associations between the time trend of dietary sustainability indicators and degree of urbanization. Results: From 1997 to 2011, the CHEI2016 score increased by 10.6%, GHGE by 23.8%, LU by 29.1%, and the inflation-corrected cost of diet by 80%. Urbanization was positively associated with these time trends, which remained after adjustment for sociodemographic and lifestyle factors (all P < 0·05). Conclusion: The rapid urbanization in China over the past two decades has been followed by an improvement in the overall dietary quality, but this has been accompanied by an increase in the environmental impacts and higher cost of the diet, especially in communities with lower urbanization index.