Dietary trends over a 15-y period (2007-2022) in the Prospective Urban Rural Epidemiology (PURE) study.
Prospective cohort studies documenting long-term dietary trends across multiple world regions are lacking.
To evaluate 15-y (2007-2022) changes in food and beverage consumption among adults aged 35-70 y living in 626 urban and rural communities across 16 high-income (HIC), middle-income (MIC) and low-income (LIC) countries.
In the Prospective Urban Rural Epidemiology Study, dietary intake was assessed using an abbreviated food-frequency questionnaire approximately every 3 y across four follow-up visits over a 15-y calendar period (2007-2022). Linear mixed-effect models and mixed-effect multinomial logistic regression were used to evaluate changes in food and beverage consumption over time. Dietary changes <0.05 servings/d (s/d) are presented as servings/wk (s/wk). Changes of <0.2 s/d change over the study period were considered modest. Participant demographics (age, sex, urban/rural residence, and education) closely matched national distributions in each country.
A total of 120 782 participants provided at least one dietary assessment (median follow-up: 12.1 y). Consumption of animal-based products has generally increased, with clear regional differences. Milk increased in China (+0.21 s/d, +0.15 to +0.26), and in LICs (+0.08 s/d, +0.05 to +0.11); decreased in HICs (-0.10 s/d, -0.12 to -0.07) and in MICs (-0.21 s/wk, -0.28 to -0.15). Eggs increased in HICs, MICs, and in China up to 0.12 eggs/d (+0.11 to +0.14); no change in LICs. All regions increased chicken intake. Only HICs increased cooked fish consumption (0.28 s/wk, +0.06 to +0.50). By contrast, plant-based food intake has generally decreased, but these changes were generally small, and there was some regional variation. Fruit consumption decreased in HICs (-0.16 s/d, -0.18 to -0.14) and MICs (-0.09 s/d, -0.10 to -0.07); increased in China (+0.13 s/d, +0.11 to +0.14) and LICs (+0.22 s/wk, +0.16 to +0.29). Fresh and cooked vegetable consumption decreased in HICs (-0.05 s/d [-0.06, -0.04] and -0.17 s/wk [-0.30 to -0.03], respectively), MICs (-0.19 s/wk [-0.23 to -0.16] and -0.08 s/d [-0.09 to -0.07], respectively), and in China (-0.07 s/d [-0.08 to -0.06] and -0.31 s/wk [-0.40 to -0.23], respectively). In LICs, fresh vegetable consumption increased (+0.19 s/wk, +0.12 to +0.26); cooked vegetable intake was unchanged. Rice consumption decreased in all regions.
In this international prospective study, dietary changes for most foods and beverages during the 15-y (2007-2022) study period were modest in size (most changes <0.2 s/d), but varied by region. Animal-source food intake generally increased, particularly in rapidly developing economies, while plant-based food intake decreased. As these shifts remain below the magnitude usually associated with measurable changes in disease risk, their clinical importance is uncertain.
To evaluate 15-y (2007-2022) changes in food and beverage consumption among adults aged 35-70 y living in 626 urban and rural communities across 16 high-income (HIC), middle-income (MIC) and low-income (LIC) countries.
In the Prospective Urban Rural Epidemiology Study, dietary intake was assessed using an abbreviated food-frequency questionnaire approximately every 3 y across four follow-up visits over a 15-y calendar period (2007-2022). Linear mixed-effect models and mixed-effect multinomial logistic regression were used to evaluate changes in food and beverage consumption over time. Dietary changes <0.05 servings/d (s/d) are presented as servings/wk (s/wk). Changes of <0.2 s/d change over the study period were considered modest. Participant demographics (age, sex, urban/rural residence, and education) closely matched national distributions in each country.
A total of 120 782 participants provided at least one dietary assessment (median follow-up: 12.1 y). Consumption of animal-based products has generally increased, with clear regional differences. Milk increased in China (+0.21 s/d, +0.15 to +0.26), and in LICs (+0.08 s/d, +0.05 to +0.11); decreased in HICs (-0.10 s/d, -0.12 to -0.07) and in MICs (-0.21 s/wk, -0.28 to -0.15). Eggs increased in HICs, MICs, and in China up to 0.12 eggs/d (+0.11 to +0.14); no change in LICs. All regions increased chicken intake. Only HICs increased cooked fish consumption (0.28 s/wk, +0.06 to +0.50). By contrast, plant-based food intake has generally decreased, but these changes were generally small, and there was some regional variation. Fruit consumption decreased in HICs (-0.16 s/d, -0.18 to -0.14) and MICs (-0.09 s/d, -0.10 to -0.07); increased in China (+0.13 s/d, +0.11 to +0.14) and LICs (+0.22 s/wk, +0.16 to +0.29). Fresh and cooked vegetable consumption decreased in HICs (-0.05 s/d [-0.06, -0.04] and -0.17 s/wk [-0.30 to -0.03], respectively), MICs (-0.19 s/wk [-0.23 to -0.16] and -0.08 s/d [-0.09 to -0.07], respectively), and in China (-0.07 s/d [-0.08 to -0.06] and -0.31 s/wk [-0.40 to -0.23], respectively). In LICs, fresh vegetable consumption increased (+0.19 s/wk, +0.12 to +0.26); cooked vegetable intake was unchanged. Rice consumption decreased in all regions.
In this international prospective study, dietary changes for most foods and beverages during the 15-y (2007-2022) study period were modest in size (most changes <0.2 s/d), but varied by region. Animal-source food intake generally increased, particularly in rapidly developing economies, while plant-based food intake decreased. As these shifts remain below the magnitude usually associated with measurable changes in disease risk, their clinical importance is uncertain.
Authors
Sikorski Sikorski, Yusuf Yusuf, Miller Miller, Anand Anand, Teo Teo, Paré Paré, Rangarajan Rangarajan, Poirier Poirier, Swaminathan Swaminathan, Mohan Mohan, Pvm Pvm, Cai Cai, Li Li, Lang Lang, Basiak-Rasała Basiak-Rasała, Swart Swart, Lanas Lanas, Rosengren Rosengren, Mat-Nasir Mat-Nasir, Mohammadifard Mohammadifard, Iqbal Iqbal, Lopez-Jaramillo Lopez-Jaramillo, Keskinler Keskinler, Yusufali Yusufali, Chifamba Chifamba, Diaz Diaz, Avezum Avezum, Mente Mente
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