Exploring the definition of the traditional Chinese diet and its associations with health outcomes and environmental sustainability

Abstract

Background: Traditional diets may reduce the risk of non-communicable diseases (NCDs) and promote environmental sustainability. However, no study has examined the traditional Chinese diet (TCD) in relation to health outcomes or environmental impacts. This PhD project aimed to: 1) define the TCD; 2) develop an index to assess TCD adherence; 3) examine associations between TCD adherence, NCD outcomes and all-cause mortality; and 4) assess its environmental impacts.

Methods: A mixed-method approach was used. Ninety-nine studies, exploring TCD definitions and related health outcomes, were systematically reviewed. Findings informed a three-round Delphi study with 58 experts to reach consensus on food groups and quantities that characterise the TCD. A TCD adherence index was developed and applied to the China Health and Nutrition Survey (1997–2011), a large and diverse cohort drawn from multiple provinces and municipalities in China, to examine associations with NCD outcomes, all-cause mortality and environmental impacts.

Results: Rice and leafy vegetables consistently characterised the TCD, although regional differences were observed. The Delphi study developed a 0-23 point TCD index comprising 15 food groups and one food-related habit, plus five regional indices. Among 11,158 participants over 8.6 years of follow-up, high TCD adherence was associated with lower risk of cardiovascular diseases (CVDs) (OR: 0.73, 95% CI: 0.61, 0.87) and all-cause mortality (HR: 0.73, 95% CI: 0.63, 0.87), but higher risk of obesity (OR: 1.19, 95% CI: 1.08, 1.32) and central obesity (OR: 1.19, 95% CI: 1.12, 1.26), although energy standardisation reversed these associations. Environmentally, higher TCD adherence was associated with reduced greenhouse gas emissions (β: −0.04, 95% CI: −0.06, −0.02) and water footprint (β: −0.07, 95% CI: −0.08, −0.06), but greater land use (β: 0.36, 95% CI: 0.30, 0.42).

Conclusion: The TCD was associated with lower risk of CVDs and all-cause mortality, alongside reduced environmental impacts. However, its associations with obesity and land use were complex and warrant cautious interpretation.

Date of Award	18 Feb 2026
Original language	English
Awarding Institution	University of Bristol
Supervisor	Angeliki Papadaki (Supervisor) & Bai Li (Supervisor)