Researchers studied how diet affects disease in China from 1990 to 2021. They found that eating too much salt, not enough fruit, and not enough whole grains causes the most health problems. As China has become wealthier, people eat more meat and sugary drinks, which is creating new health challenges. The good news is that overall disease from poor diet has decreased, but certain problems like heart disease and diabetes remain serious concerns, especially in older adults and in certain regions of China.

The Quick Take

  • What they studied: How different eating habits affect disease and death rates in China, and how these patterns have changed over 30 years
  • Who participated: This wasn’t a traditional study with volunteers. Instead, researchers analyzed health data from 33 provinces and regions across China for adults aged 25 and older, covering data from 1990 to 2021
  • Key finding: In 2021, poor eating habits caused 1.7 million deaths and serious health problems affecting 38.39 million people in China. The biggest culprits were eating too much salt, not eating enough fruit, and not eating enough whole grains
  • What it means for you: If you live in China or eat a similar diet, paying attention to salt intake, eating more fruits and whole grains, and limiting sugary drinks could significantly reduce your risk of heart disease, cancer, and diabetes. However, these findings are specific to China’s population and may not apply equally to other countries

The Research Details

This research analyzed massive amounts of health data collected from across China over 31 years (1990-2021). Instead of conducting their own experiments, researchers used information from the Global Burden of Disease Study 2021, which is like a giant health database that tracks diseases and deaths worldwide. They looked at specific measurements: how many people died, how many years of healthy life were lost, and how many years people lived with disabilities. They organized this information by age, gender, and region to see patterns.

The researchers tracked how eating habits changed over time. They noticed that as China became wealthier, people ate less rice and grains but more meat and processed foods. They then connected these dietary changes to specific diseases like heart disease, cancer, and diabetes to understand which foods had the biggest impact on health.

This type of study is powerful because it looks at real-world health patterns across an entire country rather than just a small group of volunteers in a lab. However, it relies on data that was already collected for other purposes, so researchers can’t control all the variables like they could in an experiment.

Understanding which foods cause the most health problems helps governments and doctors create better health advice. By tracking changes over 30 years, researchers can see how economic development affects what people eat and how that changes disease patterns. This information is especially important for China because the country is experiencing rapid changes in diet and lifestyle, and these findings can guide public health policies to prevent future disease.

This study is based on data from the Global Burden of Disease Study, which is one of the most respected health databases in the world. The researchers analyzed information from all 33 provinces and regions in China, making it very comprehensive. However, the study relies on data quality from different regions, which may vary. The findings show clear patterns over 30 years, which makes the trends more reliable. One limitation is that this type of analysis cannot prove that specific foods directly cause disease—it can only show associations or connections between diet and health problems.

What the Results Show

In 2021, dietary risk factors were responsible for approximately 1.7 million deaths among Chinese adults aged 25 and older. This represents a massive health burden affecting millions of people. The three biggest dietary problems were: (1) eating too much salt, (2) not eating enough fruit, and (3) not eating enough whole grains. These three factors alone caused more disease than any other dietary issues.

Heart disease was the leading cause of health problems related to diet, followed by cancer and diabetes. Men experienced more disease burden than women, and older adults—especially those aged 80 and older—were hit hardest. Interestingly, different regions of China had very different problems. The Northeastern and Western regions showed the highest disease burden from poor diet.

Over the 31-year period from 1990 to 2021, the overall disease burden from poor diet actually decreased, which is good news. However, the type of burden changed. While fewer people died, more people were living with chronic diseases like diabetes and heart disease. This suggests that while diet-related deaths are declining, more people are managing long-term health conditions.

The study revealed important shifts in which foods are causing problems. Thirty years ago, not eating enough vegetables was the third-biggest dietary problem in China. By 2021, it had dropped to 12th place—a huge improvement. However, eating too much red meat jumped from 15th place to 7th place, showing that as people became wealthier and ate more meat, this became a bigger health concern. Perhaps most striking, sugary drink consumption increased dramatically in its impact on health—the disease burden from sugary drinks increased by 689% between 1990 and 2021, even though it wasn’t the top problem overall. This suggests that sugary beverages are becoming an increasingly serious health threat in China.

This research fits into a larger global pattern. Many countries around the world have seen similar shifts as they become wealthier: people eat less whole grains and vegetables and more processed foods, meat, and sugary products. This study shows that China is following this same pattern. The good news is that China’s overall disease burden from diet has decreased, which is better than some other countries. However, the rising problems with red meat and sugary drinks suggest that China may face increasing health challenges from these foods in the future unless action is taken.

This study has several important limitations to understand. First, it’s based on data analysis rather than controlled experiments, so researchers can identify connections between diet and disease but cannot prove that specific foods directly cause disease. Second, the quality of health data varies across different regions of China, which may affect accuracy. Third, the study doesn’t account for other lifestyle factors like exercise, smoking, or stress that also affect disease risk. Fourth, dietary data comes from surveys and estimates rather than precise measurements of what people actually eat. Finally, these findings are specific to China’s population and may not apply equally to people in other countries with different genetics, healthcare systems, and food environments.

The Bottom Line

Based on this research, here are evidence-based recommendations: (1) Reduce salt intake—this is the single biggest dietary risk factor in China, so cutting back on salty foods could have the largest health impact (high confidence). (2) Eat more fruits and whole grains—these were the second and third biggest problems, and increasing intake could significantly reduce disease risk (high confidence). (3) Limit red meat consumption—while not the top problem, red meat’s impact is rising and reducing intake may help prevent heart disease and cancer (moderate confidence). (4) Avoid sugary drinks—these are becoming an increasingly serious problem and should be limited or eliminated (moderate confidence). These recommendations are most relevant for Chinese adults and people eating similar diets.

These findings are most directly relevant to people living in China and those eating a similar diet pattern. Adults aged 25 and older should pay special attention, as this is the age group studied. Men and older adults (especially those over 80) should be particularly concerned since they showed higher disease burden. People in Northeastern and Western China should prioritize these dietary changes since their regions showed higher disease burden. However, these findings may also apply to people in other countries experiencing similar dietary transitions, such as other Asian countries becoming wealthier and adopting more Western eating patterns. People with existing heart disease, diabetes, or cancer risk should be especially motivated to follow these recommendations.

Realistic expectations for seeing benefits vary by change: Reducing salt intake can lower blood pressure within weeks to months, which reduces heart disease risk. Eating more fruits and whole grains may improve cholesterol levels and blood sugar control within 2-3 months. Reducing red meat and sugary drinks may help with weight management and diabetes prevention over 3-6 months. However, preventing serious diseases like heart disease and cancer typically takes years of consistent healthy eating. Think of dietary changes as long-term investments in your health rather than quick fixes.

Want to Apply This Research?

  • Track daily sodium intake (target: less than 2,300 mg per day), servings of fruit (target: 2-3 servings daily), servings of whole grains (target: 3-5 servings daily), and sugary drink consumption (target: zero or minimal). Use the app to log these four categories daily and review weekly trends to see progress.
  • Start with one change at a time: Week 1-2, focus on reducing salt by choosing lower-sodium versions of common foods and not adding salt at the table. Week 3-4, add more fruit by having fruit as snacks or with meals. Week 5-6, switch to whole grain versions of rice and bread. Week 7-8, replace sugary drinks with water or unsweetened tea. Use the app to set reminders and celebrate small wins.
  • Set up weekly check-ins to review your dietary tracking. Create a simple scorecard: Did you meet your salt reduction goal? Did you eat enough fruit and whole grains? Did you avoid sugary drinks? Track these weekly, then monthly, to see patterns. If you have access to health measurements, monitor blood pressure and weight monthly to see if dietary changes are improving your health markers. Share progress with a friend or family member for accountability.

This research provides important insights into population-level dietary patterns and disease trends in China, but individual results may vary significantly. These findings should not replace personalized medical advice from your doctor or registered dietitian. If you have existing health conditions like heart disease, diabetes, or high blood pressure, consult with a healthcare provider before making major dietary changes. This study identifies associations between diet and disease but cannot prove that specific foods directly cause disease in every individual. Dietary needs vary based on age, sex, genetics, activity level, and existing health conditions. The recommendations in this article are general guidance based on population research and should be adapted to your individual circumstances with professional guidance.