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300 million adults and 16 million children in China are now obese. The rapid economic development, urbanization and associated environmental changes occurring in China are thought to be responsible for this growing obesity epidemic. My dissertation research has gradually developed into four interconnected parts which are presented in Chapter 1, 2, 3 and future work. First (Chapter 1), culturally specific food environment survey instruments were developed and used to document the longitudinal changes in food availability in six representative neighborhoods in Kunming via field audits. Second (Chapter 2), to pilot test our integrated methodology, a 12-person cohort was recruited in Kunming, and individual dietary behavior was modeled and topologies were proposed. Third (Chapter 3), to further test our methodology on a larger cohort aiming to examine the relationship between food environment and sugar-sweetened beverage consumption, we worked with Carolina Population Center on their China Beverage Validation Study in urban and rural Shanghai. Lastly (future work), to examine the health impacts of the changing food environment, a 300 adolescent cohort was recruited from two high schools in Kunming, and followed for two years. Their dietary, physical activity, mental, social and physical changes were assessed via traditional research surveys, smartphone-based activity tracking and Internet datamining. Preliminary results on the cohort’s BMIs are presented.

This paper addresses the need for diet assessment methods that capture the rapidly changing beverage consumption patterns in China. The objective of this study was to develop a 3-day smartphone-assisted 24-hour recall to improve the quantification of beverage intake amongst young Chinese adults (n=110) and validate, in a small subset (n=34), the extent to which the written record and smartphone-assisted recalls adequately estimated total fluid intake, using 24-hour urine samples. The smartphone-assisted method showed improved validity compared with the written record-assisted method, when comparing reported total fluid intake to total urine volume. However, participants reported consuming fewer beverages on the smartphone-assisted method compared with the written record-assisted method, primarily due to decreased consumption of traditional zero-energy beverages (i.e. water, tea) in the smartphone-assisted method. It is unclear why participants reported fewer beverages in the smartphone-assisted method than the written record -assisted method. One possibility is that participants found the smartphone method too cumbersome, and responded by decreasing beverage intake. These results suggest that smartphone-assisted 24-hour recalls perform comparably but do not appear to substantially improve beverage quantification compared with the current written record-based approach. In addition, we piloted a beverage screener to identify consumers of episodically consumed SSBs. As expected, a substantially higher proportion of consumers reported consuming SSBs on the beverage screener compared with either recall type, suggesting that a beverage screener may be useful in characterizing consumption of episodically consumed beverages in China's dynamic food and beverage landscape.本研究的目的是探讨一种能够反映中国快速变化的饮料消费模式的膳食调查方 法。我们设计了一种智能手机协助的3 天24 小时回顾调查以改善饮料消费的 调查，调查对象包括110 名中国青年，并在其中的34 名青年中收集24 小时尿 样，以比较问卷调查与智能手机协助调查的总液体摄入量。结果表明，当与总 尿量比较时，智能手机协助的方法比问卷调查能更好地反映总液体的摄入量， 但被调查者通过智能手机提供的饮料消费量较少，主要是传统的不含能量的饮 料（如水和茶）报告较少。导致该现象的原因不明，可能是智能手机调查相对 繁琐引起的。与现行的问卷调查相比，智能手机调查能获得相当的饮料消费量 但并不能从根本上改善调查质量。此外，我们还尝试用问卷筛查加糖饮料的消 费，报告的消费量比智能手机或传统问卷调查获得的消费量都高，说明在变化 的中国膳食与饮料模式中调查饮料消费特征时加入饮料消费筛查可能会帮助提 高调查质量，获得更准确的饮料消费量。

Background: Worldwide over one billion adults are overweight. Lack of access to a diverse food environment may limit dietary choices and contribute to obesity risk. Current diet assessment instrume...