title: Does the Dietary Pattern of Shanghai Residents  Change across Seasons and Area of Residence:  Assessing Dietary Quality Using the Chinese Diet  Balance Index (DBI).
abstract: BACKGROUND
  Few studies have applied the Chinese Diet Balance Index (DBI) in evaluating dietary quality across seasons.
  
  
  METHODS
  The Shanghai Diet and Health Survey (SDHS) included 1680 participants from all districts of Shanghai from 2012 to 2013. Dietary data were obtained using three-day 24-h recall in spring, summer, fall, and winter. Higher bound score (HBS), lower bound score (LBS) and diet quality distance (DQD) were calculated according to compliance with the dietary guidelines and based on the recommendations for consumption within the main food groups. HBS, LBS, and DQD represent over-intake, under-intake, and overall imbalance of the diet, respectively.
  
  
  RESULTS
  836 males and 844 females were included. The HBS indicated that 10.08%, 11.84%, 10.31%, and 12.73% people have moderate or high levels of over-intake of food in spring, summer, fall, and winter, respectively; and 74.04%, 37.61%, 53.09%, and 42.72% people have moderate or high levels of deficit food intake for each of the four seasons. The mean HBS and LBS among the four seasons were statistically significant difference (p < 0.001). The mean (SD) DQD was 43.27 (10.21), 35.67 (9.71), 39.19 (9.36), and 36.84 (9.45) in each season. A multivariable model showed statistically significant differences in DQD according to age, gender, occupational status, education, smoking, drinking status, season, and residency (p < 0.001).
  
  
  CONCLUSIONS
  An unbalanced diet is common among people living in Shanghai. Seasonality and area of residence were found to be two significant predictors. Strengthening the accessibility and the supply of food across seasons and regions should be considered.
authors.affiliation: Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China. zangjiajie@scdc.sh.cn.
authors.forename: Jiajie
authors.initials: J
authors.lastname: Zang
authors.affiliation: Department of Vital Statistics, Division of Health information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China. yuhuiting@scdc.sh.cn.
authors.forename: Huiting
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China. zhuzhenni@scdc.sh.cn.
authors.forename: Zhenni
authors.initials: Z
authors.lastname: Zhu
authors.affiliation: Department of Molecular Biology for Public Health, Division of Non-Communicable Diseases, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China. luye@scdc.sh.cn.
authors.forename: Ye
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Physical Examination, Division of Non-Communicable Diseases, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200070, China. liuchanghe@scdc.sh.cn.
authors.forename: Changhe
authors.initials: C
authors.lastname: Liu
authors.affiliation: Songjiang Center for Disease Control and Prevention, Shanghai 201620, China. yaochunxia1@126.com.
authors.forename: Chunxia
authors.initials: C
authors.lastname: Yao
authors.affiliation: Pudong Center for Disease Control and Prevention, Shanghai 200136, China. 340bpq@163.com.
authors.forename: Pinqing
authors.initials: P
authors.lastname: Bai
authors.affiliation: Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China. guochangyi@scdc.sh.cn.
authors.forename: Changyi
authors.initials: C
authors.lastname: Guo
authors.affiliation: Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China. Jiaxiaodong@scdc.sh.cn.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Jia
authors.affiliation: Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China. zoushurong@scdc.sh.cn.
authors.forename: Shurong
authors.initials: S
authors.lastname: Zou
authors.affiliation: Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China. wufan@scdc.sh.cn.
authors.forename: Fan
authors.initials: F
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002681:China; D015331:Cohort Studies; D004032:Diet; D005260:Female; D063427:Food Quality; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D018673:Nutrition Policy; D012621:Seasons; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Shanghai Diet and Health Survey;  Diet Balance Index;  predictors;  season