in the United States and it takes a lot of effort to cook them at home. As an obvious byproduct of urbanization and economic prosperity, the consumption of soft drinks, sweet beverages, sweets, and candies is increasing in China (23). A cross-sectional self-administered survey that included 399 Chinese Americans in Pennsylvania found that more acculturated Chinese Americans have increased consumption of sweets and beverages (27). In addition to western soft drinks, most Chinese drink liangcha, which is herbal tea with a lot of sugar added.


Many Chinese lack aldehyde dehydrogenase, an enzyme that metabolizes alcohol, and thus respond


to a small amount of alcohol with a “flushing” reaction. They are therefore more susceptible to complications of alcohol consumption (28). However, it is noteworthy that Chinese Americans have the lowest percentages of both lifetime drinking and heavy drinking among all Asian Americans. Only 25% of Chinese-Americans in California reported consuming 10 or more alcoholic drinks in their lifetime (29).


Another change in dietary practice involves the daily intake pattern. A daily intake of three meals per


day has been the established eating pattern among Chinese since ancient times. In the Chinese custom, breakfast usually is the lightest meal, always eaten at home as the first activity at daybreak. Breakfast usually consists of bland-tasting congee in the south and soy bean milk with mantou (steamed buns) in the north. With the advance of economic growth and Westernization, people in the urban areas are shifting to a heavy breakfast of egg, milk, meat, and bread (17,30). Lunch is almost inevitably eaten away from home, in worksite canteens or fast-food restaurants (9). An urban light lunch practice goes hand in hand with an increasing trend of between-meal snacks, which was unusual in the past. A study of the total energy intake of women in the cities of Beijing, Shanghai, and Nanning showed that 7% consisted of snacks (9). Dinner has been the most substantial meal of the day, regarded as the family’s daily congregation, and it has remained so amidst all the other changes.


The Chinese urban population is adopting a trendy practice of having a night snack at eat-out


restaurants such as dim sum restaurants in the south and noodle-jiaozi (dumpling) shops or BBQ street vendors in the north (31). However, Chinese Americans don’t have the same chances to eat out at late night due to the unavailability of night street vendors in most areas of the United States.


As people in mainland China are moving from rural agricultural areas to urban industrialized centers,


they are also migrating from the less-developed regions to the highly urbanized cosmopolitan cities of Beijing, Shanghai, Guangzhou, and Hong Kong. Their eating patterns become more Westernized as Western foods are easily available there. There has also been a shift toward higher protein and fat intakes (17,20).


Generally, the eating pattern in China has been changing due to the urbanization and economic reform


over the last three decades. The total amount of grains decreased, and the type shifted from whole grains to refined grains. Animal protein consumption increased, soy and legume consumption decreased, and vegetable consumption decreased. The dietary pattern shifted from three meals to three meals plus snacks and more frequent eating out.


China is a large country with a diverse population. Food practices in central China can be divided into four geographical regions: Hua Bei area (northern and northeastern China), Hua Nan area (southern China), Hua Dong area (eastern China), and Hua Xi area (western China). The northwest region (Xinjiang autonomous region) and southwest region (Xizang autonomous region) to the border, which is geographically vast and relatively sparsely populated, has remained indigenous. The proportion of


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