Development and preliminary evaluation of Chinese Adult Dietary Behavior Scale

Haiyue Zhang¹Xinrui Li¹Yuan Wang²Wei Zhang¹Liang Ying¹Yue Wang¹Zhe Yang¹Zhijun Tan^1*Junrong Xu^3*Lei Shang^1*

• ¹Department of Health Statistics, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, Xi’an, China
• ²Xi'an No.3 Hospital, the Affiliated Hospital of Northwest University, Xi'an, China
• ³Department of Gastroenterology, Xi'an No.3 Hospital, the Affiliated Hospital of Northwest University, Xi'an, China

Background: There is currently no widely accepted multidimensional tool to assess adult dietary behaviors in China. This study developed the Chinese Adults Dietary Behavior Scale (CADBS) to evaluate Chinese adults' eating-related traits and preliminarily examined its reliability, validity, and ability to distinguish different groups. Methods: The scale was developed through three rounds of surveys conducted from 2020 to 2021. Items were screened using item analysis. After item selection, exploratory and confirmatory factor analyses were used to determine the final structure of the scale, and its reliability, structural validity, and discriminative ability were assessed accordingly. Results: The final scale consists of 7 dimensions with 39 items: Snacking, Food Responsiveness, Emotional Eating, Restrictive Eating, Food Fussiness, Healthy Dietary Awareness, and External Eating. Exploratory factor analysis showed a total cumulative variance contribution rate of 60.60%. Confirmatory factor analysis yielded a Tucker–Lewis index (TLI) of 0.892 and a comparative fit index (CFI) of 0.903. The total scale had a Cronbach’s α coefficient of 0.890, a split-half reliability coefficient of 0.920, and a test-retest reliability coefficient of 0.740. Snacking (β = 0.422), Food Responsiveness (β = 0.412), and Restrictive Eating (β = 0.675) were positively associated with BMI, while Healthy Dietary Awareness (β = -0.396) was negatively associated with BMI. Conclusions: Following standard procedures, this study developed a self-report scale for assessing Chinese adults' dietary behaviors. The CADBS has good reliability and structural validity, making it suitable for epidemiological surveys of dietary behaviors and public health intervention practices. Specifically, it shows that Chinese adults who snack more, have stronger food responsiveness are more likely to be overweight or obese. Conversely, an overweight or obese Chinese adult tend to be restrictive towards eating. In contrary, those with greater healthy dietary awareness are more likely to have a normal weight.