目的 基于中国膳食平衡指数(DBI_22)综合评价2002-2022年广东省成年居民的膳食质量,旨在明确其长期趋势与现存不足,为推进针对性营养干预提供数据支撑和理论指导。方法 利用2002年至2022年间进行的四轮广东省居民营养与健康状况监测的调查数据,采用多阶段分层整群抽样调查,选取18岁及以上常住成年居民作为研究对象,通过连续3d 24h膳食回顾法结合称重法获得膳食数据;应用DBI_22计算各指标评分,包括正端分（HBS）、负端分（LBS）和膳食质量距（DQD）;采用加权处理,运用χ²检验、Kruskal-Wallis H检验及Jonckheere-Terpstra趋势检验等方法进行统计分析,并开展性别、城乡等因素分层比较。结果 广东省成年居民总体膳食质量长期处于“中度失衡”（DQD中位数36~41分）状态,表现为“中度摄入不足”与“轻度摄入过量”并存;蔬菜水果、奶类及大豆制品摄入严重不足（不足率分别高达77.23%~89.46%和95.61%~99.07%）;谷物摄入过量比例虽从43.63%下降至28.18%,但不足比例上升至17.40%;动物性食物消费模式发生显著转变,从以摄入不足为主（2002年不足率26.07%）转为出现过量问题（2022年过量率16.40%）;纯热能食物、调味品过量及膳食多样性不足问题持续存在。分层分析显示,膳食质量存在显著的城乡、性别及社会经济梯度差异,农村居民、男性、低文化程度及低收入人群的膳食失衡问题更为突出,城市居民、男性及高收入者的失衡更多由“过量”驱动,而农村居民、女性及低收入者的失衡则主要源于“不足”。结论 广东省成年居民膳食质量在近20年虽有所改善,但整体仍处于中度膳食失衡水平;未来需构建城乡有别、精准施策的综合干预体系,通过政策引导、环境改善与健康教育多层面协同,以优化居民膳食结构,促进慢性病防控。

Objective Based on the Chinese Diet Balance Index (DBI_22), this study comprehensively evaluated the dietary quality of adult residents in Guangdong Province from 2002 to 2022, aiming to identify long-term trends and existing deficiencies, and provide data support and theoretical guidance for implementing targeted nutritional interventions. Methods Data from four rounds of the Guangdong Provincial Nutrition and Health Monitoring Survey (2002-2022) were utilized, focusing on permanent adult residents aged 18 years and older. A multistage stratified cluster sampling approach was employed. Dietary data were collected using a 3-day 24-hour dietary recall method combined with weighing techniques. The DBI_22 was applied to calculate scores for various indicators, including positive-end score (HBS), negative-end score (LBS), and dietary quality distance (DQD). Data were weighted and analyzed using χ², Kruskal-Wallis H, or Jonckheere-Terpstra trend tests, with stratified comparisons by gender and urban/rural residence. Results During the study period, the overall dietary quality of adult residents in Guangdong Province remained persistently in a state of “moderate imbalance” (median DQD scores ranging from 36 to 41 points), characterized by concurrent “moderate deficiencies of intake” and “mild excesses of intake.” Severe deficiencies existed in vegetable/fruit, dairy, and soy product intakes (deficiency rates ranging from 77.23% to 89.46% and 95.61% to 99.07%), with limited improvement over two decades. While grain overconsumption decreased from 43.63% to 28.18%, deficiency rates rose to 17.40%. Animal food consumption patterns underwent significant shifts by transitioning from predominant deficiency (26.07% deficiency rate in 2002) to emerging excess (16.40% excess rate in 2022). Persistent issues include excessive intakes of pure energy foods and condiments and insufficient dietary diversity. Stratified analysis revealed significant urban-rural, gender, and socioeconomic differences in dietary quality. Dietary imbalances were more pronounced among rural residents, males, low-educated individuals, and low-income groups. Imbalances among urban residents, males, and high-income individuals were primarily driven by “excess”, while those among rural residents, females, and low-income individuals stemmed mainly from “insufficiency”. Conclusion Although dietary quality among Guangdong adults has improved over the past two decades, it remains at a moderate level of dietary imbalance. Future efforts should establish a comprehensive intervention system tailored to urban and rural contexts through precise policy measures.