Dietary patterns were assessed in a prospective study of cardiovascular disease (CVD) risk factors in four Chinese populations: Beijing urban (BJ-U) and rural (BJ-R), Guangzhou urban (GZ-U) and rural (GZ-R). A total of 10,076 men and women 35-54 years old were surveyed in 1983-84 and resurveyed in 1987-88. Dietary data were obtained in a subsample of about 10% (n=169 BJ-U, 178 BJ-R, 198 GZ-U, 230 GZ-R). Three 24-hr recalls were collected on each participant in each survey. Comparison of mean intakes in the two periods showed increases in meat, poultry, fish (except GZ-R), eggs (rural only), milk (except BJ-R) and alcoholic beverages. The largest shifts were in meat intake (29%-39%), alcoholic beverages (71%-104%) and fats in the urban samples (33%-35%). These changes are reflected in increased mean intakes of animal protein, fat, saturated fatty acids (SFA) and higher Keys scores. Mean total fat intake now exceeds the PRC recommended range of 20-25% of energy in three of the four samples. During this period BMI increased in all samples especially among men (3% - 6%). These surveys, conducted during a period of rapid economic development in China, show that such changes promote shifts in dietary patterns and energy balance towards increased risk of cardiovascular disease.