Quantification of regional variation in ultra-processed food consumption and its sociodemographic correlates across Bangladesh, India, Pakistan, and Sri Lanka: insights from the South Asia Biobank
The Lancet Regional Health Southeast Asia 2025 ; 39: .
Forouhi NG, Forouhi N, Bhagtani D, Adams J, Adams JM, Imamura F
DOI : https://doi.org/10.1016/j.lansea.2025.100633
URL : https://doi.org/10.1016/j.lansea.2025.100633
Abstract
Background
Sales of ultra-processed foods (UPFs) are rising in South Asia, yet UPF consumption and its sociodemographic determinants remain largely unknown. We aimed to quantify UPF consumption and investigate its sociodemographic correlates in four countries of South Asia.
Methods
Between January 2020 and September 2022, the South Asia Biobank recruited 63,914 participants aged 18 years or older who were resident in Bangladesh, Pakistan, Sri Lanka, and North and South India, and self-reported as being of South Asian ethnicity. We analysed data from 60,714 eligible adults. Dietary consumption was assessed using interviewer-led 24-h recalls. Foods were classified by their degree of processing using the NOVA classification. Two-part multivariable-adjusted regression models examined associations of sociodemographic factors with the likelihood and quantity of UPF consumption.
Findings
In Bangladesh, Sri Lanka, and North India, ∼75% of participants reported consuming UPFs during the previous day, versus 41% in South India and Pakistan. Among consumers, UPFs contributed 13–17% of total energy intake, with biscuits being a common source across regions. Other UPFs included sweetened beverages in Pakistan, packaged salty snacks in South India, and breakfast cereals in Bangladesh. Younger age was associated with UPF consumption in Pakistan and Sri Lanka whereas in Bangladesh and North India, older age was. Women were more likely to consume UPFs in all regions except Bangladesh. In Bangladesh, Pakistan, and North India, any level of education above none (i.e., primary, secondary, or higher) was associated with UPF consumption. Among consumers, UPF consumption was lower in married or cohabiting than single people, in all regions. UPF consumption was higher in rural versus urban residents in Bangladesh and Sri Lanka but lower in Pakistan.
Interpretation
UPF consumption varied across South Asia by sociodemographic factors including age, gender, and education. Understanding this heterogeneity is crucial when designing interventions aimed at reducing UPF consumption. Our findings of regional variations in the types of UPFs consumed provide valuable insights for targeted interventions.
Funding
The South Asia Biobank is funded by the National Institute for Health Research.
Lay Summary
Ultra-processed foods (UPFs) like packaged snacks, sugary drinks, and instant noodles are becoming increasingly common in diets around the world. These foods are often high in sugar, salt, and fats as well as food additives such as artificial sweeteners, emulsifiers and stabilisers. The regular consumption of UPFs has been linked to health concerns such as obesity, diabetes, and heart disease. While there’s growing awareness of UPFs in many parts of the world, little has been known about who is eating them and in what form in South Asia — a region home to nearly two billion people and undergoing rapid shifts in food environments that determine the availability and cost of foods and in diet and nutrition related health behaviours.
With colleagues in South Asia, we set out to understand how much UPF people are eating in South Asia, and whether certain groups are more likely to consume them. We analysed dietary data from over 60,000 adults aged 18 years or older, across Bangladesh, India (both North and South), Pakistan, and Sri Lanka. Dietary data was collected using a digital tool that allowed researchers to conduct detailed interviews about what people ate in the past 24 hours.
We found that UPF consumption varied widely between countries and even within regions. In Bangladesh, Sri Lanka, and North India, around three in four people reported eating UPFs the previous day, compared to about four in ten in South India and Pakistan. The most commonly eaten UPFs included biscuits (across all countries), sugary drinks (in Pakistan), salty packaged snacks (in South India), and breakfast cereals (in Bangladesh).
We also found that factors like age, gender, education, and where people live influences who eats UPFs. For example, women were more likely to eat UPFs than men (except in Bangladesh), and people with some education were more likely to consume UPFs than those with none. In Bangladesh and Sri Lanka, UPF intake was higher in rural areas, while in Pakistan it was more common in urban areas.
Understanding these patterns is crucial. It helps public health experts develop nutrition strategies and policies that can be directed to the people most at risk. With UPF sales rising in South Asia, acting now could help prevent future health problems across the region.