What Adults in Rural South Asia Eat and When They Eat It: Evidence From Bangladesh, India, and Nepal.

Background: Poor diets are associated with all forms of malnutrition and diet-related noncommunicable diseases (NCDs). Data on dietary patterns are scarce in South Asia.

Objectives: We sought to describe overall diet quality and intake of foods and food groups at different eating occasions among adults in rural South Asia.

Methods: We collected cross-sectional data from 5 districts across Bangladesh (n = 2802 individuals), India (n = 1672), and Nepal (n = 1451). The Global Diet Quality Score (GDQS) application was used to measure food intake on the previous day, with each food tagged to an eating occasion. Diet quality and risk of dietary inadequacy and diet-related NCDs were assessed using GDQS total (0-49 points), GDQS positive (0-32), and GDQS negative (0-17) metrics for overall, healthy, and unhealthy food group intake, respectively.

Results: Diet quality was low, with similar scores across countries for GDQS total (17-19), GDQS positive (7-8), and GDQS negative (10-12). Over 90% of adults had levels of GDQS scores associated with moderate/high risk of nutrient inadequacy and diet-related NCDs, with the proportion at high risk in Bangladesh being 2-3× higher than that in other countries. One-third of adults skipped breakfast in Nepal, and snacking was twice as common in males (63%) vs females (33%) in Bangladesh. Lower GDQS total scores (worse diets) were associated with female gender and lower household wealth but not with household production of crops or livestock.

Conclusions: These findings may help inform interventions to improve diets in South Asia, focusing on increasing intake of healthy fresh foods, while limiting intake of processed foods high in sugar, salt, and saturated fat.