Dietary assessment, ultra-processed food consumption, and adiposity in four countries of South Asia

Evidence on the link between ultra-processed food (UPF) consumption and non-communicable diseases (NCDs) and mortality is growing. However, much of this evidence is from Western countries with little known from non-Western countries such as those in South Asia, where the burden of NCDs like type 2 diabetes and cardiovascular disease is disproportionately high. This lack of evidence on the health correlates of UPF consumption in South Asia stems partly from the paucity of detailed food consumption data and the lack of readily available dietary assessment tools capable of collecting individual-level dietary intake data at scale. In my PhD, I aimed to – 1) operationalise and assess the validity of a 24-hour dietary recall instrument for South Asia and 2) quantify consumption, identify sociodemographic correlates, and investigate the association between UPF consumption and adiposity in South Asians. I adapted and operationalised the UK-based Intake24 dietary assessment tool for use in the South Asia Biobank (SAB) across four countries: Bangladesh, India, Pakistan, and Sri Lanka. I tested its performance in ~30,000 participants using both subjectively and objectively estimated physical activity data and found that the tool performed well in South Asia and was comparable to the UK Intake24 version. Using dietary data from over 60,000 participants in the SAB, I quantified UPF consumption, examined its sociodemographic correlates, and investigated its relationship with markers of adiposity among South Asians. On average, UPFs contributed 11% of total energy intake. The sociodemographic patterns of UPF consumption varied across South Asia, emphasising the need for region-specific data. Higher UPF consumption was significantly associated with markers of adiposity in the region. Future studies are needed to confirm findings, but reducing UPF intake may aid in averting obesity and associated health conditions in South Asia.

Name dc:type.qualificationname

Doctor of Philosophy (PhD)

Level dc:type.qualificationlevel

Doctoral

Grantor dc:publisher.institution

University of Cambridge

Year dc:date.issued

2025

Author dc:creator

• Bhagtani, Divya

Advisors dc:contributor.advisor

• Forouhi, Nita
• Adams, Jean

• Adiposity
• diet
• Dietary assessment
• South Asia
• ultra-processed

Licence

• https://www.repository.cam.ac.uk/bitstreams/76d0ae36-a5fe-4d34-80b2-b72a884a8187/download
• http://purl.org/NET/rdflicense/allrightsreserved

Language dc:language

eng

Author Identifier

0000-0002-7546-3144

OAI identifier oai:identifier

oai:www.repository.cam.ac.uk:1810/390888