Small Island Developing States (SIDS) have high burdens of nutrition-related chronic diseases. This has been associated with lack of access to adequate and affordable nutritious foods and increasing reliance on imported foods. Our aim in this study was to investigate dietary patterns and food insecurity and assess their associations with socio-demographic characteristics and food sources. We recruited individuals aged 15 years and above from rural and urban areas in Fiji (n = 186) and St. Vincent and the Grenadines (SVG) (n = 147). Data collection included a 24 h diet recall, food source questionnaire and the Food Insecurity Experience Scale. We conducted latent class analysis to identify dietary patterns, and multivariable regression to investigate independent associations with dietary patterns. Three dietary patterns were identified: (1) low pulses, and milk and milk products, (2) intermediate pulses, and milk and milk products and (3) most diverse. In both SIDS, dietary pattern 3 was associated with older age, regularly sourcing food from supermarkets and borrowing, exchanging, bartering or gifting (BEB). Prevalence of food insecurity was not statistically different across dietary patterns. In both SIDS, food insecurity was higher in those regularly sourcing food from small shops, and in SVG, lower in those regularly using BEB. These results complement previous findings and provide a basis for further investigation into the determinants of dietary patterns, dietary diversity and food insecurity in these settings.

South Asia's diverse food supply, food preparations, and eating behaviors require dietary instruments that reflect the consumption patterns of South Asians to enable context specific dietary assessment. Such instruments are not readily available for detailed dietary assessment at scale in South Asia. We describe the adaptation, implementation, and performance evaluation of Intake24, an open-source digital 24-h dietary recall tool, for dietary assessment in South Asia. We adapted Intake24 for dietary assessment in the South Asia Biobank (SAB), a large population-based study in Bangladesh, India, Pakistan, and Sri Lanka. Intake24 adaptation encompassed the development of a South Asian food database with commonly consumed foods, linked with corresponding portion sizes, food probes, and nutrient information. Trained interviewers conducted the 24-h recalls. Performance of Intake24 was evaluated in 29,113 South Asian adults. The South Asia Intake24 food database included 2283 items and demonstrated good coverage of foods consumed across SAB regions. Median recall completion time was 13 min. Quality control metrics showed 99% of recalls included >8 items and 8% had missing foods. Median energy intake was higher in younger individuals compared to older, and in males compared to females. Underweight participants reported lower energy intake, with no discernible difference across other BMI categories. Intake24 enables comprehensive dietary assessment in regions of South Asia and will facilitate the analysis of dietary patterns, food and nutrient intake, and their relationship with health outcomes among South Asians.

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. 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. 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. 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. The South Asia Biobank is funded by the National Institute for Health Research.