Rural Diets Under Pressure: Food Environments and their Influence on Food Choice in South Asia

Abstract The rapid South Asia rural transformation, driven by globalization and industrialization, has introduced a complex interaction between traditional and modern food systems. This study characterizes rural food environments in five districts across Bangladesh, India, and Nepal, focusing on how affordability, availability, accessibility, desirability, and convenience shape dietary choices and quality. Through extensive household and market surveys, we find rural diets characterized by low intake of healthy foods and moderate to high consumption of unhealthy options, influenced by a lack of affordability and the desirability and widespread availability of cheap ultra-processed products in rural markets. Snacking plays a significant role in shaping dietary patterns, promoting both dietary diversity and unhealthy food consumption. These findings provide essential insights for designing interventions tailored to rural food systems, supporting efforts to improve nutrition and health outcomes in rapidly changing markets. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study was funded under the Transforming Agri Food Systems in South Asia initiative by the CGIAR. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol, informed consent forms, and questionnaires were approved by the Institutional Review Boards (IRBs) of the International Food Policy Research Institute (Washington, DC, USA), the Institute of Health Economics (University of Dhaka, Bangladesh), Centre for Media Studies (Delhi, India), and the Nepal Health Research Council (Kathmandu, Nepal). The datasets analyzed during this study are publicly available and can be accessed at https://www.cgiar.org/news-events/news/open-access-agrifood-system-data-from-4000-households-across-bangladesh-india-and-nepal/ and https://dataverse.harvard.edu/dataverse/IFPRI/?q=%22TAFSSA+District+Agrifood+Systems+Assessment%22+AND+%22Market%22+AND+%22Retail%22 I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes