Nutrient gaps and dietary Adequacy among Adolescent Girls in Rural North-Eastern Ghana: The Role of Local Food-Based Approaches, School-Lunch and Multiple-Micronutrient Fortified Biscuits

A local food-based approach, including school-lunch (SL) with multiple-micronutrient fortified biscuits (MMB) as supplementary snacks, may enhance dietary adequacy, although current data is sparse on this strategy. This study evaluated nutrient inadequacies in adolescent girls and evaluated food-based dietary recommendations (FBRs), incorporating SL from the Ghana School Feeding Programme (GSFP) and MBB. Data from 292 girls aged 10-17 were analysed as part of the Ten2Twenty-Ghana study using a quantitative 24-hour dietary recall. Model parameters included non-condiment foods consumed by at least 5% of the girls, median serving sizes, intake frequency, energy and nutrient content, and cost per 100g. Constraints were based on estimated energy intake and population reference nutrient intakes defined by harmonized average requirements (H-AR). Usual energy and nutrient intakes and the prevalence of nutrient inadequacies were estimated using the National Cancer Institute method. Optifood Linear Programming tool was used for FBRs. The mean usual energy intake was 2351±66 kcal/day. Calcium (99.8%), vitamin B12 (99.8%), riboflavin (96.2%), vitamin A (91.5%), vitamin C (87.6%), iron (73.7%), folate (49.3%), and zinc (8.5%) inadequacies were prevalent. Optimised-diets achieved adequacy for protein and most micronutrients, except calcium and vitamin B12, besides vitamin A for 15-17-years girls. SL from the GSFP did not enhance micronutrient levels when added to daily diet. Adding MMB to daily diet ensured adequacy for vitamin C, riboflavin, and iron, although marginal for iron. Calcium and vitamin A improved substantially with MMB for girls aged 15-17 but remained below the H-AR. Integrating regular SL with specialized fortified-foods may be a cost-effective strategy to enhance dietary adequacy for adolescent girls in rural areas.