Adolescent-selected food intake and engagement with the external food environment contribute to unhealthy diets in Accra, Ghana
Background
As adolescents gain autonomy, they interact more independently with their food environments, increasing their vulnerability to rapidly changing and often unhealthy food environments. In Accra, Ghana, unhealthy foods and beverages are widely available and heavily marketed.
Objective
To assess the healthiness and nutrient adequacy of adolescents’ diets in Accra; and to examine whether diet healthiness is associated with independent adolescent food selection and their engagement with home, school and outlet food environments.
Methods
We conducted a cross-sectional study using quantitative 24-hour dietary recalls among 911 adolescents aged 12 to 18 years living in five low- and five middle-class neighborhoods in Accra. For each food and beverage consumed, we documented who selected it and where it was obtained and consumed. We calculated the Global Diet Quality Score (GDQS) and the prevalence of adequate intake for fruits and vegetables, protein, fiber, total sugar, total fat, saturated fat and 11 micronutrients. Mixed effects models assessed associations between independent adolescent food selection and food acquisition location (home, school, or other food outlets), and diet healthiness and macro- and micronutrient intake.
Results
A large proportion of adolescents consumed excessive amounts of total sugar (49%) and total fat (44%) and inadequate amounts of fruits and vegetables (98%), fiber (45%), and eight of the eleven micronutrients assessed (39-100%). Greater adolescent-selected food intake (62% of energy intake, on average) was associated with lower GDQS and intakes of fruit and vegetables, protein, fiber, and six micronutrients, and with higher sugar intake (P<0.05). Greater reliance on foods from the external food environment (school: 14%, other outlets: 46%) showed similar associations with poorer dietary indicators.
Conclusion
Strengthening the design, implementation and enforcement of coordinated food policy bundles is needed to shift adolescents’ preferences towards healthy foods, and reduce the availability, accessibility, and appeal of unhealthy options in their food environments.
Authors
Becquey, Elodie; Zagré, Rock Romaric; Ogum, Deda; Huybregts, Lieven; Aryeetey, Richmond; Ruel, Marie T.; Leroy, Jef L.
Citation
Becquey, Elodie; Zagré, Rock Romaric; Ogum, Deda; Huybregts, Lieven; Aryeetey, Richmond; et al. Adolescent-selected food intake and engagement with the external food environment contribute to unhealthy diets in Accra, Ghana. Current Developments in Nutrition. Article in press. First published online on July 10, 2026. https://doi.org/10.1016/j.cdnut.2026.109435
Keywords
Africa; Sub-saharan Africa; Western Africa; Adolescents; Food Intake; Food Environment; Healthy Diets; Feeding Preferences; Diet Quality; Food Policies; Urban Areas
Project
Sustainable Healthy Diets
Record type
Journal Article
