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Ultraprocessed food intake is associated with lower sTfR concentrations in rural Ghanaian schoolgirlsUltraprocessed foods linked to lower iron markers in schoolgirls

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Key Takeaway
Note that ultraprocessed food intake is associated with lower sTfR concentrations in this adolescent population.

This randomized controlled trial secondary analysis evaluated 300 rural Ghanaian adolescent schoolgirls over a 6-month follow-up period. The study assessed the relationship between diet quality indicators, including Global Diet Quality Score (GDQS), Minimum Dietary Diversity for Women (MDD-W), and NOVA food groups, and various iron and vitamin A biomarkers.

Results showed that higher intake of whole or minimally processed foods was positively associated with sTfR concentrations (beta: 3.0%, 95% CI: 1.0%, 6.2%). Conversely, ultraprocessed food intake was negatively associated with sTfR concentrations (beta: -3.9%, 95% CI: -5.8%, -1.0%). While higher GDQS, GDQS+, and MDD-W scores were inversely associated with ferritin concentrations, these scores were not associated with hemoglobin (Hb), sTfR, or vitamin A biomarkers in the broader analysis.

No significant associations were observed between diet quality scores and the presence of anemia or the risk of vitamin A deficiency (VAD). Safety and tolerability data were not reported. These findings suggest that while specific dietary components correlate with certain iron-related biomarkers, they do not directly correlate with clinical anemia status in this population.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in understanding the nutritional drivers of iron status in specific populations. While previous coverage noted that sickle cell trait is associated with increased risk of anemia and that traditional Tibetan feeding practices are linked to high anemia rates, this study focuses on the impact of ultraprocessed versus whole foods on sTfR concentrations. It does not directly relate to the findings on pegylated erythropoietin for CKD-related anemia or the risk of anemia in cardiac surgery patients.

For many young girls in rural areas, getting enough iron and vitamins is a constant challenge. A study of 300 schoolgirls in northern Ghana looked at how different types of food affect their health. The researchers specifically looked at iron-related markers and vitamin A levels over a six-month period.

The results showed a clear split between food types. Girls who ate more whole or minimally processed foods had higher sTfR concentrations, which are markers used to track iron status. In contrast, eating more ultraprocessed foods was linked to lower sTfR levels.

While the study found these specific links to iron markers, it did not find a significant connection between diet scores and overall anemia or vitamin A deficiency. Because these findings are based on associations rather than direct cause and effect, they provide a starting point for understanding how modern food processing impacts nutrition.

What this means for you:
Ultraprocessed foods are linked to lower iron markers, while whole foods show a positive link to iron status.

Common questions

What did the study find about ultraprocessed foods?

The study found that eating more ultraprocessed foods was negatively associated with sTfR concentrations. sTfR is a marker used to measure iron status in the body. This means that a higher intake of these processed foods was linked to lower levels of this specific iron indicator.

Are there benefits to eating whole foods for iron?

Yes, the study found that a higher intake of whole or minimally processed foods was positively associated with sTfR concentrations. This suggests that choosing less processed options is linked to better iron-related markers in the girls studied.

Did the study find a link to anemia?

The researchers did not find any significant associations between the girls' diet scores and the presence of anemia or the risk of vitamin A deficiency. While the food types affected specific iron markers, they did not show a clear link to overall anemia status.

Study Details

Study typeRct
EvidenceLevel 2
PublishedOct 2026
View Original Abstract ↓
BACKGROUND: Evidence linking food-based diet quality indicators to micronutrient biomarkers during adolescence in rural sub-Saharan Africa remains limited. OBJECTIVES: To examine associations between baseline diet quality and 6-mo changes in hemoglobin (Hb), iron-related biomarkers, and vitamin A status among rural schoolgirls in northern Ghana. METHODS: This secondary analysis used data from the Ten2Twenty-Ghana randomized controlled trial, which included 300 girls aged 10 to 17 y from 19 schools. Dietary intake was assessed using a quantitative 24-h recall. Diet quality indicators included the Global Diet Quality Score (GDQS), Minimum Dietary Diversity for Women (MDD-W), and gram-weighted intakes of NOVA (food classification system based on the nature, extent, and purpose of food processing) food groups. Multilevel linear and modified Poisson regression models examined associations between diet quality indicators and biomarkers of iron and vitamin A status, adjusting for baseline biomarkers, inflammation, height-for-age and BMI-for-age z-scores, household factors, energy intake, treatment allocation, and school clustering. RESULTS: Participants had a mean age of 12.7 ± 1.9 y; mean GDQS was 20.4 ± 3.3, and mean MDD-W was 3.8 ± 1.2, with 29.5% achieving MDD-W ≥5. At baseline, 38% had anemia, including 6.2% with iron-deficiency anemia (IDA) and 2.7% with vitamin A deficiency (VAD). Higher intake of whole or minimally processed foods was positively associated with soluble transferrin receptor (sTfR) concentrations [β: 3.0%; 95% confidence interval (CI): 1.0%, 6.2%], whereas ultraprocessed food intake was negatively associated with sTfR concentrations (β: -3.9%; 95% CI: -5.8%, -1.0%). Higher GDQS, GDQS+ (positive submetric of the GDQS), and MDD-W scores were inversely associated with ferritin concentrations but not with Hb, sTfR, or vitamin A biomarkers. No significant associations were observed with anemia or with risk of VAD. CONCLUSIONS: Conventional diet quality indicators and processing-based dietary measures were associated with iron-related biomarkers, although associations differed by biomarker. These findings suggest that dietary diversity and food processing capture complementary dimensions of diet quality in rural Ghanaian adolescent girls. This trial was registered at clinicaltrials.gov as NCT03368053.
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