Compliance with the Ethiopian Food–Based Dietary Guidelines for Fruit and Vegetables Consumption and Associated Factors among Adults in Bahir Dar City, Northwest Ethiopia: A community–based cross–sectional study

Eating a diet rich in fruits and vegetables is one of the most reliable ways to protect the human body from chronic illness. These foods provide essential vitamins, minerals, and fiber that help maintain health throughout adulthood and lower the risk of heart disease, diabetes, and certain cancers. Health organizations around the world recommend that adults consume at least 400 grams of these foods every day, which is roughly five servings. Despite this clear guidance, many people in low- and middle-income countries struggle to reach this target. The gap between what people should eat and what they actually eat creates a significant public health challenge, contributing to malnutrition and a rising burden of preventable diseases.

In Ethiopia, the government introduced new national dietary guidelines in 2022 to help citizens navigate these choices. These guidelines suggest that adults eat between four and six servings of fruits and vegetables daily. However, until recently, there was little evidence to show whether ordinary adults in Ethiopian cities were actually following these recommendations. To fill this gap, researchers from Bahir Dar University conducted a study in Bahir Dar, a city in the northwest of the country. They set out to measure how many adults were meeting the national guidelines and to understand what factors helped or hindered them.

The research team visited the homes of 413 adults aged 19 to 64 in Bahir Dar during a two-week period in early 2026. They used a detailed questionnaire to ask participants about what they had eaten in the previous day, paying close attention to the types and amounts of fruits and vegetables consumed. The researchers also gathered information about the participants' lives, including their income, education, physical activity, and whether they had access to fresh produce in their neighborhoods. To ensure accuracy, the interviewers used pictures of real food items and common household utensils, such as ladles and plates, to help participants estimate portion sizes correctly.

The results revealed a stark reality: compliance with the dietary guidelines was extremely low. Only 4.5 percent of the adults surveyed ate enough fruits and vegetables to meet the national recommendation. This means that more than 95 percent of the people in the study were falling short of the minimum daily intake needed for good health. The researchers found that this shortfall was not random; it was closely tied to two specific factors. First, people who had a high availability of fruits and vegetables in their local area were significantly more likely to eat them. Second, wealth played a major role. Adults from households with higher economic status were much more likely to meet the guidelines compared to those from poorer households.

Interestingly, the study found that while many people could walk to a market to buy produce, the cost remained a barrier for almost everyone. Nearly 99 percent of the participants considered fruits and vegetables to be unaffordable, even though they were physically accessible. This suggests that the problem is not just about having the food nearby, but about having the money to buy it. The researchers also noted that the low consumption rates were not due to a lack of knowledge or a strict measurement method, as the national guidelines set a realistic target that is easier to reach than some international standards. Instead, the data points to a genuine difficulty in obtaining and paying for these foods.

The study highlights that simply having dietary guidelines is not enough to change eating habits. For adults in Bahir Dar to improve their diets, the focus must shift to making fruits and vegetables more available and affordable, particularly for low-income families. The researchers suggest that strengthening local farming and improving market systems could help lower prices and increase supply. Without addressing these economic and logistical barriers, the goal of a healthier population through better nutrition will remain out of reach for the vast majority of adults in the city.