Ultra-processed food consumption and diet quality among adolescents in urban Ethiopia: baseline findings from a school-based study

Abstract Adolescents are increasingly exposed to ultra-processed foods (UPFs) as food systems change in low- and middle-income countries, yet evidence from sub-Saharan Africa remains limited. This study assessed UPF consumption, associated factors, and overall diet quality among secondary-school adolescents in Adama City, Ethiopia. Baseline cross-sectional data were obtained from a quasi-experimental study conducted in October-November 2024 among 713 students in grades 9–12. Dietary intake was assessed using the Diet Quality Questionnaire and a food frequency questionnaire, with foods classified according to the NOVA system. UPF consumption was defined as intake of at least one UPF item in the previous 24 h, and diet quality was measured using Global Dietary Recommendation (GDR) scores. Overall, 41.9% (95% CI 38.3–45.6%) of adolescents reported UPF consumption in the past 24 h, and 94% reported weekly intake. Fried snacks, cakes, and sugar-sweetened beverages were most commonly consumed. The mean (± SD) GDR-total score was 11.6 (± 1.4) on a 0–18 scale, with higher scores indicating greater adherence to global dietary recommendations. UPF consumption was higher among Grade 12 students and physically active adolescents, and lower among those with greater nutrition knowledge. Adolescents from middle-income households had higher GDR-total score; however, the diet-quality model explained only a small proportion of the variation in GDR scores (R² = 0.027). These findings highlight widespread UPF exposure and socioeconomic and behavioral influences on adolescent diets in urban Ethiopia.