Food-based dietary guidelines for optimizing calcium intakes for reproductive-aged women in Ethiopia using local foods

Increasing dietary calcium intakes of Ethiopian women of reproductive age (WRA) is a public health priority for reducing pre-eclampsia in pregnancy. Using linear programming, we determined whether locally available foods consumed by WRA in nine regions (urban and rural) and two administrative cities of Ethiopia could provide 1000 mg/day of dietary calcium, and we identified food-based recommendations (FBRs) to improve dietary calcium adequacy in each region. Results showed that diets providing 1000 mg/day of calcium were feasible in eight regions (40%) of the target populations examined. It would, however, require marked changes for most populations (90%), increasing the number of servings per week of several food groups to levels close to those of high consumers in each population. The selected calcium-specific FBRs integrate well into the 2022 Ethiopian Dietary Guidelines, requiring additional messages to consume green leafy vegetables, milk, root crops, or teff (Eragrostis tef) or to consume a higher number of servings of vegetables than currently recommended, depending on the population. In conclusion, these analyses show that a food-based approach can be used to achieve dietary calcium adequacy among WRA in 40% of the populations examined. For the other populations, food-based interventions alone may be inadequate and other interventions are likely needed.