BACKGROUND: Micronutrients deficiencies, anemia, coupled with unhealthy eating are major problems among women in Ghana. To enable individuals in Ghana to choose and eat healthy diets to enhance health and wellbeing, a National Food-Based Dietary Guideline (FBDG) was developed as a tool to support adoption of healthier diets and lifestyles. Although the FBDG has been developed, and presumably adhered to, data on adherence to the guidelines and possible relationships with disease outcomes among vulnerable subpopulations is unknown. We aimed to assess the adherence to the daily recommendations of the FBDG, and to explore the relationships between adherence and anemia status among women. METHODS: In this nationally representative cross-sectional study (n = 3, 744), sociodemographic information (Age, religion, marital status, place of residence, household wealth index, household head sex and age), anemia status (Hemoglobin (Hb) <
12 g/dl for non-pregnant women and Hb <
11 g/dl for pregnant women), and food intake data of women (15-49yrs) were extracted from the 2022 Ghana Demographic and Health Survey. The food intake information was obtained from the qualitative 24 h recall food intake data in the survey. The analyses were done using logistic regression with survey weights applied, and the findings presented in OR (95% CI). RESULTS: Nearly all the women adhered to the daily recommendations for grains, vegetables, and animal source foods intake. More than half (54%) of the population adhered to the diet quality and legumes' intake recommendations. About three out of four (72%) women did not meet the fruits' intake recommendation. Household wealth index but not adherence to the FBDG predicted women's anemia status. CONCLUSION: The study findings suggest that factors associated with anemia in the research setting are not limited to diet intake only. As such, well-coordinated governmental, non-governmental, and multinational organizations' actions are needed to handle anemia and micronutrient deficiencies in Ghana. CLINICAL TRIAL NUMBER: Not applicable.