Daily calcium intake is well below current recommendations in most low- and middle-income countries (LMICs). Calcium intake is usually related to bone health, however an adequate calcium intake has also been shown to reduce hypertensive disorders of pregnancy, lower blood pressure and cholesterol values, and to prevent recurrent colorectal adenomas. Fortification of foods has been identified as a cost-effective strategy to overcome micronutrient gaps in public health. This review summarizes regulatory aspects of fortification of commonly consumed foods with micronutrients, with an emphasis on calcium. We selected a convenient sample of 15 countries from different WHO regions and described the regulatory framework related to calcium fortification of staple foods. We assessed the relevant policies in electronic databases including the WHO Global database on the Implementation of Nutrition Action (GINA) for fortification policies and the Global Fortification Data Exchange Database, a fortification database developed and maintained by Food Fortification Initiative (FFI), Global Alliance for Improved Nutrition (GAIN), Iodine Global Network (IGN), and Micronutrient Forum. Food fortification with micronutrients is widely used in many of the selected countries. Most countries had national legislation for the addition of micronutrients to staple foods, especially wheat flour. These national legislations, that includes regulations and standards, can provide the framework to consider the implementation of adding calcium to the fortification strategies, including the selection of the adequate food vehicle to reach the targeted population at risk safely. The strategy to include calcium in the fortification mix in fortified staple foods seems promising in these countries. However, potential undesired changes on the organoleptic characteristics of fortified foods and products thereof, and operational feasibility at the manufacturing site should be evaluated by the stakeholders during the planning stage. Codex Alimentarius standards should be considered by regulators in order to assure adherence to international standards. While the selected countries already have established national regulations and/or standards for fortification of key staple food vehicles, and there are experiences in the implementation of fortification of some staple foods, national food intake surveys can help plan, design, and modify existing fortification programs as well as monitor food and nutrient consumption to assess risk and benefits.

Countries around the world have been implementing public health interventions to provide vitamins and minerals. There is a concern that the cumulative micronutrient contribution of coexisting programs, when targeting the same population, may exceed their safe levels of intake, thus potentially challenging the primum non nocere principle. We assessed the regulatory framework of such interventions and determined qualitatively whether there were provisions in the regulations that called for coordination among programs to ensure their innocuousness. Country cases from various WHO regions were selected for the study: (1) the Americas: Chile, Costa Rica, and Guatemala; (2) Africa: Malawi, Uganda, and Zambia; (3) South Asia: Bangladesh; and (4) the Western Pacific Region: China and the Philippines. We did not identify any provisions in the existing regulations requiring coordination mechanisms among interventions. However, in some countries, governments have established national micronutrient fortification commissions or alliances aimed to foster interprogram coordination. Their focus, however, has been mostly on the efficacy of the programs and less on their safety. A regulatory framework for coexisting micronutrient interventions should be comprehensive, accounting for all micronutrient sources and including regulatory provisions for coordination among programs.

ObjectiveTo evaluate the adequacy of intake of micronutrients and fiber in women from the ENSANUT‐2006.MethodsDietary intake and compliance with dietary recommendations were estimates for a sample of Mexican women aged >;19 years from ENSANUT‐2006. Food intake came from a food frequency questionnaire. Dietary adequacy was classified into adequate (adequacy >;100%), moderately inadequate (50–99%), and highly inadequate (<50%).AnalysisMeans of adequacy were estimated through linear and polynomial multiple regression.ResultsThe adequacy for vitamin A varied by age from 69–79%, the following intakes decreased progressively with age: Vitamin C 69–50%, folate 26–12.4%, vitamin B12 56.4–34.4%. For minerals iron decreased from 21.2–12‐13% and increased to 45% in >;50 years of age. Calcium increased with age from 24.9–32.9% and declined to 15.0%. Magnesium intake decreased from 56.6–36.9% and phosphate increased from 57.8–88.2%. The adequacy for fiber increased with age from 12–36%.DiscussionWe documented evidence about the low dietary intake of vitamins and minerals prevailing in Mexican women, although the coincidence with the prevalence of micronutrients deficiencies only occurred with vitamins A and C, calcium, magnesium.

Mexican children consuming breakfast and ready‐to‐eat cereals had a higher intake and adequacy of micronutrients than breakfast skippers: ENSANUT 2012Salvador Villalpando1, Vanessa De la Cruz Gongora1, Alejandra Contreras Manzano1, Filiberto Beltran‐Velazquez2, Deisy Hervert‐Hernandez21Centro de Investigacion en Nutricion y Salud, Instituto Nacional de Salud Publica, Cuernavaca, México; 2Kellogg Company Mexico, Queretaro, Mexico Studies in children suggest that ready to cereal (RTEC) breakfast eaters are more likely to meet daily nutrient intake guidelines and less likely to be obese. Objective: To examine the nutrient intakes of Mexican children consuming RTEC breakfast, other type of breakfast or breakfast skippers . Methods: Dietary data from children aged 1‐11 years (n=4863) participating in the Mexican National Health and Nutrition Examination Survey (ENSANUT) 2012 were analyzed. Results: Overall, 90% and 86% of children aged 1‐4 and 5‐11 years of age, respectively, ate breakfast. For 1‐4 year old children, energy intakes did not differ among breakfast consumers and breakfast skippers. Children 5‐11 y breakfast consumers, had a higher intake of energy than breakfast skippers (p<0.05). Children who ate breakfast had a higher intake of vitamins A, B2, D, calcium and zinc (p<0.05) than breakfast skippers. Particularly, children who had a breakfast with RTEC had a higher intake of vitamins A, E, B1, B2, B3, B6, folate, iron, calcium and zinc (p<0.05) than children skipping breakfast or consuming other types of breakfast. Conclusion: Children eating breakfast and especially RTEC breakfast had a higher dietary micronutrients intake than breakfast skippers. Grant Funding Source: Supported by a non‐commited grant of Kellogg Company