Calcium‐fortified foods in public health programs: considerations for implementation

Abstract

Low calcium intake is common worldwide and can result in nutritional rickets in children and osteomalacia in adults. Calcium-fortified foods could improve calcium intake. However, there is limited calcium fortification experience, with technical and practical issues that may hamper its adoption. The objective of this landscape review is to summarize these issues to help policymakers guide the planning and design of calcium fortification as a public health strategy. One challenge is the low bioavailability of calcium salts (∼20-40%); thus, large amounts need to be added to food to have a meaningful impact. Solubility is important when fortifying liquids and acidic foods. Calcium salts could change the flavor, color, and appearance of the food and may account for 70-90% of the total fortification cost. Safety is key to avoid exceeding the recommended intake; so the amount of added calcium should be based on the target calcium intake and the gap between inadequate and adequate levels. Monitoring includes the quality of the fortified food and population calcium intake using dietary assessment methods. Calcium fortification should follow regulations, implemented in an intersectorial way, and be informed by the right to health and equity. This information may help guide and plan this public health strategy.

Nutritional Content and Health Profile of Non-Dairy Plant-Based Yogurt Alternatives

“…Most calcium salts used to fortify foods and beverages exhibit a bioavailability similar to that of milk calcium [25], which has a fractional absorption of about 30%. The absorbability of calcium varies depending upon the food matrix, including the pH and the presence of stabilizers [25,26]. Calcium carbonate absorption is very similar to milk calcium, while calcium lactate and calcium citrate tends to be a little better absorbed; TCP is absorbed less well than milk calcium [25].…”

Vitamin D fortification: A perspective to improve immunity for COVID-19 infection

“…It is helpful in maintaining the metabolism and keeping the bone healthy, on contrary lower intake of calcium can lead to rickets in children and fortificants [18]. Some of the foods fortified with calcium include fruit and juice beverages, cereals, and snack bars [19].…”

Impact of flour fortification with calcium on calcium intake: a simulation study in seven countries

“…Food fortification strategies for calcium may be an effective and cost-effective alternative strategy. [15][16][17] Preliminary steps to assess food fortification as a strategy include to determine the appropriate food (vehicle) and calcium salt (fortificant) as well as the fortification level necessary to improve calcium intake without putting any population group at risk of excessive intake. 18 In order to define the fortification level, representative data on food and nutrient intake for the aimed population are required so as to identify the level of nutrient inadequacy in the population and the appropriate food vehicle that is sufficiently consumed to cover this gap.…”