Could local foods achieve recommended calcium intakes for nutritionally vulnerable populations in Uganda, Guatemala, and Bangladesh?

Abstract

Globally, dietary intake of calcium is often insufficient, and it is unclear if adequacy could be achieved by promoting calcium‐rich local foods. This study used linear programming and household consumption data from Uganda, Bangladesh, and Guatemala to assess whether local foods could meet calcium population reference intakes (Ca PRIs). The most promising food‐based approaches to promote dietary calcium adequacy were identified for 12‐ to 23‐month‐old breastfed children, 4‐ to 6‐year‐old children, 10‐ to 14‐year‐old girls, and nonpregnant and nonbreastfeeding (NPNB) women of reproductive age living in two regions of each country. Calcium‐optimized diets achieved 75–253% of the Ca PRI, depending on the population, and were <100% for 4‐ to 6‐year‐olds in one region of each country and 10‐ to 14‐year‐old girls in Sylhet, Bangladesh. The best food sources of calcium were green leafy vegetables and milk, across geographic locations, and species of small fish, nixtamalized (lime‐treated) maize products, sesame seeds, and bean varieties, where consumed. Food‐based recommendations (FBRs) achieving the minimum calcium threshold were identified for 12‐ to 23‐month‐olds and NPNB women across geographic locations, and for 4‐ to 6‐year‐olds and 10‐to 14‐year‐old girls in Uganda. However, for 4‐ to 6‐year‐olds and 10‐ to 14‐year‐old girls in Bangladesh and Guatemala, calcium‐adequate FBRs could not be identified, indicating a need for alternative calcium sources or increased access to and consumption of local calcium‐rich foods.

Including calcium‐fortified water or flour in modeled diets based on local foods could improve calcium intake for women, adolescent girls, and young children in Bangladesh, Uganda, and Guatemala

“…[33][34][35] The complete model parameters can be viewed in the supplementary tables from the previous paper. 6 We matched food list items with energy and nutrient composition data from the 2012 Harvest Plus Food Composition Table (FCT) for Central and Eastern Uganda and published data on specific foods 36,37 (Uganda), the Nutrition Institute of Latin America and the Caribbean's (INCAP) FCT 38 (Guatemala), and the Indian National FCT and the USDA FCT 39,40 (Bangladesh).…”

“…As a next step in the development of calcium-promoting FBRs, 6 we analyzed calcium-fortified flour and water using LPA in Optifood to explore their potential contribution to complement these food-based approaches and further improve calcium intake. Abbreviation: NPNB, nonpregnant, nonbreastfeeding adult woman.…”

“…• 100 mg/L to simulate a calcium concentration level for drinking water potentially compliant with drinking water hardness regulations • 400 and 500 mg/L to simulate higher calcium concentrations that could be added to water distributed in containers, such as bottled water or water provided by tanker trucks, and are in line with estimates of the calcium intake gap between population intakes and calcium requirements in LMICs 11,21 Ability to meet calcium targets in the context of optimized diets, without any FBRs We first ran Modules 2 and 3 (identify recommendations and test recommendations, as explained elsewhere 6,28,35 ) in Optifood using food lists that contained calcium-fortified water and flour without any FBRs, meaning without forcing the consumption of any foods, fortified or unfortified. 6 This was to determine the extent to which Ca PRIs could be achieved in optimized diets based on local foods, and within realistic dietary patterns, if fortified water or fortified flour could be selected during diet optimization. We conducted separate analyses for each fortified product, fortification level/calcium concentration, and daily portion size.…”

“…Fortified flour and water in the context of FBRs Next, we tested the fortified products within the context of FBRs, focusing only on the adolescent girl (10-to 14-year-old) target group due to particular vulnerability in terms of required calcium density and ability to meet the daily recommended calcium intakes using local foods. 6 We first assessed whether a diet with the lowest possible amount of calcium could meet adequacy targets using recommendations of consuming fortified water or flour, in different quantities/concentrations, in combination with the FBRs developed previously. 6,48 In this calcium-minimized diet, each combination of calcium fortification level and daily portion size option of fortified water or flour was modeled as a stand-alone recommendation as well as with every possible combination of the target group-specific FBRs from the previous study.…”

“…The analysis assessed whether calcium population reference intakes (Ca PRIs) could be met using optimized diets based on locally available foods, identified local calcium food sources, and simulated food-based recommendations (FBRs) to improve dietary calcium adequacy. 6 The best context-specific FBR sets could meet the calcium intake targets of 65% PRI in a calcium-minimized diet for NPNB women and 12-to 23-monthold breastfeeding children but not for the 4-to 6-year-old and 10to 14-year-old girl groups. These findings indicate that either greater access, in terms of availability, prices, accessibility, and affordability, 7 to local calcium-rich foods or alternative food sources of calcium are needed to ensure that diets meet the PRI targets for all age groups.…”