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

Abstract

Adequate calcium intake is essential for health, especially for infants, children, adolescents, and women, yet is difficult to achieve with local foods in many low‐ and middle‐income countries. Previous analysis found it was not always possible to identify food‐based recommendations (FBRs) that reached the calcium population recommended intake (PRI) for these groups in Bangladesh, Guatemala, and Uganda. We have modeled the potential contribution of calcium‐fortified drinking water or wheat flour to FBR sets, to fill the remaining intake gaps. Optimized diets containing fortified products, with calcium‐rich local foods, achieved the calcium PRI for all target groups. Combining fortified water or flour with FBRs met dietary intake targets for adolescent girls in all geographies and allowed a reduction from 3–4 to the more feasible 1–2 FBRs. Water with a calcium concentration of 100 mg/L with FBRs was sufficient to meet calcium targets in Uganda, but higher concentrations (400–500 mg/L) were mostly required in Guatemala and Bangladesh. Combining calcium‐fortified wheat flour at 400 mg/100 g of flour and the FBR for small fish resulted in diets meeting the calcium PRI in Bangladesh. Calcium‐fortified water or flour could improve calcium intake for vulnerable populations, especially when combined with FBRs based on locally available foods.

A simulation study to improve calcium intake through wheat flour fortification

“…[14] HDP represents the main obstetric cause of maternal mortality in Argentina and calcium is one of the most deficient micronutrients in the population, with little changes since 2005. [14,15] The World Health Organization recommends exploring calcium fortification of staple foods in populations with low calcium intake as it is an important public health intervention for the prevention of pre-eclampsia, as well as having additional benefits for the general population. [16]Food fortification is an effective strategy to improve micronutrient intake.…”

“…[9,17] Different analyses have modelled the impact of water and flour calcium fortification in LMICs and high-income countries (HICs). [15,[18][19][20] A recent analysis from the second Nutrition and Health National Survey in Argentina (abbreviated as ENNyS2 in Spanish), found that the prevalence of low calcium intake was as high as 88% in girls and women. [21] The objective of this study was to simulate the impact -effectiveness and safety -of fortifying wheat flour with 200, 400 and 500 mg of calcium per 100 g of flour using the ENNyS2 performed in Argentina between 2018 and 2019.…”