Department of Dietetics and Nutrition, Stempel School of Public Health, Florida International University, Miami, Florida.
Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina.
Ann N Y Acad Sci. 2021 Feb;1485(1):3-21. doi: 10.1111/nyas.14495. Epub 2020 Sep 28.
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.
钙摄入量低在全球范围内很常见，可导致儿童营养性佝偻病和成人骨软化症。强化钙的食物可改善钙的摄入。然而，钙强化经验有限，存在技术和实际问题，可能会阻碍其采用。本景观综述的目的是总结这些问题，以帮助决策者指导钙强化作为公共卫生策略的规划和设计。一个挑战是钙盐（约 20-40%）的生物利用度低；因此，需要向食物中添加大量钙才能产生有意义的影响。在强化液体和酸性食物时，溶解度很重要。钙盐可能会改变食物的味道、颜色和外观，其成本可能占总强化成本的 70-90%。安全性是避免超过推荐摄入量的关键；因此，添加钙的量应基于目标钙摄入量和不足与充足水平之间的差距。监测包括强化食品的质量和人群的钙摄入量，使用膳食评估方法。钙强化应遵循法规，以跨部门的方式实施，并以健康权和公平为指导。这些信息可能有助于指导和规划这一公共卫生策略。
