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.

中文翻译：

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公共卫生计划中的钙强化食品：实施注意事项

钙摄入量低在世界范围内很常见，可能导致儿童营养性佝偻病和成人骨软化症。钙强化食品可以提高钙的摄入量。然而，钙强化的经验有限，技术和实际问题可能会阻碍其采用。本次景观审查的目的是总结这些问题，以帮助政策制定者指导钙强化作为公共卫生战略的规划和设计。其中一项挑战是钙盐的生物利用度较低（∼20-40%）；因此，需要在食品中添加大量物质才能产生有意义的影响。在强化液体和酸性食品时，溶解度很重要。钙盐可以改变食品的风味、颜色和外观，可能占总强化成本的 70-90%。安全是避免超过推荐摄入量的关键；因此，钙的补充量应根据目标钙摄入量以及不足与充足之间的差距而定。监测包括使用膳食评估方法强化食品的质量和人群钙摄入量。钙强化应遵循法规，以跨部门的方式实施，并以健康权和公平权为依据。这些信息可能有助于指导和规划这一公共卫生策略。