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Daily calcium intake is well below current recommendations in most low- and middle-income countries (LMICs). Calcium intake is usually related to bone health, however an adequate calcium intake has also been shown to reduce hypertensive disorders of pregnancy, lower blood pressure and cholesterol values, and to prevent recurrent colorectal adenomas. Food fortification of foods has been identified as a cost-effective strategy to overcome micronutrient gaps in public health. This review summarizes regulatory aspects of fortification of commonly consumed foods with micronutrients, with an emphasis on calcium. We selected a convenient sample of 15 countries from different WHO regions and described the regulatory framework related to calcium fortification of staple foods. We assessed the relevant policies in electronic databases including the WHO Global database on the Implementation of Nutrition Action (GINA) for fortification policies and the Global Fortification Data Exchange Database, a fortification database developed and maintained by Food Fortification Initiative (FFI), Global Alliance for Improved Nutrition (GAIN), Iodine Global Network (IGN), and Micronutrient Forum. Food fortification with micronutrients is widely used in many of the selected countries. Most countries had national legislation for the addition of micronutrients to staple foods, especially wheat flour. These national legislations, that includes regulations and standards, can provide the framework to consider the implementation of adding calcium to the fortification strategies, including the selection of the adequate food vehicle to reach the targeted population at risk safely. The strategy to include calcium in the fortification mix in fortified staple foods seems promising in these countries. However, potential undesired changes on the organoleptic characteristics of fortified foods and products thereof, and operational feasibility at the manufacturing site should be evaluated by the stakeholders during the planning stage. Codex Alimentarius standards should be considered by regulators in order to assure adherence to international standards. While the selected countries already have established national regulations and/or standards for fortification of key staple food vehicles, and there are experiences in the implementation of fortification of some staple foods, national food intake surveys can help plan, design, and modify existing fortification programs as well as monitor food and nutrient consumption to assess risk and benefits.

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Corn flour and maize meal fortification can benefit the consumer when the added nutrient contents are in amounts appropriate to address nutrient gaps. Legislative instruments (standards and regulations) are needed to provide guidance to the producers and food control authorities. We reviewed a number of national standards and regulations of fortified corn flour and maize meal and identified constraints; contrary to current belief, the practice of using minimum contents or ranges of nutrients has caused confusion, misinterpretation, and conflict, and should therefore be abandoned. On the basis of the findings, a model of fortification legislation is proposed, in which the additional content and the expected average nutrient content in a final product are recommended as the main parameters for quality control and enforcement. For labeling, the average content, or one adjusted to the expected content of the product at the market, can be applied. Variation in micronutrient contents should still be checked to ensure homogeneity but with adherence to clear procedures of sampling and testing, which should be part of the standards and regulations.

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Los estudios observacionales han demostrado, de manera consistente, una asociación positiva entre el consumo de dietas ricas en frutas y vegetales, y un menor riesgo de enfermedad cardiovascular, cáncer, enfermedad cerebrovascular y otras enfermedades crónicas. El consumo de suplementos de vitaminas antioxidantes ha ido en aumento, bajo la premisa de que estos podrían ayudar a prevenir o curar enfermedades crónicas. Sin embargo, a pesar de la gran cantidad de investigaciones que se han realizado en este campo, no se ha logrado esclarecer realmente el papel que la suplementación con estos micronutrientes pueda estar ejerciendo en la patología de esas enfermedades. El Instituto Nacional de Salud de los Estados Unidos establece, que no existe, suficiente evidencia científica para promover o desestimular, el uso de suplementos multivitamínicos para la prevención de las enfermedades crónicas. Los datos emergentes cuestionan los beneficios reales que los suplementos antioxidantes puedan tener en los sujetos con un adecuado estado nutricional, y sugiere que su consumo podría no ser seguro en comparación con las vitaminas y minerales contenidos naturalmente, en los alimentos. Los meta-análisis realizados, con estudios randomizados no han logrado demostrar efectos benéficos de la suplementación con multivitaminas sobre la mortalidad por enfermedades crónicas, y más bien, algunos análisis han sugerido que los B-catorenos, la vitamina A y la vitamina E podrían aumentar el riesgo de muerte.

Observational studies have consistently demonstrated a positive association between high fruits and vegetables intake and a reduced risk of heart disease, cancer, cerebrovascular disease, and other chronic diseases. Under the premise that vitamin and mineral supplements can have thesame effects of those naturally found in food, many people are using them to prevent or treat chronic diseases. But in spite of intensive research, the benefitial effect of antioxidant supplements is still not clear. The US National Institute of Health states that there is not enough evidence torecommend or discourage the use of multivitamin supplements to prevent chronic diseases. Growing scientific data questions the benefitial value of supplementing with antioxidant vitamins,in well nourished population and raises the possibility that they may not be safe compared with vitamin consumption within a healthy diet. Meta-analyses of randomized trials have failed todemonstrate that supplementations with antioxidant vitamins can have benefitial effects on mortality. Even more, some analyses suggested that β-carotenes, vitamin A or vitamin E can increase the risk of death.

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