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Got milk? For countries that do not, calcium-fortified food might be the way to curb rickets

It’s time to make sure everyone gets their daily dose of calcium, says dietetics professor Cristina Palacios of the Robert Stempel College of Public Health & Social Work. That could mean putting the bone-supporting dietary mineral on the growing list of nutrients already being added to food around the world.

Palacios recently published two WHO-funded research papers that survey global intake of calcium and address the potential to incorporate it into foods consumed in countries with a high prevalence of nutritional rickets. The disease is characterized by the softening and weakening of bones and considered a major health problem in many parts of the world.

While a variety of foods offer a significant source of calcium—among them leafy greens, beans and fish canned with bones—dairy packs the biggest nutritional punch.

In cultures where animal milk and products such as cheese and yogurt have not traditionally played a role in diet, such as Japan, and in those developing countries without easy access to such foods, such as Nigeria, the prevalence of nutritional rickets can be several hundred percent greater than elsewhere.

But even in the United States and United Kingdom, where dairy production and consumption are among the world’s highest, Palacios found that calcium intake would fall below recommended levels were it not for the practice of food fortification. She highlights the correlation between the mandated calcium enrichment of wheat flour—the base ingredient for homemade breads and pastries as well as commercially produced baked goods and cereals—and adequate levels of dietary calcium in the United Kingdom.

She cites that country’s National Health Service, which found that without fortification, about 21 percent of girls and 12 percent of boys would have intakes below the minimum nutritional requirements. Additionally, a significant percentage of women of child-bearing age would experience a shortfall, putting them at potential risk for gestational hypertension (preeclampsia). In the United States, wheat flour, orange juice and other foods are often fortified with calcium.

Palacios suggests that introducing calcium fortification programs in other countries could have a positive return on health. She recognizes potential barriers in poor nations, among them cost and lack of technically trained personnel. And she notes the possibility of a program’s inability to reach rural residents who rely on locally grown foods over processed ones.

Despite the perceived obstacles, however, there is good reason to expect that calcium fortification could expand worldwide: fully 155 countries, including many developing nations, are already adding nutrients such as iodine, iron, folic acid and vitamin A, which have been prioritized in recent years.

“The consequences of deficiency in these”—anemia (iron) and childhood blindness (vitamin A), for example—“have been viewed as far greater than calcium deficiency,” Palacios points out. “It takes a longer time to see acute bone issues, and they’re probably not life threatening in the general population. But now that some countries have already implemented important programs to address these issues and already have plenty of nutritional strategies to deal with that,” she continues, “we’re looking at other nutrients of importance, such as calcium.”

Palacios is an expert on vitamin D, which aids in the absorption of dietary calcium, and has previously conducted research for the WHO in support of its guidelines on the vitamin. Notably, dietary increases in vitamin D alone will not always stave off bone deformities without an increase in calcium intake, a fact that prompted the current scientific inquiry.

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