Impact of water fortification with calcium on calcium intake in different countries: a simulation study

OBJECTIVE: To simulate the impact – effectiveness and safety – of water fortification with different concentrations of Ca using the Intake Modelling, Assessment and Planning Program. DESIGN: This is a secondary analysis of national or sub-national dietary intake databases. SETTING AND PARTICIPANTS: Uganda, Lao People’s Democratic Republic (PDR), Bangladesh, Zambia, Argentina, USA and Italy. RESULTS: We found that for dietary databases assessed from low- and middle-income countries (LMIC), the strategy of fortifying water with 500 mg of Ca/l would decrease the prevalence of low Ca intake in all age groups. We also found that this strategy would be safe as no group would present a percentage of individuals exceeding the upper limit in >2 %, except women aged 19–31 years in Lao PDR, where 6·6 % of women in this group would exceed the upper limit of Ca intake. The same strategy would lead to some groups exceeding the upper limit in USA and Italy. CONCLUSIONS: We found that for most LMIC countries, water fortified with Ca could decrease the prevalence of Ca intake inadequacy without exceeding the upper levels of Ca intake.