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Calcium intake remains inadequate in many low‐ and middle‐income countries, especially in Africa and South Asia, where average intakes can be below 400 mg/day. Given the vital role of calcium in bone health, metabolism, and cell signaling, countries with low calcium intake may want to consider food‐based approaches to improve calcium consumption and bioavailability within their population. This is especially true for those with low calcium intake who would benefit the most, including pregnant women (by reducing the risk of preeclampsia) and children (by reducing calcium‐deficiency rickets). Specifically, some animal‐source foods that are naturally high in bioavailable calcium and plant foods that can contribute to calcium intake could be promoted either through policies or educational materials. Some food processing techniques can improve the calcium content in food or increase calcium bioavailability. Staple‐food fortification with calcium can also be a cost‐effective method to increase intake with minimal behavior change required. Lastly, biofortification is currently being investigated to improve calcium content, either through genetic screening and breeding of high‐calcium varieties or through the application of calcium‐rich fertilizers. These mechanisms can be used alone or in combination based on the local context to improve calcium intake within a population. [ABSTRACT FROM AUTHOR]

Biofortification is the process of increasing the density of vitamins and minerals in a crop through plant breeding-using either conventional methods or genetic engineering-or through agronomic practices. Over the past 15 years, conventional breeding efforts have resulted in the development of varieties of several staple food crops with significant levels of the three micronutrients most limiting in diets: zinc, iron, and vitamin A. More than 15 million people in developing countries now grow and consume biofortified crops. Evidence from nutrition research shows that biofortified varieties provide considerable amounts of bioavailable micronutrients, and consumption of these varieties can improve micronutrient deficiency status among target populations. Farmer adoption and consumer acceptance research shows that farmers and consumers like the various production and consumption characteristics of biofortified varieties, as much as (if not more than) popular conventional varieties, even in the absence of nutritional information. Further development and delivery of these micronutrient-rich varieties can potentially reduce hidden hunger, especially in rural populations whose diets rely on staple food crops. Future work includes strengthening the supply of and the demand for biofortified staple food crops and facilitating targeted investment to those crop-country combinations that have the highest potential nutritional impact. [ABSTRACT FROM AUTHOR]

The economic feasibility of maize flour and maize meal fortification in Kenya, Uganda, and Zambia is assessed using information about the maize milling industry, households' purchases and consumption levels of maize flour, and the incremental cost and estimated price impacts of fortification. Premix costs comprise the overwhelming share of incremental fortification costs and vary by 50% in Kenya and by more than 100% across the three countries. The estimated incremental cost of maize flour fortification per metric ton varies from $3.19 in Zambia to $4.41 in Uganda. Assuming all incremental costs are passed onto the consumer, fortification in Zambia would result in at most a 0.9% increase in the price of maize flour, and would increase annual outlays of the average maize flour-consuming household by 0.2%. The increases for Kenyans and Ugandans would be even less. Although the coverage of maize flour fortification is not likely to be as high as some advocates have predicted, fortification is economically feasible, and would reduce deficiencies of multiple micronutrients, which are significant public health problems in each of these countries. [ABSTRACT FROM AUTHOR]