Effect of ultrasonic treatment during fermentation on the quality of fortified sweet wine.

The present study aimed to investigate the potential of ultrasonic treatment during fermentation for enhancing the quality of fortified wines with varying time and power settings. Chemical analysis and sensory evaluation were conducted to assess the impact of ultrasonic treatment on wine quality. Results showed that ultrasonic treatment could increase total anthocyanin and total phenol content, reduce anthocyanin degradation rate, and improve color stability. Moreover, ethyl carbamate content was lower in the ultrasonic group after aging compared to non-ultrasonic group. A combination of 200 W for 20 min resulted in higher sensory scores and more coordinated taste, while a combination of 400 W for 40 min produced higher levels of volatile compounds (21860.12 µg/L) leading to a richer and more elegant aroma. Therefore, ultrasound can be used as a potential technology to improve the quality of wine.

Vitamin D3 Bioaccessibility from Supplements and Foods-Gastric pH Effect Using a Static In Vitro Gastrointestinal Model.

Vitamin D3 deficiency is a global phenomenon, which can be managed with supplementation and food fortification. However, vitamin D3 bioaccessibility may depend on factors such as matrix composition and interactions throughout the gastrointestinal (GI) tract. This research focused on the effect of different matrices on vitamin D3 content during digestion, as well as the effect of pH on its bioaccessibility. The INFOGEST protocol was employed to simulate digestion. Three different types of commercial supplements, two foods naturally rich in vitamin D3, and three fortified foods were investigated. High-Performance Liquid Chromatography was used to determine the initial vitamin D3 content in the supplements and foods, as well as after each digestion stage. The results indicate that the foods exhibited higher bioaccessibility indices compared to the supplements and a higher percentage retention at the end of the gastric phase. The pH study revealed a positive correlation between an increased gastric pH and the corresponding content of vitamin D3. Interestingly, exposing the matrix to a low pH during the gastric phase resulted in an increased intestinal content of D3. Vitamin D3 is more bioaccessible from foods than supplements, and its bioaccessibility is susceptible to changes in gastric pH. Fasting conditions (i.e., gastric pH = 1) enhance the vitamin's bioaccessibility.

Ten2Twenty-Ghana: a randomised controlled trial on the efficacy of multiple micronutrient-fortified biscuits on the micronutrient status of adolescent girls.

Adolescent girls are an important target group for micronutrient interventions particularly in Sub-Saharan Africa where adolescent pregnancy and micronutrient deficiencies are common. When consumed in sufficient amounts and at levels appropriate for the population, fortified foods may be a useful strategy for this group, but little is known about their effectiveness and timing (regarding menarche), particularly in resource-poor environments. We evaluated the effect of consuming multiple micronutrient-fortified biscuits (MMB), sold in the Ghanaian market, 5 d/week for 26 weeks compared with unfortified biscuits (UB) on the micronutrient status of female adolescents. We also explored to what extent the intervention effect varied before or after menarche. Ten2Twenty-Ghana was a 26-week double-blind, randomised controlled trial among adolescent girls aged 10-17 years (n 621) in the Mion District, Ghana. Biomarkers of micronutrient status included concentrations of Hb, plasma ferritin (PF), soluble transferrin receptor (TfR) and retinol-binding protein (RBP), including body-iron stores. Intention-to-treat analysis was supplemented by protocol-specific analysis. We found no effect of the intervention on PF, TfR and RBP. MMB consumption did not affect anaemia and micronutrient deficiencies at the population level. MMB consumption increased the prevalence of vitamin A deficiency by 6·2 % (95 % CI (0·7, 11·6)) among pre-menarche girls when adjusted for baseline micronutrient status, age and height-for-age Z-score, but it decreased the prevalence of deficient/low vitamin A status by -9·6 % (95 % CI (-18·9, -0·3)) among post-menarche girls. Consuming MMB available in the market did not increase iron status in our study, but reduced the prevalence of deficient/low vitamin A status in post-menarcheal girls.

Micronutrient intakes in the Dutch diet: foods, fortified foods and supplements in a cross sectional study.

PURPOSE: This study investigates intakes of risk micronutrients from non-fortified foods, fortified foods and food supplements in different age and gender sub-groups of the Dutch population. METHODS: This is a secondary analysis of the Dutch National Food Consumption Survey (DNFCS 2012-2016, N = 4313, 1-79 years). The proportion of the population with Habitual Intakes below the Estimated Average Requirement (EAR) and above the Upper Level (UL) for calcium, iron, zinc, vitamin A, vitamin B6, folate, vitamin D and vitamin E from non-fortified foods, fortified foods and total intake including food supplements was calculated using Statistical Program to Assess Dietary Exposure (SPADE). RESULTS: More than 50% of the population had an intake below the EAR for calcium, iron, vitamin D and folate. Intakes were inadequate for certain sub-groups for the other vitamins and minerals. Adolescents and women were the population sub-groups most likely to have an intake below the EAR. For zinc, vitamin A and folic acid, more than 1% of toddlers exceeded the UL from the total intake. A negligible proportion exceeded the UL for the other vitamins and minerals. CONCLUSION: Inadequate intakes were found for several micronutrients in various population sub-groups despite an apparently well-nourished population. Intakes of zinc, folic acid and vitamin A from food supplements in toddlers and preschoolers should be investigated further to ensure they do not exceed recommended amounts. These results can be used to inform policy makers and to design nutritional interventions to improve micronutrient intakes in the Netherlands.

Effect of intake of iron-fortified milk on levels of ferritin and hemoglobin in preschoolers: A systematic review and meta-analysis.

BACKGROUND: Food fortification is often the simplest way to increase iron intake on a broad and sustainable basis. It is one of the most cost-effective global development efforts. OBJECTIVE: To systematize data from randomized and nonrandomized controlled trials investigating the effect of consumption of iron-fortified milk (IFM) on serum iron status in preschoolers. METHODS: The trials were systematically searched in five electronic databases that evaluated the effect of iron-fortified milk (IFM) consumption on hemoglobin and ferritin in children aged 1-6 years. The randomized the meta-analysis model was used to calculate total and stratified effects. RESULTS: Seven trials representing 1210 preschoolers showed a significant effect of IFM on hemoglobin [difference in means (MD) 0.33 g/dL (95% CI 0.23, 0.44; I2 = 3.85%, p (Q statistic) < 0.01)] and ferritin concentrations [effect size (SMD) 0.57 (95% CI 0.19, 0.95; I2 = 84.63%, p (Q statistic) < 0.01)]. In stratified analyses, hemoglobin showed an increase when subjects received iron with other co-interventions [MD 0.35 g/dL (95% CI 0.22, 0.48; I2 = 11.01%; p (Q statistic) = 0.36)]; and when the iron dose was above 5 mg/day [MD 0.34 g/dL (95% CI 0.23, 0.45; I2 = 2.33%; p (Q statistic) = 0.37)] and the intervention time was over 6 months [MD 0.39 g/dL (95% CI 0.18, 0.60; I2 = 37.90%; p (Q statistic) = 0.20)]. For ferritin, stratified analyses showed a larger effect size when they used dose higher than 5 mg/day [SMD 0.60 (95% CI 0.02, 1.18; I2 = 91.06, p (Q statistic) < 0.01)] and intervention was conducted longer than 6 months [SMD 0.96 (95% CI - 0.16, 1.76; I2 = 93.38%, p (Q statistic) < 0.01)]. CONCLUSIONS: Our findings indicate that although milk iron fortification modestly increases serum hemoglobin levels or the effect size of serum ferritin of participants, it cannot be considered in the coadjuvant treatment for anemia. Register: CRD42020213604.

The Potential of Condiments, Seasonings, and Bouillon Cubes to Deliver Essential Micronutrients in Asia: Scenario Analyses of Iodine and Iron Fortification.

Micronutrient deficiencies are still highly prevalent in Asia. Fortification of cooking aids, such as condiments (fish and soy sauces), seasonings, and bouillon cubes, may be an additional strategy to improve micronutrient intake. The current study evaluated the potential impact of iodine and iron fortification of cooking aids on micronutrient intake in Asian countries. A systematic literature search was performed to collect consumption data from different countries in Asia. Data from 18 studies in nine Asian countries were included. Scenario analyses were performed using different fortification levels based on regulations and literature. Mean intake of cooking aids ranged from 3.2-15.9 g/day for condiments and 0.4-11.7 g/day for seasonings and bouillon cubes. When replacing salt with iodized salt (30 µg of iodine/g of salt), iodine intake would increase by 13-119 µg/day for soy and fish sauces (9-80% of the Nutrient Reference Value (NRV)), and 5-83 µg/day for bouillon cubes and seasonings (4-56% of the NRV). Fortification with iron 0.5 mg/g food product for condiments or 1 mg/g food product for bouillon cubes and seasonings improved iron intake for soy and fish sauces by 1.6-8.0 mg/day (11-57% of the NRV), and for bouillon cubes and seasonings by 0.4-5.6 mg/day (3-40% of the NRV). These results indicate that, depending on the consumption pattern, fortification of cooking aids can be a suitable strategy to increase intake of micronutrients.

Development of Innovative Vitamin D Enrichment Designs for Two Typical Italian Fresh Cheeses: Burrata and Giuncata.

The aim of this research was to develop innovative cheeses fortified with vitamin D3 (VD3). Formulation studies and analyses of textural properties and chemicals were carried out for these developments. Two traditional Italian varieties of cheese (giuncata and burrata) were studied. For giuncata, the fortification of milk for cheese production provided a VD3 retention level of 43.9 ± 0.6% in the food matrix. For burrata, the VD3 ingredient was incorporated into the creamy inner part after mixing, maintaining the textural quality of the product (adhesiveness 4.3 ± 0.4 J × 10-3; firmness 0.7 ± 0.0 N; and cohesiveness 0.8 ± 0.2). The optimized enrichment designs allowed to obtain homogenous contents of VD3 during the production of giuncata (0.48 ± 0.01 µg/g) and burrata cheeses (0.32 ± 0.02 µg/g). Moreover, analyses revealed the high stability of VD3 during the storage of the two fortified cheese types (2 weeks, 4 °C). These fortification designs could be implemented at an industrial scale to obtain new cheese types enriched in VD3 and thus contribute to the reduction in VD deficiency prevalence.

Reactivity of Fe(III)-containing pyrophosphate salts with phenolics: complexation, oxidation, and surface interaction.

Mixed pyrophosphate salts with the general formula Ca2(1-x)Fe4x(P2O7)(1+2x) potentially possess less iron-phenolic reactivity compared to ferric pyrophosphate (FePP), due to decreased soluble Fe in the food-relevant pH range 3-7. We investigated reactivity (i.e., complexation, oxidation, and surface interaction) of FePP and mixed salts (with x = 0.14, 0.15, 0.18, and 0.35) in presence of structurally diverse phenolics. At pH 5-7, increased soluble iron from all salts was observed in presence of water-soluble phenolics. XPS confirmed that water-soluble phenolics solubilize iron after coordination at the salt surface, resulting in increased discoloration. However, color changes for mixed salts with x ≤ 0.18 remained acceptable for slightly water-soluble and insoluble phenolics. Furthermore, phenolic oxidation in presence of mixed salts was significantly reduced compared to FePP at pH 6. In conclusion, these mixed Ca-Fe(III) pyrophosphate salts with x ≤ 0.18 can potentially be used in designing iron-fortified foods containing slightly water-soluble and/or insoluble phenolics.

Industry Self-Regulation of Food Fortification Compliance: Piloting the Micronutrient Fortification Index in Nigeria.

Sustaining large-scale and good-quality food fortification requires strategies that incentivize food processors to invest in and consistently meet national food fortification standards where they exist. A standardized Micronutrient Fortification Index (MFI) piloted in Nigeria has provided a ranking of fortified branded products for each participating company, based on a score aggregating the effectiveness and efficiency of the company's systems and levels of product fortification. The MFI has demonstrated the significance of brands as a focal point for investment and industry accountability in food fortification and the power of harnessing the competitive nature of businesses to drive their food fortification performance. The initiative started with a pilot consisting of well-known brands of 4 companies and has since expanded participation to 15 companies, representing 31 brands, having completed the first entire ranking cycle. The publicly listed brands on the Index now cover approximately 80% of the flour milling market, 40% of the edible oils market, and 88% of the sugar market in Nigeria, reaching an estimated 134 million people in the country in 2022 according to analysis by TechnoServe Supporting African Processors of Fortified Foods (SAPFF) program in Nigeria. The data inputs are made through company-owned digital portals, and the results are published on a secure, web-based public portal which also serves as a gateway for stakeholders to access related information on micronutrient fortification and food quality (https://technoserve-mfi.web.app/). The ultimate aim of the MFI is to serve as a leverage for private sector efforts to both digitalize quality assurance and business processes linked to industrial automation and to harness their competitiveness through voluntary participation in the Index to drive improved food fortification performance based on industry best practices and quality benchmarks.

Promoting Protein Intake in an Ageing Population: Product Design Implications for Protein Fortification.

Protein is a macronutrient of interest for an ageing population and intake requirements increase with age. Accordingly, protein is often fortified into products for older adults to help alleviate malnutrition and impede sarcopenia. However, more emphasis needs to be placed upon designing protein-fortified products to ensure suitability for older adults. This study involved a two-stage approach: (1) an initial review of products commonly fortified with protein and (2) two questionnaires for younger and older adults (n = 73; 18-30; 65+) to investigate optimal portion sizes (drinks and cakes) as well as attitudes, consumption habits and preferences towards protein fortification. The initial literature and market review demonstrated protein-fortified products are typically in liquid or snack format; however, there is considerable variability in terms of product types, serving size and protein sources. There were no age-related differences found for ideal cakes portion size whereas there were for liquids. Older adults are typically not consuming protein-fortified products; therefore, more importance should be placed on the consumption moment (breakfast or as snacks between meals) and on cereals, pasta, porridge, cakes, and biscuits. Older adults need increased awareness of, and more education on, the benefits of protein consumption, coupled with products tailored and designed to encourage intake.

5-Methyltetrahydrofolate Is a Crucial Factor in Determining the Bioaccessibility of Folate in Bread.

This study investigated the bioaccessibility of folate in wheat bread baked with different ingredients and processing methods. Next, different matrices were spiked with 5-methyltetrahydrofolate, gallic acid (GA), or both to investigate the stability of 5-methyltetrahydrofolate during in vitro digestion. The folate bioaccessibility in bread varied from 44 to 96%. The inclusion of whole-grain or faba bean flour significantly improved both folate content and bioaccessibility. Baking with yeast increased the folate content by 145% in bread but decreased folate bioaccessibility compared to the bread without added yeast because of the instability of 5-methyltetrahydrofolate. Spiking experiments confirmed oxidation as a critical reason for 5-methyltetrahydrofolate loss during digestion. However, GA protected this vitamer from degradation. Additionally, 5-methyltetrahydrofolate was less stable in whole-grain wheat matrices than other matrices. This study demonstrated that the stability of 5-methyltetrahydrofolate is crucial for folate bioaccessibility in bread, and methods for stabilizing this vitamer should be further studied.

Targeted fortification with human milk analysis: An opportunity for innovation.

Human milk's variable macronutrient composition is a necessary consideration when caring for very low birthweight infants. Targeted fortification is the practice of fortifying human milk using its known composition from human milk analysis, rather than its assumed macronutrient values. Utilization of human milk analyzers to measure the protein, fat, lactose, and energy composition within human milk samples has allowed the translation of this practice into the clinical setting. This review discusses the rationale of why targeted fortification is an important practice, what barriers exist in its implementation in the clinical setting, and what research gaps remain to be addressed.

Design of Cereal Products Naturally Enriched in Folate from Barley Pearling By-Products.

Folate is a fundamental vitamin for human health in prevention of many diseases; however, unfortunately its deficiency is widespread, so a greater availability of folate rich foods is desirable. The aim of this study was to design new cereal products naturally enriched in folate using barley flour from pearling as ingredient. Folate content of unfortified and fortified commercial grain-based products was considered to identify the best ingredients for new formulation and for folate content comparisons. Nineteen Italian barley cultivars were evaluated for their folate content and Natura was chosen for its highest folate levels = 69.3 µg/100 g f.w. Application of pearling gave a by-product flour with a high folate level: 221.7 ± 7.0 µg/100 g; this flour was employed to design pasta and biscuits naturally enriched in folate: 87.1 µg/100 g and 70.1 ± 3.7 µg/100 g f.w., respectively. Folate content of new products is higher than commercial samples: 39.2 µg/100 g in refined pasta, 60.4 µg/100 g in wholemeal pasta, 62.1 µg/100 g in fortified biscuits and 10.4 µg/100 g in unfortified ones. Enriched pasta had higher folate retention (68.5%) after cooking compared to the fortified one (27.8%). This research shows promising results concerning the pearling technique to design new cereal products naturally enriched in folates.

Role of Nutrition Information in Acceptance and Willingness to Pay for Biofortified Cereal Food: Implications for Better Health and Sustainable Diet.

A range of nutritional needs are met through the use of fortified farm-based foods. Wheat biorfortification with zinc is such an example where biorfortification is carried out for a crucial element like Zinc. Zinc-biofortified wheat (Zn-wheat) has been officially launched in Pakistan since 2016 but its wide-scale dissemination, adoption and consumption have not taken place till to date. On the other hand, essential nutrients deficiencies have wide-ranging implications for public health especially for children and lactating mothers. This study is undertaken to know the reasons for the slow progression of scaling up of biofortified wheat varieties in Pakistan, people's awareness about biofortified wheat and to recognize the role of information in acceptance and willingness to pay for this wheat. For this purpose, randomly selected 474 households were interviewed from four districts of Punjab province. They were categorized into four groups based on their exposure to information in real and hypothetical cheap talk (game theory context). Study findings reveal that respondents were ready to pay for fortified wheat if they are aware about nutrient aspects and Zn deficiency. Using Discrete Choice Experiment, the preferences for and factors affecting the willingness to pay for fortified wheat are evaluated. Main factors having positive impact include household head's education and income, having pregnant women and children <5 years age. It was also found that people having valid information about nutrients of a food would be willing to pay more. The study highlights need for policy focus on educating people about nutritional aspects as well as making available biofortified foods to promote healthy living.

Leafy vegetables fortification enhanced the nutritional profile and reduced the glycemic index of yellow cassava pasta.

Food-to-food fortification of yellow cassava flour with leafy vegetable powders (Amaranthus and Telfairia occidentalis) was employed in this study to develop cassava-vegetable spaghetti-like pasta products (YP, YPA5, YPA10, YPU5, YPU10, YPA5O). The nutritional profile, micronutrient retention, bioaccessibility, starch digestibility and in vitro glycemic index were assessed. The incorporation of leafy vegetable powder enhanced the nutritional quality of the yellow cassava pasta (YCP) products. The fortification increased (up to 3-fold) the protein in fortified YCP, increased the fibre (11%), doubled the ash and increased the beta-carotene (about 7-fold), iron (72%) and zinc contents by 10%. The phenolic content of fluted pumpkin leaf-fortified pasta with 10% leaf powder inclusion (YPU10) was 1100 µg GAE g-1, almost four times higher than that of the unfortified YCP. Leaf powders in the cassava pasta also favoured the retention of micronutrients during cooking and slowed down the starch digestibility. The retention during cooking was up to 91% in YPU10 for beta-carotene with no loss in iron, while the bioaccessibility of beta-carotene was impeded, the zinc retention was high and became significantly more bioaccessible with leaf addition and cooking. The estimated glycemic index of YCP was reduced by 19% and 15% in YPU10 and YPA10, respectively. The inclusion of the vegetables also reduced the glycemic index of the fortified YCP. Thus, adding leafy vegetable powder up to 10% into YCP is a promising approach to both valorise yellow provitamin A biofortified cassava and enhance the nutritional value.

Biofortified tomatoes provide a new route to vitamin D sufficiency.

Poor vitamin D status is a global health problem; insufficiency underpins higher risk of cancer, neurocognitive decline and all-cause mortality. Most foods contain little vitamin D and plants are very poor sources. We have engineered the accumulation of provitamin D3 in tomato by genome editing, modifying a duplicated section of phytosterol biosynthesis in Solanaceous plants, to provide a biofortified food with the added possibility of supplement production from waste material.

Effect of vitamin D3-fortified fruit juice supplementation of 4000 IU daily on the recovery of iron status in childbearing-aged women with marginally low iron stores: Protocol for an 8-week, parallel group, double-blind randomized controlled trial.

BACKGROUND: In recent years, emerging evidence has highlighted the role of vitamin D as an iron absorption enhancer by suppressing hepcidin concentration, albeit with an unclear underlying mechanism. Dietary-based approach in improving iron status has been widely practised, however, there is a scarcity in randomized controlled trials (RCT) to elucidate the effect of vitamin D-fortified juice on iron status recovery. Therefore, this study aims to investigate the effect of an 8-week vitamin D3-fortified fruit juice supplementation on iron status indicators in childbearing-aged women with marginally low iron stores. METHODS: In a placebo-controlled, double-blind, RCT, a total of 120 women aged between 19-40 with serum ferritin < 20 µg/l and fulfilled the eligibility criteria will be randomized into consuming either vitamin D3-fortified fruit juices containing 4000 IU (100 mcg) (vitamin D) or placebo-fruit juices (placebo) daily for eight weeks. At every 4-week interval, 10 ml fasting blood sample, information on dietary habit and anthropometric measurement will be collected. A mixed model repeated-measures analysis of variance will be performed to determine the effect of the intervention and the interaction with time points for all iron and vitamin D status blood biomarkers. DISCUSSION: Vitamin D supplementation in food fortification as a novel iron absorption enhancer might be a future and relevant alternative management of iron deficiency as opposed to the oral iron therapy that has poor adherence. TRIAL REGISTRATION: Clinicaltrials.gov: registration number NCT04618289, registration date October 28, 2020, protocol ID JKEUPM-2020-033.

Contribution of fortified margarines and other plant-based fats to micronutrient intake in the Netherlands.

PURPOSE: In the Netherlands, margarines and other plant-based fats (fortified fats) are encouraged to be fortified with vitamin A and D, by a covenant between the Ministry of Health and food manufacturers. Frequently, these types of fats are also voluntarily fortified with other micronutrients. The current study investigated the contribution of both encouraged as well as voluntary fortification of fortified fats on the micronutrient intakes in the Netherlands. METHODS: Data of the Dutch National Food Consumption Survey (2012-2016; N = 4, 314; 1-79 year.) and the Dutch Food Composition Database (NEVO version 2016) were used to estimate micronutrient intakes. Statistical Program to Assess Dietary Exposure (SPADE) was used to calculate habitual intakes and compared to dietary reference values, separate for users and non-users of fortified fats. RESULTS: Of the Dutch population, 84% could be considered as user of fortified fats. Users consumed mostly 1 fortified fat a day, and these fats contributed especially to the total micronutrient intake of the encouraged fortified micronutrients (vitamins D and A; 44% and 29%, respectively). The voluntary fortification also contributed to total micronutrient intakes: between 7 and 32%. Vitamin D and A intakes were up to almost double among users compared to non-users. Intakes were higher among users for almost all micronutrients voluntarily added to fats. Higher habitual intakes resulted into higher risks of excessive vitamin A-intakes among boys and adult women users. CONCLUSION: Consumption of fortified fats in the Netherlands resulted into higher vitamin A and D-intakes among users, compared to non-users of these products.

Chemical composition, quality attributes and antioxidant activity of stirred-type yogurt enriched with Melastoma dodecandrum Lour fruit powder.

This study for the first time used Melastoma dodecandrum Lour fruit powder (MDLP) as a novel functional ingredient for improving the quality of stirred-type yogurt (STY). Physicochemical properties, polyphenol content, antioxidant activity, textural analysis, fat globules, microstructure, and sensorial properties of MDLP-fortified STY were evaluated during storage (at 4 °C). The results indicated that MDLP significantly (p < 0.05) improved the total phenolics, flavonoids, anthocyanins, and proanthocyanidins, as well as increased the antioxidant activity of fortified yogurts compared to an STY-control. Interstitially, MDLP altered the structure of STY, making it firmer and more cohesive, increased its viscosity index, and significantly reduced whey and fat globule release compared to the STY-control during cold storage. Among all MDLP concentrations, 1% MDLP-fortified STY showed the best results followed by 0.5%. This study concluded that MDLP can be used as a potential nutritious ingredient and as a natural stabilizer for yogurt and related products.

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.