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Effect of Calcium Fortified Foods on Health Outcomes: A Systematic Review and Meta-Analysis

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dc.contributor.author Cormick, Gabriela
dc.contributor.author Betran, Ana Pilar
dc.contributor.author Romero, Iris Beatriz
dc.contributor.author Cormick, María Sol
dc.contributor.author Belizán, José M.
dc.contributor.author Bardach, Ariel
dc.contributor.author Ciapponi, Agustín
dc.date.accessioned 2021-01-26T12:36:28Z
dc.date.available 2021-01-26T12:36:28Z
dc.date.issued 2021-01-22
dc.identifier.citation Cormick G. Betran AP., Romero IB, Cormick MS, Belizán JM, Bardach A, Ciapponi A. Effect of Calcium Fortified Foods on Health Outcomes: A Systematic Review and Meta-Analysis. Nutrients. 2021; 13 (2): 316. doi: 10.3390/nu13020316. en_US
dc.identifier.uri https://doi.org/10.3390/nu13020316
dc.identifier.uri https://repositorio.fleni.org.ar/handle/123456789/341
dc.description.abstract Calcium supplementation and fortification are strategies widely used to prevent adverse outcome in population with low-calcium intake which is highly frequent in low-income settings. We aimed to determine the effectiveness and cost-effectiveness of calcium fortified foods on calcium intake and related health, or economic outcomes. We performed a systematic review and meta-analysis involving participants of any age or gender, drawn from the general population. We searched PubMed, Agricola, EMBASE, CINAHL, Global Health, EconLit, the FAO website and Google until June 2019, without language restrictions. Pair of reviewers independently selected, extracted data and assessed the risk of bias of included studies using Covidence software. Disagreements were resolved by consensus. We performed meta-analyses using RevMan 5.4 and subgroup analyses by study design, age group, and fortification levels. We included 20 studies of which 15 were randomized controlled trials (RCTs), three were non-randomised studies and two were economic evaluations. Most RCTs had high risk of bias on randomization or blinding. Most represented groups were women and children from 1 to 72 months, most common intervention vehicles were milk and bakery products with a fortification levels between 96 and 1200 mg per 100 g of food. Calcium intake increased in the intervention groups between 460 mg (children) and 1200 mg (postmenopausal women). Most marked effects were seen in children. Compared to controls, height increased 0.83 cm (95% CI 0.00; 1.65), plasma parathyroid hormone decreased −1.51 pmol/L, (−2.37; −0.65), urine:calcium creatinine ratio decreased −0.05, (−0.07; −0.03), femoral neck and hip bone mineral density increased 0.02 g/cm2 (0.01; 0.04) and 0.03 g/cm2 (0.00; 0.06), respectively. The largest cost savings (43%) reported from calcium fortification programs came from prevented hip fractures in older women from Germany. Our study highlights that calcium fortification leads to a higher calcium intake, small benefits in children’s height and bone health and also important evidence gaps for other outcomes and populations that could be solved with high quality experimental or quasi-experimental studies in relevant groups, especially as some evidence of calcium supplementation show controversial results on the bone health benefit on older adults. en_US
dc.language.iso eng en_US
dc.publisher MDPI Publishing en_US
dc.rights info:eu-repo/semantics/openAccess
dc.rights.uri https://creativecommons.org/licenses/by/2.5/ar/
dc.subject Calcium en_US
dc.subject Calcio en_US
dc.subject Systematic Review en_US
dc.subject Revisión Sistemática en_US
dc.title Effect of Calcium Fortified Foods on Health Outcomes: A Systematic Review and Meta-Analysis en_US
dc.type info:eu-repo/semantics/publishedVersion
dc.type info:eu-repo/semantics/article en_US
dc.description.fil Fil: Cormick, Gabriela. Instituto de Efectividad Clínica y Sanitaria; Argentina. Universidad Nacional de La Matanza; Argentina.
dc.description.fil Fil: Betran, Ana Pilar. Organización Mundial de la Salud; Suiza.
dc.description.fil Fil: Romero, Iris Beatriz. Instituto de Efectividad Clínica y Sanitaria; Argentina.
dc.description.fil Fil: Cormick, María Sol. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.
dc.description.fil Fil: Belizán, José M. Instituto de Efectividad Clínica y Sanitaria; Argentina.
dc.description.fil Fil: Bardach, Ariel. Instituto de Efectividad Clínica y Sanitaria; Argentina.
dc.description.fil Fil: Ciapponi, Agustín. Instituto de Efectividad Clínica y Sanitaria; Argentina.
dc.relation.ispartofVOLUME 13
dc.relation.ispartofNUMBER 2
dc.relation.ispartofCOUNTRY Suiza
dc.relation.ispartofCITY Basilea
dc.relation.ispartofTITLE Nutrients
dc.relation.ispartofISSN 2072-6643
dc.type.snrd info:ar-repo/semantics/artículo es_ES


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