Food fortification demonstrates cost-effective solution to global malnutrition

A comprehensive economic analysis of food fortification demonstrates it is a potential solution to global malnutrition and a cost-effective way to tackle hidden hunger in over 63 countries. 

Scientists from the Cochrane Collaboration, the Food Fortification Initiative, Emory University (US), and TechnoServe reviewed 56 studies, including 200 economic analyses across 63 countries, of which 40 were from low- and middle-income economies.

They found that a large-scale food fortification is highly cost-effective while delivering substantial health benefits. The review stresses that food fortification is a great investment as the “benefits far outweigh the costs.”

“This research provides the most up-to-date data about the cost-effectiveness of food fortification on a global scale. The findings highlight the economic feasibility and tremendous potential of fortification programs to address micronutrient deficiencies and prevent their related deaths and illnesses,” says Dr. Elise Cogo, lead author and epidemiologist at Cochrane Collaboration.

“Large-scale food fortification stands out as a highly cost-effective public health intervention, and these results may provide useful indicators for evidence-informed decision making, especially in resource-constrained economies.”

Favorable investment

Published in The Journal of Nutrition, the study examined multiple combinations of foods and nutrients. The most analyzed were adding vitamins A and B9, iron, and iodine to staple foods such as cereals, grains, and wheat flour, as well as to condiments such as sugar, salt, and edible oils.

Tsang says food fortification has been championed as a cost-effective nutrition strategy since 2008.It used 232 main cost-effectiveness analyses. It found that 58% reported incremental cost-effectiveness ratios (ICERs) below US$150 per disability-adjusted life year (DALY) averted. In other words, over half of the interventions that provided one additional year of healthy life cost under $150.

The researchers explain that DALY is an established measure of disease burden calculated based on years of life lost and lived with disability. The lower the ICER score, the more cost-effective.

Of the 232 analyses, 84% had ICERs below US$1,000 per DALY averted compared with no fortification.

The researchers also used GDP per capita for each study country, and the ICER analyses showed that, overall, 87% of interventions fell within 50% of a country’s GDP per capita. For low- and middle-income countries, 84% of interventions were below 35% of GDP per capita, and 71% of low-income countries were below 20% of GDP per capita.

Becky Tsang, senior technical advisor at the Food Fortification Initiative, comments: “Fortification has been championed as a cost-effective nutrition strategy since the Copenhagen Consensus ranked it among the top cost-effective nutrition interventions to prioritize in 2008. Researchers have published many studies since 2008, and we wanted to better understand and interpret their findings.”

“This comprehensive assessment provides a much-needed, updated case for increased investment in and expansion of food fortification initiatives worldwide. The evidence shows that fortification programs consistently deliver exceptional value for money while addressing some of the world’s most pressing nutrition challenges.”

At a crucial time

Global aid cuts in 2025 equated to 44% of the US$1.6 billion provided for global malnutrition in 2022, say the researchers. This will increase the number of malnourished people and hidden hunger while potentially causing 369,000 preventable child deaths per year.

Global aid cuts in 2025 equated to 44% of the US$1.6 billion provided for global malnutrition in 2022.The cuts put vital global nutrition programs at risk, with the hardest effects on low- and middle-income countries.

“As such, prioritizing cost-effective nutrition interventions like fortification is more important than ever for governments,” states the Cochrane Collaboration.

Hidden hunger occurs when a person does not consume adequate amounts of essential micronutrients — vitamins and minerals — needed for a healthy life. It affects children and women the most, with global estimates of 56% of children aged six to 59 months and 69% of non-pregnant women aged 15 to 49 currently suffering from hidden hunger.

During periods of food insecurity and increased food prices, hidden hunger increases as the vulnerable population’s access to nutritious food decreases.

The research was funded by the US Agency for International Development. Bringing together expertise in economics, nutrition, and epidemiology, the team acknowledges limitations in the quality of reporting in the studies used. However, they affirm that the review consistently offers positive results and confidence in the cost-effectiveness of large-scale food fortification programs.