Food fortification prevents billions of nutrient gaps annually, but impact could triple

A landmark study has demonstrated that food fortification currently prevents seven billion nutrient gaps globally at a cost of US$0.18 per person. Food fortification is a cost-effective approach, with a return on investment of US$27 per dollar for health and productivity. The study authors say that with the right approach, food fortification could triple its overall impact. 

Expensive foods keep nutritious diets out of reach for billions of people globally, say the authors. This causes micronutrient deficiencies, which are currently affecting half of preschool children and two out of three women of reproductive age, globally.

Micronutrient deficiencies are linked to poor health, increased disease risk, and poor cognitive development. Fortifying foods — adding essential vitamins and minerals to staple foods, such as flour, rice, oil, and salt — is a solution to this problem.

“This research confirms that food fortification is one of the most cost-effective public health interventions available,” says Dr. Mduduzi Mbuya, director of Knowledge Leadership at the Global Alliance for Improved Nutrition (GAIN) and co-author of the study.

“Salt iodization alone prevents 3.3 billion iodine deficiencies each year — reducing global iodine deficiency by 87%. But we’re also leaving major gains on the table. With targeted improvements, we could reach billions more people.”

Potential to triple impact

The study has been published in The Lancet Health and was led by researchers from the Swiss non-profit GAIN, in collaboration with the University of California, the World Bank, and Tufts University, all US-based.

The research team argues that by expanding and improving current food fortification programs, its impact could triple and prevent 25 billion nutrient gaps per year.

The research model covered over 99.3% of the global population across 185 countries.Their model covered over 99.3% of the global population across 185 countries. The team examined six scenarios ranging from no fortification to optimized global programs.

It found that at a cost of US$1.06 billion, current programs are preventing seven billion nutrient gaps annually, resulting in a cost per person of US$0.18. Accounting for nearly half of those are iodized salt, followed by iron fortification of flour.

However, there are still 38.6 billion global nutrient gaps, fueled by poor diet quality, low industry compliance, suboptimal fortification standards, and limited program coverage in regions of high need.

Time to act

The team found three priority actions that, if combined, could triple the impact of food fortification programs.

Firstly, improving compliance by 90% to current standards could prevent 6.1 billion nutrient gaps at an annual cost of US$0.23 per person. Secondly, the team stresses that aligning national standards to the WHO’s guidelines could prevent 10.3 billion nutrient gaps at an annual cost of US$0.63 per person.

Lastly, expanding programs to countries of high need would prevent 17.7 billion additional nutrient gaps at an annual cost of US$1.15 per person. That is, if the expansion is in combination with improving compliance and aligning national standards.

“Although many countries require food processors to fortify staple foods, compliance is often low,” says Dr. Christopher Free, a research professor at the University of California, Santa Barbara, and joint first author of the study.

“Improving compliance with current laws could prevent 6.1 billion more nutrient gaps at an additional annual cost of only $0.05 a person.”

For example, the researchers estimate that a combination of these actions would prevent nutrient gaps in folate (2.6 billion), vitamin A (2.5 billion), zinc (2.2 billion), vitamin B6 (2 billion), and iron (1.6 billion). 

Return on investment

A recent comprehensive economic analysis of food fortification demonstrated it to be a potential solution to global malnutrition and a cost-effective way to tackle hidden hunger in over 63 countries. The study stressed that food fortification is a great investment as the “benefits far outweigh the costs.”

The authors argue that food fortification is the most cost-effective approach to health and development interventions.The study authors echo that food fortification is the most cost-effective approach to health and development interventions, as it delivers large returns.

With the most expensive model, which was US$1.15 per person, it is a modest investment compared to the “tens of billions of dollars in economic losses currently attributed to micronutrient deficiencies every year.”

GAIN says that, on average, every dollar invested in food fortification provides a return of US$27 in health and productivity.

“Fortification is a powerful tool, but it is most effective as part of a comprehensive strategy,” says Florencia Vasta, global lead for large-scale food fortification at GAIN.

“Achieving optimal nutrition for everyone will require parallel investments in dietary diversity, supplementation for vulnerable groups like pregnant women and young children, and making healthy diets more affordable and accessible.”

However, the most optimized program would still leave approximately 20.9 billion nutrient gaps, highlighting the need for complementary approaches.