Many foods on grocery store shelves quietly contain added vitamins and minerals. Flour is enriched with iron and B vitamins. Salt often contains iodine. Cooking oils may include vitamin A.
These additions are not random. They are part of a public health strategy known as food fortification, designed to prevent nutrient deficiencies that can harm growth, development and long-term health.
A new systematic review published in The Journal of Nutrition suggests that strategy continues to deliver strong results. Researchers examined 56 studies and more than 200 economic analyses from 63 countries and found that large-scale fortification programs consistently provide major health benefits at relatively low cost.
Hidden hunger, the type of malnutrition caused by insufficient vitamins and minerals, affects millions of people worldwide. Children and women of reproductive age are especially vulnerable. Estimates suggest that roughly 56% of children ages 6 to 59 months and 69% of women ages 15 to 49 experience some form of micronutrient deficiency globally.
Fortification programs attempt to address that problem by adding essential nutrients to foods people already consume regularly.
“This research provides the most up-to-date data about the cost-effectiveness of food fortification on a global scale,” said lead author Dr. Elise Cogo, an epidemiologist with Cochrane Response. “The findings highlight the economic feasibility and tremendous potential of fortification programs to address micronutrient deficiencies and prevent their related deaths and illnesses.”
The review analyzed economic evaluations of fortification programs involving nutrients such as iron, iodine, folate and vitamin A. These nutrients are commonly added to staple foods including wheat flour, edible oils, sugar and salt.
Across the studies reviewed, the majority of fortification programs produced large health benefits relative to their cost. In 58% of the economic analyses examined, the cost of preventing a year of disease or disability was less than $150. In 84% of cases, the cost remained below $1,000.
Researchers often use these kinds of measures to compare public health interventions across different settings and determine where investments can produce the largest improvements in health.
The review also found that every benefit-cost analysis included in the research reported positive results, meaning the value of improved health outcomes exceeded the cost of implementing the programs.
Co-author Becky Tsang, senior technical advisor at the Food Fortification Initiative, said the findings reinforce decades of research supporting fortification as a practical strategy for improving nutrition.
“The decision by policymakers to enact or strengthen food fortification programs is influenced by many factors, including costs and cost-effectiveness,” Tsang said. “This comprehensive assessment provides a much-needed, updated case for increased investment in and expansion of food fortification initiatives worldwide.”
Fortification has been widely used for nearly a century. Iodized salt, introduced in the early 20th century, dramatically reduced iodine deficiency disorders in many countries. Later programs added nutrients such as iron and folic acid to flour to help prevent anemia and birth defects.
The new analysis comes at a time when global nutrition programs face significant financial pressure. International aid reductions in recent years have raised concerns that millions of people could lose access to nutrition interventions that help prevent severe malnutrition.
Because fortification works through foods people already eat, researchers say it remains one of the most scalable strategies for improving nutrient intake across large populations.
While the review noted that some studies varied in quality and reporting methods, the results across countries and program types were consistently positive.
Taken together, the findings suggest that adding key vitamins and minerals to commonly consumed foods continues to be one of the most effective ways to address micronutrient deficiencies worldwide.
The research was supported by the United States Agency for International Development through the Advancing Food Fortification Opportunities to Reinforce Diets program. The authors noted that the findings represent the work of the research team and do not necessarily reflect the views of USAID or the U.S. government.