Food fortification helps close affordability gap in global nutrition

Among all fortified foods modeled, wheat flour fortification produced the largest global benefit, leading to meaningful cost reductions across demographic and regional groups. Rice fortification also yielded noticeable gains, especially in Asian economies where rice forms the caloric base of national diets. However, oil and maize flour fortification showed minimal or no cost effects, suggesting that their role in affordability depends on local consumption levels and nutrient requirements.

A team of international researchers have shared new insights into how fortifying staple foods can modestly reduce the cost of achieving a nutrient-adequate diet across the developing and developed world.

Titled “Impacts of Large-Scale Food Fortification on the Cost of Nutrient-Adequate Diets: A Modeling Study in 89 Countries”, the research quantifies the economic benefits of national fortification programs and their role in reducing nutritional inequality. Conducted under the Food Prices for Nutrition project and funded by the Swiss Agency for Development and Cooperation and the Bill & Melinda Gates Foundation, the study provides the first comprehensive global modeling of fortification’s effect on diet affordability.

How the study measured the economic value of food fortification

The study modeled 5,874 least-cost diets across 89 countries, spanning 22 sex and age groups, using 2021 retail food price data. The analysis considered three scenarios to estimate how large-scale food fortification (LSFF) affects affordability: diets meeting only nutrient adequacy, diets that include basic food diversity such as starchy staples and fruits and vegetables, and diets reflecting national consumption patterns.

Fortification policy data were drawn from the Global Fortification Data Exchange, with the assumption that 90% of existing standards were implemented effectively. The research modeled the addition of key nutrients, including iron, folic acid, zinc, calcium, and vitamin A, into staple foods like wheat flour, rice, maize flour, salt, and oil.

The findings revealed that LSFF reduced the cost of nutrient-adequate diets by 1.7% to 4.5%, depending on the scenario. While the global averages appear modest, the effect was significant for populations on the margins of affordability. In particular, fortification benefits were greatest in diets that mirrored local consumption patterns, underscoring that fortification programs must be adapted to national contexts rather than standardized across regions.

Out of the total simulated diets, 54.8% saw reductions in cost, 38% remained unchanged, and 7.3% increased. The increases occurred in countries or food systems where fortification inadvertently pushed nutrient intake beyond safe limits or where price distortions affected cost parity.

Which foods and nutrients drive the greatest cost savings?

Among all fortified foods modeled, wheat flour fortification produced the largest global benefit, leading to meaningful cost reductions across demographic and regional groups. Rice fortification also yielded noticeable gains, especially in Asian economies where rice forms the caloric base of national diets. However, oil and maize flour fortification showed minimal or no cost effects, suggesting that their role in affordability depends on local consumption levels and nutrient requirements.

From a nutrient perspective, iron and calcium fortification proved most cost-effective. Diets enriched with these nutrients showed the highest reductions in affordability gaps, particularly among adolescents and women of reproductive age. Selenium and zinc fortification, by contrast, occasionally increased costs in certain countries. This was attributed to upper intake constraints and market pricing that made balancing these nutrients more complex in the least-cost diet models.

The researchers found that the impact of fortification varied widely between regions. Latin America and the Caribbean achieved the largest proportional savings, with dietary cost reductions of up to 34% in Colombia, 30% in the United States, and over 25% in Argentina and Uruguay. These high reductions were linked to the widespread coverage of wheat flour and oil fortification in the region.

Comparatively, Sub-Saharan Africa experienced the least benefit. Here, the already extensive fortification coverage meant that additional nutrient additions yielded diminishing returns. Furthermore, fortification levels in some African countries exceeded optimal thresholds, which in certain cases increased overall dietary costs.

Who benefits most and where fortification falls short

The research found that LSFF offers disproportionate benefits to nutritionally vulnerable populations. The analysis found that fortification reduces costs most effectively for individuals with higher nutrient requirements, especially women of reproductive age, adolescent boys, and older men.

Across the sample, women experienced a median cost reduction of 2.6%, compared to 2.1% for men, with non-pregnant, non-lactating women seeing the largest savings at 3.2%. This gender difference reflects the fact that fortification of iron and folic acid, key nutrients for women’s health, significantly improves dietary adequacy without increasing total food expenditure.

However, the study also notes that fortification alone is not a comprehensive solution to global nutritional challenges. While LSFF can improve affordability, its impact remains limited in magnitude compared to broader structural factors driving food prices and access. In several low-income countries, even fortified diets remain beyond reach for large segments of the population due to income inequality and inflationary pressures on staple foods.

The authors argue that LSFF must therefore be integrated into wider food system strategies, including agricultural investment, targeted subsidies, and social protection policies. These complementary measures are essential for addressing the root causes of unaffordable diets, particularly in low- and middle-income economies facing rapid urbanization and climate-related disruptions to food supply.

The modeling further suggests that fortification effectiveness depends heavily on policy coherence and implementation quality. Countries that achieve broad coverage of fortified staples, enforce standards rigorously, and tailor programs to national dietary habits tend to gain more from LSFF. Conversely, fragmented supply chains, lack of regulation, and weak monitoring dilute fortification’s potential to reduce nutrient deficiencies at scale.

Policy implications: Designing smarter, context-specific fortification programs

The study delivers a strong policy message: moderately fortified, context-appropriate programs are the most sustainable path forward. The authors caution against overfortification, which can increase nutrient costs or risk excessive intake for certain populations. They recommend a balance between nutritional adequacy and economic efficiency, ensuring that fortification complements rather than distorts local food markets.

The researchers also call for integrating fortification data into national nutrition surveillance systems, enabling policymakers to track both nutrient intake and affordability outcomes. Expanding fortification coverage to staples widely consumed by low-income households, such as rice in Asia and maize in Africa, could further enhance equity.

Moreover, the paper highlights that economic modeling can help policymakers identify priority foods and nutrients for fortification. By simulating affordability impacts before implementation, governments can avoid inefficiencies and design programs that deliver the highest returns per dollar invested.