A new analysis of food fortification programs finds that the fortification of consumer foods is cost-effective in the majority of contexts in reducing deficiency diseases of micronutrients (vitamins and minerals). The findings are available online, as published by Elise Cogo, Ferruccio Pelone, et al in the new edition of Journal of Nutrition, Vol. 156, Issue 4.
Called a systematic review, the study culled through existing databases to tease out the incremental cost-effectivneess ratios of fortification, by nutrient. Fifty-six studies were used, drawing on over 200 analyses, covering 63 low or medium income countries. Not included were biofortification, home fortification, probiotics or pills.
The authors explain, “Large-scale food fortification (LSFF) (conducted at the postharvest, food processing stage) is a system-level intervention defined as, ..deliberately increasing the content of essential micronutrients, i.e., vitamins and minerals (including trace elements), in a food so as to improve the nutritional quality of the food supply and to provide a public health benefit with minimal risk to health”.. Most frequent interventions were as follows: vitamin A, folic acid, iron, and iodine added to cereal grains/products (e.g., flours), oils, and condiments (e.g., sugar, salt).”
The study focused primarily on cost-effectiveness rather than directly measuring health outcomes, but key health benefits are embedded in how cost-effectiveness was calculated. The key findings include that 84% of analyses found fortification costs less than $1,000 per disability-adjusted life year (DALY) averted (per healthy year of life gained or death prevented) and 58% cost less than $150 per healthy year gained. These are considered very favorable numbers.
Specific nutrients and conditions addressed by the studies included vitamin A deficiency, iron deficiency and anemia, iodine deficiency, neural tube birth defects (linked to folic acid), and conditions like goiter and encephalopathy.
See: “Cost-Effectiveness of Food Fortification for Reducing Global Malnutrition: A Systematic Review of Economic Evaluations Across 63 Countries”, Journal of Nutrition https://www.sciencedirect.com/science/article/pii/S0022316626000301?via%3Dihub
