Impacts of large-scale food fortification on the cost of nutrient-adequate diets: a modeling study in 89 countries

Large-scale food fortification (LSFF) is a widely accepted intervention to alleviate micronutrient deficiencies, yet policy implementation is often incomplete and its effects on diet costs are not well established. We estimated the extent to which LSFF reduces the cost of nutrient-adequate diets using retail food prices and fortification policy data from 89 countries. In total, we modeled 5,874 least-cost diets across 22 sex-age groups and 3 nutrient-adequacy scenarios: meeting nutrient requirements only; adding minimum intakes for starchy staples and fruits and vegetables; and aligning food group shares with national consumption patterns. Assuming 90% implementation of existing LSFF standards, we found median cost reductions of 1.7%, 2.4%, and 4.5% across the three scenarios. Cost reductions varied widely by sex-age groups, national fortification strategies and food price structures. These findings highlight that LSFF may improve diet affordability when policies are carefully designed for local contexts, making it a valuable complement to other efforts that improve access to nutritious diets.