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The Economics of Food Fortification

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Horton, Sue·2006·The Journal of Nutrition

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Abstract

This paper summarizes some of the literature on the cost effectiveness and cost benefit of food fortification with selected micronutrients most relevant for developing countries. Micronutrients covered include iron, iodine, vitamin A, and zinc. The main focus is on commercial fortification, although home fortification and biofortification are mentioned. Fortification with iron, vitamin A, and zinc averts significant numbers of infant and child deaths and is a very attractive preventive health-care intervention. Fortification with iron, iodine, and potentially zinc provides significant economic benefits and the low unit cost of food fortification ensures large benefit:cost ratios, with effects via cognition being very important for iron and iodine. Fortification will not reach all individuals and is most attractive as an investment where there is a convenient food vehicle, where processing is more centralized, and where either the deficiency is widespread or the adverse effects are very costly even though only a small group is affected.

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Background
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“While there might be reservations about the biopolitics of such a paternalistic approach, it is already well-established and little contested with the largely invisible industrial fortification of food items in Uganda and elsewhere (Horton, 2006).”
Background
Iodine Supplementation
Taylor, P. N., & Okosieme, O. E. (2017) · Springer eBooks · doi:10.1007/978-3-319-49505-7_9 · Cited by 2
Cost‐effectiveness of zinc interventions in China: A cohort‐based Markov model
Tan, F., Wang, J., Guo, Y., Deng, T., Steur, H. D., & Fan, S. (2023) · Agribusiness · doi:10.1002/agr.21861 · Cited by 1
A Mixed Model Approach for Estimating the Optimal Food Fortification of Vitamin D: Experiment Based on Mashhad Cohort Study in Iran
Pourmohamadkhan, M., Khorasanchi, Z., Ghazizadeh, H., Sedighnia, A., Kiani, B., Salemi, O., Ferns, G. A., Kalhori, S. R. N., & Ghayour‐Mobarhan, M. (2023) · Archives of Iranian Medicine · doi:10.34172/aim.2023.82 · Cited by 1
Política mundial de yodación de sal: desafíos
Bermeo, F. E. C., Arteaga-Díaz, J. M., & Deubel, A.-N. R. (2021) · Revista de Salud Pública · doi:10.15446/rsap.v23n6.98302 · Cited by 1
HALK SAĞLIĞI UYGULAMALARINDA GIDA ZENGİNLEŞTİRİLMESİ
Demircioğlu, E. Ö., & Aslan, D. (2023) · STED / Sürekli Tıp Eğitimi Dergisi · doi:10.17942/sted.1087701 · Cited by 1
Nutritional composition and acceptance of a complimentary food made with provitamin A-biofortified maize.
Govender, L. (2014) · ResearchSpace (University of KwaZulu-Natal) · Cited by 1
Evaluation of Iron (Fe) and Zinc (Zn) concentration among selected potato (Solanum tuberosum) genotypes in South Africa
Managa, L. R. (2015) · Unisa Institutional Repository (University of South Africa) · Cited by 1
Measuring food fortification coverage in household surveys: formative research findings from Bangladesh and EthiopiaPreprint
Scott, S., Myers, E. C., Jungjohann, S. M., Manohar, S., Neupane, S., Banerjee, A., Berhane, H. Y., Workneh, F., Ferdaweke, F., Zaman, Z. I., et al. (2025) · doi:10.12688/verixiv.2491.1 · Cited by 1
Cassava (Manihot Esculenta) Chips Fortified with Sagip Nutri Powder
Manugay, L. J., & Delos Reyes-Peñalber, M. (2026) · International Journal of Sustainability and Advanced Integrated Research · doi:10.65339/ijsair.v2.i2.259
[Evaluation of blood sugar and blood insulin levels in the oral glucose tolerance test].
Aiello, C. R., Turner, D., Aparicio, N. J., Turner, E. A. D., & Vazquez, A. (1974) · PubMed
Prévention de la carence en fer chez le nourrisson, l’enfant et l’adolescent
Andersson, M., & Hurrell, R. F. (2010) · Annales Nestlé (Ed française) · doi:10.1159/000328818
Iodbedarf und Risiken und Nutzen einer Korrektur des Iodmangels in Populationen
Zimmermann, M. B. (2013) · Perspectives in Medicine · doi:10.1016/j.permed.2013.07.001
Asimulation-based method for evaluating potential impact of biofortified crops.
Gunaratna, N. S., McCabe, G. P., Groote, H. D., & Ahmed, K. (2007) · 8th African Crop Science Society Conference, El-Minia, Egypt, 27-31 October 2007
Regular consumption of a complementary food fortified with ascorbic acid and ferrous fumarate or ferric pyrophosphate is as useful as ferrous sulfate in maintaining hemoglobin concentrations .105 g/L in
Davidsson, L., Jamil, K. A., Sultana, S., & Hurrell, R. F. (2009)
Estado de la consejería nutricional prestada a niños menores de 3 años en un municipio de Sancti Spiritus
Pérez, Y. S. (2015) · Revista Cubana de Alimentación y Nutrición
Program Performance and Synthesis of Monitoring Information for Food Fortification
Ruth, L. J., Jungjohann, S. M., Pachón, H., & Serdula, M. K. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-802861-2.00028-6
Potential of compost and Plant Growth Promoting Rhizobacteria for biofortification of iron and zinc in wheat
Javed, H. (2017)
Health Risks from Long-term Consumption of Micronutrient Fortified Foods
Dasa, F. (2019) · Global Journal of Nutrition & Food Science · doi:10.33552/gjnfs.2019.01.000513
Iodine Content of Packaged Salt and Related Knowledge and Storage Practices at Household Level in Dhaka City, Bangladesh
Hossen, M. S., & Khan, M. N. I. (2020) · European Journal of Nutrition & Food Safety · doi:10.9734/ejnfs/2020/v12i1130318
“Realizing this severe impact, the UN organizations in collaboration with the global leaders have taken initiatives in the 1990s and discovered fortification of all kinds of dietary salt with iodine (known as universal salt iodization or USI) as the most cost-effective approach to prevent and control the disorders at t…”
Background
Diversified strategies for improving iron bioavailability of maize
Proulx, A. K. (2007) · doi:10.31274/rtd-180813-17054
“Alleviating iron deficiency can improve health, wellbeing (Zimmerman and Hurrell, 2007) and economic status (Horton, 2006) but challenges do exist in implementing iron supplementation and fortification programs in some of the most isolated and resource poor regions of the world where iron deficiency is most prevalent.”
Background
Innovations, nudging interventions and food and nutrition security : Evidence from experimental and quasi-experimental studies in Ethiopia
Jada, K. (2022) · doi:10.18174/574235
The effect of crude extract of Cyathula prostrata leaves on serum c-reactive proteins levels of normal albino Wistar rats after an administration period of 7 days
Etta, O. S., Bassey, O. B., Augustine, U. E., & Jerimoth, C. P. (2023) · World Journal of Advanced Research and Reviews · doi:10.30574/wjarr.2023.20.3.2592
Additional file 2 of Ending malnutrition in all its forms requires scaling up proven nutrition interventions and much more: a 129-country analysis
Scott, N., Delport, D., Hainsworth, S. W., Pearson, R., Morgan, C., Huang, S., Akuoku, J. K., Piwoz, E., Shekar, M., Levin, C., et al. (2020) · Figshare · doi:10.6084/m9.figshare.13233304
Cost-effectiveness of food fortification for reducing global malnutrition: a systematic review of economic evaluations across 63 countriesPreprint
Cogo, E., Pelone, F., Pachón, H., Buckley, B. S., Christou, M., Villanueva, G., Woldt, M., Henschke, N., & Tsang, B. L. (2025) · medRxiv · doi:10.1101/2025.06.12.25329169
Simulated Impact of Vitamin A‐Fortified Sugar on Dietary Adequacy and Association of Usual Sugar Intake With Plasma and Breast Milk Retinol Among Lactating Zambian Women
Haile, D., Engle‐Stone, R., Caswell, B., Luo, H., Dodd, K. W., Arnold, C. D., Jobarteh, M. L., Greene, M., Chipili, M., Haskell, M. J., et al. (2025) · Maternal and Child Nutrition · doi:10.1111/mcn.70077
“Large ‐ scale food fortification programmes (LSFFs) have been identified as cost ‐ effective strategies to increase vitamin A intake and thus minimise the consequences of vitamin A deficiency (Bruins and Kraemer 2013; Fiedler and Macdonald 2009; Horton 2006; Phillips et al. 1996).”
Application of plant breeding and genomics for improved sorghum and millet grain nutritional quality
Are, A. K., Gaddameedi, A., Gorthy, S., Habyarimana, E., Gupta, S. K., Srivastava, R. K., Govindaraj, M., Jaganathan, J., & Santra, D. K. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-23954-0.00002-1
Iron as Vital Mineral Nutrient for Human Health: Food Sources, Bioavailability, Non-heme Fortified Beverages and Future Prospects
Sharma, U., Jadaun, S., Khapudang, R., & Siddiqui, S. (2025) · World sustainability series · doi:10.1007/978-3-031-98200-2_17
Additional file 1 of Ending malnutrition in all its forms requires scaling up proven nutrition interventions and much more: a 129-country analysis
Scott, N., Delport, D., Hainsworth, S. W., Pearson, R., Morgan, C., Huang, S., Akuoku, J. K., Piwoz, E., Shekar, M., Levin, C., et al. (2020) · Figshare · doi:10.6084/m9.figshare.13233301
Food-based strategies to enhance iron and zinc bioavailability of complementary foods consumed by young children in Ethiopia
Yimam, K. B. (2013) · theses.fr (ABES) · doi:10.70675/ae0f572ez8727z49aez9d5az9d844df3b2bb
What Endocrinologists Should Know About Iodine: Population Deficiency, Individual Excess and Misinformation in the United Kingdom
Taylor, P. N., Prentice, M., Bath, S. C., Combet, E., Schoenmakers, N. A., Smith, V. E., Gibb, F. W., Zammitt, N. N., Okosieme, O. E., Boelaert, K., et al. (2026) · Clinical Endocrinology · doi:10.1111/cen.70162
“The Iodine Global Network estimates that universal salt iodisation costs approximately £0.02–0.05 per person per year, while the economic return typically exceeds £30 for every £1 invested [5, 38].”
Influential
Bridging iron biofortification through integrative strategies from QTL mapping to regulatory-compliant genome editing
Hakeem, S., Khushi, S., Tahir, M. H. N., Ahmed, N. H., Bibi, A., & Ali, Z. (2026) · Cereal Research Communications · doi:10.1007/s42976-026-00816-x
“These include food fortification, industrial fortification, dietary food diver - sification, food supplementation, and biofortification (Table 3 ) (Horton 2006).”

Authors: Horton, S.
Affiliations: Wilfrid Laurier University (CA)
Corresponding author: Horton, Sue
Venue: The Journal of Nutrition
Publisher: Elsevier BV
Published: 2006-04
Volume: 136
Issue: 4
Pages: 1068-1071
ISSN: 0022-3166 (ISSN-L)
DOI: 10.1093/jn/136.4.1068
OpenAlex: W1946220486
Cited by: 197
References: 8
Citations by year: 2026: 3 · 2025: 8 · 2024: 6 · 2023: 15 · 2022: 7 · 2021: 15 · 2020: 21 · 2019: 10 · 2018: 15 · 2017: 8 · 2016: 7 · 2015: 9 · 2014: 13 · 2013: 12 · 2012: 10
FWCI: 6.46
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 6152 d)
Locations: Journal of Nutrition (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Life Sciences › Agricultural and Biological Sciences › Food Science › Nutrition, Health, and Society Studies
Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
Keywords: food fortification, cost-effectiveness, cost-benefit analysis, micronutrients, iron, iodine, vitamin A, zinc, infant and child mortality, home fortification, biofortification, cognitive effects, developing countries, public health investment
MeSH terms: Cost-Benefit Analysis, Developing Countries, Food, Fortified, Humans, Iodine, Iron, Vitamin A, Zinc, Micronutrients

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