Abstract Micronutrient deficiencies in industrialized countries are being controlled effectively by food fortification but deficiencies are still widespread in many low- and middle-income countries (LMIC). The introduction of national fortification programs in many LMIC has become a major strategy to combat deficiencies that negatively effect health. Most of the basic science and technologies exist to effectively fortify staple cereals, edible oils, condiments, and a range of voluntary fortified manufactured food products. The successful programs with iodized salt, folic acid-fortified cereals, and vitamin D-fortified dairy foods that have markedly improved the health of consumers are being consolidated and extended. The same beneficial impact on health is now expected for the iron, zinc, vitamin A, and vitamin B12 fortification programs that are in place or being established. To ensure the successful consolidation and expansion of fortification programs, a multisectoral approach is needed. The public sector has recognized the need to engage and stimulate the private sector to contribute to the public good and, in LMICs, governments, development agencies, nonprofit organizations and the private sector are now collaborating through public–private partnerships to scale up programs and increase funding. It may be additionally necessary to find points of integration between fortification programs and biofortification programs, infection control, improved hygiene, and better sanitation while carefully monitoring changes in micronutrient malnutrition caused by rapid urbanization, changing lifestyles, globalization, and climate change. Additionally, clear communication on health benefits is needed to create and maintain consumer demand. The safety of adding micronutrients to the food supply will also remain an important consideration. Consumer demand depends on the demonstration of a positive health impact with little potential risk. National fortification programs should thus be well controlled to achieve health benefits while avoiding excessive intakes, especially if micronutrient supplementation is also practiced and fortified manufactured foods are available. Optimizing food fortification for impact moving forward will be facilitated by improved accuracy of micronutrient intake and status data at the national level, a continued extension of the scientific and technical base, and overcoming the current bottlenecks in LMICs that include targeted advocacy to build new programs, improved regulatory monitoring, additional resources, increased transparency and accountability, and more evidence of impact.

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