Fortified blended foods for malnutrition recovery in food aid programs

Abstract

Fortified Blended Foods (FBFs) are widely used in food aid programs to address malnutrition in low- and middle-income countries. Recent innovations, including microbiota-directed complementary foods (MDCFs), have expanded the scope of nutritional intervention beyond basic supplementation to include gut health restoration. However, questions remain about the sustainability, cost-effectiveness, and policy integration of these interventions. This scoping review evaluates the effectiveness, sustainability, and policy alignment of FBFs, with particular emphasis on fortification innovations and emerging microbiome-targeted formulations. The review followed PRISMA-ScR guidelines. Studies published between 2012 and 2024 were identified using Google Scholar and Web of Science. Inclusion criteria focused on peer-reviewed human studies assessing FBFs or MDCFs in food aid contexts. Data were extracted on nutritional efficacy, bioavailability, sustainability, and policy relevance, and synthesized thematically. Ten studies met inclusion criteria. FBFs improved anthropometric indicators, iron and zinc bioavailability, and in the case of MDCFs, enhanced gut microbiota maturity and growth-related biomarkers. Cost analyses favored locally sourced and enzyme-enhanced blends. However, implementation often occurred in fragmented policy environments, lacking regulatory consistency, community engagement, or long-term integration into national systems. FBFs remain essential tools in addressing malnutrition, and innovations like MDCFs mark a promising shift toward systems-based nutritional recovery. To ensure sustainable impact, future programs must integrate scientific advancements with supportive policies, local procurement strategies, and culturally responsive delivery models.