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Could Fortified Staples Fill the Gap? Mapping Iron Intake Across India: What the Data Reveals India has made a strong push toward food fortification in its efforts to combat iron deficiency and anaemia. But how much iron are Indians consuming from their daily diet? And how much iron does fortification add? Even though vegetables, cereals, and pulses are a big part of Indian diets, our analysis shows that they often don’t provide enough iron, especially for women and children in many states. When fortified staples, wheat flour, rice, and double fortified salt (DFS), are consumed regularly, they can contribute iron amounts nearly equal to those from the regular diets., Fortification has the potential to almost double total daily iron intake and close the nutritional gap in states with high staple consumption. This has major implications for rural areas and vulnerable groups, where nutritional needs and anaemia prevalence are high and dietary diversity is limited. The impact of fortification isn’t equal across the country - it varies by region, diet, and food access, making a case for more targeted and data-driven nutrition strategies. Our recent analysis, using national consumption data (HCES 2011-12), estimates iron intake across Indian states from the regular diet, based on food iron values from the Indian Food Composition Tables (IFCT) and ICMR-NIN RDA 2024 It also models the additional contribution from fortified staples (wheat flour, rice, and salt) using Indian standards recommended by FSSAI. The results highlight key rural-urban and state-wise patterns in total iron availability. How Much Iron Are We Getting? At the national level, rural and urban populations show similar iron intake from the regular diet (intrinsic/natural iron from the food source) (~20 mg/day), but fortification significantly increases iron intake. As shown in Figure 1, the contribution from fortification is almost equivalent (an additional 15–18 mg/day) to that of the regular diet, underscoring its significance.  Where Is the Iron Coming From? - Major Contribution of Food Groups Iron from natural diet comes from a wide range of food groups like vegetables, cereals, pulses and legumes, fruits, dairy, meat, egg, nuts and oil seeds. Vegetables and cereals are the primary contributors to iron intake in rural and urban diets, jointly accounting for nearly 90% of total iron. However, urban diets tend to show a higher share of iron from vegetables, reflecting greater access to a variety of fresh produce, and a more diverse intake across food groups like pulses, milk, meat, and fruits. (Figures 2a & 2b). This dietary diversity in urban areas may be influenced by better market access, higher income levels, and changing food preferences, which collectively support a more balanced iron profile beyond staple cereals.  How Does This Compare with Iron Requirements? According to the ICMR-NIN 2024 recommendations, the daily iron requirement (RDA) varies by age, sex, and physiological status. Women of reproductive age have higher iron intake requirements - 29 mg/day for adult women, 27 mg/day for pregnant women, and 23 mg/day for lactating women, with a Tolerable Upper Limit (TUL) of 45 mg/day for most adults. Our modelling analysis shows that in many states, women of reproductive age, including pregnant and lactating women, fall short of these recommended intake levels when relying solely on dietary sources in the regular diet (Figure 3a & 3b). Given their increased physiological demand and high risk of iron deficiency, fortified staples serve as a critical intervention to bridge this gap and improve iron adequacy in these vulnerable populations. State-wise Trends in Iron Intake Our analysis of diets across states shows big differences in how much natural and fortified iron people get. This is mainly due to the types of staples they eat, how varied their diets are, and how easily they can access fortified foods. Some states show relatively high total iron intake, largely due to higher consumption of iron-rich cereals like wheat and widespread fortification coverage. Iron intake from fortified staples is closely linked to the consumption patterns of wheat and rice (Figures 3a and 3b). States with high rice consumption, such as Tripura, Manipur, Nagaland, Mizoram, Arunachal Pradesh, and Assam and those with high wheat consumption, like Rajasthan, Punjab, Haryana, and Madhya Pradesh, show relatively higher total iron intake when fortification is layered on top of their staple diets. In contrast, states like Kerala, Goa, and many northeastern states tend to have lower total iron availability, especially in rural areas, due to lower staple consumption and/or comparatively reduced dietary diversity. Fortification’s Role in Bridging the Gap The inclusion of fortified staples like wheat flour, fortified rice, and DFS (double fortified salt) plays a pivotal role in closing this gap in many states (Figure 3a & 3b). In several regions, fortification provides an additional intake of iron almost equal to natural iron received from the regular diet, significantly improving adequacy without causing excess iron intake crossing the TUL. This helps fill the shortfall of required dietary intake, especially for rural populations who consume large quantities of staples but have limited dietary diversity and women and children with higher requirements (Figure 1 shows the additional contribution of iron from different fortified staples for the All India Population).   Key Implications for Food Fortification Policy and Programmes
Final Thoughts Fortification is a significant public health tool, but data-driven strategies are key to maximising its impact while avoiding excess intake. Mapping iron intake across India can help us tailor interventions more precisely and equitably. At Fortify Health, we are committed to evidence-based solutions that improve public health. Subscribe to our newsletter for the latest research updates and insights into our work.
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