Iron fortification of wheat flour may have little to no effect on anemia or iron deficiency, and in some cases, poor diet quality can compromise its benefits.

Field et al. (2020) found that fortifying wheat flour with iron had little or no effect on anemia [14] and had little to no impact on iron deficiency compared to unfortified wheat flour... The findings showed an unexpected increase in anemia among children. Despite the average intake of fortified flour detected by the study amounting to 100 g per day, the poor diets quality of children with low bioavailability of iron compromised the benefits of fortified flour [41].