Association of nutritional status, protein and iron intake, and physical activity with hemoglobin levels in adolescent girls: a case-control study in Rural East Java, Indonesia 10.55131/jphd/2025/230309

Main Article Content

Kartika Pibriyanti
Dono Indarto
Desy Auliya Qudsi
Lulu’ Luthfiya
Qothrunnadaa Fajr Rooiqoh
Indahtul Mufidah
Nur Amala
Ladya mayupinasti
Ivena Claresta

Abstract

Anemia among adolescent girls is a significant public health concern, negatively affecting physical development, cognitive function, and quality of life. This study aims to analyze the impact of nutritional status, dietary intake, and physical activity on hemoglobin levels. A case-control study design was employed on 116 adolescent girls aged 12-18 years. Data were collected through structured interviews. Statistical tests were used to determine the association between nutritional status, protein and iron intake, and physical activity with hemoglobin levels. Adolescent girls with good nutritional status had a significantly lower risk of anemia compared to those with poor nutritional status (p < 0.05). Low protein intake, both in quantity and frequency, increased the risk of anemia nearly sixfold (OR = 5.884, 95% CI = 2.634–13.146; p < 0.05). This finding underscores the critical role of sufficient protein intake in supporting hemoglobin synthesis and preventing anemia. Adequate consumption of iron-rich foods was significantly associated with higher hemoglobin levels. Regular physical activity was also found to have a protective effect, with physically active adolescent girls demonstrating better hemoglobin levels than their less active counterparts. This suggests that an active lifestyle not only improves circulation and red blood cell production but also helps maintain optimal hemoglobin levels. In conclusion, good nutritional status, sufficient protein and iron intake, and regular physical activity are key factors in preventing anemia among adolescent girls. These findings emphasize the importance of holistic nutritional interventions, including improved dietary quality and promotion of physical activity, to reduce anemia prevalence.

Article Details

How to Cite
1.
Kartika Pibriyanti, Indarto D, Auliya Qudsi D, Lulu’ Luthfiya, Fajr Rooiqoh Q, Mufidah I, Amala N, mayupinasti L, Claresta I. Association of nutritional status, protein and iron intake, and physical activity with hemoglobin levels in adolescent girls: a case-control study in Rural East Java, Indonesia: 10.55131/jphd/2025/230309. J Public Hlth Dev [internet]. 2025 Sep. 30 [cited 2025 Dec. 5];23(3):113-27. available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/274542
Section
Original Articles
Author Biographies

Kartika Pibriyanti, Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Dono Indarto, Department of Physiology and Biomedical Laboratory, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.

Department of Physiology and Biomedical Laboratory, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.

Desy Auliya Qudsi, Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Lulu’ Luthfiya, Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Qothrunnadaa Fajr Rooiqoh, Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Indahtul Mufidah, Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Nur Amala, Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Ladya mayupinasti, Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Ivena Claresta, Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

Department of Nutrition Sciences, Faculty of Health Science, Universitas Darussalam Gontor, Ponorogo, East Java, Indonesia.

References

Merid MW, Chilot D, Alem AZ, Aragaw FM, Asratie MH, Belay DG, et al. An unacceptably high burden of anaemia and it’s predictors among young women (15–24 years) in low and middle income countries; set back to SDG progress. BMC Public Health. 2023;23(1):1292. Available from: https://doi.org/10.1186/s12889-023-16187-5

Sari P, Herawati DM, Dhamayanti M, Hilmanto D. Anemia among Adolescent Girls in West Java, Indonesia: Related Factors and Consequences on the Quality of Life. Nutrients. 2022 Sep 13;14(18):3777. doi: 10.3390/nu14183777.

Sigit FS, Ilmi FB, Desfiandi P, Saputri D, Fajarini ND, Susianti A, et al. Factors influencing the prevalence of anaemia in female adolescents: A population-based study of rural setting in Karanganyar, Indonesia. Clin Epidemiol Glob Heal. 2024 Jan 1;25:101500. doi: 10.1016/j.cegh.2023.101500

Gonete, K.A., Tariku, A., Wami SD. Prevalence and associated factors of thinness among adolescent girls attending governmental schools in Aksum Town, Northern Ethiopia. Arch Public Heal. 2018;76(79):158–64. doi: https://doi.org/10.1186/s13690-018-0324-y

Wemakor A, Kwaako M, Abdul-Rahman A. Nutritional, health and socio-demographic determinants of anaemia in adolescent girls in Kumbungu District, Ghana. BMC Nutr. 2023;9(1):90. doi: https:// doi.org/10.1186/s40795-023-00749-2

Soliman A, Alaaraj N, Hamed N, Alyafei F, Ahmed S, Itani M, et al. Nutritional interventions during adolescence and their possible effects . Acta Biomed. 2022;93(1):1–14.

Nagarajan SFS and S. Haemoglobin status to determine nutritional anaemia and its association with breakfast skipping and BMI among nursing undergraduates of Farasan Island, KSA. J Nutr Sci. 2022 Mar 14;93(1): e2022087. doi: 10.23750/abm.v93i1. 12789.

Pibriyanti K, Zahro L, Ummah SK, Luthfiya L, Sari FK. Macronutrient , nutritional status , and anemia incidence in adolescents at Islamic boarding school. J Gizi Klin Indones. 2021;18(2):97–103. doi: https:// doi.org/10.22146/ijcn.63122.

Cohen CT, Powers JM. Nutritional Strategies for Managing Iron Deficiency in Adolescents: Approaches to a Challenging but Common Problem. Adv Nutr. 2024;15(5):100215. doi: https:// doi.org/10.1016/j.advnut.2024.100215

Fitri NL, Sudaryanti L, Amalia RB. The relationship between nutrition , physical activity , and sleep quality to changes in anemia status in adolescent girls with anemia. World J Adv Reseach Rev. 2024;24(02):990–5. doi:10.30574/wjarr.2024.24.2.3409

Lombardo M, Feraco A, Camajani E, Gorini S, Strollo R, Armani A, et al. Effects of Different Nutritional Patterns and Physical Activity on Body Composition: A Gender and Age Group Comparative Study. Foods. 2024; 13(4):529. https://doi.org/ 10.3390/foods13040529

Grygiel-Górniak B, Tomczak A, Krulikowska N, Przysławski J, Seraszek-Jaros A, Kaczmarek E. Physical activity, nutritional status, and dietary habits of students of a medical university. Sport Sci Health. 2016;12(2):261–7. doi: https://doi.org/ 10.1007/s11332-016-0285-x

Zeinalabedini M, Zamani B, Nasli-Esfahani E, Azadbakht L. A systematic review and meta-analysis of the association of dietary diversity with undernutrition in school-aged children. BMC Pediatr. 2023;23(1):269. doi: https://doi.org/10.1186/s12887-023-04032-y

Ma J, Huang J, Zeng C, Zhong X, Zhang W, Zhang B, et al. Dietary Patterns and Association with Anemia in Children Aged 9–16 Years in Guangzhou, China: A Cross-Sectional Study. Nutrients. 2023 Sep 25;15(19): 4133. doi: 10.3390/nu15194133.

Sari P, Tina R, Judistiani D, Hilmanto D. Iron Deficiency Anemia and Associated Factors Among Adolescent Girls and Women in a Rural Area of Jatinangor , Indonesia. Int J Womens Health. 2022 Aug 23;14:1137-1147. doi: 10.2147/IJWH.S376023.

Andriastuti M, Ilmana G, Nawangwulan SA, Kosasih KA. Prevalence of anemia and iron profile among children and adolescent with low socio-economic status. Int J Pediatr Adolesc Med. 2020 Jun;7(2): 88-92. doi: 10.1016/j.ijpam.2019. 11.001

Kounnavong S. Anaemia among adolescents : assessing a public health concern in Lao PDR. Glob Health Action. 2020;13(2):103–11. doi: https://doi.org/10.1080/16549716.2020.1786997

Risonar MGD, Rayco-Solon P, Ribaya-Mercado JD, Solon JAA, Cabalda AB, Tengco LW, et al. Physical activity, energy requirements, and adequacy of dietary intakes of older persons in a rural Filipino community. Nutr J. 2009;8(1):19. doi: https://doi.org/10.1186/1475-2891-8-19

Shaka MF, Wondimagegne YA. Anemia, a moderate public health concern among adolescents in South Ethiopia. PLoS One. 2018 Jul 17; 13(7):e0191467. doi: https://doi.org/ 10.1371/journal.pone.0191467

Deivita Y, Syafruddin S, Andi Nilawati U, Aminuddin A, Burhanuddin B, Zahir Z. Overview of Anemia; risk factors and solution offering. Gac Sanit. 2021;35 Suppl 2:S235-S241. doi: 10.1016/j.gaceta. 2021.07.034

Alfawaz H, Yakout SM, Wani K, Aljumah GA, Ansari MGA, Khattak MNK, et al. Dietary intake and mental health among Saudi adults during COVID-19 lockdown. Int J Environ Res Public Health. 2021 Feb 9;18(4): 1653. doi: 10.3390/ijerph18041653

Wang P, Wang R, Tian M, Sun Y, Ma J, Tu Y, et al. The pathways from type a personality to physical and mental health amid covid-19: A multiple-group path model of frontline anti-epidemic medical staff and ordinary people. Int J Environ Res Public Health. 2021 Feb 15;18(4):1874. doi: 10.3390/ijerph18041874

Paramastri R, Hsu C yeh, Lee H an, Lin L yin, Kurniawan AL, Chao JC. Association between Dietary Pattern , Lifestyle , Anthropometric Status , and Anemia-Related Biomarkers among Adults : A Population-Based Study from 2001 to 2015. Int J Environ Res Public Health. 2021 Mar 26;18(7): 3438. doi: 10.3390/ijerph18073438.

Salam RA, Hooda M, Das JK, Arshad A, Lassi ZS, Middleton P, et al. Interventions to Improve Adolescent Nutrition: A Systematic Review and Meta-Analysis. J Adolesc Heal. 2016 Oct 1;59(4):S29–39. doi: https://doi. org/10.1016/j.jadohealth.2016.06.022

Mustafa A, Widajati E, Halis F, Khairuddin K. Peer Tutoring on Fish and Vegetables-Based Diets Education to Prevent Anemia and Hypoalbuminemia in Adolescents. Indones J Hum Nutr. 2023;10(1):68–76. doi: 10.21776/ub.ijhn.2023.010. 01.8

Apu MAI, Halder D, Shuvo MS, Sarker MR. Iron Deficiency in Children Can Impair Growth and Contribute to Anemia. Am J Heal Res . 2023 Apr 24;11(2):58–67. doi: https://doi.org/10.11648/j.ajhr.20231102.14

Franco E, Urosa J, Barakat R, Refoyo I. Physical activity and adherence to the mediterranean diet among spanish employees in a health-promotion program before and during the covid-19 pandemic: The sanitas-healthy cities challenge. Int J Environ Res Public Health. 2021 Mar 8;18(5):2735. doi: 10.3390/ijerph18052735.

Cohen CT, Powers JM. Nutritional Strategies for Managing Iron Deficiency in Adolescents: Approaches to a Challenging but Common Problem. Adv Nutr. Adv Nutr. 2024 May;15(5):100215. doi: 10.1016/j.advnut.2024.100215

Solberg A, Reikvam H. Iron Status and Physical Performance in Athletes. Life (Basel). 2023 Oct 2;13(10):2007. doi: 10.3390/life13102007.

Morales-Suárez-Varela M, Peraita-Costa I, Llopis-Morales A, Llopis-González A. Cross-Sectional Assessment of Nutritional Status, Dietary Intake, and Physical Activity Levels in Children (6–9 Years) in Valencia (Spain) Using Nutrimetry. Nutrients. 2024 Aug 10;16(16):2649. doi: 10.3390/nu16162649.

Sirojova ZN. The impact of physical activity on the physical health and psychological well-being of students. BIO Web Conf. 2024;120.doi: https://doi.org/10.1051/bioconf/202412001054

Huang Z, Li X, Liu X, Xu Y, Feng H, Ren L. Exercise blood pressure , cardiorespiratory fitness , fatness and cardiovascular risk in children and adolescents. Front Public Health. 2024 Jun 13;12:1298612. doi: 10.3389/ fpubh.2024.1298612.