Relationship Between Consumption of Iron (Fe) and Breakfast Habits

with the Incidence of Anemia in Adolescent Girls at SMP

Negeri 6 Karawang Barat

Ajeng Ayu Indrawati, Mohammad Furqan and Imas Arumsari

Nutritional Study Program, Faculty of Health Science, Universitas Muhammadiyah Prof. DR. HAMKA,

Jl. Limau II No. 3, Jakarta Selatan, Indonesia

Keywords: Anemia Status, Iron Consumption, Breakfast Habits.

Abstract: Anemia is a globally public health problem. Anemia is a condition when the Hb level is below the normal

value (<11 g/dl). Adolescent girls have higt risk of anemia. Several factors cause anemia, including

consumption of iron (Fe) and the habits of delaying breakfast. The purpose of this study was to determine the

relationship between consumption of iron (Fe) and breakfast habits with the incidence of anemia in adolescent

girls at SMP Negeri 6 Karawang Barat. This study used a cross sectional design. The sampling technique in

this study was the cluster random sampling with a total sample of 63 students of class VIII. Data analysis in

this study used the chi-square test. Statistic tests showed a P-Value <0,05 for the category of consumption of

iron (Fe) sourced foods and consumption of Fe supplements which showed a significant relationship between

the consumption of iron (Fe) paint foods and consumption of iron (Fe) supplement and the incidence of anemia

in adolescent girls. Statistical test showed a P-Value >0,05 for the category of breakfast habits which showed

no significant relationship between breakfast habits and the incidence of anemia in adolescent girls at SMP

negeri 6 Karawang.

1 INTRODUCTION

Adolescents are one of the groups that are prone to

anemia. This causes inhibition of growth and

decrease in the immune system, so the body is easily

to infected. Anemia is a condition in which the total

of red blood cells or hemoglobin levels is below the

normal value (<11 g/dl). Hemoglobin has a role as an

oxygen carrier and nutrients to the brain and nutrients

to brain ang throughout the body. Deficiency of red

blood cells will have an impact on the body’s system

because it plays a role in distributing nutrients needed

during physiological and biochemical processes of

body tissues. Easily tired, headache, pale and feel

cold in the palms of the hand and feet is the result of

a lack of haemoglobin in the body.

Anemia among adolescent girls still becomes a

public health problem. WHO in 2018 states the

prevalence of people in the world who had anemia

was 40%. While in Indonesia the prevalence of

anemia sufferes with an age range of 15-24 years old

reaches 21,7% to 57%. According to the household

health survey (SKRT) in 2018, the prevalence of

anemia in West Java was 41,5%. Based on Riskesdas

data in 2018, 26,54% of adolescents in west java were

anemic. Compared with the national prevalence of

anemia sufferers which is 40%.

There are factors that cause anemia. Among them

is the less-than-optimal storage of iron due to low

absorption of iron due to a less diverse variety of

foods, while in adolescence there is an increase in

nutritional needs, this requires adolescent girls to

meet the nutritional needs to support the growth and

development of the body needed in adolescence.

Arrange and paying attention to food and nutrition

intake, including breakfast is one-way to prevent

anemia. Breakfast is the habit of eating and drinking

when you wake up in the morning until before doing

school or other activities to meet about 300-600 or15-

25% according to the daily nutritional needs of an

individual.

Delaying and skipping breakfast causes a lack of

nutrients in the body in the morning, these causing

diseases due to iron deficiency. Research conducted

by Sirajuddin and Masniin 2015 stated that the wrong

breakfast habit is one of the risk factors for the

136

Indrawati, A., Furqan, M. and Arumsari, I.

Relationship Between Consumption of Iron (Fe) and Breakfast Habits with the Incidence of Anemia in Adolescent Girls at SMP Negeri 6 Karawang Barat.

DOI: 10.5220/0011672900003608

In Proceedings of the 4th International Conference on Social Determinants of Health (ICSDH 2022), pages 136-141

ISBN: 978-989-758-621-7; ISSN: 2975-8297

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

incidence of nutritional anemia in schoolchild,

students who breakfast 2-3 times a week 2,95 times

are at risk of experiencing all of them compared to

student who often breakfast. Fulfilment of nutrients,

especially iron through a variety of food intake can

reduce the risk of anemia. Breakfast is an important

thing because the nutrients consumed at night have

been converted into energy to be circulated

throughout the body. The brain requires glucose as a

source of energy for the body which is obtained at the

time of breakfast. If someone skips breakfast,

hypoglycaemia can occur, which is where the body’s

glucose level is below normal, which is characterized

by using, shaking, and having difficulty

concentrating.

Based on the description above, it is known that

the prevalence of anemia in adolescent in West Java

reaches 26,54% (Riskesdas,2018). In Addition, a

similar study was also conducted by Sari et al in 2018

which stated that 11,68% of adolescent girls at SMPN

Tempuran Karawang Regency were anaemic. Several

previous studies have explained the prevalence of

anemia among adolescent girls, but there is no

evidence that explained the relationship between

factors that cause anemia, such as consumption of

iron and breakfast habit on the incidence of anemia I

adolescent girls in the West Karawang region. So, the

researcher is interested in researching further

regarding “The Relationship Between Iron

Consumption and Breakfast Habit with The Incidence

of Anemia in Adolescent Girls” which will be

conducted at SMP Negeri 6 Karawang Barat.

2 METHOD

This research is an observational study using a cross

sectional design was conducted in Maret 2022. The

sample in this study were 63 student who were still

student in 8th grade at SMP Negeri 6 Karawang

Barat. A total of 63 adolescent girl from the 10 classes

in SMP Negeri 6 Karawang Barat were selected as

subject for this study by cluster random sampling

technique.

Data was taken in this study include

antropometric data, Hb level data was taken using Hb

Diaspect Easy Touch, iron intake data consisting of

dietary intake data from iron sources and consuming

Fe supplement using a questionnaire and forms SQ-

FFQ, and breakfast habits of adolescent using a

questionnaire. To collect the data during the Covid-

19 pandemic, the researcher and respondent always

obey the health protocol in prevention Covid-19 such

as wearing masks, maintaining distances, and

washing hand with soap before entering and leaving

the SMP Negeri 6 Karawang.

The variables in this study include the dependent

variabel and independent variable. Dependent

variable was anemia status in adolescent girls.

Anemia is a condition when the body experiences a

decrease in haemoglobin levels based on age and

gender groups. Haemoglobin or red blood cells have

a role in carrying oxygen and nutrients to the brain a

throughout the body. Anemia causes the blood to be

unable to transport and bind oxygen from the lungs to

the rest of the body, causing the body to tire easily so

it will interfere with daily activities (Muhayati &

Ratnawati, 2019). Anemia status was measured by

taking the blood by laboratory analysis to assess Hb

level by Hb Diaspect Easy Touch. Respondents were

categorized anemia if Hb level <11 g/dl and normal if

Hb level 11 g/dl. The independent variable were iron

(Fe) consumption and dietary habits using

questionnaire and forms SQ-FFQ. In this study, the

data was edited, entry an analysed by univariate and

bivariate using SPSS software. Then the data will be

analysed by using the chi-square test.

Data collection was carried out by means of the

respondent reading the agreement text to become a

respondent then the respondent signed the agreement,

after that, anthropometric measurements were carried

out to obtain data on the weight and height of the

respondent. To Hb checking, the researcher firs

confirmed to the respondents would do a Hb check

using Hb diaspecct Easy Touch. After that,

respondents will be interviewed regarding their

breakfast habits and iron consumption using a

questionnaire and forms SQ-FFQ.

3 RESULT AND DISCUSSION

Respondent Characteristics

The majority of adolescent girl at SMP Negeri 6

Karawang barat are 15 years old (77,8%). The

respondents were in the age range of 14-17 years old.

The majority of adolescent girl’s mother’s education

at SMP Negeri 6 Karawang Barat is in the high school

category (34,9%). Then in the category of mother’s

work, the majority work as housewives (92,1%)

compared to working mothers (7,9%).

Prevalence of Anemia

From a total of 63 students participated in this study,

42 (66,7%) respondents had anemia. Based on the

results of Hb measurements that have been carried out

using the Hb Diaspect Easy Touch test, it was found

that the Hb levels of adolescent girls in SMP Negeri

Relationship Between Consumption of Iron (Fe) and Breakfast Habits with the Incidence of Anemia in Adolescent Girls at SMP Negeri 6

Karawang Barat

137

6 Karawang Barat ranged from 9,5-14 g/dl with an

average Hb level of 11,1 g/dl.

Intake of Food Sources of Iron (Fe)

The majority of food intake of iron sources for

adolescent girls in SMP Negeri 6 Karawang Barat not

fulfilled (65,1%), with an average iron intake of 14,6

mg/day with a range of iron intake between 5,25-

20,70 mg/day.

Intake of Supplement Fe

The majority of adolescent girls at SMP Negeri 6

Karawang Barat did not consume Fe supplement

(79,4%) compared to those who took fe supplement

(20,6%). The average value of Fe supplement intake

was 0,81 with a range of Fe supplement intake

between 0-1 grains/week. At SMP Negeri 6

Karawang Barat there is an activity of giving Fe

supplement from the health centre. The health centre

gives Fe supplement of “Ferrous Fumarate Folic

Acid”, each student is given 4 tablets every month

which they explain to take 1 tablet of Fe

supplement/week.

Breakfast Habits

The majority of adolescent girls at SMP Negeri 6

Karawang Barat are adolescent who do not obey

breakfast (52,4%) at least <5 times a week and get an

average intake of 123,9 kcal with ideal intake

breakfast of 300-600 kcal or supply 15-25% of daily

needs.

Table 1: Distribution of Adolescent Girls based on Characteristics.

Variable Category n % Median Min-Max SD

Age 15.00 14-17 0,503

4,8

77,8

15,9

1,6

Total 63 100

Mother’s Education

Not In School 2 3,2

SMP

SMA

SMK

14,3

33,3

34,9

3,2

6,3

1,6

Total 63 100

Mother’s Work

Laundry Worker 1 1,6

Housewives 58 92,1

Trader 1 1,6

Private Employee 1 1,6

Self-employed 1 1,6

Businessman 1 1,6

Total 63 100

Table 2: Distribution of Adolescent Girls Based on Hb Level Intake of Food Sources of Iron (Fe).

Variable Category n % Mean Median Min-Max SD

Hb Value 11,1 10,8 9,5-14 1,030

Not In Anemia 21 33,3

Anemia 42 66,7

Total

63 100

ICSDH 2022 - The International Conference on Social Determinants of Health

138

Table 3: Distribution of Adolescent Girls Based on Intake of Food Sources of Iron.

Variable Category n % Mean Min-Max SD

Intake of Food

Sources of Iron

14,6 5,25-20,70 2,966

Not Filled (<15 mg/dl) 41 65,1

Fille

22 34,9

Total

63 100

Table 4: Distribution of Adolescent Girls Based on Intake of Supplement Fe.

Variable Category n % Mean Min-Max SD

Intake of Supplement Fe 0,81 0 - 1 0,396

No 50 79,4

Yes 13 20,6

Total

63 100

Table 5: Distribution of Adolescent Girls Based on Breakfast Habits.

Variable Category n % Mean Min-Max SD

Breakfast Habit 123,9 0-392 0,503

No Breakfast 33 52,4

Breakfast 30 47,6

Total

63 100

The Relationship between Consumption of Food

Sources of Iron with the Incidence of Anemia in

Adolescent Girls

It’s known that the majority of respondents who

experience anemia are found in respondents whose

body iron need are not filled as many as 41 person

(100%), while respondents who experience anemia

with iron intake are filled as many as 1 person (4,5%).

Then, the majority of normal respondents were found

in respondents whose iron intake was filled as many

as 21 people (95,5%). Based on the result of the

Pearson chi-square test, a p-value off 0,000 was

obtained (p-value <0,005) which indicates that there

is a significant relationship between the consumption

of food sources of iron and the incidence of anemia in

adolescent girls at SMP Negeri 6 Karawang Barat.

Table 6: The Relationship Between Consumption of Food

Sources of Iron with The Incidence of Anemia.

Konsumsi

Zat Besi

(Fe)

Anemia Status

Total

Value

Anemia Normal

(

)

(

)

(

)

Not Filled

(100%)

0 (0,0%) 41 (100%)

0,000

Fille

(

4,5%

)

(

95,5%

)

(

100%

)

The Relationship Between Consumption of

Supplement Fe with The Incidence of Anemia in

Adolescent Girls

It’s known that the majority of respondents who

experience anemia are found in respondents whose do

not consume supplement Fe as many as 37 person

(74%), while respondents who experience anemia

whose consume supplement Fe as many as 5 people

(38,5%). Based on the result the person chi-square

test, a p-value off 0,023 was obtained (p-value

<0,005) which indicates that there is a significant

relationship between the consumption of supplement

Fe and the incidence of anemia in adolescent girls at

SMP Negeri 6 Karawang Barat.

Table 7: The Relationship Between Consumption

Supplement Fe with The Incidences of Anemia.

Consumption

Supplement

Anemia Status

Total

Value

Anemia Normal

(

)

(

)

(

)

Yes 5 (38,5%)

(

61,5%

)

(

100%

)

0,023

No 37 (74,0%)

(26,0%)

(100%)

The Relationship Between Breakfast Habit with

The Incidence of Anemia in Adolescent Girls

Its known that 26 person (78,8%) respondents who

experience anemia are found in respondents whose

don’t do breakfast, while respondents who experience

anemia whose do breakfast as many as 16 person

(53,3%). Then, 14 people (46,7%) normal respodents

were found in respondents whose do breakfast. Based

on the result of the pearson chi-square test, a p-value

off 0,060 was obtained (p-vlue0,005) which indicates

that there is no significant relationship between

breakfast habit and the incidence of anemia in

adolescent girls at SMP Negeri 6 Karawang Barat.

Relationship Between Consumption of Iron (Fe) and Breakfast Habits with the Incidence of Anemia in Adolescent Girls at SMP Negeri 6

Karawang Barat

139

Table 8: The Relationship of Breakfast Habit with the

Incidences of Anemia.

Breakfast

Habit

Anemia Status Total P

Value

Anemia Normal n %

n % n %

Breakfast 16 53,3 14 46,7 30 100

Breakfast

26 78,8 7 21,2 33 100 0,060

Anemia in adolescents is one of the nutritional

problems in the world, which is characterized by Hb

levels below normal. In this study, it was found that

the prevalence of anemia among adolescent girls at

SMP Negeri 6 Karawang Barat was 66,7%. This is

obtained from the data from Hb measurement carried

out by researchers using the Hb Diaspect Easy Touch,

the results show that the Hb levels of adolescent girls

at SMP Negeri 6 Karawang Barat ranged from 9,5-14

g/dl with an average value of Hb levels of 11,1 g/dl.

One of the factors that causes anemia in

adolescent girls is the consumption pattern of food

sources of iron. This study it was found that 41

adolescent girls at SMP Negeri 6 Karawang Barat

have a low intake of food sources of iron, with a p-

value 0,000 which means there is a significant

relationship between intake of food sources of iron

and the incidence of anemia. This study is like the

results of study conducted by Helda (2017) which

found that 60,4% of adolescent girls at an integrated

Islamic high school in Yogyakarta experienced all

and 66,7% had low iron intake. The result of this

study is due to the consumption patterns of adolescent

girls where they prefer fast food which causes

nutritional needs especially iron to beless fulfilled,

and many of the adolescent girls in SMP Negeri 6

Karawang Barat do not like and rarely consume fruits

and vegetables.

Deficiency of iron in the body is also one of the

causes of anemia in adolescent girls. Iron is the most

important component in the formation of red blood

cells in the bone marrow and affects Hb levels in the

body. This study was found that 74,0% of adolescent

girls experience anemia due to not consume iron

supplement, with a p-value of 0,023 which mean that

is a significant relationship girl. This is like the study

by Putra Kristian Adi et al (2020), where in this study

there was a relationship between consumption of iron

supplement and the incidence of anemia in adolescent

girls. The existence of this relationship of this study

is because respondents are less interested in taking Fe

supplement due to several factors, one of which is

fear of the side effects that occur after consuming Fe

supplement such as nausea and among them some are

not allowed by their parents to consume Fe

supplements which are prescribed by their parents

provide by the program held at the school.

The next factor that causes anemia in adolescent

is breakfast habits. The majority of adolescent girls at

SMP Negeri 6 Karawang Barat it was found that

52,4% of them did not have breakfast before doing

activities at school. This study found as many as

78,8% of adolescent girls experience anemia due to

not having breakfast, whit a p-value of 0,060 which

mean there is no significant relationship between

breakfast habits and the incidence of anemia. This is

similar to Jiwaning Basuki (2019) where based on the

p-value they got was 0,167 which the value was >0,05

which means there is no significant relationship

between breakfast habits and haemoglobin levels,

which means there is no relationship with the

incidence of anemia. There is no relationship in this

category because of them not have breakfast. Some of

them we have mother who work, so often do not have

time to prepare breakfast for their family at home.

Some of them also have reason that they are not used

to breakfast because they are worried that they will

feel stomachache after breakfast, so they prefer to eat

during the first break.

4 CONCLUSIONS

1. Majority of adolescent girls at SMP Negeri 6

Karawang Barat are 15 years old (77,8%). As

many as 38,1% of respondent’s mothers have a

high school education, and 92,1 of respondent’s

mothers work as housewives.

2. The prevalence of anemia in SMP Negeri 6

Karawang Barat was found 66,7% of adolescent

girls experiencing anemia with an average Hb

level of 11,1 g/dl.

3. 65,1% of the intake of food sources of iron for

adolescent girls in SMP Negeri 6 Karawang

Barat is in the low category with an average

intake of 14,6 mg/day.

4. 79,4% of adolescent girls in SMP Negeri 6

Karawang Barat do not comply with taking Fe

supplements given by health workers at schools

and health centres.

5. There was a significant association between

consumption of food sources of iron with the

incidence of anemia among adolescent girls

6. There was a significant association between

consumption of supplement Fe with the

incidence of anemia among adolescent girls.

ICSDH 2022 - The International Conference on Social Determinants of Health

140

7. There is no significant relationship between

breakfast habits and the incidence of anemia

among adolescent girls.

It should be attention for adolescent girls, it is

better to pay more attention to the daily nutritional

needs especially iron, by paying attention and

consuming foods that are a source of iron like beans,

red meat, and egg. Do not forget also to pay attention

to the inhibitors and substances that help the

absorption of iron in the body. And for the health

workers around to provide counseling about anemia

in adolescent girls, so that adolescent know more

about the causes and effects of anemia.

ACKNOWLEDGEMENTS

The research would like to thank to the principal,

school curriculum and teachers of SMP Negeri 6

Karawang Barat for allowing researhers to do

research in SMP Negeri 6 Karawang Barat. Thanks

also to the enumerators who helped complete the

research. Especially thank you for the students of

SMP Negeri 6 Karawang Barat who are willing to be

respondents in this research.

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Karawang Barat

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