Association of Protein Intake with Anemia among Adolescent Girls in Indonesia: A Systematic Review

  • Adita Puspitasari Swastya Putri Doctoral Program of Public Health, Public Health Faculty, Universitas Diponegoro, Semarang, Central Java, Indonesia
  • Mateus Sakundarno Adi Public Health Faculty, Universitas Diponegoro, Semarang, Central Java, Indonesia
  • Suhartono Suhartono Public Health Faculty, Universitas Diponegoro, Semarang, Central Java, Indonesia
  • Nurjazuli Nurjazuli Public Health Faculty, Universitas Diponegoro, Semarang, Central Java, Indonesia
DOI: https://doi.org/10.56338/mppki.v9i8.10229
Keywords: Anemia, Protein Intake, Haemoglobin, Adolescent Girls, Systematic Review

Abstract

Introduction: Anemia remains highly prevalent among adolescent girls. Protein intake influence haemoglobin synthesis, iron transport, and overall diet quality. However, evidence regarding the association between protein intake and anemia remains inconsistent. The aim of this study was to examine the association between protein intake and anemia among adolescent girls in Indonesia.

Methods: A systematic review was undertaken with the PRISMA. The literature searched in PubMed, Embase, Scopus, Web of Science and Google Scholar from inception to August 2025. The search used the keywords related to anemia, protein intake, and adolescents. Eligible studies included Indonesian adolescent girls aged 10–19 years that assessed dietary protein intake and reported anemia-related outcomes, including haemoglobin concentration, or iron status indicators such as ferritin or haematocrit. Data were extracted on study characteristics, exposure and outcome assessment, and key findings. Risk of bias was appraised using established checklists corresponding to each included study.

Results: Eighteen studies (2016–2025) met the inclusion criteria. The included studies showed inconsistent findings regarding the association between protein intake and anemia among adolescent girls. Overall, inadequate protein intake tended to be associated with lower haemoglobin levels and higher anemia risk. However, the association became weaker or non-significant after adjustment for iron intake, menstrual characteristics, and other potential confounding factors.

Conclusion: Protein intake appears to be associated with anemia among adolescent girls in Indonesia, particularly when accompanied by adequate iron and micronutrient intake. However, further research using longitudinal and intervention designs are needed to disentangle the specific role of protein intake from other major determinants of anemia.

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References

  1. Gardner WM, Razo C, McHugh TA, Hagins H, Vilchis-Tella VM, Hennessy C, et al. Prevalence, Years Lived with Disability, and Trends in Anaemia Burden by Severity and Cause, 1990–2021: Findings from the Global Burden of Disease Study 2021. Lancet Haematol. 2023;10(9): e713–34. https://doi.org/10.1016/S2352-3026(23)00160-6
  2. Tesfaye M, Yemane T, Adisu W, Asres Y, Gedefaw L. Anemia and Iron Deficiency among School Adolescents: Burden, Severity, and Determinant Factors in Southwest Ethiopia. Adolesc Health Med Ther. 2015; 6:189–96. https://doi.org/10.2147/ahmt.s94865
  3. Suprapti E, Hadju V, Ibrahim E, Indriasari R, Erika KA, Balqis B. Anemia: Etiology, Pathophysiology, Impact, and Prevention: A Review. Iran J Public Health. 2025;54(3):509–20. https://doi.org/10.18502/ijph.v54i3.18244
  4. Jáuregui-Lobera I. Iron Deficiency and Cognitive Functions. Neuropsychiatr Dis Treat. 2014;10:2087–95. https://doi.org/10.2147/NDT.S72491
  5. Yang J, Li Q, Feng Y, Zeng Y. Iron Deficiency and Iron Deficiency Anemia: Potential Risk Factors in Bone Loss. Int J Mol Sci. 2023;24(6891):1–20. https://doi.org/0.3390/ijms24086891
  6. Lubis MM, Azzahra S, Apriningsih A. Determinants of Anemia among Adolescent Girls: A Systematic Literature Review. Jurnal Kesmas Jambi. 2026;10(1):1–9. https://doi.org/10.22437/jkmj.v10i1.53616
  7. Knutson MD. Iron transport proteins: Gateways of Cellular and Systemic Iron Homeostasis. Journal of Biological Chemistry. 2017;292(31):12735–43. https://doi.org/10.1074/jbc.R117.786632
  8. Sheffield S, Fiorotto ML, Davis TA. Nutritional Importance of Animal-Sourced Foods in a Healthy Diet. Front Nutr. 2024;11(1424912):1–6. https://doi.org/10.3389/fnut.2024.1424912
  9. Suarjana IM, Nursanyoto H, Dewi NNA. Protein and Iron Bioavailability, Perception, Menstrual Cycle as Adolescent Girls Anemia Factors. Journal of Health and Medical Sciences. 2021;4(2):84–93. https://doi.org/10.31014/aior.1994.04.02.159
  10. Li H, Moosavian SP, Ghanbari N, Mirlohi SH, Rahimlou M. Association of Dietary Diversity and Odds of Anemia in Children and Adolescents: A Systematic Review and Meta-Analysis of Observational Studies. BMC Nutr. 2025;11(83):1–16. https://doi.org/10.1186/s40795-025-01069-3
  11. Takyi SA, Arko-Mensah J, Basu N, Bawuah S, Dwomoh D, Fobil JN. Iron and Protein Rich Diets May Boost Hemoglobin Levels among Informal Electronic Waste Recyclers Exposed to Metals at Agbogbloshie, Ghana. Hygiene and Environmental Health Advances. 2023;8(1):1–31. https://doi.org/10.1016/j.heha.2023.100073
  12. Tateishi Y, Toyoda S, Murakami H, Uchida R, Ichikawa R, Kikuchi T, et al. A Short-Term Intervention of Ingesting Iron along with Methionine and Threonine Leads to a Higher Hemoglobin Level than that with Iron Alone in Young Healthy Women: A Randomized, Double-Blind, Parallel-Group, Comparative Study. Eur J Nutr. 2023;62(7):3009–19. https://doi.org/10.1007/s00394-023-03213-w
  13. Kitamura N, Yokoyama Y, Taoka H, Nagano U, Hosoda S, Taworntawat T, et al. Iron Supplementation Regulates the Progression of High Fat Diet Induced Obesity and Hepatic Steatosis via Mitochondrial Signaling Pathways. Sci Rep. 2021;11(10753):1–7. https://doi.org/10.1038/s41598-021-89673-8
  14. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An Updated Guideline for Reporting Systematic Reviews. BMJ. 2021;372(n71):1–8. https://doi.org/10.1136/bmj.n71
  15. Hidayanti L, Murwani R. Dietary Patterns and Haemoglobin Levels in Female Adolescents Living in Boarding Schools in Tasikmalaya City, Indonesia. Malays J Nutr. 2025;31(2):215–27. https://doi.org/10.31246/mjn-2024-0127
  16. Widiasta A, Ayuningtyas TR, Megawati G. Relationship Between Total Protein and Energy Consumption and Hemoglobin Levels in Adolescents with High Body Mass Index. European Journal of Medical and Health Research. 2025;3(3):206–10. https://doi.org/10.59324/ejmhr.2025.3(3).30
  17. Fauziyah NAM, Hadi H, Afifah E, Aji AS. Analysis of Determinant Factors for Anaemia Status among Adolescent Girls in Cigalontang Sub-District, Tasikmalaya District, Indonesia. Univers J Public Health. 2024;12(4):766–73. https://doi.org/10.13189/ujph.2024.120416
  18. Abby SO, Arini FA, Sufyan DL, Ilmi IMB. The Relationship between the Compliance of TTD Consumption, Nutrition Intake, and Nutrition Status on the Incidence of Anemia in Adolescent Girls at SMPN 1 Gunungsari. Amerta Nutrition. 2023;7(2SP):213–23. https://doi.org/10.20473/amnt.v7i2SP.2023.213-223
  19. Handayani WD, Suryani D. Relationship Supplement Consumption, Protein and Tannin Intake with Anemia Condition in Adolescent Girls at SMP Negeri 19 Bengkulu. B-ICON Proceeding. 2023;409–22. https://doi.org/10.33088/bicon.v2i1.202
  20. Jumiyati, W TW, Krisnasary A, Yulianti R. Anemia Among Adolescent Girls: Its Association with Protein and Iron Intake. National Nutrition Journal. 2023;18(1SP):14–20. https://doi.org/10.20473/mgi.v18i1SP.14-20
  21. Lestari DT, Khomsan A, Anwar F, Damayanti DS. Protein Intake and Menstruation with Anemia Status in Young Women based on Economic Status in Cianjur District. Al Gizzai Public Health Nutrition Journal. 2022;2(2):75–84. https://doi.org/10.24252/algizzai.v%vi%i.26002
  22. Sari P, Herawati DMD, Dhamayanti M, Hilmanto D. Anemia among Adolescent Girls in West Java, Indonesia: Related Factors and Consequences on the Quality of Life. Nutrients. 2022;14(3777):1–13. https://doi.org/10.3390/nu14183777
  23. Baha MH, Patimah S, Sumiaty S, Gobel FA, Nurlinda A. Hubungan Konsumsi Zat Besi, Protein, Vitamin C dengan Kejadian Anemia Remaja Putri Kabupaten Majene. Window of Public Health Journal. 2021;2(4):657–69. https://doi.org/10.33096/woph.v2i4.258
  24. Fithria F, Junaid J, Sarmin WOS. Hubungan antara Asupan Zat Gizi dengan Kejadian Anemia pada Remaja Putri SMA Negeri 1 Barangka Tahun 2019. Jurnal Ilmiah Mahasiswa Kesehatan Masyarakat. 2021;6(1):132–42. http://doi.org/10.37887/jimkesmas.v6i1.16342
  25. Ekasanti I, Adi AC, Yono M, G FN, Isfandiari MA. Determinants of Anemia among Early Adolescent Girls in Kendari City. Amerta Nutrition. 2020;4(4):271–9. https://doi.org/10.2473/amnt.v4i4.2020. 271-279
  26. Pratama FN, Syahadatina Noor M, Heriyani F. Hubungan Asupan Protein dan Zat Besi dengan Kejadian Anemia pada Remaja Putri di SMPN 18 Banjarmasin. Homeostasis, Jurnal Mahasiswa Pendidikan Dokter. 2020; Vol.3(No.1):43–8. https://doi.org/10.20527/ht.v3i1.2014
  27. Sholicha CA, Muniroh L. Correlation Between Intake of Iron, Protein, Vitamin C and Menstruation Pattern with Haemoglobin Concentration among Adolescent Girl in Senior High School 1 Manyar Gresik. Media Gizi Indonesia. 2019;14(2):147–53. https://doi.org/10.20473/mgi.v14i2.147-153
  28. Sholihah N, Andari S, Wirjatmadi B. Correlation between Consumption Level of Protein, Vitamin C, Iron and Folic Acid with Anemia among Female Teenagers at SMAN 4 Surabaya. Amerta Nutrition. 2019;3(3):135–41. https://doi.org/10.2473/amnt.v3i3.2019.135-141
  29. Silvia A, Kartini A, Nugraheni SA. Hubungan Asupan Zat Gizi (Protein, Zat Besi, Vitamin C) dan Pola (Siklus, Lama) Menstruasi dengan Kadar Hemoglobin (Studi pada Remaja Putri di SMK Negeri 10 Semarang). Jurnal Kesehatan Masyarakat. 2019;7(4):504–16. https://doi.org/10.14710/jkm.v7i4.24867
  30. Khasanah U, Maryanto S, Purbowati. The Corelation Between the Intake of Protein, Vitamin C and URI with High Levels of Anemia in Adolescents at Sosial Services Unit for Children “Wira Adhi Karya” Ungaran. Jurnal Gizi dan Kesehatan. 2019;9(22):109–16. Available from: https://jurnalgizi.unw.ac.id/index.php/JGK/article/view/196
  31. Lewa AbdF. Hubungan Asupan Protein, Zat Besi dan Vitamin C dengan Kejadian Anemia pada Remaja Putri di MAN 2 Model Palu. Publikasi Kesehatan Masyarakat Indonesia. 2016;3(1):26–31. https://doi.org/10.20527/jpkmi.v3i1.2736
  32. Restuti AN, Susindra Y. Hubungan antara Asupan Zat Gizi dan Status Gizi dengan Kejadian Anemia pada Remaja Putri di SMK Mahfilud Durror II Jelbuk. 2016;74–80. https://doi.org/10.25047/jii.v16i3.305
  33. Takeuchi H, Kawashima R. A Prospective Study on the Relationship between Iron Supplement Intake, Hemoglobin Concentration, and Risk of Parkinsonism. Nutrients. 2022;14(4671):1–13. https://doi.org/10.3390/nu14214671
  34. Paramastri R, Hsu CY, Lee HA, Lin LY, Kurniawan AL, Chao JCJ. 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;18(3438):1–15. https://doi.org/10.3390/ijerph18073438
  35. Semba RD, Trehan I, Gonzalez-Freire M, Kraemer K, Moaddel R, Ordiz MI, et al. Perspective: The Potential Role of Essential Amino Acids and the Mechanistic Target of Rapamycin Complex 1 (mTORC1) Pathway in the Pathogenesis of Child Stunting. Advances in Nutrition. 2016;7(5):853–65. https://doi.org/10.3945/an.116.013276
  36. Zutphen KG van, Kraemer K, Melse-Boonstra A. Knowledge Gaps in Understanding the Etiology of Anemia in Indonesian Adolescents. Food Nutr Bull. 2021;42(1_suppl): S39–58. https://doi.org/10.1177/0379572120979241
  37. Yewodiaw TK, Alemayehu MA, Teshome DF. Anemia Status and Associated Factors among Adolescent Girls Under Weekly Iron and Folic Acid Supplementation (WIFAS) and non-WIFAS Programs in Public Schools in Janamora District, Northwest Ethiopia 2023: A Comparative Cross-Sectional Study. BMC Nutr. 2025;11(50):1–13. https://doi.org/10.1186/s40795-025-01033-1
  38. Rahmatina A, Ghozali M, Adnani Q, Hilmanto D, Zuhairini Y, Susiarno H, et al. A Scoping Review of Nutritional Intake and Physical Activity in Adolescent Girls with Anemia. Int J Womens Health. 2025; 17:2891–907. https://doi.org/10.2147/IJWH.S519269
Published
2026-08-19
How to Cite
Putri, A. P. S., Adi, M. S., Suhartono, S., & Nurjazuli, N. (2026). Association of Protein Intake with Anemia among Adolescent Girls in Indonesia: A Systematic Review. Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 9(8), 1646-1656. https://doi.org/10.56338/mppki.v9i8.10229
Issue
Vol. 9 No. 8 (2026)
Section
Review Article

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