skip to main content

Dietary patterns and menstrual cycle: incidence of anemia in female adolescents in Bondowoso Regency

11Nutrition Study Program, Faculty of Public Health, University of Jember, Jember, East Java, Indonesia

2Public Health Study Program, Faculty of Public Health, University of Jember, Jember, East Java, Indonesia

Received: 24 Jan 2025; Revised: 28 Aug 2025; Accepted: 9 Apr 2026; Available online: 30 Jun 2026; Published: 30 Jun 2026.

Citation Format:
Abstract

ABSTRACT

Background: Anemia is one of the three significant nutritional burdens being addressed in Indonesia. The risk of anemia in female adolescents is ten times higher than in male adolescents because female adolescents are menstruating. Most causes of anemia include protein, iron, and vitamin C deficiencies, as well as irregular menstrual cycles.

Objective: This study aims to analyze the correlation between dietary patterns, the menstrual cycle, and the incidence of anemia among female adolescents at Bondowoso Vocational High School 1.

Materials and Methods: This study used a cross-sectional design with a sample of 116 female adolescents aged 15–18 at Bondowoso Vocational High School 1, selected through simple random sampling. Interviews were conducted with respondents who completed observation sheets on their menstrual cycles and diets using the SQ-FFQ form. Hemoglobin levels were measured using a digital hemoglobin check tool, and researchers collaborated with healthcare professionals authorized to perform hemoglobin level tests. The analyses used were univariate and bivariate, with the chi-square test and Fisher's Exact test.

Results: The study showed that protein intake was insufficient (78.4%), while iron intake (74.1%) and vitamin C intake (71.6%) were sufficient. And there was no correlation between protein intake and the incidence of anemia (OR = 1.855 (CI 95% = 0.772 – 4.452; p-value 0.443). The menstrual cycle and anemia showed a significant correlation (OR = 2.489 (CI 95% = 1.053 – 5.883; p-value 0.035). Iron intake and anemia showed a significant correlation (OR = 2.888 (CI 95% = 1.204 – 6.923; p-value 0.015), and vitamin C intake also showed a correlation with anemia ( OR = 2.807 (CI 95% = 1.193 – 6.603; p-value 0.016).

Conclusion: Iron intake, vitamin C, and the menstrual cycle are related to the incidence of anemia. Monitoring and evaluation of regular iron and folic acid supplementation, emphasizing socialization about the “Aksi Bergizi Program” nutrition action programs through balanced nutrition, and building social support schemes for reproductive health among female adolescents are necessary.

Keywords: Anemia; dietary habit; female adolescent; menstrual cycle

Keywords: Anemia; dietary habit; female adolescent; menstrual cycle

Article Metrics:

  1. Rah JH, Melse-Boonstra A, Agustina R, van Zutphen KG, Kraemer K. The Triple Burden of Malnutrition Among Adolescents in Indonesia. Food and Nutrition Bulletin. 2021;42(1_suppl):S4–8.doi: 10.1177/03795721211007114
  2. Rita Sari M. Hubungan Pola Menstruasi Dan Status Gizi dengan Kejadian Anemia pada Remaja Putri di SMA Negeri 2 Tembilahan. Jurnal Kesehatan Mercusuar. 2020;3(1):28–36. https://doi.org/10.36984/jkm.v3i1.81
  3. Organization WH. Anaemia in women and children [Internet]. World Health Organization. 2023. Available from: https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children
  4. Shah R, Tata LJ, Fogarty A, Lemanska A, Kabra P, Ahankari A. Prevalence and Risk Factors Associated With Anemia in Adolescent Females From Rural Maharashtra, India: Findings From the MAS 2 Project. Anemia. 2025;2025(1).doi: 10.1155/anem/7015604
  5. 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. Clinical Epidemiology and Global Health. 2024;25(September 2023):101500. https://doi.org/10.1016/j.cegh.2023.101500
  6. Bonnie RJ, Backes EP. The Promise of Adolescence. The Promise of Adolescence. 2019
  7. 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(18):1–13. doi: 10.3390/nu14183777
  8. Mosiño A, Villagómez-Estrada KP, Prieto-Patrón A. Association between school performance and anemia in adolescents in mexico. International Journal of Environmental Research and Public Health. 2020;17(5).doi: 10.3390/ijerph17051466
  9. Tursina E, Adhimukti F. The Effect of Maternal Anemia on Low Birth Weight: Meta Analysis. Journal of Epidemiology and Public Health. 2022;7(2):175–86. https://doi.org/10.26911/jepublichealth.2022.07.02.03
  10. Lee JM. Time to pay attention to anemia in female adolescents. Clinical and Experimental Pediatrics. 2021;64(2):78–9.doi: 10.3345/cep.2020.02117
  11. Syah MNH, Novianti H, Asna AF, Perdana SM. Studi Kepatuhan Konsumsi Tablet Tambah Darah (Ttd) Dan Asupan Zat Gizi Terkait Anemia Pada Siswa Perempuan Di Sekolah Menengah Kejuruan (Smk) Kota Bekasi, Indonesia. Media Gizi Mikro Indonesia. 2022;13(2):105–16.DOI: 10.22435/mgmi.v13i2.5156
  12. Hikmah Y, Supriatiningrum DN, Rahma A. Hubungan Pola Makan dan Status Gizi terhadap Kadar Hemoglobin Mahasiswi Fakultas Kesehatan Universitas Muhammadiyah Gresik. Ghidza Media Journal. 2023;4(2):161. https://doi.org/10.30587/ghidzamediajurnal.v4i2.4629
  13. Agustina R, Wirawan F, Sadariskar AA, Setianingsing AA, Nadiya K, Prafiantini E, et al. Associations of Knowledge, Attitude, and Practices toward Anemia with Anemia Prevalence and Height-for-Age Z-Score among Indonesian Adolescent Girls. Food and Nutrition Bulletin. 2021;42(1_suppl):S92–108.doi: 10.1177/03795721211011136
  14. Bodega P, de Cos-Gandoy A, Fernández-Alvira JM, Fernández-Jiménez R, Moreno LA, Santos-Beneit G. Body image and dietary habits in adolescents: a systematic review. Nutrition Review. 2024;82(1):104–27.doi: 10.1093/nutrit/nuad044
  15. Tort-Nasarre G, Pocallet MP, Artigues-Barberà E. The meaning and factors that influence the concept of body image: Systematic review and meta-ethnography from the perspectives of adolescents. International Journal of Environmental Research and Public Health. 2021;18(3):1–16. doi: 10.3390/ijerph18031140
  16. Kocaoz S, Cirpan R, Degirmencioglu AZ. The prevalence and impacts heavy menstrual bleeding on anemia, fatigue and quality of life in women of reproductive age. Pakistan Journal of Medical Science. 2019;35(2):365–70.doi: 10.12669/pjms.35.2.644
  17. Nofianti IGATP, Juliasih NK, Wahyudi IWG. Hubungan Siklus Menstruasi Dengan Kejadian Anemia Remaja Putri Di SMP Negeri 2 Kerambitan Kabupaten Tabanan. Jurnal Widya Biologi. 2021;12(01):58–66.DOI: 10.32795/widyabiologi.v12i01.1324
  18. Ilham, M. Arifin, S. Nurul, H. Syahrul et al. Gangguan Siklus Menstruasi Remaja. Jurnal Penelitian Perawat Profesional. 2023;5:185–92. DOI: https://doi.org/10.37287/jppp.v5i1.1385
  19. Wati E, Sistiarani C, Rahardjo S. Diet behavior and consumption of iron inhibitors: Incidence anemia in adolescent girls. Journal of Public Health in Africa. 2023;14(12):6. doi: 10.4081/jphia.2023.2593
  20. Chandrakumari AS, Sinha P, Singaravelu S, S J. Prevalence of Anemia Among Adolescent Girls in a Rural Area of Tamil Nadu, India. Journal of Family Medicine and Primary Care. 2019;8(4):1414–7.doi: 10.4103/jfmpc.jfmpc_140_19
  21. Anisa A, Ayuningtyas RA, Jauharany FF, Isworo JT. Relationship between Body Image and Adequacy of Iron Intake with Hemoglobin Levels in Adolescent Females. Jurnal Gizi dan Pangan. 2023;18(Supp.1):16–8. https://doi.org/10.25182/jgp.2023.18.Supp.1.16-18
  22. Puspitasari HZG, Armini NKA, Pradanie R, Triharini M. Anemia prevention behavior in female adolescents and related factors based on Theory of Planned Behavior: A cross-sectional study. Jurnal Ners. 2022;17(1):25–30. https://doi.org/10.20473/jn.v17i1.27744
  23. Bondowoso DKK. Data Hasil Skrining Anemia Remaja Putri Kabupaten Bondowoso Kelas 7 dan Kelas 10 (TA 2022/2023). 2023
  24. Fauziyah SH, Rahayu NS. Faktor-faktor Yang Berhubungan Dengan Status Anemia Pada Remaja Putri di Kampung Cariu Tangerang. ARGRIPA (Arsip Gizi dan Pangan). 2021;6(1):21–32.DOI: 10.22236/argipa.v6i1.6502
  25. Pibriyanti K, Nufus NT, Luthfiya L. The Relationship of Menstrual Cycle, Menstrual Length, Frequency of Menstruation, and Physical Activities with The Incidence of Anemia in Adolescents Girl at Islamic Boarding School. Journal of Nutrition College. 2021;10(2):112–9. DOI: https://doi.org/10.14710/jnc.v10i2.29855
  26. Yadav K, Kant S, Ramaswamy G, Ahamed F, Vohra K. Digital Hemoglobinometers as Point-of-Care Testing Devices for Hemoglobin Estimation: A Validation Study from India. Indian Journal of Community Medicine. 2020;45(4):506–10. doi: 10.4103/ijcm.IJCM_558_19
  27. Mykolayivna NI, Adebusoye FT, Awuah WA, Anatoliivna SA, Volodymyrivna BT, Fedorivna HS, et al. Stress-induced menstrual disorders in adolescents during the Ukrainian war: cross-sectional study. Annals of Medicine and Surgery. 2023;85(7):3428–33.doi: 10.1097/MS9.0000000000000974
  28. Yoon Y, Eisenstadt M, Lereya ST, Deighton J. Gender difference in the change of adolescents’ mental health and subjective wellbeing trajectories. European Child & Adolescent Psychiatry. 2023;32(9):1569–78. Available from: https://doi.org/10.1007/s00787-022-01961-4
  29. Mardalena I. Dasar-dasar Ilmu Gizi Dalam Keperawatan. Pustaka Baru Press. 2021;1–256
  30. Agustina R, Nadiya K, El Andini A, Setianingsih AA, Sadariskar AA, Prafiantini E, et al. Associations of meal patterning, dietary quality and diversity with anemia and overweight-obesity among Indonesian schoolgoing adolescent girls in West Java. PLoS One. 2020;15(4):1–19. Available from: http://dx.doi.org/10.1371/journal.pone.0231519
  31. Agustini Purnama NL. Perilaku Makan Dan Status Gizi Remaja. Jurnal Penelitian Kesehatan. 2019;9(2):57–62. https://doi.org/10.54040/jpk.v9i2.172
  32. Kementerian Kesehatan Indonesia. Tabel Komposisi Pangan Indonesia. Tabel Komposisi Pangan Indonesia. 2018. 135 p
  33. Putri MP, Dary D, Mangalik G. Putri, M. P., Dary, D., & Mangalik, G. (2022). Asupan Protein, Zat Besi Dan Status Gizi Pada Remaja Putri. Journal of Nutrition College, 11(1), 6–17. https://doi.org/10.14710/jnc.v11i1.31645Asupan Protein, Zat Besi Dan Status Gizi Pada Remaja Putri. Journal of Nutrition College. 2022;11(1):6–17.
  34. Skolmowska D, Głąbska D. Analysis of heme and non-heme iron intake and iron dietary sources in adolescent menstruating females in a national Polish sample. Nutrients. 2019;11(5). doi: 10.3390/nu11051049.PMID:31083370
  35. Gallo Ruelas M, Alvarado-Gamarra G, Aramburu A, Dolores-Maldonado G, Cueva K, Rojas-Limache G, et al. A comparative analysis of heme vs non-heme iron administration: a systematic review and meta-analysis of randomized controlled trials. European Journal of Nutrition. 2025;64(1):1–21. https://doi.org/10.1007/s00394-024-03564-y
  36. Skolmowska D, Głąbska D, Kołota A, Guzek D. Effectiveness of Dietary Interventions in Prevention and Treatment of Iron-Deficiency Anemia in Pregnant Women: A Systematic Review of Randomized Controlled Trials. Nutrients. 2022;14(15):1–15. doi: 10.3390/nu14153023
  37. Kemenkes RI. Angka Kecukupan Gizi Mayarakat Indonesia. Permenkes Nomor 28 Tahun 2019. 2019;Nomor 65(879):2004–6
  38. Veronika AP, Puspitawati T, Fitriani A. Associations between nutrition knowledge, protein-energy intake and nutritional status of adolescents. Journal of Public Health Research. 2021;10(2):385–9.doi: 10.4081/jphr.2021.2239
  39. 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
  40. Waluyo D, Daud AC. Hubungan Kebiasaan Makan dengan Kejadian Anemia pada Remaja Putri di Desa Poowo Barat Kabupaten Bone Bolango. Gema Wiralodra. 2022;13(1):34–42. https://doi.org/10.31943/gemawiralodra.v13i1.221
  41. Sholicha CA, Muniroh L. Hubungan Asupan Zat Besi, Protein, Vitamon C Dan Pola Menstruasi Dengan Kadar Hemoglobin Pada Remaja Putri Di SMAN 1 Manyar Gresik. Media Gizi Indonesia. 2019;14(2):147. https://doi.org/10.20473/mgi.v14i2.147-153
  42. Paoli A, Tinsley G, Bianco A, Moro T. The influence of meal frequency and timing on health in humans: The role of fasting. Nutrients. 2019;11(4):1–19. doi: 10.3390/nu11040719
  43. Wahyurin IS, Rahmah HA. Amount of Menstrual Blood and Nutrient Intake with Hemoglobin Level. Jurnal Kesehatan Masyarakat. 2021;17(1):31–6. https://doi.org/10.15294/kemas.vi!.24540
  44. Ukey UU, Sharma SK, Chitre DS, Waghmare PR, Dabir AJ, Desai R, et al. Effect of oral vitamin C administration along with iron supplementation for treating anaemia among adolescent girls ‑ Protocol for systematic review and meta‑analysis. Journal of Family Medicine and Primary Care. 2024;13(2):537–41.doi: 10.4103/jfmpc.jfmpc_660_23
  45. Lee J. Association between Coffee and Green Tea Consumption and Iron Deficiency Anemia in Korea. Korean Journal of Family Medicine. 2023;44(2):69–70.doi: 10.4082/kjfm.44.2E
  46. Lutfiyati A, Susanti D. Hubungan Status Gizi Dengan Gangguan Siklus Menstruasi Di SMPN 1 Sleman Yogyakarta. Riset Informasi Kesehatan. 2021;10(1):18–24. https://doi.org/10.30644/rik.v10i1.514
  47. Mai Revi, Anggraini W, Warji. Hubungan Status Gizi Dengan Siklus Menstruasi Pada Siswi Sekolah Menengah Atas. Cendekia Medika Jurnal Stikes Al-Ma`arif Baturaja. 2023;8(1):123–31. https://doi.org/10.52235/cendekiamedika.v8i1.219
  48. Harahap DA, Afrinis N, Hamidi MNS. Perbedaan Konsumsi Pangan Ibu HamilAnemia dan Nonanemia di Puskesmas Tapung Hilir 1. Jurnal Kesehatan Komunitas. 2021;7(3):387–91. https://doi.org/10.25311/keskom.Vol7.Iss3.1015
  49. Arozah R, Duvita W A, Dewi R Y. Hubungan Status Gizi Asupan Fe, Asupan Protein, dan Siklus Menstruasi terhadap Kejadian Anemia pada Siswi MTs. ULIL ALBAB Jurnal Ilmiah Multidisiplin. 2023;2(11):5232–7. https://doi.org/10.56799/jim.v2i11.2335
  50. Mursyidah Halim Baha, Sitti Patimah, Sumiaty, Fatmah Afrianty Gobel, Andi Nurlinda. 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
  51. Billah SM, Ali NB, Khan ANS, Raynes-Greenow C, Kelly PJ, Siraj MS, et al. Factors influencing quality nutrition service provision at antenatal care contacts: Findings from a public health facility-based observational study in 21 districts of Bangladesh. PLoS One. 2022;17(1 January):1–18. http://dx.doi.org/10.1371/journal.pone.0262867
  52. Chalise B, Aryal KK, Mehta RK, Dhimal M, Sapkota F, Mehata S, et al. Prevalence and correlates of anemia among adolescents in Nepal: Findings from a nationally representative cross-sectional survey. PLoS One. 2018;13(12):1–11.doi: 10.1371/journal.pone.0208878
  53. Anisa Yulianti, Siti Aisyah, Sri Handayani. Faktor-Faktor yang Berhubungan dengan Anemia pada Remaja Putri. Lentera Perawat. 2024;5(1):10–7. https://doi.org/10.52235/lp.v5i1.276
  54. Qomarasari D, Mufidaturrosida A. Hubungan Status Gizi, Pola Makan Dan Siklus Menstruasi Dengan Kejadian Anemia Pada Remaja Putri Kelas VIII Di SMPN 3 Cibeber. Jurnal Ilmiah Kesehatan Ar-Rum Salatiga. 2022;6(2):43–50. https://doi.org/10.36409/jika.v6i2.150
  55. Sriwani F, Noorma N, Setyawati E, Kesehatan P, Timur K. Hubungan Siklus Menstruasi dengan Kejadian Anemia pada Remaja Putri di SMP Negeri 1 Tanjung Palas Tengah. SAINTEKES Jurnal Sains, Teknologi dan Kesehatan. 2023;2(2):534–42. https://doi.org/10.55681/saintekes.v2i4.209
  56. Wiafe MA, Ayenu J, Eli-Cophie D. A Review of the Risk Factors for Iron Deficiency Anaemia among Adolescents in Developing Countries. Anemia. 2023;Jan 3;2023:6406286.doi: 10.1155/2023/6406286
  57. Chaparro CM, S. P, Suchdev. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Annals of the New York Academy of Sciences. 2019;1450(1):15–31.doi: 10.1111/nyas.14092

Last update:

No citation recorded.

Last update: 2026-06-30 22:44:56

No citation recorded.