Research: Daily Protein Intake Effective in Reducing Anemia and Stunting

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Research: Daily Protein Intake Effective in Reducing Anemia and Stunting

By Forayya Official
10 min read
May 11, 2023, 06:40 pm

Nutritional issues are major health problems in Indonesia. The prevalence of stunting in Indonesia reaches 24.4%, which is still higher than the global average of 20%, according to the WHO. Stunting and other nutritional deficiencies that occur during the first 1,000 days of life pose risks to physical growth, increase vulnerability to diseases, raise mortality rates, and hinder cognitive development, which in turn affects intelligence and future productivity.

Early Prevention of Stunting

In the short term, stunting and malnutrition in infants contribute to increased infant mortality rates caused by asphyxia, low birth weight, and infections (Ministry of Health Indonesia, 2016). The increased risk of infant mortality is influenced by maternal factors, one of which is anemia during pregnancy (Ministry of Health Indonesia, 2016).

Anemia in pregnant women is strongly associated with maternal and infant mortality and morbidity. Pregnant women with anemia have a 3.7-times higher risk of maternal death compared to non-anemic women. If anemia is not addressed, it can cause problems for both the mother and the fetus (Ministry of Health, Indonesia, 2016). In low-income and developing countries, it is estimated that about 25–50% of deaths among women of reproductive age are due to pregnancy-related complications, childbirth, and postpartum issues (WHO, 2015). Anemia in mothers can lead to miscarriages, bleeding during delivery, postpartum hemorrhage, and increased susceptibility to infections. Anemic mothers have a nine-times higher risk of giving birth to low-birth-weight babies compared to non-anemic mothers (Rahmawaty, 2016).

Anemia is a condition characterized by a decrease in hemoglobin levels in the body. Hemoglobin is a metalloprotein that contains iron and is present in red blood cells. It functions as an oxygen transporter from the lungs to the entire body. Anemia is caused by deficiencies in iron, folate, vitamin B12, and vitamin C, all of which are rooted in inadequate or poor dietary intake and low bioavailability (Arisman, 2010). Anemia can also be influenced by the mother's nutritional status. Malnutrition during early pregnancy significantly affects embryonic development and viability, while poor nutrition in later stages of pregnancy affects fetal growth.

Demographically, adolescent girls are at a higher risk of anemia due to rapid growth and development during this period, leading to higher requirements for macro and micronutrients, especially during menstruation (Malhora, 2004). The prevalence of anemia in Indonesian adolescents is relatively high, reaching 32%, meaning that 3–4 out of 10 adolescents suffer from anemia (Riskesdas, 2018).

The Interconnection between Stunting, Anemia, and Protein

Iron-deficiency anemia is a consequence of insufficient intake of macronutrients such as carbohydrates, protein, and fats, as well as micronutrients such as vitamins and minerals (Badriah, 2011). The high prevalence of iron-deficiency anemia is usually due to low food intake, especially iron, which is a crucial component for hemoglobin synthesis.

Therefore, the greatest risk factor for the increased prevalence of anemia is nutritional status. A study conducted by Chalise et al. (2018) found that adolescents with a low body mass index (BMI) are 1.20 times more likely to experience anemia compared to those with a higher BMI. Good nutritional status for individuals, including adolescent girls, contributes to their overall health and improves the quality of their nutrition. If the nutritional status is not normal, the iron status is also affected, leading to an increased risk of anemia. Moreover, adolescence is a period of optimal physical and mental growth and activity, requiring higher nutrition to meet their dietary needs.

In addition, another important nutrient involved in hemoglobin formation is protein. Protein functions as an oxygen carrier in the blood and binds with hemoglobin to optimize the absorption of iron in the body (Ekasanti et al., 2020). Insufficient protein intake can affect the levels of iron in the body. A study conducted by Rudolf and Djendra (2019) in North Sulawesi showed a significant relationship between protein consumption, dietary patterns, and the risk of anemia among adolescent girls.

Unfortunately, a survey conducted by the Give Protein Initiative among 5,930 adolescent girls across Indonesia revealed that 54% of them experience protein deficiency and 56.4% suffer from iron deficiency (Protein Meter, 2022).

Furthermore, the lack of protein and iron consumption is associated with poor dietary patterns among adolescent girls, leading to deficiencies in macronutrients such as carbohydrates (55.5%), fats (45%), and energy (42.5%). Adolescent girls commonly have unhealthy eating habits, such as skipping breakfast, having inadequate water intake, following improper diets to achieve a slim figure by neglecting the consumption of protein, carbohydrates, vitamins, and minerals, consuming low-nutrient snacks, and having a preference for fast food. As a result, adolescents are unable to meet the diverse nutritional needs required by the body for hemoglobin synthesis. When this persists for a long period, hemoglobin levels continue to decline, leading to anemia, especially during reproductive phases or pregnancy (Massawe, 2002).

Economic and Nutritional Education Factors

Socio-economic factors such as education and income can also influence the occurrence of anemia. A study by Listiana (2016) found that adolescent girls from low-income families have a 2,442 times higher chance of experiencing anemia compared to those from high-income families. This is because high-income families have the ability to purchase food and have more options when selecting ingredients or types of cuisine. Increased income has an impact on the health and well-being of families, which is related to nutrition, including anemia status. The study also explains that adolescent girls with low maternal education tend to experience anemia compared to those with highly educated mothers (Listiana, 2016). Education also determines how easily a person absorbs and understands the nutrition knowledge they receive. Therefore, education is needed to make individuals more responsive to nutrition issues within the family and take action promptly.

Education and improving dietary patterns should be established as early as possible to prevent nutritional problems that impact physical development. The eating habits of an adolescent girl will influence the eating habits she passes on to her children. Therefore, efforts to prevent stunting should focus on improving nutritious dietary patterns to enhance nutritional adequacy (IPFRI, 2016). Adequate nutrient intake for prospective mothers, including both macro and micronutrients, plays a crucial role in fetal growth and the prevention of growth disorders (Elshazly & Haridy, 2018; Mzumara et al., 2018).

Protein Intake as a Solution for Anemia Prevention

The importance of protein consumption and improving nutritional status can be the initial steps in improving the nutritional quality of the community and reducing stunting rates among young children. Studies have shown that stunting is influenced by low protein intake. Protein is significantly related to a child's length or height (Arsenault & Brown, 2017; Ghosh, 2016; Michaelsen et al., 2019). Chronic protein deficiency in young children leads to inhibited and lower growth compared to average growth standards. Children with protein intakes below recommendations are at a four-times higher risk of stunting compared to those with sufficient intakes (Fikawati, 2021). A survey of 75,548 children in 39 low- and middle-income countries showed that children who do not consume protein have a 1.4-times higher risk of stunting (Krasevec et al., 2017). However, a child's nutritional intake greatly depends on the mother's understanding of nutrition and food. A mother with limited nutrition knowledge can contribute to increased stunting due to a lack of awareness about child feeding practices and food choices (Abuya, Ciera, & Kimani-Murage, 2012; Fadare et al., 2019).

Promotive and preventive efforts to achieve stunting-free areas in Indonesia (zero stunting) should be directed towards nutritional education targeting adolescent girls through regular nutritional status assessments and increasing daily protein consumption. Protein plays a crucial role in hemoglobin formation and binding iron for optimal absorption in the body, thereby reducing the prevalence of anemia. Women with anemia have a nine-times higher risk of giving birth to low-birth-weight babies (BBLR) compared to those without anemia.

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Reference:

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