Ardesy Melizah Kurniati, Eka Handayani Oktharina, Aryani Aziz, Corinna Faustina

Association between animal protein adequacy and anemia among pregnant women in Palembang, Indonesia

Introduction

Association between animal protein adequacy and anemia among pregnant women in palembang, indonesia . Study in Palembang, Indonesia reveals a significant association between adequate animal protein consumption and lower anemia prevalence among pregnant women. Sufficient animal protein protects against anemia.

Abstract

Background: Palembang City has the highest prevalence of anemia in South Sumatra, Indonesia. Protein contributes to hemoglobin formation and insufficient protein intake increases the risk of anemia. However, Sumatera studies on protein intake based on protein sources in pregnant women are still limited.   Objective: This study aimed to examine the association between animal protein consumption and anemia prevalence in pregnant women. Methods: A cross-sectional analytic study was conducted from July to October 2024 at six public health centers and seven private midwife clinics selected to represent Palembang’s geographic diversity. A total of 62 pregnant women in their second or third trimester were recruited using consecutive sampling. Dietary intake was assessed via interviewer-administered 2×24-hour recalls on non-consecutive days. Protein intake was analyzed using modified NutriSurvey 2004 and categorized based on the Indonesian RDA. Hemoglobin levels were measured using venous blood samples and classified according to trimester-specific anemia thresholds. Bivariate analysis with Fisher’s exact test was used to examine the association between animal protein intake and anemia prevalence. Results: The Fisher Exact Test showed a statistically significant association between animal protein consumption levels and anemia in pregnant women in Palembang City (p = 0.018). The mean total protein intake was 80.40 ± 20.53 g/day, with animal and vegetable proteins contributing 40.22 ± 18.63 g/day and 40.91 ± 24.5 g/day, respectively. Mean hemoglobin level was 11.18 ± 1.17 g/dL. Conclusion: Sufficient consumption of animal protein was found to be more protective against the occurrence of anemia.

Review

This study addresses a crucial public health issue, investigating the association between animal protein adequacy and anemia among pregnant women in Palembang, a city identified with a high prevalence of anemia. The objective is clearly stated, aiming to fill a gap in the literature regarding protein intake from specific sources in pregnant women in the region. The methodology employed, including interviewer-administered 2x24-hour dietary recalls and venous blood samples for hemoglobin, is appropriate for assessing nutritional status and anemia. The use of the Indonesian RDA for protein categorization and trimester-specific anemia thresholds demonstrates a thoughtful approach to local and physiological contexts. The reported statistically significant association (p = 0.018) provides an important preliminary insight for potential nutritional interventions. However, the study exhibits several notable limitations that temper the strength and generalizability of its conclusions. Primarily, the sample size of only 62 pregnant women is considerably small, especially given the ambition to represent Palembang's geographic diversity. This raises serious concerns about the statistical power of the study and the representativeness of the findings. As a cross-sectional design, the study can only identify an association, not establish causality; thus, the concluding statement that animal protein was "more protective" should be interpreted with caution. The abstract also lacks information regarding the consideration of potential confounding factors such as socioeconomic status, parity, or the intake of other micronutrients vital for hemoglobin synthesis (e.g., iron, folate), which could significantly influence both dietary patterns and anemia status. In conclusion, this study offers valuable preliminary evidence on the potential link between animal protein consumption and anemia among pregnant women in a high-prevalence area. Despite its contribution to understanding regional dietary factors, the significant limitations, particularly the small sample size and cross-sectional design, warrant a cautious interpretation of the results. Future research should prioritize replication with a substantially larger and more diverse sample, ideally utilizing a longitudinal or interventional study design to explore causality and the effectiveness of targeted nutritional interventions. Furthermore, incorporating a comprehensive assessment of socioeconomic factors and other relevant dietary and health confounders would significantly enhance the robustness of the findings and inform more effective public health strategies to combat maternal anemia.

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