Association between Lifestyle and Dietary Habit with Hemoglobin

Level

Mutiara Indah Sari

, Alegra Rifani

, Zaimah Z. Tala

, Dian Keumala Sari

and Nenni Dwi Aprianti Lubis

Departemen of Biochemistry, Faculty of Medicine, Universitas Sumatera Utara, Jl.Dr. Mansur No.5 Medan, Indonesia

Departemen of Medical Education, Faculty of Medicine, Universitas Sumatera Utara, Jl.Dr. Mansur No.5 Medan,

Indonesia

Departemen of Nutrition, Faculty of Medicine, Universitas Sumatera Utara, Jl.Dr. Mansur No.5 Medan, Indonesia

Keywords: lifestyle, dietary habit, hemoglobin

Abstract: The lifestyle and dietary habit often leads to a decrease in hemoglobin levels. This research aimed to determine

the relationship between lifestyle and dietary habit with hemoglobin level in the college students of Faculty

of Medicine, University of Sumatera Utara. The research was observational analytics study with cross

sectional approach. The research was administered in Faculty of Medicine, University of Sumatera Utara,

students of this Faculty as responden. Lifestyle and dietary habit data such as the habit of lifestyle as a

vegetarian, the lifestyle of consuming coffee and tea, and also the lifestyle of consuming supplements were

obtained from interviews using questionnaires. The hemoglobin level was measured by using a digital

hemoglobinometer. The results of this research were showed that the percentage of students had hemoglobin

levels <12 g/dL were more in the vegetarian group than non-vegetarians (40% VS 8%) and more in the student

with consumption supplement than non consumption it (15 % VS 8 %) but less in the student with

consumption tea/ coffe than non consumption it (9 % VS 10 %). This research found that there is a significant

difference of hemoglobin level in the vegetarian group compared to non vegetarian group.

1 INTRODUCTION

Hemoglobin is a human body protein present in

erythrocytes. Hemoglobin serves as a transporter of

oxygen from the lungs to the tissues and transports

carbon dioxide from tissue to lung for excretion. If the

amount of hemoglobin decreases from the normal

value can decrease daily activity of human

(Hoffbrand et al, 2005). The amount of hemoglobin

less than normal level is called anemia. Anemia was

one of the health issues that occured in many

teenagers, including the college students community

in developing countries. There were other clinical

manifestations caused by anemia, such as impaired

growth, decreased intelligence, and decreased

physical ability. Decreased intelligence affected the

learning process of college students, those who

suffered anemia had the problem of short-term

memory .(WHO, 2005).

Low levels of hemoglobin can occur because of

the bleeding, impaired nutritional intake, and

reabsorption disorders of those nutrient substances

that formed hemoglobin (Hoffbrand et al, 2005).

Impaired nutritional intake may occur due to dietary

patterns. One of the dietary patterns that often leads

to a decrease in hemoglobin levels is the vegetarian

diet. One of the dietary patterns that often caused

anemia was vegetarian diet. Vegetarian diet was a

dietary restriction that did not consume meat at all,

mainly or only consumed food from the plant (Craig

et al 2009). Vegetarian diet tended to cause low intake

of iron, vitamin B6, vitamin B12 (multivitamin) etc,

comparing with omnivore diet (Fraser, 2009). The

research before showed that the level of hemoglobin

was found below the normal range in the female and

male vegetarian communities (Gorczyca et al, 2013).

Being known, if the adequate intake was not

followed by a good absorption could also cause

decrease in hemoglobin levels. Absorption of

nutrients forming haemoglobin can be disrupted due

to obstacles by certain substances such as substances

contained in tea. The research done by Fan (2016)

showed a decrease in hemoglobin levels in the group

Sari, M., Rifani, A., Tala, Z., Sari, D. and Lubis, N.

Association between Lifestyle and Dietary Habit with Hemoglobin Level.

DOI: 10.5220/0010041802830287

In Proceedings of the 3rd International Conference of Computer, Environment, Agriculture, Social Science, Health Science, Engineering and Technology (ICEST 2018), pages 283-287

ISBN: 978-989-758-496-1

283

of respondents who have a habit of consuming tea

(Fan, 2016).

Increased prevalence of anemia due to decreased

levels of hemoglobin levels encourage people to

consume supplements. The types of supplements

consumed are those containing nutrients supporting

the synthesis of haemoglobin such as iron

supplements, and multivitamin supplements. Iron

supplementation was one of the ways to overcome

iron deficiency and decrease anemia prevalence

(Fikawati, 2010).. The research done by Ahmed

(2005) showed Iron and mulvitamin supplementation

increased hemoglobin level and decreased anemia

effectively to the primary school children (Ahmed et

al, 2005).

Based on the above matter, this research aimed to

determine the relationship between lifestyle and

dietary habit with hemoglobin level in the college

students of Faculty of Medicine, University of

Sumatera Utara.

2 METHOD

The type of research used was observational analytics

study with cross sectional approach. The research was

administered in Faculty of Medicine, University of

Sumatera Utara, with the college students of Faculty

of Medicine, University of Sumatera Utara as the

target population. Lifestyle and dietary habit data

were obtained from interviews using questionnaires

that have been tested for their validity and reliability.

Lifestyle and dietary habit data that were assessed in

this research showed the habit of lifestyle as a

vegetarian, the lifestyle of consuming coffee and tea,

and also the lifestyle of consuming supplements.

Blood sampling was done to know the

hemoglobin level by using a digital

hemoglobinometer. The level of hemoglobin was

classified low if it was below 12 g / dL, normal if it

was 12-15 g / dL, and high if it was > 15 g / dL

(Hoffbrand et al, 2005). The research sample was the

subject taken from an affordable population with

consecutive sampling method. The approximate of

minimum sample in this research was based on the

sample size formula to test the one-sided hypothesis,

which was 99 students. The research samples that met

the inclusion criteria were as below:

Inclusion criterias:

1. Willing to be a research respondent.

2. No smoking.

3. Not after menstruation at least 3 days before the

examination.

4. Not after transfusing blood and donating at least

3 months.

Exclusion criterias for sample collection were:

1. Suffered from chronic infectious diseases

diagnosed by a doctor (such as tuberculosis).

2. Suffered from diseases that were related to blood

disorders diagnosed by a doctor (such as

Thalasemia).

The relationship between variables was analyzed

bivariately with chi square test with significance level

(α) of 5%.

3 RESULTS AND DISCUSSION

The characteristic of respondent's gender in this

research could be seen in Table 1.

Table 1. The characteristics of gender.

n %

Male 35 35,4

Female 64 64,6

Total 99 100,0

From the table above, it could be seen that most

respondents was female group with the total of 64

people (64,6%).

The classification of hemoglobin could be seen in

table 2.

Table2. The classification of hemoglobin

Hemoglobin

n %

<12

10 10,1

12-15

69 69,7

>15

20 20,2

Total 99 100,0

In table 2 it can be seen that the hemoglobin level

in the respondents of this study is much on the normal

value that is between 12-15 g / dL (69 people /

69.7%).

Results of the habit or lifestyle and dietary habit

on the respondents can be seen in table 3

ICEST 2018 - 3rd International Conference of Computer, Environment, Agriculture, Social Science, Health Science, Engineering and

Technology

284

Table 3. Frequency Distributions by Lifestyle and dietary

habit

Consumption

n %

Vegetarian

Yes 5 5,1

No 94 94,9

Tea/ coffee

Yes

53 53,5

No 46 46,5

Suplement

Yes 20 20,2

NO 79 79,8

Total

99 100,0

In Table 3. It could be seen that the respondents

who had vegetarian habits only 5 people (5.1%) while

the remaining 94 people (94.9%) did not have that

habit. This was in contrast with the respondents who

liked to consume tea or coffee, most of the

respondents were 53 people (53.5%) who liked to

consume and 46 people (46.5%) who did not like. The

respondents data who consumed supplements only 20

people (20.2%) who had that habit, while 79 people

(79.8%) did not.

The relationship between vegetarian habits and

hemoglobin level of this research respondent could be

seen in Table 4.

Table 4. The Relationship of between vegetarian habits and

hemoglobin level

Hemoglobin Vegetarian Non

Vegetarian

p Value*

< 12 2 8 0,003

12 – 15 3 66

> 15 0 20

Total 5 94

*chi square

From Table 4. it could be seen that there were 2

college students (40%) who had vegetarian habits and

hemoglobin levels below 12 g/dL, while the

remaining 8 (8 %) did not have vegetarian habits and

their hemoglobin level were below 12 g / dL. Then,

between the hemoglobin levels of 12 - 15 g / dL, there

were 3 people (60 %) who had vegetarian habits and

66 people (70 %) who did not. There was not any

person with vegetarian habit in the group of

hemoglobin level with more than 15 g / dL, there were

20 (22 %) non-vegetarians. Analysis with chi square

test showed significant difference of hemoglobin

level in the vegetarian group compared to non

vegetarian group with p <0,05

This research result is similar to the research result

done by Gorczyca (2013) to the vegetarian and non-

vegetarian communities in Poland (Gorczyca et al,

2013). Similar results were also shown in a research

conducted by Yen (2008) to a group of vegetarian

children (Yen et al, 2008). A research conducted by

Mahajani and Bhatnagar (2015) showed that the

average hemoglobin level in non-vegetarian groups

were higher the vegetarian groups (12.07 ± 1.08 g / dl

VS 10.09 ± 0.95 g / dl). The intake of iron, protein,

multivitamins, folic acid, and other nutrients to form

hemoglobin were lower in the vegetarian groups than

the non-vegetarian groups ((Mahajani & Bhatnagar ,

2015)

A vegetarian diet is a diet pattern that did not

consume animal products. Vegetarians could cause

the nutritional needs including nutrients that formed

hemoglobin were not met adequately which resulting

to anemia. One of the lowest intake of nutrients in the

vegetarian community was iron (Pawlak and Bell,

2017). The research conducted by Istiqomah in 2009

to the male of vegetarians in Semarang city got the

result that only 60% of the research subjects had less

iron intake( Istiqomah, 2009).

Low iron intake in vegetarian adolescents could

be caused by the iron from the food they consumed

was a type of non-hem iron. Non-hem iron had iron

and bioavailability which was relatively lower than

that contained in food sources of hem iron. Iron hem

could be absorbed several times more than non-hem

iron. Heme iron absorption could achieve 25%, while

non-hem was only 5%. Consumption of hem iron and

non-hem iron if done together could increase iron

absorption hem (Wang et al, 2011).

The relationship between the habit of consuming

tea or coffee and hemoglobin level in this research

could be seen in table 5

Table 5. The Relationship between Hemoglobin Level with

Tea or Coffee Consumption

Hemoglobin Consumption

Tea/Coffee

Non

Tea/Coffee

Value*

< 12 5 5 0,120

12 – 15 33 36

> 15 15 5

Total 53 46

*chi square

Table 5 showed that the number of respondents

with hemoglobin level below 12 g / dL who

Association between Lifestyle and Dietary Habit with Hemoglobin Level

285

consumed tea or coffee that contained caffeine were

5 people (9 %). It was the same with those 5 people

(10 %) in the group who did not consume tea or

coffee. Respondents with hemoglobin level between

12 - 15 g / dL were 33 people (62 %) who consumed

tea or coffee and 36 people (78 %) did not consume.

While 15 respondents (28 %) who consumed tea or

coffee containing caffeine had hemoglobin levels

more than 15 g /dL, 5 people (10 %) who did not

consume tea or coffee. Chi square test was done to see

the association of hemoglobin level between the

people who consumed tea or coffee and those who did

not consume tea or coffee obtained no significant

relationship with p value of 0.120 (p> 0.05). This

result was different from the research conducted by

Septiawan &Sugerta (2015) (Septiawan & Sugerta,

2015)

Tea and coffee were very popular drinks in the

world. Being known that the habit of consuming tea

and coffee with other foods at the same time caused

lower iron absorption from the food eaten. The

concentration of tannin in tea and coffee were the

factors that inhibited the absorption of iron in food.

The tannin compound which was a polyphenol which

could inhibit the absorption of iron by binding it (Ma,

et al, 2011; Kim et al, 2008). Tea and coffee could

also increase the acidity of the stomach, decrease

gastric pH could increase the solubility of iron. The

differences in the results of this research with studies

showing the association of hempglobin levels with tea

and coffee habits might be attributable to

consumption patterns and coffee was not done at the

same time as consuming other main meals (not

together with breakfast time, lunch and dinner. In

addition, in this study also not examined the type of

respondents consumed whether the black tea or other

types.

The relationship between the habit of taking

supplements that contained iron and or multivitamin

with hemoglobin level in this research could be seen

in table 6

Table 6. The Relationship of Consumption supplements

with hemoglobin level

Hemoglobin Consumption

Supplement

Non

Supplement

p Value*

< 12 3 7 0,163

12 – 15 15 54

> 15 2 18

Total 20 79

*chi square

Table 6 showed that the number of respondents

with hemoglobin level below 12 g / dL consumed

supplements that contained iron and / or multivitamin

were 3 people (15 %) while those who did not

consume were 7 people (8 %). Respondents with

hemoglobin level between 12 - 15 g / dL who

consumed supplements that contained iron and / or

multivitamin were 15 people (75 %) while those who

did not consume were 54 people (68 %). Respondents

with hemoglobin level above 15 g / dL were only 2

(10 %) who took supplements that contained iron and

/ or multivitamin, while the remaining 18 people (23

%) did not take them. Chi square test was done to see

the association of hemoglobin levels in between the

people who had the habit of taking supplements

compared with those who did not consume had no

significant relationship with p> 0.05

Iron supplementation and multivitamins were one

of the ways to overcome iron deficiency and reduce

the anemia prevalence (Peyrin-Biroulet et al, 2015;

Auerbach, M., and Adamson, 2015). In addition, iron

supplementation and multivitamins could promote

growth in preschoolers children and school-aged

children with anemia (Ahmed, 2005)). In this

research, we tested the variables of hemoglobin level

correlation with consumption of supplements on the

respondents. It was done to consider the respondents

in this research were the students of medical faculty

who understood the benefits of supplements for the

body health. Consuming iron supplements and

multivitamins for students in the medical faculty was

a lifestyle to support the density of daily activities. In

this research the percentage of low hemoglobin levels

was less common in the group of students who took

supplements than did not consume supplements. But

statistical analysis did not show any significant

relationship. This result was different from that of

Zulaekah (2009) which showed that iron

supplementation and multivitamin in primary school

children effectively increased hemoglobin levels and

decreased anemia by a meaningful association

((Zulaekah, 2009). The insignificant differences in

the results of the present research were made possible

because of the low number of samples and the

nutrient intake of main nutrients not analyzed in this

research

4 CONCLUSIONS

This research found that there is a significant

difference of hemoglobin level in the vegetarian

group compared to non vegetarian group. The

relationship between the habit of consuming tea or

ICEST 2018 - 3rd International Conference of Computer, Environment, Agriculture, Social Science, Health Science, Engineering and

Technology

286

coffee with hemoglobin level showed no association

and the same result in the habit of taking supplements

ACKNOWLEDGEMENTS

We would like to say our gratitude to the Dean of

Medical Faculty of University of Sumatera Utara

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