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2025; 45(1):98-102
Artículo Original DOI: 10.12873/451tirtawati

Red guava (Psidium guajava L) juice increases hemoglobin

levels in female adolescent
Gusti Ayu TIRTAWATI1, Kusmiyati KUSMIYATI2, Meivy ROMPAS2, Maria TEROK2, Lorrien Grace RUNTU3,
Vega Roosa FIONE4, Yulien ADAM2, Sesca Diana SOLANG2
1 Department of Midwifery, Health Polytechnic of the Ministry of Health Denpasar, Denpasar, Indonesia.
2 Department of Midwifery, Health Polytechnic of the Ministry of Health Manado, Manado City, Indonesia.
3 Department of Health Promotion, Health Polytechnic of the Ministry of Health Manado, Manado City, Indonesia.
4 Department of Dental Health, Health Polytechnic of the Ministry of Health Manado, Manado City, Indonesia.

Recibido: 27/octubre/2024. Aceptado: 16/diciembre/2024.

ABSTRACT dicating no significant increase in hemoglobin levels during

the posttest. After consuming red guava juice, there was a
Background: One nutritional issue Indonesian adoles-
considerable change from anemia to non-anemia.
cents face is micronutrient deficiency, with approximately
12% of male adolescents and 23% of female adolescents Conclusion: Consuming red guava (Psidium guajava L.)
experiencing anemia, predominantly due to iron deficiency. juice demonstrates potential as a non-pharmacological inter-
Anemia in adolescent girls is particularly concerning as they vention for increasing hemoglobin levels in adolescent fe-
are future mothers who will conceive and give birth, thereby males, with research findings indicating a significant improve-
increasing the risk of maternal mortality, preterm birth, and ment in the treatment group compared to the control group.
low birth weight. An initial survey of 7 female students re- Nevertheless, further studies with larger sample sizes and ex-
vealed that 4 were anemic. This study aims to determine the tended durations are necessary to validate red guava juice’s
effect of red guava juice on hemoglobin levels in female efficacy in managing anemia among the general population of
adolescents at a junior high school of SMP N 2 Belang, adolescent females.
Belang District.
Methods: This quasi-experimental study employed a KEYWORDS
pretest-posttest with control group design, involving a total Anemia, Adolescent Health, Functional Drinks, Preventive
sampling of 30 respondents divided into 15 respondents in Nutrition.
the treatment group and 15 in the control group. Data were
collected through observation sheets and analyzed using INTRODUCTION
paired sample t-tests.
Adolescence is a transitional period from childhood to adult-
Results: The paired sample t-test results indicated a sig- hood. According to the WHO (2024)1, adolescents or young
nificant effect of red guava juice on increasing hemoglobin people are between 10 and 24 years old. Age is considered a
levels in female adolescents, with a p-value of 0.002 and a poor indicator because growth and development vary among
mean value of 11.46 during the pretest and 12.58 during the individuals. Physiologically, adolescence is defined as the pe-
posttest in the treatment group. In contrast, the control group riod when physiological development begins, specifically the
did not receive any treatment and had a p-value of 0.334, in- maturation of reproductive organs2.
One nutritional issue Indonesian adolescents face is mi-
cronutrient deficiency, with approximately 12% of male ado-
lescents and 23% of female adolescents experiencing ane-
Correspondencia: mia, predominantly due to iron deficiency (iron deficiency
Gusti Ayu Tirtawati anemia)3. The prevalence of anemia is higher among female
[email protected] adolescents compared to their male counterparts. Anemia in

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 NUTRICIÓN CLÍNICA Y DIETÉTICA HOSPITALARIA

adolescents adversely affects immunity, concentration, aca- intervention in both groups (treatment and control). This
demic performance, fitness, and productivity4. Additionally, study was conducted on adolescent girls aged 12-15 years at
anemia in female adolescents is particularly concerning as Junior High School 2 Belang, Belang District, Southeast
they are future mothers who will conceive and give birth, Minahasa Regency, North Sulawesi, Indonesia. The research
thereby increasing the risk of maternal mortality, preterm design involved two stages of observation: before the admin-
birth, and low birth weight5. istration of red guava juice (pretest) and after the adminis-
tration of red guava juice (posttest). The red guava juice was
The factor influencing hemoglobin levels in the blood is the
made from 100 g of red guava fruit, 10 g of granulated sugar,
adequacy of iron in the body. Adolescents suffering from ane-
and 150 ml of water, blended and strained. The composition
mia may experience suboptimal growth, such as osteoporo-
included 228 mg of vitamin C, 0.73 mg of vitamin E, 49 μg of
sis, in later life6,7. Osteoporosis can occur rapidly if adoles-
folate, 0.26 mg of iron, 0.23 mg of zinc, and 5204 μg of ly-
cents experience eating disorders and reduced cognitive
copene. The juice was administered for 7 days. The respon-
abilities8. Furthermore, female adolescents with anemia may
dents’ hemoglobin levels were measured before and after
experience decreased concentration, lack of enthusiasm in
7 days of consuming the red guava juice. The population in
activities due to fatigue, and deficiencies that can affect at-
this study consisted of 30 female students, using a total sam-
tention, intelligence, and academic performance at school9–11.
pling technique, which included the entire population of
Research by Sulistiyowati (2016)12 Sulistiowaty found that 30 respondents divided into 2 groups: 15 respondents in the
red guava juice can aid in iron absorption and treat anemia. treatment group and 15 respondents in the control group.
Iron in food is absorbed with the help of vitamin C. Vitamin C The intervention involved administering red guava juice to
can increase the pH in the stomach, thereby enhancing iron the treatment group for 7 days, consumed in the morning,
absorption by up to 30%. Research by Prasetyanti & Putri while the control group did not receive any treatment. Data
(2017)13 demonstrated that hemoglobin levels can increase analysis was performed using the paired t-test.
significantly with the consumption of iron tablets, and factors
such as the consumption of vitamin C-rich fruits also influence Ethical Approval Number: 301/Kepk/Vii/2019 from Health
the absorption of iron tablets. Research Ethics Committee, Manado Health Polytechnic
Ministry of Health.
Based on the number of students at a junior high school of
SMP N 2 Belang, totaling 362 students, an initial survey was
RESULTS
conducted on 11 February 2019. Among the 7 female stu-
dents surveyed, 4 were identified to be anemic. Thus, many Hemoglobin Levels Pretest and Posttest in the
female adolescents still suffer from anemia. Anemia can be Treatment Group.
defined as a deficiency in hemoglobin levels. This study aims Based on Table 1, there were 6 non-anemic respondents in
to analyze the effect of red guava juice on changes in hemo- the pretest, which increased to 13 non-anemic respondents in
globin levels in female adolescents at a junior high school of the posttest in the treatment group. In contrast, in the con-
SMP N 2 Belang, Belang District. trol group, there were 6 non-anemic respondents in the
pretest, with no increase in non-anemic respondents in the
METHOD posttest.

This study used a quasi-experimental design with a pretest-

posttest control group design. The main variable to be com-
Normality Test
pared in this study was hemoglobin levels in female adoles- This test was conducted to determine whether there were
cents. Hemoglobin levels were measured before and after the changes in hemoglobin levels before and after the adminis-

Table 1. Distribution of respondents based on hemoglobin levels in the pretest and posttest of the treatment and control groups at a
junior high school of SMP N Belang

Treatment Group Control Group

Hemoglobin
Category
Levels
Pretest Posttest Pretest Posttest

≥ 12 g/dl Non-Anemic 6 13 6 6

< 12 g/dl Anemic 9 2 9 9

Total 15 15 15 15

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RED GUAVA (PSIDIUM GUAJAVA L) JUICE INCREASES HEMOGLOBIN LEVELS IN FEMALE ADOLESCENT

tration of red guava juice in the treatment group and in the Based on Table 2, the difference in hemoglobin levels be-
control group without any treatment. The results of the paired tween the pretest and posttest in the treatment group was
sample t-test for changes in hemoglobin levels before and af- 1.12. The paired sample t-test in the treatment group showed
ter treatment in the treatment group are shown in Table 2. a p-value of 0.002 < 0.05, whereas the difference in hemo-

Table 2. Results of the paired sample t-test for changes in hemoglobin levels before and after treatment in the treatment and control groups

Treatment Group Control Group

Hemoglobin
Levels
Mean Standard Deviation P value Mean Standard Deviation P value

Pretest 11.46 0.882 0.02 11.77 1.052 0.334

Posttest 12.58 0.882 11.78 1.050

globin levels between the pretest and posttest in the control 10.50 g/dl (intervention), and the mean serum ferritin level
group was 0.01. The paired sample t-test in the control group was 33.63 μg/L (control) and 36.63 μg/L (intervention).
showed a p-value of 0.334. It can be concluded that there The mean posttest Hb level was 10.98 g/dl (control) and
was a significant change in hemoglobin levels between the 12.48 g/dl (intervention), and the mean serum ferritin level
pretest and posttest in the treatment group, whereas there was 40.35 μg/L (control) and 57.40 μg/L (intervention).
was no significant change in hemoglobin levels between the Statistical tests showed that red guava juice significantly af-
pretest and posttest in the control group. fected hemoglobin and serum ferritin levels in anemic ado-
lescent girls, with a p-value of <0.001.
DISCUSSION This study is consistent with the research by Winarni et al.
The characteristics of respondents based on age, as indi- (2020)15, which found that the increase in hemoglobin levels af-
cated by the research data, show that respondents in both ter administering red guava juice with Fe tablets was 2.96 g/dl,
the treatment and control groups fall within the range of red guava alone was 2.89 g/dl, red guava juice with honey was
13 years. The research results indicate a significant increase in 1.21 g/dl, a combination of spinach and red guava juice was
hemoglobin levels with a p-value of 0.002 < 0.05. The mean 0.96 g/dl, Fe tablets with orange juice was 0.40 g/dl, orange
pretest hemoglobin level was 11.46 g/dl, which increased to juice alone was 0.63 g/dl, and Fe-Folate with orange juice was
12.58 g/dl in the posttest for the treatment group. The mean 0.47 g/dl. Thus, among all these studies, the combination of red
increase in hemoglobin levels from the pretest was 1.12 g/dl, guava juice with Fe tablets was the most effective in increasing
indicating a significant change in hemoglobin levels. In con- hemoglobin levels in anemic pregnant women compared to or-
trast, the control group, which did not receive any treatment, ange juice.
had a p-value of 0.334 > 0.05, with a mean pretest hemoglo-
This study is also consistent with the research by Yuviska &
bin level of 11.77 g/dl, which increased to 12.78 g/dl in the
Armiyanti (2019)16, which found that the average hemoglobin
posttest. The mean increase in hemoglobin levels from the
(Hb) level in adolescents before consuming mung bean juice
pretest was 1.01 g/dl, indicating no significant difference in
was 10.107 with a standard deviation of 1.0278. The average
the control group during the posttest. Univariate analysis
Hb level in mothers after consuming mung bean juice was
showed that 6 respondents were not anemic and 9 respon-
10.813, with a standard deviation of 1.0460. The average Hb
dents were anemic during the pretest, which increased to
level in mothers before consuming guava juice was 10.040, with
13 respondents not anemic and 2 respondents anemic during
a standard deviation of 1.2403. The average Hb level in moth-
the posttest. In the control group, 6 respondents were not ane-
ers after consuming guava juice was 10.507, with a standard
mic and 9 were anemic during the pretest, with no increase in
deviation of 1.3456. There is a difference in the effect of mung
non-anemic and anemic respondents during the posttest.
bean juice and red guava juice on the increase in hemoglobin
This study aligns with research conducted at the Rusdi et levels in RISMA in Desa Maja. This study is in line with the re-
al. (2018)14 Orphanage in Padang Panjang City on 34 ane- search by Carolin et al. (2021)17, which found a difference in the
mic adolescents selected through simple random sampling. effect of red guava juice and beet juice on hemoglobin levels in
Subjects were divided into two groups: control and treat- pregnant women. The average hemoglobin level before and af-
ment. The treatment group was given 100 grams of red ter consuming red guava juice was 8.4 g/dl and 11.5 g/dl, re-
guava processed into juice for 7 days. Data analysis used spectively, and the average hemoglobin level before and after
the dependent t-test with a significance level of α=0.05. consuming beet juice was 8.5 g/dl and 10.2 g/dl, respectively,
The mean pretest Hb level was 10.26 g/dl (control) and with a p-value of 0.001.

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ment group receiving Fe tablets and guava juice increased masalahan-dan-upaya-pencegahan
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ing only Fe tablets increased from 10.2 g/dL to 10.6 g/dL18. [Internet]. Dinas Kesehatan Kab. Karangasem. 2018. Available
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(p<0.05) compared to green bean juice alone (2.2 g/dL in-
5. Pérez-López FR, Chedraui P, Kravitz AS, Salazar-Pousada D,
crease)20. This suggests that combining red guava with other
Hidalgo L. Present problems and controversies concerning preg-
iron-rich foods may enhance its effectiveness in increasing
nant adolescents. Open Access Journal of Contraception. 2011;2:
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The limitations of this study include a small sample size and
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ability to observe long-term effects of red guava juice inter-
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cations highlight the need for future studies with larger sam-
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CONCLUSION AND RECOMMENDATIONS
10. Samson KLI, Fischer JAJ, Roche ML. Iron Status, Anemia, and
This study suggests that red guava juice may have a posi- Iron Interventions and Their Associations with Cognitive and
tive effect on hemoglobin levels in adolescent females. Daily Academic Performance in Adolescents: A Systematic Review.
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associated with a significant increase in hemoglobin levels in
11. Suharjiman, Inden. Pengaruh Pemberian Jus Jambu Biji Merah
the treatment group, while no significant changes were ob-
Terhadap Kadar Hemoglobin Pada Remaja Putri Dengan Anemia
served in the control group. These findings indicate the po-
Defisiensi Besi di Stikes Jendral Ahmad Yani Cimahi. Jurnal
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larger sample sizes and longer durations is recommended to 12. Sulistiyowati. Pengaruh Jambu Biji Merah Terhadap Kadar
confirm the long-term effectiveness of red guava juice in im- Hemoglonin Saat Menstruasi Pada Mahasiswi DIII Kebidanan Stikes
Muhamadiyah Lamongan. Jurnal Kebidanan dan Keperawatan
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Aisyiyah. 2016;11:135–42.

ACKNOWLEDGEMENTS 13. Prasetyanti DK, Putri LEAA. Efektifitas Jus Jambu Biji Terhadap
Perubahan Kadar Hemoglobin Pada Ibu Hamil Trimester III di
We want to express our sincere gratitude to the honorable Wilayah Kerja Puskesmas Bacem Kabupaten Kabupaten Blitar.
Director Politeknik Kemenkes Manado, Indonesia, the partici- STRADA Jurnal Ilmiah Kesehatan. 2017; 6(1):9–13.
pants, and all the people who helped us conduct this re-
14. Rusdi PHN, Oenzil F, Chundrayetti E. Pengaruh Pemberian Jus
search. Jambu Biji Merah (Psidium Guajava.L) Terhadap Kadar
Hemoglobin dan Ferritin Serum Penderita Anemia Remaja Putri.
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