Stunted overweight teenagers are at risk of having iron deficiency. Iron deficiency is caused by various factors including the high food absorption inhibitors of iron such as phytate and tannins. Phytate and tannin contain polyphenol compounds which have a strong ability to bind iron so that it inhibits iron absorption in the intestine. This study aims to analyze the correlation between phytate, tannin intake and serum transferrin receptor (sTfR) and hemoglobin in stunted overweight adolescents. The research method was a cross-sectional study of 64 stunted overweight adolescents selected by consecutive sampling in four high schools/vocational high schools in Banyumanik District, Semarang City. Phytate and tannin intake data using SQ-FFQ method. The serum transferrin receptor examination uses the ELISA method and the hemoglobin level uses the Cyanomethemoglobin method. The results of the study, most of the respondents had high phytate and tannin intake of 96.9% and 89.1%. Respondents with low serum transferrin receptor were 7.8% and low hemoglobin levels were 7.8%. There was no correlation between phytate intake with serum transferrin receptor or hemoglobin (
Iron deficiency and stunted overweight are two nutritional problems that still occur in Indonesia. Iron deficiency and stunted overweight are known to be interconnected and often occur simultaneously (
The prevalence of short and very short adolescents aged 16 – 18 years in Semarang City reached 18.3% and 3.7%. The prevalence of obese and obese adolescents is 7.6% and 2.7%. Semarang City is one of 16 districts/cities with obesity prevalence above the provincial prevalence of 5.4% obese and 1.7% obese (Santoso et al., 2013). Research in several countries proves that stunted children have a risk of overweight and obesity as teenagers. In a Brazilian study, the prevalence of stunted adolescents was 11%, and 30% of them were obese (
The increasing prevalence of stunted overweight and obesity adolescents is caused by changes in lifestyle and eating patterns to sedentary lifestyle and consumption of energy-dense foods. Energy-dense food consumption is a shift in traditional and high consumption patterns of eating vegetables and fruits and is shifting to high-energy and low micronutrient food consumption habits (
Stunted overweight and obesity are body conditions where there is excess fat accumulation with an unproportionally increased characteristic of adipose tissue (
Iron deficiency in adolescents will have a negative impact on health, namely the occurrence of growth and development disorders, fatigue, increased body susceptibility to infections, decreased physical ability and endurance as well as academic ability (
The hypothesis of this study is that phytate and tannin intake correlates with serum transferrin receptor and hemoglobin in stunted overweight adolescents.
This study was approved by the Health Research Ethics Commission (KEPK) of the Faculty of Medicine, Diponegoro University as stipulated in Ethical Clreance No. 67/EC/FK UNDIP/III/2019 dated March 11, 2019. Written agreement was obtained from all participants and participating parents.
A cross-sectional study was conducted at SMAN 9 Semarang, Hidayatullah Islamic High School, SMKN 11 Semarang, Hidayah Vocational School. Research respondents were 64 people selected by consecutive sampling according to inclusion and exclusion criteria (
Measurements of body weight using a digital Camry EB9003 scale with an accuracy of 0.1 kg, placed on a flat floor surface. Respondents took off their footwear, dressed as seminally as possible, took off their hats and took off their cell phones, watches, wallets and other objects that could affect the outcome of the weighing. Respondents are welcome to rise on the digital scale, both feet are in the middle of the scale and look straight ahead. The height is measured using Seka's microtoise with the accuracy of 0.1 cm, taped to a wall as high as at least 2 meters with a flat surface. Respondents were asked to take off their footwear and then stand upright against the wall. The heel, calf, buttocks, shoulders, head stick well to the wall and look straight ahead. The anthropometric measurements of the respondents were carried out to determine nutritional status based on TB/U < -2 SD, BMI/U overweight z-score 1 SD 2 SD and obesity z-score ≥2 SD. Nutrition status data using WHO-Antro Plus Software. Phytate intake and tannin respondents were obtained through interviews using the SQ-FFQ (Semi Quantitative-Food Frequency Questionnaire) form. Phytate and tannin intake data were processed using Nutrisoft sofware
Blood sampling was conducted in the morning between 8 and 10 am by experienced analysts from the Diponegoro University GAKY laboratory. Blood was taken as much as 3 cc through the antecubital vein and analysed at the GAKY Laboratories at Diponegoro University. The serum transferrin receptor level of the respondents was measured using the ELISA method. Serum transferrin receptor levels were categorized as normal (1.8 – 4.6 mg.L-1), low (<1.8 mg.L-1) and high (> 4.6 mg.L-1) (
Statistical analysis using SPSS Version 21. Test the normality of the data using Kolmogorov-smirnov. Data are presented in the form of percentages, medians and maximum-minimum values. Spearman correlation test to see the correlation between phytate, tannin intake and serum transferrin receptor and hemoglobin with significant at
Table
Subject characteristics.
Characteristics | n | % | Average ± |
Median (min – max) |
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Gender | ||||
Male | 22 | 34.4 | ||
Female | 42 | 65.6 | ||
Age (Years) | 15.97 ±0.73 | 16 (15 – 17) | ||
15 | 18 | 28.1 | ||
16 | 30 | 46.9 | ||
17 | 16 | 25 | ||
Nutritional Status(TB/U) | -2.14 ±0.22 | -2.04 (-3.3 – (-2.01)) | ||
Very Short | 1 | 1.6 | ||
Short | 63 | 98.4 | ||
Nutritional Status (IMT/U) | 2.02 ±0.71 | 1.86 (1.03 – 5.15) | ||
Overweight | 42 | 65.6 | ||
Obesity | 22 | 34.4 |
The accelerated linear growth in adolescent girls takes place at the age of 9.5 – 14.5 years and slows down at the age 16 years and stopped at the age of 19 years, while men started at around 14.4 years and stopped at 21 years. Age 14 years is the average maximum age for women experiencing first menstruation, where menstrual conditions are associated with changes in the hormones estrogen and progesterone which increase lipoprotein lipase activity and fat stores in the body. Adolescent girls have more fat around 22 – 26% than men around 18 – 23% (
Table
Fitat intake, Tannin, sTfR levels and Hemoglobin.
Characteristics | n | % | Average ± |
Median (min – max) |
---|---|---|---|---|
|
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Fitat intake | 1193.7 ±334.01 | 1103 (674 – 2173) | ||
High >718 mg | 62 | 96.9 | ||
Low <718 mg | 2 | 3.1 | ||
Tannin intake | 0.38 ±0.25 | 0.29 (0 – 1.16) | ||
High >0.29 mg | 57 | 89.1 | ||
Low <0.29 mg | 7 | 10.1 | ||
Iron Status (sTfR) | 2.69 ±0.60 | 2.77 (1.04 – 3.53) | ||
High (1.8 – 4.6 mg.L-1) | 59 | 92.2 | ||
Low (< 1.8 mg.L-1) | 5 | 7.8 | ||
High (> 4.6 mg.L-1) | 0 | 0 | ||
Iron Status (Hemoglobin) | 14.10 ±1.78 | 13.9 (9.4 – 17.8) | ||
Male | 15.88 ±1.08 | 15.8 (13.9 – 17.8) | ||
Normal (13.2 – 7.3 g.dL-1) | 19 | 29.7 | ||
Low(<13.2 g.dL-1) | 0 | 0 | ||
High (>17.3 g.dL-1) | 3 | 4.7 | ||
Female | 13.17 ±1.30 | 13.25 (9.4 – 15.6) | ||
Normal (11.7-15.2 g.dL-1) | 35 | 54.7 | ||
Low (<11.7 g.dL-1) | 5 | 7.8 | ||
High (>15.2 g.dL-1) | 2 | 3.1 |
Bivariate analysis was performed to see the correlation between independent variables including phytate and tannin intake on serum transferrin receptor and hemoglobin dependent variables. Bivariate analysis can be seen in Table
Correlation of intake of Fitat, Tannin to sTfR and Hemoglobin.
Variabel | sTfR | Hemoglobin | ||
---|---|---|---|---|
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|
|
|
|
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Phytate | 0.937 | -0.010 | 0.192 | 0.165 |
Tannin | 0.0052 |
0.344 | 0.002 |
-0.374 |
Note: * Significant (
Table
Double Linear Regression Test for Hemoglobin.
Variabel | Hemoglobin | |
---|---|---|
|
||
|
|
|
|
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Phytate | -0.000099 | 0.869 |
Tannin | -3.674 | 0.000 |
Note: *Adjusted
Phytate acid is the main form of phosphorus storage in cereals and legumes (
The high intake of phytate subjects came from everyday foods such as white rice, tempeh and tofu. In 100 grams of white rice there are 126 mg phytate, in 25 grams tempeh there are 99 mg phytate and in 25 grams tofu is 94 mg phytate. Fitat is an iron absorption inhibitor, its effect is influenced by the dose. 2 mg intake of phytate inhibits iron absorption by 18%, and 25 mg of phytate inhibits iron absorption by 64%, and 250 mg of phytate inhibits iron absorption by 82% (
Phytate intake did not correlate with serum transferrin receptor (
Fitat has a stable tendency towards heat, the inhibitory effect of phytate can be reduced by boiling the boiled water is discarded (
Most respondents had tannin intake in the high category of 89.1% with a mean tannin intake of 0.29 (0 – 1.16 mg). The results of the Spearman correlation test analysis showed that tannin was significantly correlated with serum transferrin receptor (
Research in India, respondents who were given a full meal consumed together with 1 cup of tea decreased iron absorption by 59% (
The results of multiple linear regression analysis, tannin is a weak determinant factor for hemoglobin. The
Tea contains tannins that can bind minerals (including iron) and in some teas (especially black tea) polyphenol compounds which act as antioxidants have been oxidized, so they can bind minerals such as Fe, Zn, and Ca so that iron absorption is reduced (
Tannins are positively correlated with serum transferrin receptor and negative correlation with hemoglobin. Excessive tannin intake can cause iron deficiency in stunted overweight adolescents.