The Intake of Beta Vulgaris and Amaranthus Tricolor L. Juice on

Increasing the Hemoglobin Level

Rapael Ginting, Frans Judea Samosir, Hartono, Victor Trimanjaya Hulu, David Ongko, Dewi Anjani,

Diah Purwaningrum and Alvi Mutiara Syahrin Pohan

Public Health Department, Universitas Prima Indonesia, Jl. Sekip, Medan, Indonesia

{rafaelginting, frans.judea, hartonoboy31, vic.trisja, davidongko123, diahpurwaningrum12,

Keywords: hb level, beta vulgaris, amaranthus tricolor l, juice

Abstract: The most common anemia in the world is the one as the result of iron deficiency in the body

. One of the

health problems that appears to be a disruption to female workers is the nutritional deficiency anemia

. This

problem has an impact on the death of mothers and children, as well as on low achievement and decreased

work productivity, especially for women who have multiple roles

. Anemia mostly occurs in women of

childbearing age, which is about 30.2% of 1.62 billion people. This study aimed to determine the

effectiveness of Beta Vulgaris juice and Amaranthus Tricolor L juice on increasing Hb levels

. This type of

research was a quasi-experiment study with a pre-test and post-test control group design. The study used a

total sampling technique with a sample of 30 teachers that consumed the Beta Vulgaris juice and the

Amaranthus Tricolor L juice for 14 days

. The results showed that there are significant increased levels of

Haemoglobin after the intake of Beta Vulgaris juice and the Amaranthus Tricolor L juice by 1.03 gr/dL and

1, 34gr/dL, respectively. Individuals are implored to consume either Beta Vulgaris juice or Amaranthus

Tricolor L juice regularly to experience the benefit of intaking it on increasing the Hb levels

1 INTRODUCTION

The most common anemia in the world is one as the

result of iron deficiency in the body

. Nutritional

anemia caused by iron deficiency is still a nutritional

problem in Indonesia

. One of the health problems

that appears to be a disruption to female workers is

the nutritional deficiency anemia

. This problem has

an impact on the death of mothers and children, as

well as on low achievement and decreased work

productivity

. Moreover, this could also happen

among women who have multiple roles such as

being professionals who spend most of their time

working outside of the house and as housewives

who have obligation to do chores at home (Wagirah,

2015)

. Anemia mostly occurs in women of

childbearing age, about 30

.2% from 1.62 billion

people

. There are around 4-5 billion people in the

world with an iron deficiency or around 66-80

percent of the world's total population

. Most

specifically, in developing countries, about 370

million women have been detected to undergo iron

deficiency anemia

. The highest prevalence of iron

deficiency anemia in developing countries is found

in South Asia with 64% in total

. At the same time,

the prevalence of anemia in women is 47% in

Southeast Asia alone (Fitri, 2016)

Based on the 2017 Indonesian Demographic and

Health Survey, the prevalence of anemia among the

ages of 13 - 18 in women was 23% in Indonesia

The prevalence of anemia in men was lower than

women, which was 17% in men aged 13 - 18 years

In line with the 2016 Home Health Survey, the

prevalence of anemia in adolescent girls aged 15 -

20 years was 57

.1%. In Riau province, the

prevalence of anemia was 25

.1%, and 19.4% aged

15 - 24 years

. Furthermore, the incidence of anemia

in women was 18

.1%, and men was 7% (Yuni,

2017)

. On the other hand, the incidence of anemia in

North Sumatra province in 2015 reached 57

.1%; in

2016, it was 54

.5%, and in 2017 it increased to

.2% (Dinkes Propsu, 2017). Based on the results

of the Basic Health Survey (Riskesdas) 2018, it is

noted that there is an increase of anemia in Indonesia

in 2018 as much as 48

.9%. The most prominent

prevalence was in pregnant women aged 15 – 24

158

Ginting, R., Samosir, F., Hartono, ., Hulu, V., Ongko, D., Anjani, D., Purwaningrum, D. and Syahrin Pohan, A.

The Intake of Beta Vulgaris and Amaranthus Tricolor L. Juice on Increasing the Hemoglobin Level.

DOI: 10.5220/0010292001580165

In Proceedings of the International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical (HIMBEP 2020), pages 158-165

ISBN: 978-989-758-500-5

years as much as 84

.6%, aged 25 – 34 as much as

.7%, aged 35 – 44 as much as 33.6%, and aged 45

– 54 as much as 24% (Kementerian Kesehatan RI,

2018)

One solution that can be implemented to fulfill

the needs of iron for the body so that the level of

Haemoglobin (Hb) in blood stays maintained is by

consuming vegetables and fruits containing iron in

high content

. One of the iron sources that plays a

role in the formation of the high Hb is in beets and

red spinach

. However, little is known about the

effects of beets (Beta Vulgaris) and red spinach

(Amaranthus Tricolor L

.) that can increase Hb

levels

. One research conducted by Kavitha, et al.

(2020), Pokharel, et al

. (2019), and Al-Aboud

(2018) suggested that there was positive effect of

giving Beta Vulgaris juice on Hb levels (Kavitha

and Denish, 2020; Pokharel and Sharmila, 2019; Al-

aboud, 2018)

. In addition, research by Bahadoran, et

. (2017) and Mirmiran, et al. (2020) revealed that

there was another beneficial effect of beets that is

lowering blood pressure and diabetes

. Apart from

beets, another food source that can optimize iron

levels in the body is red spinach

. Research

conducted by Yudhistira, et al

. (2018), Muliani, et

. (2017), and Majelti, et al. (2017) showed that

positive effect could be gained by giving

Amaranthus Tricolor L juice to increase hemoglobin

levels

(Yudhistira, Affandi, and Nusantari, 2018;

Muliani et al

., 2017; Maljeti, Mapanawang and

Korompis, 2017)

. Meanwhile, research by Pradana,

et al

. (2017) and Kumar, et al. (2019) stated that

there was healthier effect of consuming red spinach,

which was preventing diabetes and reducing LDL

levels (Pradana, Pondawinata and Widyarini, 2017;

Kumar et al

., 2019).

Those previous researches have been done with

several approaches

. The research method used by

Kavitha, et al

. (2020) and Phokarel, et al. (2019) was

a one-group pre-test post-test design that compared

only one treatment group with the aiming to

determine the effectiveness of giving beets on Hb

levels (Kavitha and Denish, 2020; Pokharel and

Sharmila, 2019). In comparison, Al-Aboud (2018)

compared the effectiveness of beetroot juice to the

hematological level, which are the levels of Hb,

Ferritin, Transferrin, etc

. (Al-aboud, 2018).

Furthermore, a research by Bahadoran, et al

. (2017)

used a meta-analysis method which showed the

effectiveness of beets on Hb levels and on

decreasing blood pressure (Bahadoran et al

., 2017).

While Mirmiran, et al

. (2020) used a literature study

to see the effectiveness of beets on reducing blood

pressure and diabetes (Mirmiran et al

., 2020).

The research method used by Muliani, et al

(2017), and Majelti, et al

. (2017) was a quasi-

experiment with a pretest-posttest with one control

group with treatment aiming to find the effectiveness

of giving red spinach on Hb levels (Muliani et al

2017; Maljeti, Mapanawang and Korompis, 2017)

In contrast, Yudhistira, et al

. (2018) combined red

spinach with tomatoes to increase Hb levels

(Yudhistira, Affandi and Nusantari, 2018)

. A

research by Pradana, et al

. (2017) compared the

effectiveness of red spinach extract against LDL

levels and histopathology (Pradana, Pondawinata

and Widyarini, 2017)

. Whereas, Kumar, et al.

(2019) used a literature study to see the effectiveness

of red spinach on lowering blood sugar (Kumar,

Abbas and Austo, 2010)

. These previous researches

help us to notice the benefits of the processing of

beets and red spinach for consumption

Based on those previous studies and the problem

mentioned about the anemia affecting people’s

productivity, this research aimed to determine the

effectiveness of intaking the Beta Vulgaris juice and

the Amaranthus Tricolor L juice on increasing Hb

levels. Our research used a different approach from

previous ones

. We implemented the quasi-

experiment method with the pre-test – post-test

which was carried out to test two experimental

groups

. They consisted of one group that consumed

the Beta Vulgaris juice and the other group

consumed the Amaranthus Tricolor L juice

. In the

end, we could see the impact of both intake on

increasing Hb levels

2 METHOD

This research was conducted at the Sekolah

Kejayaan Indonesia, Binjai Barat, Binjai City, North

Sumatra. The research was conducted from

December 9 - 23, 2019. This type of research used a

quasi-experiment with a pre-test and post-test with

control group design. This study used a total

sampling technique, which was all the teachers in

the school. So, the number of samples in this study

was 30 teachers. The inclusive criteria for the

samples was female aged 20 – 40 years old, active

teacher at the school, and not on period or

pregnancy. Conversely, the exclusive criteria was

male teacher above 40 years old.

The Intake of Beta Vulgaris and Amaranthus Tricolor L. Juice on Increasing the Hemoglobin Level

159

Figure 1: Research flow.

This research was conducted through several

stages as follows:

1. Preparation phase.

The researchers prepared facilities and

infrastructure that would support research

under the research permit and coordination

with the school principal. The researchers

defined the subjects of the research that

happened to be the teachers in the school who

were willing to be respondents in this study.

Then, the researchers determined the schedule

of meetings with respondents and provided

them with instructions to follow. Then, the

researchers hold face-to-face meetings with all

respondents to present the flow of research

activities that would be carried out for the next

two weeks. The researchers also provided

education related to research material. After

that, the researcher distributed the respondent's

consent statement to take part in the research

activities carried out without coercion from any

party. The researcher also gave instructions

about things that should not be done during the

research activity. Some things that should not

be done by respondents were consuming food

or drinks that contain tannins such as tea and

coffee. This procedure was done because the

tannin content in tea and coffee could interfere

with the absorption of iron in the body so that it

could cause the respondents' hb levels to

appear low.

2. Implementation phase.

This research was begun by checking the Hb

level of the respondent before doing the

research (pre-test) to determine the Hb level in

each respondent before being given any special

treatment. After obtaining the results of the hb

levels of all respondents, the researchers

immediately proceeded to the experiment stage

by repeatedly giving red spinach and beet juice

to respondents. The juice distribution was

divided into two different groups of

respondents. There was a group of respondents

who was given beet juice, and a group of

respondents who was assigned to intake red

spinach juice within two weeks of giving. The

intake was as much as 180 ml per day for two

weeks. Then, to keep the respondents following

these instructions, at the time of the research,

the researcher distributed food recall to the

respondents to find out what types of food or

drink the respondents consumed during the

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

160

research. It was intended that researchers could

monitor respondents' adherence to each

research procedure. Besides, researchers

continued to remind respondents of the

importance of complying with each process of

the study and improve closeness with

respondents so that proper communication

relationships were established. As a result,

respondents could respond as expected by

researchers. After the research time ended in

two weeks, the researcher checked again the

respondents’ Hb level (post-test). Then, the

researchers compared the results of the pre-test

and the post-test of the respondents’ Hb level.

The bivariate analysis used in this study was by

using the Saphiro-Wilk test for normality test

because the number of samples was less than 50

samples. After that, researchers would use the

dependent t-test if the data were normally distributed

and the Wilcoxon test if the data were not normally

distributed to determine the effectiveness of

increasing Hb levels between beet juice and red

spinach juice.

The independent t-test would be used if the data

were normally distributed and the Mann-Whitney

test would be used if the data were not distributed

normally; in order to know the difference in elevated

Hb levels between the Beta Vulgaris juice and the

Amaranthus Tricolor L juice at the significance level

α = 0.05 (Hulu and Sinaga, 2019).

3 RESULTS AND DISCUSSION

Table 1: Characteristics of Respondents.

No Characteristics Total

Percentage

(100%)

1 Age

20 – 25

26 – 30

31 – 35

36 – 40

Total 30 100

2 Anemia status

Anemia

No anemia

Total 30 100

Based on the characteristics of the respondents

on Table 1, most the respondents’ age was 31 - 35

years as many as nine people (30%)

. On the other

hand, the minorities aged 36 – 40 years were six

people (20%)

. Most respondents with anemia status

were 23 people (76

.7%) and the minority of seven

people did not have anemia (23

.3%).

Table 2: Pre-test and post-test of juice intake (gr/dL).

Amaranthus Tricolor L Juice

Respondents Pre-Test Post-Test

.4 10.4

4 10 11

.4 13.8

8 13 12

.6 12.2

10 14 12

11 10

12 11

.4 15.3

14 10

.4 12.8

Beta Vulgaris Juice

Respondents Pre-Test Post-Test

.4 10.1

.9 11.3

.2 10.8

411

.8 9.5

7 13 18

914

.9 10.5

12 9 12

15 11 10

The Intake of Beta Vulgaris and Amaranthus Tricolor L. Juice on Increasing the Hemoglobin Level

161

Table 3: Effectiveness of Increasing Hb Levels through Beta Vulgaris Juice to Teachers.

Results of Hb

Levels of Beta

Vul

aris Juice

N Mean SD Min – Max Normality

p-value

Pre-test Hb levels

15 10,887 1,602 8,8 – 14

0,212

0,046

Post-test Hb levels

15 11,920 2,284 9,5 – 18

Table 4: Effectiveness of Increasing Hb Levels through Amaranthus Tricolor L. Juice to Teachers.

Results of Hb

Levels of

Amaranthus

Tricolor L

N Mean SD Min – Max Normality p-value

Pre-test Hb levels 15 10,827 1,602 8,4

–

0,592 0,032

Post-test Hb levels 15 12,167 1,925 10 - 17

Table 5: The difference of the effectiveness of Increasing Hb Levels between Amaranthus Tricolor L. Juice and Beta

Vulgaris juice for teachers.

Hb levels N Mean Homogeneity p-value

Hb levels of Beta Vulgaris juice 15 11,920

0,715

Hb levels of Amaranthus Tricolor L. juice

15 12,167

0,477

The results of the bivariate analysis on Beta

Vulgaris juice, Table 3, show that the average pre-

test Hb level was 10

.887 gr / dL with a standard

deviation of 1

.602. The average post-test Hb level

was 11,920 gr / dL, with a standard deviation of

2,284

. The average Hb level after being given Beta

Vulgaris juice increased by 1

.033 gr / dL. Before the

paired t-test was performed, researchers conducted a

normality test in which to find out the data that were

normally distributed

. It resulted that the data of 15

respondents of the Beta Vulgaris juice group were

normally distributed due to 0

.2118 > 0.05. The

results of the bivariate analysis using paired t-test

obtained p-value = 0

.046, which means that Ho was

rejected

. This result showed that there was a positive

effect of increasing Hb levels through the intake of

Beta Vulgaris juice

Based on Table 4, the average pre-test Hb level

is 10

.827 gr / dL with a standard deviation of 1.602.

The average post-test Hb level is 12

.167 gr / dL with

a standard deviation of 1

.925. The average Hb level

after being given Amaranthus Tricolor L juice

increased by 1,340 gr / dL

. This shows an increase

in the value of the standard deviation between the

pretest and posttest from 1

.602 to 1.925, meaning

that the greater the standard deviation value of a

data, the greater the data distribution of each average

value of the respondents’ Hb level

. The results of the

bivariate analysis using paired t-test was p-value =

.032, which means that Ho was rejected. This

showed that there was a statistically significant

effect (p value < 0

.05), which brings to remark that

there was a beneficial effect of increasing Hb levels

through the administration of Amaranthus Tricolor L

juice to the teachers

The results of the bivariate analysis using

unpaired t-test obtained p-value = 0

.715 (Table 5),

which means that Ho was accepted

. This showed

that it was not statistically significant effect (p value

> 0

.05), meaning that there was no difference in the

effectiveness of increasing Hb levels through the

provision of Beta Vulgaris juice and Amaranthus

Tricolor L juice to teachers

The results of this study are in line with the

study of Kavitha & Denish (2020) with the same

topic about the effect of beetroot juice on

Hemoglobin among girls of selected hostel girls with

the approach of experimental design. The research

involved 30 respondents, and the intervention was

run for 20 days

. The study concluded that there was

a statistically significant difference (p-value < 0

.05)

which indicated that there was a positive impact on

beet juice administration to increase Hb levels; the

average Hb level grew from 8

.8 gr / dL to 11.17 gr /

dL (Kavitha and Denish, 2020)

. The findings of this

study are also consistent with Al-aboud 's study

(2018), with the research title being Impact of Red

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

162

Beetroot (Beta vulgaris L

.) Intake at the Level of

Certain Hematological Tests in a Group of Female

Volunteers

The study concluded that variations in beet

efficacy were observed at Hb levels, namely the

average Hb levels increased from 11

.9 gr / dL to

.6 gr / dL (Al-aboud, 2018). Furthermore, the

results of this study are in line with the research of

Stephana et al

. (2017) entitled Effectiveness of

Beetroot Juice Giving Against Hemoglobin Levels

of Pregnant Women with Anemia in Pekanbaru City

Health Center in 2017

. There was effectiveness in

giving beetroot juice to increase hemoglobin levels

of 34 people in Pekanbaru City Health Center, using

the quasi-experimental approach with p-value =

.001 (p-value <α). It means that there was positive

efefct in giving beet juice to increase the Hb levels

(Stephana, Utami and Elita, 2017)

According to the researchers' assumptions, one

of the factors that cause anemia is meal or food

selection

. The components of nutrients that play a

role in the formation of hemoglobin in food include

iron and protein

. A variety of food consumption

patterns, such as types of food and the frequency of

food consumed, can affect the value of a person's Hb

level

. Beets (Beta Vulgaris) are rich in B vitamins,

and one of its main ingredients is folic acid

. Folic

acid itself serves to help the formation of red blood

cells in the body so that if you regularly consume

beets then you will increase the supply of red blood

cells that are rich in oxygen throughout the body to

prevent anemia. The body does not produce vitamin

B, so to meet the need for vitamin B, it is essential to

pay attention to the intake of foods that contain lots

of vitamin B such as beets (Beta Vulgaris)

(Proverawati and Asfuah, 2015)

The result of the bivariate analysis on

Amaranthus Tricolor L juice was that the average

pre-test Hb level was 10

.827 gr / dL with a standard

deviation of 1

.602. The average post-test Hb level

was 12,167 gr / dL, with a standard deviation of

1,925

. The average Hb level after being given

Amaranthus Tricolor L juice increased by 1,340 gr /

. It can be seen that the data of the 15 respondents

of the Amaranthus Tricolor L juice group were

normally distributed due to 0

.5922 > 0.05. The

results of the bivariate analysis using the paired T-

test obtained p-value = 0

.0321 (p-value <0.05),

which means that Ho was rejected

. This result

proved the effectiveness of increasing Hb levels

through the intake of Amaranthus Tricolor L

. juice.

The findings of this study also agree with the

report made by Muliani, et al

. ( 2017) titled Impact

of Consuming Red Spinach (Amaranthus Tricolor L)

Extract on Hemoglobin Levels In Postpartum

Mothers

. This study involved 30 respondents with

the provision of intervention for 14 days

. The result

in this analysis was that the intake of red spinach has

had a statistically important effect (p-value = 0

.047

< 0

.05). This means that red spinach juice was given

effectively at Hb levels; the average Hb level

increased by 1

.25 gr / dL (Muliani et al., 2017). The

results of this study are following the research of

Majelti et al

. (2017) that there is good effect of

giving red spinach to increase Hb levels (p-value

.05), where Hb levels increased from 7.1 gr / dL

to 9

.6 gr / dL (Maljeti, Mapanawang and Korompis,

2017)

. The results of this study are also consistent

with those conducted by Meylawati, et al

. (2018). It

showed there was positive effect of spinach juice

administration on Hb levels with p-value = < 0

.001;

with an average Hb level before getting intervention

was 9

.45 gr / dL and the average Hb level after

intervention increased to 10

.41 gr / dL (Meylawati,

Nursanti and Widakdo, 2018)

According to the researchers, the previous study

results are reinforced by Juliarti's statement in 2017,

which stated that iron absorption is more efficient

and effective if it is in the form of ferro since it

dissolves quickly

. For that, we need an acidic

atmosphere in the stomach and a compound that can

convert Feri into ferrous in the intestine, the

compound in question is ascorbic acid (vitamin C)

Apart from high iron content, there are other

substances in red spinach that play a role in the

formation of hemoglobin (Juliarti, 2017)

. Folic acid

and vitamin B12 are essential ingredients in the

formation of cell nuclei

. Vitamin B6 and amino

acids and lysine in red spinach play a role in the

initial reaction of heme formation

. Also, vitamins

B6 and B12 are required in the process of

synthesizing globin (Dondi, Rian and Putri, 2019)

The results of the homogeneity test showed a

value of 0

.477 < 0.05, so that it can be said that the

data has the same variance

. Therefore, researchers

used unpaired T-test

. The unpaired t-test has been

granted a p-value of 0

.715, so it can be inferred that

Ho has been approved, and Ha has been denied

. It

means there is no difference in the efficacy of the

consumption of Beta Vulgaris juice and Amaranthus

Tricolor L

. juice to increase the Hb levels. The

assumptions of the researchers that the results could

be due to the increase in Hb levels between the two

The Intake of Beta Vulgaris and Amaranthus Tricolor L. Juice on Increasing the Hemoglobin Level

163

juices were not much different; the difference in

average Hb level was 0

.247 gr / dL. Women workers

without anemia will be more productive at work

than women with anemia

. Therefore, women need

food intake that contains iron in high levels, such as

beets (Beta Vulgaris) and red spinach (Amaranthus

Tricolor L), which are very helpful in the process of

forming red blood cells in the body that can prevent

anemia

. If it is based on the average difference

between Beta Vulgaris juice and Amaranthus

Tricolor L juice, which are 1

.033 gr / dL and 1,340

gr / dL, then Amaranthus Tricolor L juice is more

effective to increase Hb levels

According to the researchers, working women

without anemia will be more productive at work

than women with anemia

. Therefore, women

desperately need meals that contain high levels of

iron, such as beets (Beta Vulgaris) and red spinach

(Amaranthus Tricolor L) which are very helpful in

the process of forming red blood cells in the body

which eventually can prevent anemia. If we look at

the average difference between Beta Vulgaris juice

and Amaranthus Tricolor L juice, which is 1

.033 gr /

dL and 1,340 gr / dL, then Amaranthus Tricolor L

juice is more effective in increasing Hb levels in

teachers at the school

. In this study, the researchers

applied the same method to the two types of juices,

both in the processing, the types of additives used to

the dosage of each type of food used

. The difference

was the price aspect of the raw materials for this

study, namely red spinach and beets

. On the market,

the price of red spinach is cheaper than beets

. For

this reason, red spinach is more efficient for

consumption from an economical point of view

Moreover, red spinach tastes better than beetroot

4 CONCLUSIONS

Based on the results of the research on the

effectiveness of increasing Hb levels through the

intake of Beta Vulgaris juice and Amaranthus

Tricolor L juice, we can conclude that there is the

effectiveness of increasing Hb levels through the

consumption of Beta Vulgaris juice and Amaranthus

Tricolor L juice

. The increase was of 1.033 gr / dL

(p-value = 0

.046) and 1,340 gr / dL (p-value =

.032) respectively. However, there is no difference

in the effectiveness of increasing Hb levels through

the intake of Beta Vulgaris juice and Amaranthus

Tricolor L juice (p-value = 0

.715). Researches

implore individuals to consume either Beta Vulgaris

juice or Amaranthus Tricolor L juice regularly to

experience the benefit of intaking it on increasing

the Hb levels

It is important for teachers to pay more attention

to good nutritional intake for the body, especially

nutrition that can increase Hb levels such as beets

(Beta Vulgaris) and red spinach (Amaranthus

Tricolor L)

. Given that these two ingredients are

very easy to find in the market

. Apart from being

beneficial for body health (increasing the body's

immune system), paying attention to nutritional

intake will also affect better performance and

increase the productivity of respondents during work

and while doing various daily activities.

ACKNOWLEDGMENTS

We would like to thank the Universitas Prima

Indonesia for its support

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