Effect of a School-Based Nurse-Led Red Dragon Fruit Intervention as an Adjunct to Iron–Folic Acid Supplementation in Adolescent Girls: A Quasi-Experimental Study
DOI:
https://doi.org/10.31674/mjn.2026.v18i02.008Abstract
Background: Background: Anemia remains a nutritional concern among adolescent girls, and routine Iron–Folic Acid (IFA) supplementation may benefit from complementary food-based strategies. Objectives: To examine whether adding 100 g of fresh red dragon fruit (Hylocereus polyrhizus) daily to routine IFA supplementation was associated with an additional change in hemoglobin levels among adolescent girls. Methods: A quasi-experimental pretest–posttest study with a non-equivalent control group was conducted among 96 adolescent girls in a public senior high school in Yogyakarta, Indonesia. Participants received routine IFA plus 100 g of fresh red dragon fruit daily for 14 days (n = 48) or routine IFA alone (n = 48). Hemoglobin was measured before and after the intervention. ANCOVA compared post-intervention hemoglobin between groups after adjustment for baseline hemoglobin, age, and menstrual cycle characteristics. Results: Hemoglobin increased by 0.274 g/dL in the intervention group and 0.145 g/dL in the control group. The unadjusted between-group difference in change was 0.129 g/dL (95% CI −0.036 to 0.294; p = 0.123). After adjustment, the estimated marginal means were 12.98 and 12.80 g/dL, respectively, with an adjusted difference of 0.18 g/dL (95% CI 0.04–0.32; F (1,91) = 6.12; p = 0.015; partial η² = 0.06). Conclusion: Adding fresh red dragon fruit to routine IFA supplementation was associated with a statistically significant but small adjusted difference in hemoglobin after 14 days. The findings should be interpreted cautiously because of the non-randomized design, short follow-up, and potential measurement uncertainty.
Keywords:
Anemia, Dietary Intervention, Hemoglobin, Iron–Folic Acid Supplementation, Vitamin CDownloads
References
Chen, S. Y., Xu, C. Y., Mazhar, M. S., & Naiker, M. (2024). Nutritional value and therapeutic benefits of dragon fruit: A comprehensive review with implications for establishing Australian industry standards. Molecules, 29(23), 5676. https://doi.org/10.3390/molecules29235676
Deng, J., Ramelli, L., Li, P. Y., Eshaghpour, A., Li, A., Schuenemann, G., & Crowther, M. A. (2024). Efficacy of vitamin C with Fe supplementation in patients with iron deficiency anemia: a systematic review and meta-analysis. Blood Vessels, Thrombosis & Hemostasis, 1(4), 100023. https://doi.org/10.1016/j.bvth.2024.100023
Evang, E. C., Habte, T. Y., Owino, W. O., & Krawinkel, M. B. (2021). Can the supplementary consumption of baobab (Adansonia digitata L.) fruit pulp improve the hemoglobin levels and iron status of schoolchildren in Kenya? Findings of a randomized controlled intervention trial. European Journal of Nutrition, 60(5), 2617-2629. https://doi.org/10.1007/s00394-020-02447-2
García-Erce, J. A., García-López, S., & Martínez-Francés, A. (2026). Iron deficiency and oral treatments: Limitations, pharmacokinetics, and the role of iron protein succinylate in clinical practice. Journal of Clinical Medicine, 15(10), 3691. https://doi.org/10.3390/jcm15103691
Haile, B., Oumer, A., Negese, T., Temesgen, M., Kebede, A., Abdurahman, D., ... & Roba, K. T. (2024). Factors associated with compliance with weekly iron and folic acid supplementation among school adolescent girls in Debub Achefer district, northwest Ethiopia: school-based cross-sectional study. Scientific Reports, 14(1), 9980. https://doi.org/10.1038/s41598-024-60800-5
Harris, A. D., McGregor, J. C., Perencevich, E. N., Furuno, J. P., Zhu, J., Peterson, D. E., & Finkelstein, J. (2006). The use and interpretation of quasi-experimental studies in medical informatics. Journal of the American Medical Informatics Association, 13(1), 16-23.https://doi.org/10.1197/jamia.M1749
Hidayanty, H., Nurzakiah, N., Irmayanti, I., Yuliana, Y., Helmizar, H., & Yahya, Y. (2025). Perceived barriers and enablers for taking iron–folic acid supplementation regularly among adolescent girls in Indonesia: A pilot study. International Journal of Environmental Research and Public Health, 22(2), 209. https://doi.org/10.3390/ijerph22020209
Kolarš, B., Mijatović J. V., Živanović, N., Minaković, I., Gvozdenović, N., Dickov K. I., & Lesjak, M. (2025). Iron deficiency and iron deficiency anemia: a comprehensive overview of established and emerging concepts. Pharmaceuticals, 18(8), 1104. https://doi.org/10.3390/ph18081104
Li, N., Zhao, G., Wu, W., Zhang, M., Liu, W., Chen, Q., & Wang, X. (2020). The efficacy and safety of vitamin C for iron supplementation in adult patients with iron deficiency anemia: a randomized clinical trial. JAMA Network Open, 3(11), e2023644. https://doi.org/10.1001/jamanetworkopen.2020.23644
Ministry of Health of the Republic of Indonesia, Health Development Policy Agency. (2024). Indonesian Health Survey 2023 in numbers. https://www.badankebijakan.kemkes.go.id/en/repositori/id/eprint/5538/
Piskin, E., Cianciosi, D., Gulec, S., Tomas, M., & Capanoglu, E. (2022). Iron absorption: factors, limitations, and improvement methods. ACS Omega, 7(24), 20441. https://doi.org/10.1021/acsomega.2c01833
Raj, R., Menon, N., & Srivaths, L. (2025). Iron deficiency and anemia in menstruating adolescents. Pediatrics In Review, 46(11), 606-616. https://doi.org/10.1542/pir.2025-006756
Sari, P., Herawati, D. M. D., Dhamayanti, M., & Hilmanto, D. (2022). Anemia among adolescent girls in west java, Indonesia: related factors and consequences on the quality of life. Nutrients, 14(18), 3777. https://doi.org/10.3390/nu14183777
Shah, K., Chen, J., Chen, J., & Qin, Y. (2023). Pitaya nutrition, biology, and biotechnology: A review. International Journal of Molecular Sciences, 24(18), 13986. https://doi.org/10.3390/ijms241813986
Skolmowska, D., & Głąbska, D. (2022). Effectiveness of dietary intervention with iron and vitamin C administered separately in improving iron status in young women. International Journal of Environmental Research and Public Health, 19(19), 11877. https://doi.org/10.3390/ijerph191911877
Sungkar, A., Bardosono, S., Irwinda, R., Manikam, N. R., Sekartini, R., Medise, B. E., ... & Vandenplas, Y. (2022). A life course approach to the prevention of iron deficiency anemia in Indonesia. Nutrients, 14(2), 277. https://doi.org/10.3390/nu14020277
Van Zutphen, K. G., Kraemer, K., & Melse-Boonstra, A. (2021). Knowledge gaps in understanding the etiology of anemia in Indonesian adolescents. Food and Nutrition Bulletin, 42(1_suppl), S39-S58. https://doi.org/10.1177/0379572120979241
Von Siebenthal, H. K., Moretti, D., Zimmermann, M. B., & Stoffel, N. U. (2023). Effect of dietary factors and time of day on iron absorption from oral iron supplements in iron deficient women. American Journal of Hematology, 98(9), 1356-1363. https://doi.org/10.1002/ajh.26987
Wangaskar, S. A., Sahu, S. K., Majella, M. G., & Rajaa, S. (2021). Prevalence of anaemia and compliance to weekly iron-folic acid supplementation programme amongst adolescents in selected schools of urban Puducherry, India. Nigerian Postgraduate Medical Journal, 28(1), 44-50. https://doi.org/10.4103/npmj.npmj_336_20
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