Association Between Dietary Inflammatory Index Scores and Hemoglobin Levels Among Pregnant Women in Asahan Regency: A Cross-Sectional Study

Fenny Anggreany  Nasution; Ninik  Rustanti; Ahmad Syauqy

doi:10.56303/jhnresearch.v5i2.1172

Authors

Fenny Anggreany Nasution Master of Nutrition Science, Universitas Diponegoro, Semarang, Indonesia
Ninik Rustanti Department of Nutrition, Universitas Diponegoro, Semarang, Indonesia
Ahmad Syauqy Department of Nutrition, Universitas Diponegoro, Semarang, Indonesia

Keywords:

Anemia, Dietary Inflammatory Index, Hemoglobin, Pregnant Women, Maternal Nutrition, Inflammation

Abstract

Anemia during pregnancy remains a major public health concern and is influenced not only by iron intake but also by dietary patterns that modulate inflammatory processes. The Dietary Inflammatory Index (DII) is a validated tool used to quantify the inflammatory potential of an individual’s diet and may be associated with hemoglobin (Hb) levels. This study aimed to examine the association between DII scores and hemoglobin levels among pregnant women in Asahan Regency, Indonesia. A cross-sectional study was conducted among 170 pregnant women selected through purposive sampling. Dietary intake was assessed using a semi-quantitative food frequency questionnaire (SQ-FFQ), and DII scores were calculated using 28 out of 45 validated dietary parameters. Hemoglobin levels were obtained from laboratory measurements. Normality testing using the Kolmogorov–Smirnov test showed that both variables were not normally distributed; therefore, Spearman’s correlation analysis was applied. The median hemoglobin level was 11.45 g/dL, while the median DII score was –3.94, indicating a predominantly anti-inflammatory dietary pattern. Spearman’s correlation analysis revealed a strong and significant negative association between DII score and hemoglobin level (ρ = –0.536; p < 0.001), indicating that higher pro-inflammatory dietary potential was associated with lower hemoglobin concentrations. Multivariable analysis adjusting for maternal age, gestational age, parity, and mid-upper arm circumference (MUAC) confirmed that DII score remained an independent predictor of hemoglobin level. These findings highlight the importance of promoting anti-inflammatory dietary patterns during pregnancy to support optimal hemoglobin status and reduce the risk of anemia. Incorporating dietary inflammatory assessment into antenatal nutrition programs may strengthen anemia prevention strategies and improve maternal health outcomes.

Downloads

Download data is not yet available.

References

Karami M, Chaleshgar M, Salari N, Akbari H, Mohammadi M. Global Prevalence of Anemia in Pregnant Women: A Comprehensive Systematic Review and Meta-Analysis. Matern Child Health J. 2022;26(7):1473-87.

Organization WH. WHO global anaemia estimates: key findings, 2025: World Health Organization; 2025.

Laporan Riset Kesehatan Dasar 2018. Jakarta: KEMENTERIAN KESEHATAN; 2019.

Fraenkel PG. Anemia of Inflammation: A Review. Med Clin North Am. 2017;101(2):285-96.

Shivappa N, Steck SE, Hurley TG, Hussey JR, Hébert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr. 2014;17(8):1689-96.

Ma H, Deng W, Chen H, Ding X. Association between dietary inflammatory index and anemia in US adults. Frontiers in Nutrition. 2024;10:1310345.

Huang C, Zhang Z, He J, Zhong Z, Ma Y, Huang X, et al. First–Second-Trimester Dietary Inflammatory Index and Anemia Risk in the Third Trimester: A Prospective Cohort Study. Nutrients. 2025;17(11):1938.

Syauqy A, Afifah DN, Purwanti R, Nissa C, Fitranti DY, Chao JC-J. Reproducibility and validity of a food frequency questionnaire (Ffq) developed for middle-aged and older adults in semarang, Indonesia. Nutrients. 2021;13(11):4163.

Kim HS, Lee H, Provido SMP, Kang M, Chung GH, Hong S, et al. Association Between Diet Quality and Prevalence of Obesity, Dyslipidemia, and Insulin Resistance Among Filipino Immigrant Women in Korea: The Filipino Women's Diet and Health Study. Frontiers in Public Health. 2021;9:647661.

Organization WH. Guideline on haemoglobin cutoffs to define anaemia in individuals and populations: World Health Organization; 2024.

Camaschella C. Iron deficiency. Blood, The Journal of the American Society of Hematology. 2019;133(1):30-9.

Shivappa N, Godos J, Hébert JR, Wirth MD, Piuri G, Speciani AF, et al. Dietary Inflammatory Index and Cardiovascular Risk and Mortality—A Meta-Analysis. Nutrients. 2018;10(2):200.

Kong L-C, Tap J, Aron-Wisnewsky J, Pelloux V, Basdevant A, Bouillot J-L, et al. Gut microbiota after gastric bypass in human obesity: increased richness and associations of bacterial genera with adipose tissue genes. The American journal of clinical nutrition. 2013;98(1):16-24.

Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood. 2019;133(1):40-50.

Weiss G, Goodnough LT. Anemia of chronic disease. New England Journal of Medicine. 2005;352(10):1011-23.

Das A, Bai C-H, Chang J-S, Huang Y-L, Wang F-F, Hsu C-Y, et al. A ferritin-related dietary pattern is positively associated with iron status but negatively associated with vitamin D status in pregnant women: a cross-sectional study. European Journal of Nutrition. 2024;64(1):30.

Ross ADB, Perrone F, Elmentaite R, Teichmann SA, Zilbauer M. Obtaining purified human intestinal epithelia for single-cell analysis and organoid culture. STAR Protoc. 2021;2(2):100597.

Reddy BHR, Thankachan P, Hatakayama M, Hiremath N, Moretti D, Nanjareddy YA, et al. A natural low phytic acid finger millet accession significantly improves iron bioavailability in Indian women. Frontiers in Nutrition. 2022;8:791392.