THE EFFECT OF DRAGON FRUIT ON INCREASING HEMOGLOBIN LEVELS IN ADOLESCENT WOMEN: LITERATURE REVIEW

ABSTRACT


INTRODUCTION
The world prevalence of anemia in adolescents ranges from 40-88%.According to the World Health Organization (WHO), the incidence of anemia in adolescent girls in developing countries is around 53.7% of all adolescent girls (WHO, 2018).The results of the 2013 Indonesian National Health Survey show that the prevalence of anemia in children aged 1-4 years, 5-14 years, and 15-24 years is 28.1%, 26.4%, and 18.4%, respectively.There was an increase in prevalence compared to the previous survey conducted in 2007, namely 27.7%, 9.4% and 6.9% respectively in children aged 1-4 years, 5-14 years and 15-24 years.In particular, the prevalence of anemia in school-age children and adolescents has almost tripled.According to the 2013 Riskedas results data, 37.1% of young women experienced anemia, which increased to 48.9% in the 2018 Riskesdas, with the proportion of anemia in the 15-24 year and 25-34 year age groups (Kemenkes, 2021).The National Health Survey also shows that the prevalence of anemia in suburban areas is higher than in urban areas (Nasruddin et al., 2021).Adolescent girls have a high risk of experiencing anemia, this is caused by loss of iron during menstruation.Adolescent girls have a higher risk of developing anemia than adolescent boys because adolescent girls experience menstruation every month and there is a desire to eat less so that the body lacks important nutrients such as iron.If the food consumed has good value, then the nutritional status will also be good, conversely if the food consumed lacks nutritional value, it will cause malnutrition and can cause anemia.(Nasruddin et al., 2021).Pharmacological therapy for anemia by administering Fe supplements.However, administering drugs and supplements causes side effects so that people look for alternative treatments other than pharmacological therapy.One alternative to overcome anemia is by consuming dragon fruit juice.Dragon fruit is classified as a super food because it is rich in nutrients and oxidants.Stated that dragon fruit contains carotene, calcium, Vitamins B1, B2, B3 and Vitamin C (Tandon), iron which is useful for the formation of hemoglobin.Another study showed that teenagers who consumed 200 grams/day for 7 consecutive days of dragon fruit obtained an increase in hemoglobin of 3,009, where initially before being given it was 12,982 to 15,991, it was concluded that dragon fruit could have an effect on hemoglobin levels.(Ratna et al., 2023).Based on the background above, the author is interested in conducting a literature review from various sources regarding the effect of dragon fruit on increasing hemoglobin levels in adolescent girls.This literature review was carried out by conducting a literature search on several journal websites to find out what research had been conducted on the effect of dragon fruit on increasing hemoglobin levels in young women.

METHODS
The design used in this research is a literature review or literature study.Literature review is a search and research of the literature by reading and reviewing various journals related to the research topic to produce an article relating to a particular topic or issue.In this KIAB report, literature study identification has been carried out using the following steps: 1. Creation of a framework as a basis for determining inclusion criteria.2. Literature searches use keywords and Boolean operators (AND, OR, AND) to specify and expand the search, making it easier to determine which articles to use.The keywords used in searching articles are Dragon Fruit (Pitaya, Hylocereus polyrhizus, Dragon Fruit), Anemia (Iron deficiency) and Adolescent Girls (Adolescence, Teenage Girl).3. Enter these keywords into the search engine on the PubMed, Google Scholar, Semantic Scholar and Science Direct databases by setting the filters on the page such as Full Text, 5 years, Human filtering.By setting the filters on the page such as custom filtering range 2019 to 2024 and select trials.4. Record database findings.5.The selection of literature used meets the inclusion and exclusion criteria.6. Save the database page to the Mandeley bibliography storage engine.In Mandeley the data has been input into a folder.7. The stored data is filtered according to the framework.Inappropriate articles are removed from the "relevant" folder.8. Record the findings on the number of articles 9. Carry out literature mapping.10.Read and describe the conclusions of each article

DISCUSSION
Based on analysis from a literature review with a discussion of the effect of dragon fruit on increasing hemoglobin levels in adolescent girls.The author chose 10 (ten) journals consisting of 1 international journal and 9 national journals.These ten journals have in common that the results of their research show a significant relationship between the interventions given and increasing hemoglobin levels in conditions of anemia.. From research conducted by (Meti et al., 2021) for 1 day with 100 grams of dragon fruit, the results showed that after being given the intervention in the green bean group and the dragon fruit group there was a difference in Hb levels before and after treatment, the green bean group had an average increase of 0.3346 gr/dl while in the dragon fruit group had an average increase of 0.1760 gr/dl.Thus, giving green beans is better in increasing Hb levels compared to giving dragon fruit.
On research (Decy et al., 2023) which was carried out on teenage girls who were divided into 2 groups and were given intervention for 14 days.The average Hb level in the experimental group before being given the intervention was 10,725 gr/dL after being given dragon fruit was 12,280 gr/dL.Meanwhile, in the control group before intervention it was 10.815 gr/dL and after being given Fe tablets alone it was 11.550 gr/dL.The results of the paired test p-value were 0.000 and the independent t test showed a p-value of 0.000 < 0.05.The increase in Hb levels was statistically significant.
In research (Ratna et al., 2023) Regarding the Effectiveness of Dragon Fruit and Date Juice on Hemoglobin Levels in Adolescent Girls.After 15 days, 200 grams/day of dragon fruit intervention was given.showed that the hemoglobin levels of young women before giving the combination of dragon fruit and Fe tablets had a mean value of 12.982, while the hemoglobin levels of young women after were given a mean value of 15.991.The increase in Hb levels was statistically significant.
Based on research (Ambar & Titin, 2023) Regarding the comparison of giving dragon fruit and beetroot to adolescent Hb levels, it shows that after 14 days of intervention given dragon fruit juice and beetroot juice to young women, 200 grams/day, before giving dragon fruit the average = 10.225gr/dl and after giving dragon fruit average = 10,650 gr/dl.The Hb level of female teenagers before giving beets was on average = 10.342gr/dl and after giving beets the average = 11.017gr/dl.And there is an effect of giving dragon fruit juice on increasing hemoglobin levels in adolescent girls.
The results of research conducted by (Ani & dkk, 2023) for 7 days with 350 ml of dragon fruit juice, the results showed that there was an increase in hemoglobin levels between before and after giving dragon fruit juice with iron tablets, namely the average value before the intervention (pretest) was 11,380 and the average value after the intervention was 11,650.It can be seen that the group given dragon fruit juice had an average difference in increase in hemoglobin levels of 0.260 (SD=0.2366)and red guava juice had an average difference in increase in hemoglobin levels of 0.630 (SD=0.3529).The results of statistical tests using T-independent with a confidence level of 95% showed that the significance value of giving dragon fruit juice and red 52 guava juice with iron tablets on the increase in hemoglobin levels of anemic adolescent girls was p=0.013 with α=0.05.So there is a difference in effectiveness between giving dragon fruit juice and red guava juice with iron tablets on the hemoglobin levels of anemic teenage girls at the Ummahatul Mukminin Islamic Boarding School, Pekanbaru City.
From the research conducted (Rohanah et al., 2023) The results of adolescent hemoglobin in the intervention group were obtained.Pretest with an average score of 10.67 (SD 0.66) and post-test 12.53 (SD 1.43).The p value shows p=0.001 so it can be concluded that Ha is accepted, so it is found that there is an effect of giving dragon fruit juice to anemic teenagers.The same results were shown in the control group (administering beetroot juice).The pre-test score showed 10.73 (SD 0.78) and posttest 12.03 (SD 0.56).The p value shows p=0.001 so it can be concluded that there is an effect of giving beetroot juice to anemic teenagers at 200 ml/day for 6 days.
On research (Ester & Tonny,2023) Regarding the Effect of a Mixture of Hylocereus Polyrhizus Juice (Red Dragon Fruit) and Moringa Leaf Flour on Hemoglobin Levels in Adolescent Girls who were given for 14 days with 100 ml dragon fruit juice, there was an increase in hemoglobin.In treatment group 1, there was an average increase in hemoglobin levels of 2.2 g/dl, where the previous average hemoglobin level was 13.3 g/dl, and after being given a mixture of Hylocereus polyrhizus juice and Moringa leaf powder for 14 days it increased to 15.5 grams/dl.Likewise, in the group given intervention 2 (Hylocereus polyrhizus juice), there was an increase in hemoglobin levels of 1.1 g/dl, while the average hemoglobin level before being given the intervention was 13.1 g/dl and after 14 days of being given red dragon fruit juice.there was an increase in Hb levels to 14.2 g/dl.
Based on research conducted by (Ummi et al., 2023) The results obtained reported changes in hemoglobin levels in the control group, hemoglobin levels decreased in almost all respondents with an average decrease of 1.4 g/dL, from 10.72 g/dL to 9.28 g/dL.Meanwhile, in the intervention group, there was an increase in all respondents after receiving boiled chicken eggs and dragon fruit intervention, with an average increase in hemoglobin levels of 4.4 g/dL, from 9.12 g/dL to 13.51 g/dL.This was seen there was an increase in hemoglobin levels in young women, given for 5 days with 36 grams/day of eggs and 365 grams/day of dragon fruit.
In research (Novi & Heni, 2023) which was carried out for 7 days by giving 500 grams of dragon fruit.Client hemoglobin results A and P after being given dragon fruit juice and anemia training for 7 days.The results of the hemoglobin examination in both clients increased and were stable.Hemoglobin before the intervention was given to client A had an Hb of 11.4gr/dl while client P had an Hb of 11.3gr/dl.After the intervention was given, the increase occurred in client A by 12.6gr/dl and client P by 13.8gr/dl.
The results of research conducted by (Santi et al, 2021) which was carried out for 7 days with 250 ml of dragon fruit juice.The average hemoglobin level before the red guava juice intervention was 13.18 gr / dL.The average value of hemoglobin levels 53 after the red guava juice intervention was 14.71 gr/dL.The average value of hemoglobin levels before the red dragon fruit juice intervention was 13.13 gr/dL.The average value of hemoglobin levels after the dragon fruit juice intervention.red was 15.46 gr/dL, there was no significant difference in the effectiveness of hemoglobin levels after intervention in the red guava and red dragon juice groups.
Anemia causes a reduction in the number of red blood cells or the amount of hemoglobin in red blood cells, so that the blood cannot carry oxygen in the amount needed by the body.Anemia is generally characterized by low levels of hemo globin below normal values so that the fulfillment of the body's physiological needs is reduced (Sayogo, 2019.)This causes a decrease in the blood's ability to carry and bind oxygen because around 98% of the total oxygen is transported by the blood via hemoglobin.Symptoms that arise due to anemia are known as "5" (weak, tired, lethargic, tired, and inattentive) and can be accompanied by headaches, dizzy eyes, easy drowsiness, and difficulty concentrating.(Briawan, 2020).
Factors that cause anemia include low intake of iron and other nutrients such as vitamins A, C, folic acid, riboflavin and vitamin B12.Apart from that, the occurrence of chronic bleeding in the digestive tract caused by worm infestation, damage to red blood cells caused by malaria, a history of pregnancy and childbirth and due to menstruation, apart from that it is also influenced by socio-economic, educational and nutritional status (Argana, 2021).The impacts that occur if teenagers experience anemia include delayed physical growth, behavioral and emotional disorders.This can affect the growth process and development of brain cells so that it can cause decreased body endurance, easy weakness and hunger, disturbed learning concentration, decreased learning achievement and can result in low work productivity.(Sayogo, 2019.)Prevention of anemia during adolescence can be done by increasing the amount of iron consumed from natural sources, especially animal source foods that are easily absorbed such as liver, meat and fish.It is also necessary to increase consumption of foods that contain lots of vitamins C and A (fruit and vegetables) to help absorb iron and help the process of forming Hb.Various efforts can be made to prevent and treat anemia both pharmacologically and non-pharmacologically.Pharmacological efforts can take the form of Fe tablet supplementation.Often consuming Fe causes side effects such as nausea, vomiting, diarrhea and dizziness.These effects make Fe tablets less attractive to the public.Meanwhile, non-pharmacological therapy can be used to increase Hb levels in anemia sufferers.Another alternative way to prevent and treat anemia non-pharmacologically is consuming dragon fruit (Astawan, 2021).

CONCLUSION
Based on the analysis and discussion in the literature review conducted : There is an effect of dragon fruit consumption on increasing hemoglobin levels in anemic adolescent girls; There are many processed dragon fruit products that can be consumed by young women as a source of iron, such as direct dragon fruit and dragon fruit juice to increase hemoglobin levels; The correct way to serve dragon fruit to increase