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Can date fruits and 7 dates replace iron tablets in increasing hemoglobin levels?

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Abstract and Figures

Background. Iron suplement programs, as an approach to overcoming anemia, indicate positive impact although many studies have also noted varying levels of success or even a failure. The known and commonly acknowledged side effect of iron supplements, such as constipation, causes a tendency for patients to stop consuming these supplements. Aim: To examine hemoglobin level and bowel movement differences resulting from an iron suplement program of the government program as well as consumption of the date fruits, and two common products freely available to the Indonesian consumers. Method. This study is a pilot randomized controlled trial with four groups consist of three treatment groups and one control group. Respondents were anemia adolescent girls with inclusive but not exclusive criteria. 40 respondents were selected using random permutated blocks. Intervention was done for 30 days with weekly assessments. Data analysis used Friedman Test, Wilcoxon Signed Rank and Multiple Linear Regression test. Results. There is a significant hemoglobin difference before and after intervention on the four groups. The differences seen in week 1, 2, 3, then tends to decline. Strong, significant correlation is found in treatment with hemoglobin and defecation duration (week 4) and bowel problems (week 2, 3, 4); feeding frequency and menstruation with hemoglobin (week 1); feeding frequency and defecation duration (week 2); water intake and defecation duration (week 4). Multiple linear regression analysis results in regression equation and participants' prediction towards dependent variables. There is a positive, significant relationship between treatment (week 2, 3) and bowel problems, water intake (week 4) and defecation duration. Conclusion. Dates can be used instead of iron tablets and 7dates can be used as a companion iron tablets.
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Indrayani, Agus Rahmadi, Dava Alpha Rakhim
1750 P J M H S Vol. 12, NO. 4, OCT DEC 2018
Can date fruits and 7dates replace iron tablets in increasing
hemoglobin levels?
INDRAYANI1, AGUS RAHMADI2,3, DAVA ALPHA RAKHIM2
ABSTRACT
Background. Iron suplement programs, as an approach to overcoming anemia, indicate positive impact
although many studies have also noted varying levels of success or even a failure. The known and commonly
acknowledged side effect of iron supplements, such as constipation, causes a tendency for patients to stop
consuming these supplements.
Aim: To examine hemoglobin level and bowel movement differences resulting from an iron suplement
program of the government program as well as consumption of the date fruits, and two common products
freely available to the Indonesian consumers.
Method. This study is a pilot randomized controlled trial with four groups consist of three treatment groups
and one control group. Respondents were anemia adolescent girls with inclusive but not exclusive criteria. 40
respondents were selected using random permutated blocks. Intervention was done for 30 days with weekly
assessments. Data analysis used Friedman Test, Wilcoxon Signed Rank and Multiple Linear Regression test.
Results. There is a significant hemoglobin difference before and after intervention on the four groups. The
differences seen in week 1, 2, 3, then tends to decline. Strong, significant correlation is found in treatment
with hemoglobin and defecation duration (week 4) and bowel problems (week 2, 3, 4); feeding frequency and
menstruation with hemoglobin (week 1); feeding frequency and defecation duration (week 2); water intake
and defecation duration (week 4). Multiple linear regression analysis results in regression equation and
participants’ prediction towards dependent variables. There is a positive, significant relationship between
treatment (week 2, 3) and bowel problems, water intake (week 4) and defecation duration.
Conclusion. Dates can be used instead of iron tablets and 7dates can be used as a companion iron tablets.
Keywords: Iron tablets, ferrous sulfate, ferrous gluconate, date fruits, 7dates, anemic, hemoglobin, bowel
movements, dietary fiber, water intake, bowel problems
INTRODUCTION
Obstetric haemorrhage is the main cause of maternal
mortality1 and it has been estimated to cause 25% of all
maternal mortality in the world and over 30% in Asia2, 3.
In fact, the real number of deaths is beyond the
estimation since many death cases caused by
postpartum haemorrhage are unreported. However, the
absolute risk of death is lower in high-income countries
with a ratio estimation of 1: 100,000 childbirths compared
to the ratio estimation of 1: 1,000 childbirths in low-
income countries4. Anemia is an advanced problem that
occurs as a result of hemorrhage, but it can also be the
indirect cause of hemorrhage5. To date, anemia
particularly iron deficiency is a serious public health
problem in developing countries6. Anemia in pregnancy
can lead to fetal growth disorders, preterm labor, low
birth weight, and haemorrhage7, 8, 9, 10, 11. Approximately
16-55% of women have suffered from anemia since early
pregnancy12. Iron supplementation is the most widely
used approach to treat anemia13. The iron tablet
administration program starting after the first trimester of
pregnancy has been applied in many developing
countries. Several studies have reported the positive
-----------------------------------------------------------------------------------------
1Akademi Kebidanan Bina Husada, Tangerang
2Akademi Kebidanan Bunda Auni, Bogor
3Klinik Sehat Indonesia
Correspondence to Indrayani, Akademi Kebidanan Bina Husada, Tangerang.
Kutai Raya No.1, Bencongan Kelapa Dua, Tangerang, Banten, Indonesia.
Zip Code 15811 Ph. +62-21-55655372 Fax. +62-21-55655372. Email:
indrayani_akbid@yahoo.co.id
effects of this effort14, 15, 16, 17 yet the impact is still far from
the expectations12 and it is considered an unsuccessful
program18 due to low adherence of women in
consumption of iron tablets. Some studies have reported
that gastrointestinal side-effects generally have dropped
women compliance in consuming iron tablets18, 19. The
most common complaints after taking iron tablets are
nausea and constipation. This condition is further
exacerbated if they are consumed by pregnant women
as the body adapts towards pregnancy hormone20, 21, 22.
Other studies also reported that iron supplementation
may cause constipation23, 24, 25. Women without a history
of bowel problems may experience constipation in the
early pregnancy, while women with previous constipation
history will experience worse complaints during their
pregnancy20. The prevalence of constipation reported in
pregnancy is 11-38%26, 27, 28. Other factors which
aggravate constipation are less dietary fiber21, 29 and low
water intake21. Moreover, a pregnancy period is a short
time period to deal with pre-existing anemia12. Therefore,
iron deficiency correction should have been done from
teenage years or before pregnancy30.
Iron is a crucial substance for biological function
including respiration, energy production, deoxy-
ribonucleic acid (DNA) synthesis, and cell proliferation31
as well as an essential element needed to produce red
blood cells which carry all of the nutrients to cells
throughout the body32. Iron can be acquired from food
and beverage. Dates are an example of iron-containing
ORIGINAL ARTICLE
Indrayani, Agus Rahmadi, Dava Alpha Rakhim
P J M H S Vol. 12, NO. 4, OCT DEC 2018 1751
nutrients often consumed and favored by the Muslim
community33. Mariyam et al. reported that Ajwa dates
contain the least iron (0.85 mg/100 gr) while the Tunisian
dates contain the most iron (7.2 mg/100 g)34. In addition
to iron, 100 gr of dates also contain 5.2% crude fiber and
minerals such as calcium (Ca) 65 mg, phosphorus (P) 72
mg, potassium (K) 521 mg, magnesium (Mg) 20 mg, and
selenium (Se) 0.34 mg. Furthermore, the contents of
vitamins in dates include vitamin A (0.04 mg), B1 (0.08
mg), B2 (0.05 mg) and nicotinic acid (2.20 mg). All these
vitamins have different functions that can help the body
to be healthy through carbohydrate metabolism,
maintaining blood glucose levels, fatty acids for energy,
and assisting in the formation of hemoglobin, leukocytes
and red blood cells32. Some studies have proven that
dates consumption can escalate hemoglobin levels35, 36.
This study was aimed to examine the divergences of
hemoglobin levels and bowel movements among iron
supplementation supplied by the government, as
opposed to the supplements circulated in the open
market and nutritional sources of iron often consumed by
the community and to identify an alternative solution to
solve anemia.
METHOD OF STUDY
This study is a pilot randomized controlled trial. The
independent variables of this study were consumption of
ferrous sulfate, ferrous gluconate, date fruits and 7dates
while the dependent variables were hemoglobin levels,
duration of defecation and bowel problems. Confounding
variables for hemoglobin levels were mean of feeding
frequency per week and menstruation, whereas for
duration of defecation and bowel problems were mean of
feeding frequency, dietary fiber and water intake per
week. There were four groups, each selected randomly,
included three intervention groups (ferrous gluconate,
date fruits and 7dates) and one control group (ferrous
sulfate).
The control group was iron tablet subsidized by the
Bogor District Health Office containing ferrous sulfate
excitation 200 mg, while the first treatment group was
Sangobion tablet which is an iron tablet commonly
consumed by Indonesian people and sold freely over the
counter in drugstores containing 250 mg ferrous
gluconate. The second treatment group consumed a
popular date sold in the Indonesian market, Sayer
dates37. The third treatment group consumed a
commonly available date drink packaged as 7dates. The
7dates election was based on its staple ingredients using
dates and water only and it has been certified as a viable
product certification from The Assessment Institute for
Food, Drugs, and Cosmetics of Indonesian Ulema
Council (figure 1).
Respondents in this study were anemic teenage
girls in the Bunda Auni community (age 18 to 25 years
old) who met the inclusion criteria and were excluded
from exclusion criteria. The inclusion criteria were
nulligravida and nullipara, having hemoglobin levels 7 to
12 gr/dL (see table 1), having one or more symptoms of
anemia, not consuming any iron supplements, and a
willingness to consume either iron tablets, dates or
7dates. The exclusion criteria were girls with excess iron
(hemocromatosis, hemosiderosis), anemia due to red-
cell fragmentation (hemolytic anemia), disorders of red
blood cells (porphyria, thalassemia), stomach ulceration
(peptic ulceration) and colon ulceration (ulcerative
colitis), alcohol drinkers and recipients of routine blood
transfusions.
Figure 1. Sayer dates and 7dates
Table 1. Diagnosis of anemia according to WHO
Group
Hb levels (g/dL)
Children aged 6 months to 6 years old
<11.0
Children aged 6-14 years old
<12.0
Adult men
<13.0
Adult women who are not pregnant
<12.0
Pregnant women
<11.0
Source: AlDallal38
Before data collection, 6 persons were recruited and
trained including 2 officers to measure hemoglobin levels
and 4 officers to observe the compliance of respondents
in consumption of ferrous sulfate 200 mg (1 tablet per
day), ferrous gluconate 250 mg (1 tablet per day), date
fruits 70-75 gr (2x35-37.5 gr per day)39 which contain
iron around 2.4 mg/75 gr dates40 and 7dates (3 bottles
per day) for 30 days. Determination of dates doses were
based on the recommended consumption of 7 dates per
day where Muslims believe that by eating 7 dates each
day, a person will be spared from poison and sorcery
(Hadith narrated Bukhari no. 356)41 and considerations
of safety aspect where lethal dose (LD) of 50 extract
dates are more than 5000 mg/kg42 whereas the LD of
Ferrous Sulfate for adults is 200-250 mg/kg body
weight43, 44. Data was collected from January to April
2018 in Bojong Kulur village, Gunung Putri district, Bogor
regency, West Java province, Indonesia. Data collection
method in this study was using primary data taken
directly from respondents through observation, interview,
and examination.
The selection of research sites was based on
considerations of access and technical observation of
respondents as most of the girls of the Bunda Auni
community reside in dormitories and some live in groups
in boardinghouses. Determining the number of samples
per group was based on the sample calculation using
Federer’s formula and 10% addition to anticipate the
drop out sample, that was 10 respondents per group or
40 respondents overall. Each member of the groups
Can date fruits and 7dates replace iron tablets in increasing hemoglobin levels?
1752 P J M H S Vol. 12, NO. 4, OCT DEC 2018
were chosen by random permutated blocks. A total of 46
anemic girls met the inclusion criteria and were not
included in the exclusion criteria and were willing to be
involved in the study. However, as many as 6 people
dropped out in the first week, 4 of them were unable to
tolerate the side-effects of iron supplements and 2 of
them moved out, while 40 others remained in the study
until the end of the study.
Anamnesis, physical examination and hemoglobin
estimation were performed before intervention for
screening respondents. Every day the officer reviewed
food intake, dietary fiber and water intake, menstruation,
bowel movements and bowel problems experienced by
respondents followed by weekly examinations including
anamnesis, physical examination and hemoglobin
estimation that was done by Sahli’s method and digital
hemoglobin test (hemoglobin testing system quick-
check) Easytouch with one prick. The main reason for
using Sahli’s method is because it is recommended by
Indonesian government while digital hemoglobin test is
most frequent used by Indonesian midwives. Data
analysis was done by using statistical procedure and
service solution (SPSS) 19 software. Univariate analysis
was performed to describe each variable studied
separately. The two-way repeated Anova test could not
be done since the data normality and homogeneity were
not eligible so the Friedman test was chosen as an
alternative test followed by advanced test or post hoc
with Wilcoxon signed rank test to identify which group is
mutually meaningful. Further, a multiple linear regression
was performed to examine the size of the influence
between variables.
This study has been submitted to the Ethics of
Health Study Committee, The Faculty of Medicine of
Universitas Padjadjaran Bandung and obtained approval
from the Ethics of Health Study Committee, The Faculty
of Medicine of Universitas Padjadjaran number
29/UN6.C10/PN/2018.
RESULT
Friedman test results showed significant differences
in hemoglobin levels in all four groups (ferrous sulfate,
ferrous gluconate, dates and 7dates) between, before
and after intervention (1, 2, 3 and 4 weeks) both using
Sahli’s method and digital hemoglobin test (table 2).
Table 2. Changes in hemoglobin levels (gr/dL)
FS*
FG
7D
Shali’s method
Initial
9.7+0.85
10.3+0.83
10.7+0.61
1 week
10.5+1.19
11.1+0.86
10.8+1.36
2 weeks
11.7+0.92
11.7+0.78
12.1+1.10
3 weeks
12.2+0.75
12.3+0.48
12.3+0.43
4 weeks
12.4+0.66
11.7+1.52
11.9+1.46
P
.000***
.001**
.002**
Digital hemoglobin test
Initial
9.8+0.95
10.5+0.60
10.6+0.56
1 week
11.2+1.34
12.9+1.22
11.3+1.83
2 weeks
13.1+1.63
13.0+1.86
12.0+1.81
3 weeks
13.8+1.97
13.5+1.45
13.0+0.96
4 weeks
13.2+1.27
13.0+1.91
12.1+1.51
P
.000***
.001**
.008**
Note: Mean+standard deviation; Ferrous Sulfate supplied by
local government (FS); Ferrous Gluconate (FG); Date
Fruits (DF); 7dates (7D); Friedman test (*p< .05 **< .01
***p< .001 are significant)
An exponential surge in hemoglobin levels occured
in the 1st week to 3rd week while in the 4th week the
overall hemoglobin levels tended to decline where the
increase was seen only in the ferrous sulfate and dates
group by Sahli’s method (figures 2 and 3).
The Wilcoxon test result provided a more detail
description of the research findings in figure 2 and 3.
There were significant differences in hemoglobin levels
between before and after treatment (weeks 1, 2, 3 and 4)
and between week 1 and in the following weeks (week 2,
3 and 4) that were found in almost all four groups both by
Sahli’s method and digital test. Furthermore, a significant
difference in hemoglobin levels between week 2 and
after week 3 and 4 was found only in ferrous sulfate and
dates groups by Sahli’s method (table 3).
All respondents reported consuming less dietary
fiber each week which in the 7dates group reporting the
least fiber intake (table 4).
Indrayani, Agus Rahmadi, Dava Alpha Rakhim
P J M H S Vol. 12, NO. 4, OCT DEC 2018 1753
Table 3. The result of Wilcoxon signed rank test in hemoglobin levels and bowel movements
Sahli’s method
Digital hemoglobin test
FS
FG
DF
7D
FS
FG
DF
7D
Z
p
Z
p
Z
p
Z
p
Z
p
Z
p
Z
p
Z
p
1 week-initial
-1.632a
.103*
-2.092a
.036*
-2.196a
.028*
-.416a
.677
-2.659a
.008*
-2.807a
.005*
-2.142a
.032*
-1.479a
.139
2 weeks-initial
-2.805a
.005*
-2.654a
.008*
-2.652a
.008*
-2.805a
.005*
-2.803a
.005*
-2.599a
.009*
-2.803a
.005*
-1.683a
.092
3 weeks-initial
-2.805a
.005*
-2.805a
.005*
-2.805a
.005*
-2.810a
.005*
-2.803a
.005*
-2.803a
.005*
-2.807a
.005*
-2.810a
.005*
4 weeks-initial
-2.805a
.005*
-2.397a
.017*
-2.805a
.005*
-1.887a
.059
-2.803a
.005*
-2.666a
.008*
-2.805a
.005*
-2.295a
.022*
2 weeks-1 week
-2.703a
.007*
-2.045a
.041*
-1.843a
.065
-2.807a
.005*
-2.347a
.019*
-.051b
.959
-2.501a
.012*
-.816a
.414
3 weeks-1 week
-2.803a
.005*
-2.807a
.005*
-2.668a
.008*
-2.547a
.011*
-2.666a
.008*
-.663a
.507
-2.397a
.017*
-2.244a
.025*
4 weeks-1 week
-2.805a
.005*
-1.173a
.241
-2.814a
.005*
-1.277a
.201
-2.599a
.009*
-.102a
.919
-2.134a
.033*
-1.172a
.241
3 weeks-2 weeks
-1.231a
.218
-1.897a
.058
-2.075a
.038*
-.534a
.593
-1.599a
.110
-.867a
.386
-.306a
.759
-1.172a
.241
4 weeks-2 weeks
-2.462a
.014*
-.204b
.838
-2.296a
.022*
-.051a
.959
-.204a
.838
-.306a
.759
-1.186b
.236
-.297a
.767
4 weeks-3 weeks
-1.245a
.213
-1.122b
.262
-.102a
.919
-.408b
.683
-.867b
.386
-1.073b
.283
-1.276b
.202
-.970b
.332
Note: Ferrous Sulfate supplied by local government (FS); Ferrous Gluconate (FG); Date Fruits (DF); 7dates (7D); *Indicates statistically significant change
(p<0.05); a. Based on negative ranks; b. Based on positive ranks; c. Wilcoxon Signed Ranks Test
Table 4. Consumption of fiber and water weekly by number of respondents
1 week
2 weeks
3 weeks
4 weeks
FS
FG
DF
7D
FS
FG
DF
7D
FS
FG
DF
7D
FS
FG
DF
7D
Mean consumption of fiber in a week
No fiber consumption
0
2
0
0
1
1
2
2
0
3
1
1
0
0
1
4
Just 1 day
2
0
0
1
1
1
1
3
2
0
0
1
4
3
1
1
2 days
1
0
1
3
1
4
1
2
2
2
3
4
0
0
2
1
3 days
1
3
2
1
1
1
4
1
3
3
3
3
2
4
3
2
4 days
2
2
2
3
3
1
0
1
1
1
1
1
2
2
2
2
5 days
1
1
2
2
3
1
1
1
2
0
1
0
2
1
0
0
Almost every day
3
2
3
0
0
1
1
0
0
1
1
0
0
0
1
0
Every day
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Mean intake of water per week
<1000 mL
1
1
1
2
3
1
4
4
4
3
2
3
5
3
3
4
>1000-1500 mL
6
5
2
3
4
6
2
4
1
6
5
5
3
5
5
4
>1500-2000 mL
2
2
4
3
2
3
2
1
4
1
1
2
2
2
1
2
>2000-2500 mL
1
2
3
1
1
0
1
1
1
0
1
0
0
0
0
0
>2500 mL
0
0
0
1
0
0
1
0
0
0
1
0
0
0
1
0
Note: Ferrous sulfate supplied by local government (FS); Ferrous gluconate (FG); Date fruits (DF); 7dates (7D)
The prominent finding of this study concerns the
duration of defecation and bowel problems each week.
Even though, the hemoglobin levels of ferrous sulfate and
dates groups showed higher levels compare to other groups
but there were differences in bowel movements. It can be
seen clearly from the table 4 and 5 that even the 7dates
group consumed less dietary fiber, but its bowel movements
was the smoothest and had the least complaints, followed
by the dates group. Meanwhile, many respondents of
ferrous sulfate and ferrous gluconate experienced bowel
problems. The complaints included inability to defecate,
hard stool and diarrhea. Inability to defecate was the most
problem complained by respondents of ferrous sulfate and
ferrous gluconate groups weekly (table 5).
Table 5. Description of bowel movements experienced by respondents
1 week
2 weeks
3 weeks
4 weeks
FS
FG
DF
7D
FS
FG
DF
7D
FS
FG
DF
7D
FS
FG
DF
7D
Mean duration of defecation per week
ND for 8 days
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
ND for 7 days
0
1
0
0
0
0
0
0
0
0
0
0
1
0
0
0
ND for 6 days
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
ND for 5 days
0
0
1
0
0
0
0
0
0
0
0
0
0
1
0
0
ND for 4 days
1
1
0
0
0
2
0
0
0
0
0
1
1
0
0
0
ND for 3 days
2
3
0
1
2
0
1
1
1
0
0
0
1
1
1
0
ND for 2 days
1
1
2
1
2
1
0
1
1
4
0
1
0
2
0
0
Routine each 2 days
0
0
0
0
0
0
0
0
0
1
0
0
0
2
0
1
Almost every day
2
0
2
3
1
3
2
1
0
2
2
2
1
0
2
1
Every day
4
4
5
5
5
4
7
7
7
3
8
6
6
4
7
8
Respondents faced bowel problems
Inability to defecate
4
2
1
0
4
2
1
0
4
2
0
0
4
2
0
0
Hard stool
2
0
2
4
0
0
2
0
0
0
0
0
0
0
2
1
Diarrhea
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
No complaints
3
8
7
6
6
8
7
10
6
8
10
10
6
8
8
9
Note: No Defecation (ND); Ferrous sulfate supplied by local government (FS); Ferrous gluconate (FG); Date fruits (DF); 7dates (7D)
Can date fruits and 7dates replace iron tablets in increasing hemoglobin levels?
1754 P J M H S Vol. 12, NO. 4, OCT DEC 2018
Table 6. Correlation: intake factors, menstruation, hemoglobin levels and bowel movements
1 week
2 weeks
3 weeks
4 weeks
1 week
2 weeks
3 weeks
4 weeks
r
p
r
p
r
p
r
p
r
p
r
p
r
p
r
p
Hemoglobin levels
Sahlis method
Digital hemoglobin test
Treatment
.043
.396
.095
.279
.075
.323
-.087
.296
-.085
.301
-.213
.093
-.207
.099
-.284
.038*
Feeding frequency
-.269
.046*
-.074
.325
-.125
.220
-.165
.154
-.243
.066
.048
.384
-.037
.410
-.124
.223
Menstruation
.276
.043*
.209
.098
.124
.223
-.086
.299
.004
.491
.243
.066
.179
.134
.192
.118
Bowel problems
Duration of defecation
Bowel problems
Treatment
.203
.105
.213
.094
.193
.117
.339
.016*
.238
.070
.333
.018*
.438
.002*
.315
.024*
Feeding frequency
-.034
.418
-.293
.033*
-.003
.492
.163
.157
-.206
.102
-.261
.052
-.193
.117
.188
.122
Fiber consumption
.096
.277
-.128
.216
.012
.470
-.178
.136
-.005
.488
-.135
.202
-.018
.456
-.005
.487
Water intake
.123
.225
.04
.403
.243
.065
.399
.005*
-.085
.301
-.019
.455
.106
.258
.202
.106
Note: Pearson’s correlation coefficient (r) and the one-tailed p-values (p); *Significant at .05 level
Table 7. Regression equation and prediction of hemoglobin levels and bowel movements
Hemoglobin levels
Sahli’s method
Digital hemoglobin test
1 week
Regression equation
Prediction
R2 = .155, F(3,36)= 2.207, p > .05
Y = 10.652 + 0.022X1 0.564X2 + 0.727X3
R2 = .068, F(3,36)= .880, p > .05
Y = 13.449 - 0.128X1 0.698X2 + 0.057X3
2 weeks
Regression equation
Prediction
R2 = .052, F(3,36)= .658, p > .05
Y = 10.703 + 0.069X1 0.065X2 + 0.526X3
R2 = .118, F(3,36)= 1.600, p > .05
Y = 10.957 - 0.325X1 + 0.220X + 1.207X3
3 weeks
Regression equation
Prediction
R2 = .029, F(3,36)= .361, p > .05
Y = 12.182 + 0.025X1 0.131X2 + 0.138X3
R2 = .082, F(3,36)= 1.067, p > .05
Y = 13.317 0.291X1 0.171X + 0.625X3
4 weeks
Regression equation
Prediction
R2 = .042, F(3,36)= .524, p > .05
Y = 13.651 - 0.111X1 0.350X2 0.330X3
R2 = .095, F(3,36)= 1.258, p > .05
Y = 13.324 0.298X1 0.294X + 0.391X3
Note: df (regression, residual); Y= constant, treatment (X1), feeding frequency (X2), menstruation (X3); a. Predictors: (Constant), menstruation, treatment,
feeding frequency; b. Dependent Variable: hemoglogin estimation by Sahli’s method and digital hemoglobin test; *p<0.05 **<0.01 ***p<0.001
Bowel movements
Duration of defecation
Bowel problems
1 week
Regression equation
Prediction
R2 = .068, F(4,35)= .634, p > .05
Y = 6.568 + .360X1 .270X2 + .170X3 + .219X4
R2 = .118, F(4,35)= 1.165, p > .05
Y = 3.674 + .274X1 .535X2 + .053X3 .159X4
2 weeks
Regression equation
Prediction
R2 = .142, F(4,35)= 1.443, p > .05
Y = 9.262 + .319X1 .904X2 + .040X3 + .203X4
R2 = .178, F(4,35)= 1.893, p > .05
Y = 3.291 + .357X1 .559X2 + .034X3 + .074X4
3 weeks
Regression equation
Prediction
R2 = .105, F(4,35)= 1.023, p > .05
Y = 7.698 + .311X1 .307X2 .028X3 + .545X4
R2 = .237, F(4,35)= 2.716, p < .05*
Y = 3.047 + .394X1 .495X2 + .017X3 + .209X4
4 weeks
Regression equation
Prediction
R2 = .287, F(4,35)= 3.516, p < .05*
Y = 7.015 + .535X1 .498X2 .132X3 + 1.017X4
R2 = .135, F(4,35)= 1.363, p > .05
Y = 2.022 + .317X1 + .030X2 + .031X3 + .223X4
Note: df (regression, residual); Y= constant, treatment (X1), feeding frequency (X2), fiber consumption (X3), water intake (X4); a. Predictors: (Constant),
water intake, feeding frequency, treatment, fiber consumption; b. Dependent Variable: duration of defecation and bowel problems; *p<0.05 **<0.01
***p<0.001
The analysis result on hemoglobin levels shows a strong
and significant correlation between treatment (r=-.284,
p=.038) and hemoglobin levels by digital hemoglobin test
at week 4; and between feeding frequency (r=-.269,
p=.046), menstruation (r=.276, p=.043) and hemoglobin
levels by Sahli’s method at week 1. While, the result
analysis on bowel movements shows a strong and
significant correlation between treatment and duration of
defecation at week 4 (r=.339, p=.016) and bowel
problems at week 2 (r=.333, p=.018), week 3 (r=.438,
p=.002) and week 4 (r=.315, p=.024); between feeding
frequency and duration of defecation at week 2 (r=-.293,
p=.033); and between water intake and duration of
defecation at week 4 (r=.399, p=.005) (table 6).
A multiple linear regression analysis was performed
to predict hemoglobin levels and bowel movements
based on its predictors that produced regression
equations and participants’ predicted towards dependent
variables (table 7).
Based on multiple regression analysis, it was
discovered that there is no correlation between
hemoglobin levels (both by Sahli’s method and digital
test) and major confounders (treatment, feeding
frequency and menstruation) (table 8).
Table 8. Multiple linear regression analysis using hemoglobin levels as the dependent variable in both estimation
Sahli’s method
Digital hemoglobin test
Variables
value
P value
95% CI
value
P value
95% CI
Lower
Upper
Lower
Upper
1 week
Treatment
.154
.878
-.273
.318
-.596
.555
-.561
.306
Feeding frequency
-1.824
.077
-1.191
.063
-1.536
.133
-1.619
.224
Menstruation
1.866
.070
-.063
1.518
.100
.921
-1.104
1.219
2 weeks
Treatment
.501
.620
-.211
.350
-1.446
.157
-.780
.131
Feeding frequency
-.245
.808
-.602
.472
.512
.612
-.652
1.093
Menstruation
1.201
.238
-.362
1.414
1.697
.098
-.235
2.649
3 weeks
Treatment
.304
.763
-.143
.193
-1.393
.172
-.716
.133
Feeding frequency
-.583
.564
-.585
.324
-.302
.765
-1.321
.979
Menstruation
.632
.532
-.305
.581
1.131
.266
-.496
1.747
Indrayani, Agus Rahmadi, Dava Alpha Rakhim
P J M H S Vol. 12, NO. 4, OCT DEC 2018 1755
Sahli’s method
Digital hemoglobin test
Variables
value
P value
95% CI
value
P value
95% CI
Lower
Upper
Lower
Upper
4 weeks
Treatment
-.586
.562
-.497
.274
-1.243
.222
-.784
.188
Feeding frequency
-.796
.431
-1.241
.541
-.531
.598
-1.417
.828
Menstruation
-.659
.514
-1.344
.685
.621
.539
-.887
1.669
Note: Dependent variables, Hb levels by Sahli’s method and digital hemoglobin test; CI: confidence interval; *p<0.05 **<0.01 ***p<0.001
However, there is a significant positive correlation
between treatment week 2 and 3 and bowel problems
after adjusting the effects of major confounders (feeding
frequency, fiber consumption, water intake) and between
water intake week 4 and duration of defecation after
adjusting the effects of major confounders (treatment,
feeding frequency, fiber consumption) (table 9).
Table 9. Multiple linear regression analysis using duration of defecation and bowel problems as the
dependent variables
Duration of defecation
Bowel problems
Variables
value
P value
95% CI
value
P value
95% CI
Lower
Upper
Lower
Upper
1 week
Treatment
1.163
.253
-.268
.988
1.560
.128
-.083
.631
Feeding frequency
-.389
.699
-1.678
1.138
-1.357
.183
-1.335
.265
Fiber consumption
.804
.427
-.259
.599
.444
.660
-.190
.297
Water intake
.630
.533
-.488
.927
-.804
.427
-.561
.243
2 weeks
Treatment
1.340
.189
-.165
.803
2.123
.041*
.016
.699
Feeding frequency
-1.901
.066
-1.870
.062
-1.663
.105
-1.241
.123
Fiber consumption
.252
.803
-.283
.363
.304
.763
-.194
.262
Water intake
.774
.444
-.330
.737
.399
.692
-.303
.451
3 weeks
Treatment
1.148
.259
-.239
.861
2.728
.010*
.101
.687
Feeding frequency
-.387
.701
-1.915
1.302
-1.172
.249
-1.353
.362
Fiber consumption
-.139
.890
-.438
.382
.160
.874
-.202
.236
Water intake
1.603
.118
-.145
1.236
1.152
.257
-.159
.577
4 weeks
Treatment
1.969
.057
-.017
1.088
1.813
.078
-.038
.671
Feeding frequency
-.567
.574
-2.279
1.284
.054
.957
-1.113
1.174
Fiber consumption
-.652
.519
-.542
.279
.240
.812
-.233
.295
Water intake
2.578
.014*
.216
1.817
.880
.385
-.291
.737
Note: Dependent variables, duration of defecation and bowel problems; CI: confidence interval; *p<0.05 **<0.01 ***p<0.001
DISCUSSION
The Friedman test result has detected a significant
difference in the hemoglobin levels in all four groups
between before and after treatment. It is undeniable that
iron consumption can improve hemoglobin levels13, 45, 46,
47 through increasing the serum retinol48. Similarly, the
consumption of dates can elevate hemoglobin levels36
through serum iron, serum ferritin, transferrin saturation
and total iron binding capacity49. This is interesting
considering that based on the composition, iron content
in 75 gr dates and 3 bottle 7dates are not equivalent to
200 mg ferrous sulfate and 250 mg ferrous gluconate.
Some studies reported that the average iron content
in 100 gr dates is approximately 0.24 mg50, 51, 52 while
100 gr Sayer dates contain 3.21 mg iron (around 2.4
mg/75 gr)40. With such a small amount of iron, dates
group can elevate hemoglobin levels almost as much as
ferrous sulfate group. Ferrous sulfate and ferrous
gluconate rely solely on iron for hemoglobin
enhancement, in contrast to dates and 7dates which use
multiple micronutrients to increase hemoglobin levels
since other micronutrient deficiencies will limit the
response of hemoglobin to iron supplements13. There are
some substances in dates contributing to hemoglobin
enhancement including iron, vitamin A, vitamin C, zinc,
and riboflavin. 100 gr of dates contain vitamins and
minerals (the percentage of each minerals in dried dates
varies from 0.1 to 916 mg)53, 54. The average vitamin
content in dates are vitamin A (23.85 μg), B1 (78.61 μg),
B2 or riboflavin (116.5 μg), B3 or niacin (1442 μg), B6
(207 μg), B9 (53.75 μg) and vitamin C (3900 μg)50.
Based on human and animal studies, Hodges et al.
concluded that vitamin A is essential for normal
hematopoiesis55. Experiments in mice show that iron
deficiency can decline serum retinol and affect on
accumulation of vitamin A in the liver as retinyl esters.
This may be related to impaired hepatic acid retinyl ester
hydrolase (iron-dependent enzymes)56. In case of
vitamin A deficiency, iron mobilization from the body’s
reserve to the circulation and tissues of hematopoietic
will be destroyed and cause disorders of erythropoiesis
(red cell production)57. Supplementation of vitamin A may
increase the response of hemoglobin to iron
supplementation13 and increase iron absorption
associated with iron concentrations in tissue57.
Therefore, a combination of iron and vitamin A
supplements may further improve iron status58, 59. Similar
to vitamin A, zinc supplement has also been proven to
elevate hemoglobin levels. Allen’s study reported that
supplement of zinc only or iron only can increase plasma
retinol. However, combination of zinc plus iron can
Can date fruits and 7dates replace iron tablets in increasing hemoglobin levels?
1756 P J M H S Vol. 12, NO. 4, OCT DEC 2018
enhance plasma retinol more than iron alone13. The next
micronutrient is riboflavin. Riboflavin deficiency can limit
the efficacy of iron supplement, increase iron loss in
intestine and interfere iron absorption and intracellular
iron mobilization60, 61, 62. This condition may also interfere
with globin sythesis and activity of NADH-FMN
oxidoreductase so that the iron is trapped in ferritin and
becomes unavailable for erythropoiesis. NADH is
nicotinamide adenine dinucleotide (reduced form) which
is an active coenzyme form of vitamin B3 (‘niacin’) and
flavin mononucleotide (FMN) or riboflavin-5’-phosphate
is a biomolecule produced from B2 ('riboflavin') by the
enzyme riboflavin kinase. NADH-FMN reductase is an
enzyme involved in releasing iron from ferritin. Riboflavin
supplement may enhance hemoglobin response towards
iron supplementation63 and iron absorption through
enhanced gastrointestinal function64. Apart from that,
riboflavin is also prominent for the synthesis of the globin
component of hemoglobin65. Hence, riboflavin plus iron
supplements can increase hematologic status better than
iron alone66, 67. The same effect was also reported by
other studies that iron supplements or iron-rich foods
combined with micronutrients are more effective in
increasing hemoglobin levels than iron alone63, 68. The
combination of substances in dates may trigger activity
of phenol compounds which can stimulate erythropoietin
production by the liver which has an impact on
increasing hemoglobin enhancement35, 36. 100 gr fresh
dates contains phenolics (134-280 mg of ferulic acid
equiv), free phenolic acids (2.61-12.27 mg), and bound
phenolic acids (6.84-30.25 mg)69. While Biglari et al.
reported total phenolic level in 100 gr dates is in range
2.89-4.82 for soft date, 4.37-6.64 for semi-dry date and
for dry date at 141.35 milligrammes of gallic acid
equivalent per 100 grammes of dry weight (mg
GAE/100g dw)70. One further matter of interest is that in
addition to containing micronutrients, dates also contain
macronutrients that can inhibit iron absorption, namely
calcium and magnesium71, 72. On average, 100 gr dates
contains 56-150 mg magnesium50, 51, 52, 73 and 123-187
mg calcium73. In spite of macronutrients contents that
can inhibit iron absorption, dates remain capable to raise
hemoglobin levels. This is caused by other substances in
dates which are able to inhibit the inhibitory effect of iron
absorption as reported by Layrisse who stated that
vitamin A may reduce the inhibitory effect of polifenol
and phytates on iron absorption74.
Hemoglobin estimation by digital test shows that the
four groups tended to experience a downward trend in
the fourth week. This is more likely to relate to the body’s
defense system in which the hemoglobin levels of
respondents in four groups had reached a normal level
at around 12.0 g/dL to 13.0 g/dL (see table 2). Human
body has evolved to keep iron from breakage in various
ways including recycling iron after the damage of red
blood cells and iron retention if there is no dispense
mechanism. However, iron excess can be toxic so that
its absorption is limited to 1-2 mg per day and the most
iron needed by the body (about 25 mg per day) is
provided through recycling by macrophaging agitated
erythematic phagocytosis. The two mechanisms are
controlled by hormone Hepcidin, which keeps total body
iron in the normal range (no deficiency or excess)75.
Iron supplements have been proven to increase
hemoglobin levels. However, high doses of iron
consumption (more than 120 mg) significantly increase
the risk of constipation, gastric pain, diarrhea,19, 76
heartburn, nausea and vomiting19. This report is in line
with the findings that the ferrous sulfate and ferrous
gluconates groups experienced more problems in
defecation. Constipation is the most frequent chronic
gastrointestinal complaint77. Patients may report
constipation even though they defecate daily. Criteria for
constipation diagnosis includes less frequent bowel
movements (less than 3 times per week), hard stool
and/or difficulty to expel feces,20, 78 and straining78. These
complaints are often ignored because these complaints
are considered taboo to be discussed and left without
treatment until constipation becomes a severe problem
for the patient79. If constipation persists and the patient
does not obtain appropriate treatment, complications will
become severe, including feacal impaction (obstruction
due to hard stool), further causing faecal incontinence80.
Straining defecation may also increase the risk of
prolapse uterovaginal81 and cause permanent damage in
the form of pudendal nerve damage and impair the
supporting function of the pelvic floor muscles82. It is not
surprising that patients with constipation have a lower
quality of life compared to inflammatory bowel disease or
gastroesophageal reflux disease83. In extreme and rare
cases, complication is caused by untreated constipation,
such as movement from thrombus vena into vena
pulmonary, or sudden cardiac death as a result of
straining and cardiac abnormalities84, 85.
On the other hand, the 7dates and dates groups had
fewer bowel complaints than ferrous sulfate and ferrous
gluconates groups. This is because dates are the best
source of dietary fiber. High fiber consumption decreases
the risk of constipation86 and obesity,87 increases the
amount and frequency of bowel movements, and
decreases the average transit time88. Recommended
daily intake (RDI) of dietary fiber for healthy adults (>20
years) is 25-35 gram per day85. Some studies reported
that 100 gr dates contains 6.4% to 11.5% dietary fiber,54,
89 including 0.84 gr soluble dietary fibre, 5.76 gr insoluble
dietary fiber and 8 gr total of dietary fiber69, 90, 91, 92.
Insoluble dietary fiber plays a very significant role in
human body. It can protect the body from many
diseases, such as diverticular disease and bowel cancer
through the increase of fecal weight, and also has a
laxative effect93. The findings in this study are also
supported by Al-Shahib et al. which stated that the
consumption of six or seven dates can meet 50-100% of
RDI of dietary fiber90. The fiber content in dates can help
to relieve bowel movements and overcome constipation.
It can be used as a natural laxative for patients with
constipation54.
Indrayani, Agus Rahmadi, Dava Alpha Rakhim
P J M H S Vol. 12, NO. 4, OCT DEC 2018 1757
In addition to fiber, the body also needs water.
Derbyshire et al. found that water intake significantly
decreases the incidence of constipation in women21.
Given the side-effects of iron consumption and people’s
habit of consuming less fiber and water, the optimization
of natural nutrients can be the recommended as a sound
strategy. In many cases, dates and its processed
products can be considered as the most ideal food54
because dates contain many other essential nutrients
needed by the human body90.
CONCLUSION
In the final analysis, dates can be used instead of iron
tablets and 7dates can be used as a companion iron
tablets. Although ferrous sulfate, ferrous gluconate,
dates and 7dates can elevate the hemoglobin levels,
both ferrous sulfate and ferrous gluconate have negative
side effects while dates and 7dates give positive effects
in bowel movements so that both dates and its
processed products should be considered as an
alternative solution for handling and preventing anemia.
Acknowledgement: We would like to present our gratitude to
the Overseas Seminar Assistance Program of Directorate
General of Research and Development Reinforcement,
Kemristekdikti that has facilitated researchers to present the
research findings at 5th World Congress on Midwifery and
Women's Health in Frankfurt, Germany. We would also like to
thank to Ms. Jayanti Chess Ruti, Ms. Tri Widiawati, Ms. Silpha
Shetty, Ms. Amatulloh Shoolihah, Ms. Windi Suparwati, Ms.
Dera Ayu Ardiana who has helped in the process of data
collection.
Conflict of interest: All authors state that there is no conflict of
interest in this study.
REFERENCES
1. El-Refaey H, Rodeck C. Post-partum haemorrhage: definitions, medical
and surgical management. A time for change. Br Med Bull.
2003;67:205-17. Retrieved from
https://academic.oup.com/bmb/article/67/1//330398
2. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Look PFAV. WHO
analysis of causes of maternal death: a systematic review. Lancet.
2006;367(9516):106674. Retrieved from
http://www.hpc4.go.th/director/data/region/WHO_MMR.pdf
3. Haeri S, Dildy GA. Maternal mortality from hemorrhage. Semin
Perinatol. 2012;36(1):48-55. Retrieved from
https://www.seminperinat.com/article/S0146-005(11)00156-X/pdf
4. Mousa HA, Walkinshaw S. Major postpartum haemorrhage. Curr Opin
Obstet Gynecol. 2001;13(6):595-603. [PMID: 11707663].
5. AbouZahr C. Global burden of maternal death and disability. Br Med
Bull. 2003;67(1-11):1-11. [DOI: 0.1093/bmb/ldg015]. Retrieved from
https://academic.oup.com/bmb/article/67/1/1/330397
6. Toteja GS, Singh P, Dhillon BS, Saxena BN, Ahmed FU, Singh LRP, et
al. Prevalence of anemia among pregnant women and adolescent girls
in 16 districts of India. Food Nutr Bull. 2006;27(4):311-5.
7. Miller JL. Iron deficiency anemia: a common and curable disease. Cold
Spring Harb Perspect Med. 2013;3(7):1-14. Retrieved from
http://perspectivesinmedicine.cshlp.org/content/3/7/a011866.full.pdf+ht
ml
8. Allen LH. Anemia and iron deficiency: Effects on pregnancy outcome.
Am J Clin Nutr. 2000;71(5):1280S4S.
https://doi.org/10.093/ajcn/71.5.s Retrieved from
https://academic.oup.com/ajcn/article/71/5/S/4729385
9. Maskey M, Jha N, Poudel SI, Yadav D. Anemia in pregnancy and its
associated factors: A study from Eastern Nepal. Nepal J Epidemiol.
2014;4(4):386-92. [DOI: http://dx.doi.org/10.3126/nje.v4i4.11358].
Retrieved from https://www.nepjol.info/index.php/NJE/article/view//9205
10. Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW.
Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes:
Systematic review and meta-analysis. BMJ. 2013;346:1-19. [Doi:
0.1136/bmj.f3443] Retrieved from
https://www.bmj.com/content/bmj/346/bmj.f.full.pdf
11. Ononge S, Campbell O, Mirembe F. Haemoglobin status and predictors
of anaemia among pregnant women in Mpigi, Uganda. BMC Res
Notes. 2014;7(1):712. Retrieved from
https://bmcresnotes.biomedcentral.com/track/pdf/10.1186/756-0500-7-
712
12. Kurz KM, Galloway R. Improving adolescent iron status before
childbearing. J Nutr. 2000;130(2):437S-9S.
https://doi.org/10.1093/jn/130.2.437S Retrieved from
https://academic.oup.com/jn/article/130/2/437S/4686452
13. Allen LH. Iron supplements: Scientific issues concerning efficacy and
implications for research and programs. J Nutr. 2002;132:813S9S.
Retrieved from
https://academic.oup.com/jn/article/132/4/813S/4687233
14. Agarwal KN, Gomber S, Bisht H, Som M. Anemia prophylaxis in
adolescent school girls by weekly or daily iron-folate supplementation.
Indian Pediatr. 2003;40(4):296-301. Retrieved from
https://indianpediatrics.net/apr2003/apr-296-301.htm
15. Cook JD, Reddy MB. Efficacy of weekly compared with daily iron
supplementation. Am J Clin Nutr. July 1995;62(1):11720. [DOI:
https://doi.org/10.1093/ajcn/62.1.117].
16. Schultink W, Gross R, Gliwitzki M, Karyadi D, Matulessi P. Effect of
daily vs twice weekly Indonesian preschool children iron
supplementation with low iron status. Am J Clin Nutr. January
1995;61(1):1115. [DOI: https://doi.org/10.1093/ajcn/61.1.111].
17. Zavaleta N, Respicio G, Garcia T. Efficacy and acceptability of two iron
supplementation schedules in adolescent school girls in Lima, Peru. J
Nutr. February 2000;130(2):462S4S, [DOI:
https://doi.org/10.1093/jn/130.2.462S]. Retrieved from
https://academic.oup.com/jn/article/130/2/462S/4686483
18. Beaton GH, McCabe GP. Efficacy of intermittent iron supplementation
in the control of iron deficiency anaemia in developing countries: an
analysis of experience. Ottawa, Canada: The Micronutrient Initiative;
1999. Retrieved from https://idl-bnc-
idrc.dspacedirect.org/bitstream/handle/10625/29662/117067.pdf?seque
nce=3
19. Hyder SMZ, Persson LÅ, Chowdhury AMR, Ekström E-C. Do side-
effects reduce compliance to iron supplementation? a study of daily-
and weekly-dose regimens in pregnancy. J Health Popul Nutr. June
2002;20(2):175-9. Available on
http://dspace.icddrb.org/jspui/bitstream/123456789/123/1/2002-
JHealthPoulNutr-175-Hyder.pdf
20. Cullen G, O’Donoghue D. Constipation and pregnancy. Best Pract Res
Clin Gastroenterol. 2007;21(5):80718. [DOI:
10.1016/j.bpg.2007.05.005]. Retrieved from
https://www.sciencedirect.com/science/article/pii/S1521691807000595
21. Derbyshire E, Davies J, Costarelli V, Dettmar P. Diet, physical inactivity
and the prevalence of constipation throughout and after pregnancy.
Matern Child Nutr. 2006;2(3):12734. [DOI: 10.1111/j.740-
8709.2006.00061.x]. Retrieved from
https://www.researchgate.net/profile/Vassiliki_Costarelli/publication/235
450087_Dietary_intake_physical_inactivity_and_prevelance_of_constip
ation_during_and_after_pregnancy/links/0deec523015be91f26000000.
pdf
22. Vazquez JC. Constipation, haemorrhoids, and heartburn in pregnancy.
BMJ Clin Evid. 2010;08:1411-28. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217736/
23. Meier PR, Nickerson HJ, Olson KA, Berg RL, Meyer JA. Prevention of
iron deficiency anemia in adolescent and adult pregnancies. Clin Med
Res. 2003;1(1):2936. Retrieved from
http://www.clinmedres.org/content/1/1/29.full.pdf+html
24. Milman N, Byg K-E, Bergholt T, Eriksen L. Side effects of oral iron
prophylaxis in pregnancy myth or reality? Acta Haematol.
2006;115:115:53-57. [DOI: 10.1159/000089466].
25. Zygmunt M, Heilmann L, Berg C, Wallwiener D, Grischke E, Munstedt
K, et al. Local and systemic tolerability of magnesium sulphate for
tocolysis. Eur J Obstet Gynecol Reprod Biol. 2003;107(2):16875. DOI:
https://doi.org/10.1016/S0301-2115(02)00368-8
26. Jewell D, Young G. Interventions for treating constipation in pregnancy
(review). Interventions for treating constipation in pregnancy. Cochrane
Database of Systematic Reviews. 2012(2):Art. No.: CD001142. [DOI:
10.1002/14651858.CD001142]. Retrieved from http://cochranelibrary-
wiley.com/doi/10.1002/.CD001142/full
27. Marshall K, Thompson KA, Walsh DM, Baxter GD. Incidence of urinary
incontinence and constipation during pregnancy and postpartum:
survey of current findings at the Rotunda lying-in hospital. Br J Obstet
Can date fruits and 7dates replace iron tablets in increasing hemoglobin levels?
1758 P J M H S Vol. 12, NO. 4, OCT DEC 2018
Gynaecol. April 1998;105:400-2. Retrieved from
https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/j.471-
0528.1998.tb10123.x
28. Lederle FA. Epidemiology of constipation in elderly patients: drug-
utilisation and cost-containment strategies. Drugs Aging.
1995;6(6):4659. Retrieved from
https://link.springer.com/article/10.2165/00002512-199506060-00006
29. Anderson AS. Dietary factors in the aetiology and treatment of
constipation during pregnancy. Br J Obstet Gynaecol. 1986;93:2459.
30. Deshmukh PR, Garg BS, Bharambe MS. Effectiveness of weekly
supplementation of iron to control anaemia among adolescent girls of
Nashik, Maharashtra, India. J Health Popul Nutr. 2008;26(1):74-8.
Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740684/pdf/jhpn0026-
0074.pdf
31. Hentze MW, Muckenthaler MU, Galy B, Camaschella C. Review two to
Tango: regulation of mammalian iron metabolism. Cell. July
2010;142(1):24-38. [Doi: 10.1016/j.cell.2010.06.028] Retrieved from
https://ac.els-cdn.com/S009286741000718X/1-s2.0-SX-
main.pdf?_tid=3a612389-47be-422b-9e0d-
dad3be08f13f&acdnat=1528603880_91ff6f066eeb4f34d7e470a9b6807
241
32. El-Sohaimy SA, Hafez EE. Biochemical and nutritional
characterizations of date palm fruits (Phoenix dactylifera L.). JASR.
2010;6(8):1060-7. Retrieved from
https://www.researchgate.net/publication/234027076_Biochemical_and
_Nutritional_Characterizations_of_Date_Palm_Fruits_Phoenix_dactylife
ra_L
33. Indrayani, Rahmadi A, Suharti, Diana O, Zeranika N. How do Muslims
consume dates? PJMHS. 2018;12(4):1732-43. [DOI:
http://doi.org/10.5281/zenodo.2586225]. Retrieved from
http://www.pjmhsonline.com/2018/oct_dec/pdf/1732.pdf
34. Mariyam P, Mary V. Nutritional analysis (macronutrients, potassium,
and iron content) of four palm date varieties (Phoenix dactylifera L.) and
study of consumption pattern among Muslim and Maharashtrian
community. J Food Processing Beverages. 2015;3(1):1-9 Retrieved
from http://www.avensonline.org/wp-content/uploads/JFPB-2332-4104-
03-0011.pdf
35. Onuh SN, Ukaejiofo EO, Achukwu PU, Ufelle SA, Okwuosa CN,
Chukwuka CJ. Haemopoietic activity and effect of crude fruit extracts of
Phoenix dactylifera on peripheral blood parameters. Int J Biol Med Res.
2012;3(2):1720-3 Retrieved from
https://www.biomedscidirect.com/journalfiles/IJBMRF2011470/haemop
oietic_activity_and_effect_of_crude_fruit_extract_of_phoenix_dactylifer
a_on_peripheral_blood_parameters.pdf
36. Zen ATH, Pertiwi D, Chodidjah. The effect of date (Phoenix dactylifera)
juice on haemoglobin level an experimental study in iron supplemented
rats. Sains Medika. Januari-Juni 2013;5(1):17-9 Retrieved from
http://jurnal.unissula.ac.id/index.php/sainsmedika/article/viewFile/359/2
98
37. Roektiningroem E, Hastuti PW, editors. Seed’s viability of two types of
dates (Phoenix dactilyfera L.) from fruit in Indonesian Market.
Proceeding of 3rd International Conference on Research,
Implementation and Education of Mathematics and Science; May 2016;
Yogyakarta, Indonesia: Universitas Negeri Yogyakarta. Retrieved from
http://seminar.uny.ac.id/icriems/sites/seminar.uny.ac.id.icriems/files/pro
siding/B-05.pdf
38. AlDallal S. Iron deficiency anemia: A short review. J Immunooncol.
2016;2(1):1-6. Retrieved from https://www.omicsonline.org/open-
access/iron-deficiency-anaemia-a-short-review-.php?aid=79233
39. Kordi M, Meybodi FA, Tara F, Nemati M, Shakeri MT. The effect of late-
pregnancy consumption of date fruit on cervical ripening in nulliparous
women. J Midwifery Reprod Health. 2014;2(3):150-6. [DOI:
10.22038/jmrh.2014.2772]. Retrieved from
http://jmrh.mums.ac.ir/article_2772_b142d1addcd29393341f33980192b
552.pdf
40. Al-Groobi B, Krepl V. Importance of dtae palms as a source of nutrition.
Agricultura Tropica et Subtropica. 2010;43(4):341-7.
41. Bukhari. Shahih al-Bukhari, volume 007, book 065, hadith number 356.
Beirut: Dar Thauq an Najah; 2001. Retrieved from
https://muflihun.com/bukhari/65/356 and
http://www.hadithcollection.com/sahihbukhari/98-
Sahih%20Bukhari%20Book%2065.%20Food,%20Meals/6409-sahih-
bukhari-volume-007-book-065-hadith-number-356.html
42. Agbon AN, Kwanashie HO, Hamman WO, Sambo SJ. Toxicological
evaluation of oral administration of Phoenix dactylifera L. fruit extract on
the histology of the liver and kidney of Wistar rats. Int J Anim Vet Adv.
2014;6(4):122-9 Retrieved from http://maxwellsci.com/print/ijava/v6--
9.pdf
43. Olenmark M, Biber B, Dottori O, Rybo G. Fatal iron intoxication in late
pregnancy. J Toxicol: Clin Toxicol. 1987;25(4):347-59. [DOI:
10.3109/15563658708992638]. Retrieved from
https://www.tandfonline.com/doi/abs/10.3109/
44. Baranwal AK, Singhi SC. Acute iron poisoning: management
guidelines. Indian Pediatrics. 2003;40(6):534-40. Retrieved from
https://www.researchgate.net/profile/Arun_Baranwal/publication/106920
32_Acute_iron_poisoning_Management_guidelines/links/53fdf9a70cf2d
ca800042a65/Acute-iron-poisoning-Management-guidelines.pdf
45. Casgrain A, Collings R, Harvey LJ, Hooper L, Fairweather-Tait SJ.
Effect of iron intake on iron status: a systematic review and meta-
analysis of randomized controlled trials. Am J Clin Nutr. October
2012;96(4):76880. Retrieved from
https://academic.oup.com/ajcn/article/96/4//4576856
46. Muslimatun S, Schmidt MK, Schultink W, West CE, Hautvast JGAJ,
Gross R, et al. Weekly supplementation with iron and vitamin A during
pregnancy increases hemoglobin concentration but decreases serum
ferritin concentration in Indonesian pregnant women. J Nutr. January
2001;131(1):8590, https://doi.org/10.1093/jn/131.1.85 Retrieved from
https://academic.oup.com/jn/article/131/1/85/4686571
47. Tang N, Zhu Y, Zhuang H. Antioxidant and anti-anemia activity of heme
iron obtained from bovine hemoglobin. Food Sci Biotechnol. April
2015;24(2):pp 63542. DOI 10.1007/s10068-015-0083-2 Retrieved
from https://link.springer.com/article/10.1007/s-015-0083-2
48. Muñoz EC, Rosado JL, López P, Furr HC, Allen LH. Iron and zinc
supplementation improves indicators of vitamin A status of Mexican
preschoolers. Am J Clin Nutr. 2000;71(3):78994. [DOI:
https://doi.org/10.1093/ajcn/71.3.789]. Retrieved from
https://academic.oup.com/ajcn/article/71/3/789/4729207
49. Youssef HEE-D, Khedr AA. Effect of black dates on iron deficiency
anemia of orphanage children. Alex J Agric Res. 2015;60(3):183-91.
Retrieved from
http://agr.p.alexu.edu.eg/Data/Sites/1/pdffiles/%D8%A7%D9%84%D9%
85%D8%B9%D8%AF%D9%84%20%D8%A7E%D9%84%D8%A3%D9
%88%D9%84%203202.pdf
50. Al-Farsi MA, Lee CY. Nutritional and functional properties of dates: A
review. Crit Rev Food Sci Nutr. 2008;48(10):877-87. [DOI:
https://doi.org/10.1080/10408390701724264]. Retrieved from
https://www.tandfonline.com/doi/abs/10.1080/
51. Ismail B, Henry J, Haffar I, Baalbaki R. Date consumption and dietary
significance in the United Arab Emirates. J Sci Food Agric.
2006;86:1196-201. [DOI: https://doi.org/10.002/jsfa.2467]. Retrieved
from https://onlinelibrary.wiley.com/doi/full/10.1002/jsfa.2467
52. Mohamed AE. Trace element levels in some kinds of dates. Food
Chem. July 2000;70(1):9-12. [DOI: 0.1016/S0308-8146(99)00232-0].
53. Borchani C, Besbes S, Blecker C, Masmoudi M, Baati R, Attia H.
Chemical properties of 11 date cultivars and their corresponding fiber
extracts. African J Biotechnol. June 2010;9(26):4096-105. [DOI:
10.5897/AJB09.1497]. Retrieved from
https://www.academicjournals.org/article/article1380810378_Borchani
%20et%20al.pdf
54. Al-shahib W, Marshall RJ. The fruit of the date palm: Its possible use as
the best food for the future? Int J Food Sci Nutr. 2003;54(4):247-59.
[DOI: https://doi.org/10.1080/09637480120091982]. Retrieved from
https://www.tandfonline.com/doi/abs/10.1080/
55. Hodges RE, Sauberlich HE, Canham JE, Wallace DL, Rucker RB,
Mejia LA, et al. Hematopoietic studies in vitamin A deficiency. Am J Clin
Nutr. 1978;31(5):87685. [DOI: https://doi.org/10.1093/ajcn/31.5.876].
Retrieved from https://academic.oup.com/ajcn/article/31/5/876/4650239
56. Rosales FJ, Jang J-T, Piero DJ, Erikson KM, Beard JL, Ross AC. Iron
deficiency in young rats alters the distribution of vitamin A between
plasma and liver and between hepatic retinol and retinyl esters. J Nutr.
June 1999;129(6):12238. [DOI: https://doi.org/10.093/jn/129.6.].
Retrieved from https://academic.oup.com/jn/article/129/6//4721925
57. Roodenburg AJC, West CE, Yu S, Beynen AC. Comparison between
time-dependent changes in iron metabolism of rats as induced by
marginal deficiency of either vitamin A or iron. Br J Nutr. May
1994;71(5):687-99. [DOI: https://doi.org/10.1079/BJN19940176].
58. Panth M, Shatrugna V, Yasodhara P, Sivakumar B. Effect of vitamin A
supplementation on haemoglobin and vitamin A levels during
pregnancy. Br J Nutr. September 1990;64(2):351-8. [DOI:
https://doi.org/10.1079/BJN19900037]. Retrieved from
https://www.cambridge.org/core/services/aop-cambridge-
core/content/view/6B427718612384D5B2FE851F72016930/S0007114
590001131a.pdf/effect_of_vitamin_a_supplementation_on_haemoglobi
n_and_vitamin_a_levels_during_pregnancy.pdf
59. Suharno D, Muhilal, Karyadi D, West CE, Hautvast JGAJ, West CE.
Supplementation with vitamin A and iron for nutritional anaemia in
pregnant women in W est Java, Indonesia. Lancet. November
1993;342(8883):1325-8. [DOI: https://doi.org/10.016/0140-
Indrayani, Agus Rahmadi, Dava Alpha Rakhim
P J M H S Vol. 12, NO. 4, OCT DEC 2018 1759
6736(93)92246-P]. Retrieved from
https://www.sciencedirect.com/science/article/pii/014067369392246P
60. Thakur K, Tomar SK, Singh AK, Mandal S, Arora S. Riboflavin and
health: A review of recent human research. Critical Rev Food Sci Nutr.
March 2016;57(17):3650-60. [DOI: 10.1080/10408398.2016.1145104].
Retrieved from
https://www.researchgate.net/publication/299509825_Riboflavin_and_h
ealth_A_review_of_recent_human_research
61. Powers HJ, Weaver LT, Austin S, Wright AJA, Fairweather-Tait SJ.
Riboflavin deficiency in the rat: effects on iron utilization and loss. Br J
Nutr. May 1991;65(3):487-96. [DOI:
https://doi.org/10.1079/BJN19910107]. Retrieved from
https://www.cambridge.org/core/journals/british-journal-of-
nutrition/article/riboflavin-deficiency-in-the-rat-effects-on-iron-utilization-
and-loss/28E9AA7CB41F0C1F28B781DF4BB46677
62. Fairweather-Tait SJ, Powers HJ, Minski MJ, Whitehead J, Downes R.
Riboflavin deficiency and iron absorption in adult Gambian men. Ann
Nutr Metab. 1992;36(1):3440. [DOI:
https://doi.org/10.1159/000177696].
63. Powers HJ, Bates CJ, Lamb WH. Haematological response to
supplements of iron and riboflavin to pregnant and lactating women in
rural Gambia. Hum Nutr Clin Nutr. Mar 1985;39(2):117-29 Retrieved
from
https://www.researchgate.net/publication/19143205_Haematological_re
sponse_to_supplements_of_iron_and_riboflavin_to_pregnant_and_lact
ating_women_in_rural_Gambia
64. Yates CA, Evans GS, Pearson T, Powers HJ. Absence of luminal
riboflavin disturbs early postnatal development of the gastrointestinal
tract. Dig Dis Sci. June 2003;48(6):115964 Retrieved from
https://link.springer.com/article/10.023/A:1023785200638
65. Fawzi WW, Msamanga GI, Kupka R, Spiegelman D, Villamor E, Mugusi
F, et al. Multivitamin supplementation improves hematologic status in
HIV-infected women and their children in Tanzania. Am J Clin Nutr.
2007;85(5):133543. [DOI: https://doi.org/10.093/ajcn/85.5.].
66. Suprapto B, Widardo, Suhanantyo. Effect of lowdosage vitamin A and
riboflavin on ironfolate supplementation in anaemic pregnant women.
Asia Pacific J Clin Nutr. 2002;11(4):2637. [DOI:
https://doi.org/10.1046/j.440-6047.2002.00310.x].
67. Ma AG, Schouten EG, Zhang FZ, Kok FJ, Yang F, Jiang DC, et al.
Retinol and riboflavin supplementation decreases the prevalence of
anemia in Chinese pregnant women taking iron and folic acid
supplements. J Nutr. 2008;138:194650, 2008. Retrieved from
https://academic.oup.com/jn/article/138/10/1946/4670060
68. Rosado JL, González KE, Caamaño MdC, García OP, Preciado R,
Odio M. Efficacy of different strategies to treat anemia in children: a
randomized clinical trial. Nutr J. 2010;9(1):40-9. [DOI: 10.1186/475-
2891-9-40]. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2955680/
69. Al-Farsi M, Alasalvar C, Morris A, Baron M, Shahidi F. Comparison of
antioxidant activity, anthocyanins, carotenoids, and phenolics of three
native fresh and sun-dried date (Phoenix dactylifera L.) varieties grown
in Oman. J Agric Food Chem. 2005;53(19):7592-9. Retrieved from
https://pubs.acs.org/doi/abs/10.1021/jf050579q
70. Biglari F, AlKarkhi AFM, Easa AM. Antioxidant activity and phenolic
content of various date palm (Phoenix dactylifera) fruits from Iran. Food
Chemistry. 2008;107:163641 Retrieved from
https://www.sciencedirect.com/science/article/pii/S0308814607010552
71. Ahn E, Kapur B, Koren G. Iron bioavailability in prenatal multivitamin
supplements with separated and combined iron and calcium. J Obstet
Gynaecol Can. September 2004;26(9):809-13. [DOI:
https://doi.org/10.1016/S701-2163(16)30153-0]. Retrieved from
https://www.jogc.com/article/S1701-2163(16)-0/pdf
72. Pallarès I, Lisbona F, Aliaga I, Barrionuevo M, Alférez M, Campos MS.
Effect of iron deficiency on the digestive utilization of iron, phosphorus,
calcium and magnesium in rats. Br J Nutr. 1993;70:609-20. Retrieved
from
https://pdfs.semanticscholar.org/a0ad/ff93e9e51cc964b6afc7525a59e9
e4c0e36a.pdf?_ga=2.63231847.971562518.1528626651-
29673584.376232
73. Assirey EAR. Nutritional composition of fruit of 10 date palm (Phoenix
dactylifera L.) cultivars grown in Saudi Arabia. J Taibah Univ Sci.
2015;9:759. Retrieved from https://ac.els-
cdn.com/S1658365514000703/1-s2.0-S-main.pdf?_tid=b0ec0f03-14fd-
47fb-93ce-
196ccbbcc49a&acdnat=1528629511_e4d120cd8474a89a6458c17d5c7
01fea
74. Layrisse M, García-Casal MN, Solano L, Barón MA, Arguello F, Llovera
D, et al. Vitamin A reduces the inhibition of iron absorption by phytates
and polyphenols. Food Nutr Bull. 1998;19(1):3-5. Retrieved from
http://journals.sagepub.com/doi/pdf/10.1177/156482659801900101
75. Camaschella C. Iron-deficiency anemia. N Engl J Med.
2015;372(19):1832-43 retrieved from
http://legeforeningen.no/PageFiles/214782/2015CamaschellaNEJM%2
0Iron-def%20anemia.pdf
76. Müller-Lissner S. General geriatrics and gastroenterology: Constipation
and faecal incontinence. Best Pract Res Clin Gastroenterol.
2002;16(1):115-33. [DOI: https://doi.org/10.1053/bega.2002.0269].
77. Norton C. The causes and nursing management of constipation. Br J
Nurs. 1996;5(20):12528. [DOI:
https://doi.org/10.12968/bjon.1996.5.20.1252].
78. Norton C. Constipation in older patients: Effects on quality of life. Br J
Nurs. 2006;15(4):188-92. [DOI:
https://doi.org/10.12968/bjon.2006.15.4.20542].
79. Norton C. Nurses, bowel continence, stigma and taboos. J Wound
Ostomy Continence Nurs. 2004;31(2):85-94.
80. Barrett JA, Brocklehurst JC, Kiff ES, Ferguson G, Faragher EB. Anal
function in geriatric patients with faecal incontinence. Gut BMJ.
1989;30(9):1244-51. Retrieved from
http://gut.bmj.com/content/gutjnl/30/9/.full.pdf
81. SpenceJones C, Kamm MA, Henry MM, Hudson CN. Bowel
dysfunction: a pathogenic factor in uterovaginal prolapse and urinary
stress incontinence. Br J Obstet Gynaecol. 1994;101(2):147-52. [DOI:
https://doi.org/10.1111/j.471-0528.1994.tb13081.x].
82. Snooks SJ, Barnes PRH, Swash M, Henry MM. Damage to the
innervation of the pelvic floor musculature in chronic constipation.
Gastroenterology. 1985;89(5):97781. Retrieved from
https://www.gastrojournal.org/article/0016-5085(85)90196-9/pdf
83. Youssef NN, Langseder AL, Verga BJ, Mones RL, Rosh JR. Chronic
childhood constipation is associated with impaired quality of life: A
case-controlled study. JPGN. 2005;41(1):56-60. [DOI:
10.1097/01.mpg.0000167500.34236.6a].
84. Kollef MH, Schachter DT. Acute pulmonary embolism triggered by the
act of defecation. Chest. February 1991;99(2):3736. [DOI:
https://doi.org/10.1378/chest.99.2.373].
85. Williams CL, Bollella M, W ynder EL. A new recommendation for dietary
fiber in childhood. Pediatrics. 1995;96(5):985-8. Retrieved from
http://pediatrics.aappublications.org/content/pediatrics/96/5/.full.pdf
86. Dukas L, Willett WC, Giovannucci EL. Association between physical
activity, fiber intake, and other lifestyle variables and constipation in a
study of women. AJG. 2003;98(8):17906. [DOI:10.111/j.572-
0241.2003.07591.x]. Retrieved from
http://mccordresearch.com/sites/default/files/pdf/Prebiotic-
Fiber/Fiber%20and%20Constipation.pdf
87. Burton-Freeman B. Dietary fiber and energy regulation. J Nutr.
February 2000;130(2):272S5S. [DOI:
https://doi.org/10.1093/jn/130.2.272S]. Retrieved from
https://academic.oup.com/jn/article/130/2/272S/4686350
88. Müller-Lissner SA. Effect of wheat bran on weight of stool and
gastrointestinal transit time: a meta analysis. Br Med J (Clin Res Ed).
1988;296(6622):6157. [PMID: 2832033]. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC545244/pdf/bmj00274-
0031.pdf
89. Sawaya WN, Khatchadourian HA, Khalil JK, Safi WM, AlShalhat A.
Growth and compositional changes during the various developmental
stages of some Saudi Arabian date cultivars. J Food Sci.
1982;47(5):1489-92. [DOI: https://doi.org/10.111/j.365-
2621.1982.tb04967.x]. Retrieved from
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2621.1982.tb.x
90. AlShahib W, Marshall RJ. Dietary fibre content of dates from 13
varieties of date palm Phoenix dactylifera L. Int J Food Sci Tech.
2002;37(6):719-21. [DOI: https://doi.org/10.1046/j.365-
2621.002.00615.x].
91. Myhara RM, Karkalas J, Taylor MS. The composition of maturing
Omani dates. J Sci Food Agric. 1999;79(11):1345-50. [DOI:
https://doi.org/10.002/(SICI)097-0010(199908)79:11<1345::AID-
JSFA366>3.0.CO;2-V].
92. El-Zoghbi M. Biochemical changes in some tropical fruits during
ripening. Food Chem. 1994;49(1):33-7. [DOI:
https://doi.org/10.1016/0308-8146(94)90229-1]. Retrieved from
https://www.sciencedirect.com/science/article/pii/0308814694902291
93. Marlett JA, McBurney MI, Slavin JL. Position of the American Dietetic
Association: Health implications of dietary fiber. J Am Dietet Assoc. July
2002;102(7):9931000. [DOI: https://doi.org/10.16/S0002-
8223(02)90228-2]. Retrieved from https://jandonline.org/article/S0002-
8223(02)-2/pdf
... Pilot randomized controlled clinical trials ↑Hemoglobin levels 25 These types of studies take a lot of risk of bias and don't provide appropriate level of documentation. These outcomes may be the clues to other clinical and experimental studies in these fields: ...
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Purpose The aim of present study was to review and categorize the clinical trials investigating the clinical effects of different botanical parts of dates compared with any controls. Methods All clinical trials (randomized, pilot, quasi-experimental, cross-over. and non-randomized clinical trials) evaluating the clinical effects of date palm from 2000 until August 2019 in English and Persian languages were included in this systematic review. The methodological quality of the included studies was evaluated according to the risk of bias assessment of Cochrane handbook of systematic reviews, and then reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Results Twenty-six studies met the inclusion criteria. Studies were performed in 8 categories based on different botanical parts of date palm. These categories were obstetrics, gynecology, oncology, dermatology, hematology, gastroenterology, endocrinology, metabolism, and infertility. A total of 38 % of included studies were randomized controlled trials. Further, 80 % of the included studies had performance and detection bias. Finally, about 50 % of them had selection bias and about 20 % had attrition and reporting bias. Conclusion The widespread consumption of date palm as medicinal and botanical plant suggests the importance of this plant in human healthcare. The clinical trials conducted so far have explained a number of clinical effects of date palm. However, there is not enough clinical evidence to support the clinical effects in other review articles and traditional medical systems, and further randomized controlled trials with robust designs and methods are required.
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Background. The Muslim community is recommended to consume dates routinely. Its sweet flavor, however, inflicts public concern related to the risk of diabetes. Not just adults, but also adolescents are at risk of experiencing blood glucose (BG) problems. Aim. To evaluate the effect of 4 weeks of consumption of date fruits and packaged date drinks (7dates) on the changes in BG levels among adolescent girls. Methods. This was a 4-week randomized controlled trial with parallel-group to a Muslim community in Bojong Kulur village. Twenty-three 23 non-diabetic subjects aged 16-24 years were randomly assigned to consume dates (N=11) or 7dates (N=12) for four weeks. Only ten subjects in each group were involved in the entire research process. The main outcomes measures were 2-hour postprandial blood glucose and weekly fasting blood glucose. Results. All respondents in both groups had normal fasting blood glucose (FBG) levels at the beginning and end of the intervention. However, there were significant differences in BG levels between the initial reading and 2 hours after consuming dates or 7dates. There were no significant correlations between feeding frequency, dietary fiber, and 2-h postprandial BG levels. There was no adverse effects reported by the participants. Conclusion. Consuming dates or 7dates in a recommended amount for four weeks tends to be safe and has no increase on the risk of diabetes among adolescent girls. Date fruit consumption is more advisable than a packaged date drink.
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The aim of the study was to determine the chemical composition of dates from 10 types of palm cultivated in Saudi Arabia (Phoenix dactylifera L.) to assess their nutritive (crude protein, crude fat and ash) and amino acid composition. The dates were rich in sugar (71.2–81.4% dry weight), while ash represented 1.68–3.94%; they contained low concentrations of protein and lipid (1.72–4.73% and 0.12–0.72%, respectively). The predominant mineral was potassium, and the main sugars were glucose and fructose. They contained high concentrations of aspartic acid, proline, alanine, glycine, valine and leucine; low concentrations of threonine, serine, isoleucine, tyrosine, arginine, phenylalanine and lysine and very low concentrations of methionine and histidine. These results show that dates are nutritious and can play a major role in human nutrition and health.
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This article reviews current knowledge of the effects of maternal anemia and iron deficiency on pregnancy outcome. A considerable amount of information remains to be learned about the benefits of maternal iron supplementation on the health and iron status of the mother and her child during pregnancy and postpartum. Current knowledge indicates that iron deficiency anemia in pregnancy is a risk factor for preterm delivery and subsequent low birth weight, and possibly for inferior neonatal health. Data are inadequate to determine the extent to which maternal anemia might contribute to maternal mortality. Even for women who enter pregnancy with reasonable iron stores, iron supplements improve iron status during pregnancy and for a considerable length of time postpartum, thus providing some protection against iron deficiency in the subsequent pregnancy. Mounting evidence indicates that maternal iron deficiency in pregnancy reduces fetal iron stores, perhaps well into the first year of life. This deserves further exploration because of the tendency of infants to develop iron deficiency anemia and because of the documented adverse consequences of this condition on infant development. The weight of evidence supports the advisability of routine iron supplementation during pregnancy.
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Introduction: Constipation, heartburn, and haemorrhoids are common gastrointestinal complaints during pregnancy. Constipation occurs in 11-38% of pregnant women. Although the exact prevalence of haemorrhoids during pregnancy is unknown, the condition is common, and the prevalence of symptomatic haemorrhoids in pregnant women is higher than in non-pregnant women. The incidence of heartburn in pregnancy is reported to be 17-45%. Methods and outcomes: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent or treat constipation in pregnancy? What are the effects of interventions to prevent or treat haemorrhoids in pregnancy? What are the effects of interventions to prevent or treat heartburn in pregnancy? We searched: Medline, Embase, The Cochrane Library and other important databases up to July 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results: We found five systematic reviews, RCTs or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: Acid-suppressing drugs, anaesthetic agents (topical), antacids with or without alginates, bulk-forming laxatives, compound corticosteroid and anaesthetic agents (topical), corticosteroid agents (topical), increased fibre intake, increased fluid intake, osmotic laxatives, raising the head of the bed, reducing caffeine intake, intake of fatty foods, and the size and frequency of meals, rutosides, sitz baths, and stimulant laxatives.
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BACKGROUND: Many women experience leg cramps in the second half of pregnancy. OBJECTIVES: The objective of this review was to assess the effects of treatments for leg cramps in pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised trials of treatments for leg cramps, persisting for at least two weeks, in pregnancy. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. MAIN RESULTS: Three trials involving 217 women were included. The trials were of moderate quality. Compared with placebo, calcium reduced leg cramps (odds ratio 0.29, 95% confidence interval 0.15 to 0.56). However there was significant heterogeneity between these results. One trial comparing sodium chloride with placebo showed a reduction in leg cramps (odds ratio 0.08, 95% confidence interval 0.03 to 0.24). Based on one trial, there appeared to be no difference between calcium and sodium chloride. REVIEWER'S CONCLUSIONS: Both calcium and sodium chloride appear to help reduce leg cramps in pregnancy. However the results of the sodium chloride trial may no longer be relevant because of dietary changes.
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Background Anemia in pregnancy is responsible for many adverse effects on maternal and fetal outcome. It is the commonest hematological disorder accompanying pregnancy. Prevalence of anemia among pregnant women is fairly high worldwide, especially in developing countries. A research finding published by World Health organization revels that the prevalence of anemia among pregnant women in developing countries averages 56% (ranging between 35 to 100%). Though Nepal has decreasing trend of prevalence of anemia, it is still high (42% in 2006). Identifying the associated factors which are responsible for the development of anemia during pregnancy would be of great help in mitigating the burden to some extent. Ojective of the study was to find out the pattern of anemia and associated risk factors for anemia during pregnancy. Materials and Methods A cross-sectional study was conducted in VDC named Hansposa. Door to door survey was carried out to collect data using pre-designed questionnaires. Ante-natal check-ups were provided with analysis of hemoglobin levels, in every individual of study population, using conventional Shali's method. Chi-square test was applied, where applicable. Results Altogether 249 pregnant women were included in the study. The proportion of anemia was found to be 46.6%, the cases of mild anemia, and moderate anemia were 51.0% and 49.0% respectively. Risk factors includes: history of complications during previous pregnancy (P<0.001), education (P<0.05), age at marriage (P=0.028), low socio-economic status (P<0.001), gravidity and parity (P<0.01), poor knowledge about anemia (P<0.001), abnormal body mass index (P<0.001) and smoking (P=0.05). Conclusion This study indicates that the prevalence of anemia during pregnancy bears a resemblance to national value. Major associated risk factors include: history of complications during previous pregnancy, low knowledge about anemia in pregnant women, women with low body mass index, age at marriage, socio-economic status, gravidity and parity, and smoking. Most importantly, the lack of commitment in female education plays vital role in its existence. DOI: http://dx.doi.org/10.3126/nje.v4i4.11358 Nepal Journal of Epidemiology 2014; 4(4):386-92