The Relationship between Nutritional Knowledge with Nutrient Intake and Adherence to the Consumption of Blood-Added Tablets in Adolescent Girls at SMA Islam SHAFTA Surabaya

Anemia is a nutritional problem of adolescents in Indonesia that occurs due to iron deficiency. The purpose of the study was to analyze the relationship of nutritional knowledge with nutrient intake and adherence to the consumption of blood-added tablets in adolescent girls at SMA Islam SHAFTA Surabaya. This type of research is analytical descriptive research with a cross sectional design. Large sample of 45 respondents. Data collection with interviews and SQ-FFQ. Furthermore, it was analyzed with the spearman correlation test. The results of the analysis indicate that the majority of respondents' characteristics are aged 16-18 years (68.9%). Good nutrition knowledge 35 respondents (77.8%). Protein intake 32 respondents (71.1%) severe deficit, iron intake 36 respondents (80%) deficient and 41 respondents (91.1%) non-compliant. There was no relationship between nutritional knowledge with protein intake (p value = 0.428), nutritional knowledge with iron intake (p value = 0.685), and nutritional knowledge with adherence to blood added tablet consumption (p value = 0.231). There is no relationship between variables and it is necessary to collaborate on independent blood added tablets and health counseling at school.


INTRODUCTION
Anemia, which is estimated to suffer 30% of the world's population, is a problem caused by micronutrient deficiencies, especially in developing countries in the adolescent age group.One of the nutritional problems in Indonesia that occurs in adolescents is anemia, which is more likely to occur in adolescent girls when they lack micronutrients.Lack of iron intake is the main cause of anemia. 1 Referring to 2018 Basic Health Research data, there are 48.9 percent of teenagers in Indonesia experiencing anemia, respectively 25-34 percent and 15-24 percent experiencing anemia. 2 The 2021 Indonesian Health Profile indicates that iron supplement coverage for adolescent girls in East Java Province is 23.5%, lower than Indonesia's target of 31.3% for 2021. 3e results of blood added tablets coverage at SHAFTA Surabaya Islamic High School in 2022 show that the number of young women who received blood added tablets was 135 female students through activities providing and monitoring blood added tablets consumption.
Referring to Fatma and Novera's research from 2022, it indicates that knowledge and compliance with iron tablet consumption are related.Adolescent girls who lack knowledge are at risk sampling technique uses a simple random sampling method.Data were collected using questionnaire interviews for knowledge and compliance data, the SQ-FFQ form was used to obtain nutritional intake data.Data analysis using the Spearman statistical test.

Respondent's Age
From the results of data collection, the following table describes the characteristics of respondents based on the age of the respondents: In Table 1 it can be seen that of the total respondents, namely 45, the majority were respondents with an age range of 16-18 years, namely 31 respondents (68.9%).

Respondent Class
From the results of data collection, the characteristics of respondents in the respondent class can be seen in the following table: In Table 2 it is clear that of the total respondents, namely 45, the majority were respondents in Class X, namely 28 respondents (62.2%).

Level of Nutrition Knowledge
The following table indicates the level of nutritional knowledge of respondents determined from the data collected: The total number of respondents was 45 people, which can be seen in Table 3.Of this number, 35 people (77.8%) had a good level of nutritional knowledge.

Protein Consumption Levels
From the results of the data collection, the results of the respondents' levels of protein consumption can be seen in the following table: In Table 4, the results show that the highest category of protein consumption level is the severe deficit category, with 32 respondents (71.1%).

Iron Consumption Levels
From the results of data collection, the respondent's level of iron consumption can be observed in the following column: In Table 5, the results show that the highest category of iron consumption level is the deficient category, there are 36 respondents (80%).

Blood Added Tablets Consumption Compliance
From the results of data collection, the table of blood added tablets consumption compliance results looks as follows:

Protein Consumption Levels Are Based on Level of Nutritional Knowledge
From the results of data collection, the results of the cross-tabulation of respondents' nutritional knowledge and protein intake are presented in the following table: In Table 7, there are 24 respondents (68.6%) with a high level of nutritional knowledge but severe protein deficiency.In contrast, only three respondents (8.6%) had a good level of nutritional knowledge and normal levels of protein consumption, while five respondents (14.3%) experienced a moderate protein deficit.

Iron Consumption Levels Are Based on Level of Nutritional Knowledge
From the results of data collection, the following table displays a cross-tabulation of respondents' nutritional knowledge and protein intake:

Compliance with Blood Added Tablets consumption is based on the level of nutritional knowledge
From the results of data collection, cross-tabulation of respondent's nutritional knowledge and compliance with iron supplement consumption resulted in the following table:

Respondent Characteristics
The characteristics of the research respondents included young women aged between 13 and 15 years, there were 14 respondents (31.1%) and 31 respondents (68.9%) at the age of 16-18 years, with class X as many as 28 respondents (62.2%) and class XI there were 17 respondents (37.8%).

Level of Nutrition Knowledge
Indirect causal factors consist of education, nutritional knowledge, lifestyle, age, social status, and distance to health facilities.Health services and iron intake are influenced by distance to health facilities through mechanisms related to travel distance and reach of health facilities and food.Nutritional knowledge is the main causal factor that influences intake and compliance with blood added tablets consumption.If a teenager's diet is unbalanced, it will disrupt the process of iron and protein absorption, which is a cause of anemia in teenage girls.So nutritional knowledge is the independent variable in this research.
The level of respondents' nutritional knowledge was measured using a questionnaire, the majority of respondents had good nutritional knowledge, 35 respondents (77.8%).The knowledge of respondents in this study was good because it was influenced by information and learning related to health and biology both inside and outside school.In general, health information can be obtained from various media, namely the internet and other electronic media such as cellphones, television and radio. 5Apart from that, respondents also said that they had received education about health at school from the community health center.So, the knowledge they have is more than just knowing.

Protein Consumption Levels
Based on the research results, it is known that the majority of protein consumption levels are in the severe deficit classification of 32 respondents (71.1%).From the research results, it was found that the average protein intake was 39.7 g.If we look at the average, referring to the Ministry of Health (2003), the respondents' protein intake is still classified as a severe deficit.
As a result of interviews with respondents, respondents said they never had breakfast at home because it was their habit that if they had breakfast, they would feel nauseous.This reason led respondents to go to the canteen and buy snacks there.Therefore, based on the results of the SQ-FFQ interview, respondents consumed more snacks than main meals as a result of which respondents felt full.This is by Arisnawati's statement that children prefer foods containing carbohydrates and salt because these foods help children feel full quickly. 6

Iron Consumption Levels
Referring to the research results, the majority of 36 respondents (80%) had deficient iron consumption.From the research results, it was found that the average iron intake was 7.8 mg.If we look at the average, referring to Gibson (2005), the respondents' iron intake is still relatively low.The SQ-FFQ results showed that the majority of respondents consumed tea along with snacks purchased from school or consumed at home.In 150 milliliters of tea, there are 25-80 mg of tannin. 7nnin is a plant-derived polyphenolic compound that can inhibit iron absorption.
Consuming tea after meals is not recommended if the body is deficient in fe. 8 This is in line with research conducted by Riswanda (2017) that the risk of anemia can be seen from tannin intake.
Tannin consumption >10.5 g/day carries a 2.21 times greater risk of anemia than tannin consumption <10.5 g/day. 9Referring to Ari Istiany, protein also functions to help absorb iron in the body, so if a person's level of protein consumption is low it will cause iron deficiency. 10

Blood Added Tablets Consumption Compliance
Referring to the results of observations, it is known that compliance with blood added tablets consumption is highest in the non-compliant classification, numbering 41 respondents (91.1%).The reason respondents did not want to drink blood added tablets regularly according to the recommended rules was that they were lazy and did not like the fishy aroma of blood added tablets.
So, what respondents consumed was only vitamin C supplements.However, some respondents also chose to consume blood added tablets regularly because they were used to consuming it and already understood the consequences of not consuming blood added tablets. 11

Relationship between level of nutritional knowledge and level of protein intake
From the correlation test, significance or Sig is obtained.(2-tailed) has a value of 0.428 > 0.05, meaning that there is no relationship between the level of nutritional knowledge and the level of protein consumption at SHAFTA Surabaya Islamic High School.This shows that even though the respondents have a good level of knowledge, it turns out that the respondents have not been able to meet their protein intake according to their daily needs.But basically the better the level of knowledge, the more adequate protein consumption will be. 12However, this is inversely proportional to this research because the nutritional knowledge they have is more than limited to what they know but is not put into practice in daily life so this influences the level of protein consumption to become a severe deficit.
However, this research is in line with the findings of Adawiyah and Nieken (2017), this study indicates that there is no relationship between the level of nutritional knowledge and protein intake because even if you have good nutrition knowledge but still make the wrong choice of food, it will result in health problems. 13One of the factors that influences eating habits is knowledge.Teenagers can develop a clear understanding of how to behave with knowledge.During adolescence, a person assumes responsibility for his or her health, behavior, and eating habits.Teenagers rely heavily on their knowledge when making decisions. 14

Relationship between level of nutritional knowledge and level of iron intake
From the correlation test, it was found that the significance was 0.685 > 0.05, meaning there was no correlation between the level of nutritional knowledge and iron intake at SHAFTA Surabaya Islamic High School.This shows that even though the respondents have a good level of knowledge, it turns out that the respondents have not been able to meet their iron intake according to their daily needs.But basically the better the level of knowledge, the better the iron consumption will be. 15wever, this is inversely proportional to this research because the nutritional knowledge they have is more than just what they know but is not put into practice in daily life, as a result, this has an effect on the level of iron consumption being low.Another thing that influences the majority of female students is not consuming vegetables, where vegetables are a food source of iron, especially green vegetables, and consuming tea along with snacks.Therefore, this is not recommended because these foods contain tannins which can inhibit fe absorption. 16is research is in line with the study carried out by Indah, M (2018) targeting students, indicating that there is no correlation between the level of knowledge and iron intake because even if you have good nutrition knowledge but still make the wrong choice of food, it will result in nutritional problems. 17One way to balance good nutritional knowledge is to practice it directly in daily life by maintaining eating habits, namely a diet based on the principles of balanced nutrition. 18

Added Tablets consumption
From the correlation test, Sig is produced.(2-tailed) was 0.231 > 0.05, meaning there was no relationship between nutritional knowledge and compliance with blood added tablets consumption at SHAFTA Surabaya Islamic High School.This shows that even though respondents have a good level of knowledge, it will not necessarily result in better compliance with blood added tablets consumption.But basically the better the level of knowledge, the more compliant the consumption of blood added tablets will be. 19According to Fatma Ryalda's research from 2022, compliance with iron supplement consumption is related to knowledge and family support.This shows that knowledge and compliance with the consumption of iron tablets are related.Adolescent girls who lack knowledge are at risk of not consuming one blood added tablets tablet per week, which is around 4.9x higher than adolescent girls who have sufficient or good knowledge.However, this is inversely proportional to this research because the nutritional knowledge they have is more than just what they know but is not put into practice in everyday life.Another influence is that you are lazy and don't like the smell of fishy blood supplement tablets.Therefore, this has an impact on the number of female students who do not comply with blood added tablets consumption.
If we look at the qualitative results of the SQ-FFQ, it can be seen that the majority of respondents' eating habits regularly consume protein sources but not green vegetables because the average respondent doesn't like vegetables.These two food groups are the greatest sources of fe. 20e sources of protein are less diverse, only chicken, eggs and tilapia fish with the most frequent consumption frequency being 1x/day for chicken.This may be due to the influence of the students' irregular eating habits.So, eating habits also play an important role in a person's nutritional knowledge.So this is where the role of educators in schools is needed as providers of guidance. 21om this research, researchers used 45 samples because these samples were sufficient to represent the research results which showed that there is no relationship between nutritional knowledge and protein intake, iron intake, and compliance with consuming blood supplement tablets in young women at SHAFTA Islamic High School Surabaya.The researcher chose a cross-sectional design as the design for this research because it is observational research which allows the researcher to carry out analysis with the same variables for all subjects in the sample population in the research period.In collecting data using the SQ-FFQ method because its use makes it easier to measure macro and micronutrient intake, provides an overview of portion sizes and frequency of food eaten by a person in years, months, weeks and days, and ranks them.Individual nutritional intake is based on standard portion sizes which can be a reference for each type of food.

CONCLUSION
Level of female students' nutritional knowledge at SHAFTA Islamic High School Surabaya the majority were in a good category, there were 35 respondents (77.8%).The majority of adolescent girls' nutritional intake at SHAFTA Surabaya Islamic High School is in the severe deficit category consisting of protein intake for 32 respondents (71.1%) and iron intake deficient for 36 respondents (80%).The majority of adolescent girls at SHAFTA Islamic High School Surabaya were in the non-compliant category with 41 respondents (91.1%).There is no relationship between nutritional knowledge and protein intake, iron intake, and compliance with the consumption of blood supplement tablets among young women at SHAFTA Islamic High School Surabaya.
This research focuses on protein and iron intake because the research was conducted on anemia in adolescent girls where food sources of protein contain iron which is a micronutrient that the body needs in blood formation for the synthesis of hemoglobin as the main component of blood.
If protein intake is low, iron levels in the body will automatically decrease and hemoglobin will decrease, causing anemia.
For follow-up plans for female students, can increase understanding and motivation for female students about the importance of consuming nutritious food and food ingredients that inhibit fe absorption so that they are applied in everyday life to develop female students' knowledge about nutrition and prevent anemia.For the school, it is necessary to hold an independent collaboration between the school and the nearest health center regarding blood supplement tablets so that the supply of blood supplement tablets at the school can be sufficient for all young female students.For the community health center, it is necessary to maintain an active iron supplementation program and provide outreach activities regarding the importance of consuming blood supplement tablets for students so that they are motivated to regularly consume blood added tablets to prevent anemia in young women.

Table 3 . Frequency Distribution of Respondents Level of Nutritional Knowledge at SHAFTA Surabaya Islamic High School in 2023
Source: Primary Data 2023

Table 7 . Cross Tabulation of Levels of Nutritional Knowledge and Levels of Protein Consumption at SHAFTA Islamic High School Surabaya in 2023 Level of Nutrition Knowledge Protein Consumption Levels Severe Deficit
Journal homepage: https://jone.poltekkesdepkes-sby.ac.id 210 Source: Primary Data 2023

Table 8 . Cross Tabulation of Levels of Nutrition Knowledge and Levels of Iron Consumption at SHAFTA Islamic High School Surabaya in 2023 Level of Nutrition Knowledge Iron Consumption Levels
Source: Primary Data 2023

Table 8
, if you look at the trend, the majority of respondents have a good level of nutritional knowledge with 27 respondents (77.1%).Meanwhile, there were only 8 respondents who had good nutritional knowledge and enough levels of iron consumption (22.9%).

Table 9 ,
if you look at the trend, the majority of respondents have good nutritional knowledge and Blood Added Tablets consumption is non-compliant, there are 32 respondents (91.4%).On the other hand, there were only 3 respondents who had a good level of nutritional knowledge and compliant to Blood Added Tablets consumption (8.6%).