The Effect of Anti-nutrition and Bioavailability of Iron of Moringa Oleifera on Rat Hematology Model Iron Deficiency Anemia. Review Article

Laode Muslimin^1, , Ramdan Panigoro², Gaga Irawan Nugraha², Susi Susanah³, Gemilang Lara Utama⁴, Mas Rizki A.Asyamsumarno⁵ and Tasnim ⁶

¹Doctoral Student of Medical Science at Padjadjaran University, Bandung, Indonesia

²Department of Basic Medical Sciences. Faculty of Medicine, Padjadjaran University, Bandung. Indonesia

³Department/KSM of Pediatrics, Faculty of Medicine, University of Padjadjaran, Bandung. Indonesia

⁴Department of Graduate School of Padjadjaran University, Bandung. Indonesia

⁵Department of Biomedical Sciences, Faculty of Medicine, Padjadjaran University. Bandung. Indonesia

⁶Public Health Postgraduate Department, Faculty of Health Sciences, Mandala Waluya University. Kendari. Indonesia

Cite this paper:
Laode Muslimin, Ramdan Panigoro, Gaga Irawan Nugraha, Susi Susanah, Gemilang Lara Utama, Mas Rizki A.Asyamsumarno and Tasnim . The Effect of Anti-nutrition and Bioavailability of Iron of Moringa Oleifera on Rat Hematology Model Iron Deficiency Anemia. Review Article. Journal of Food and Nutrition Research. 2023; 11(1):25-36. doi: 10.12691/jfnr-11-1-3

Abstract

Anemia is one of the current health problems, about 50% of anemia is caused by dengue fever so this situation has become a global problem that harms human health, and the social and economic development of the country. The purpose of this review is to examine the implications of drying and fermentation processing methods, anti-nutrients and iron bioavailability of Moringa leaves on parameters of iron deficiency anemia. The narrative method describes research results based on inclusion criteria through article searches in the Google Scholar, PubMed, and Garuda databases. 54 articles corroborate the claims of the effectiveness of Moringa leaves in the treatment of iron deficiency anemia. consists of 34 preclinical research articles using mouse models. Moringa leaf supplementation as an anti-anemia in iron deficiency anemia rat model can be in the form of extract or dry powder and obtained from different processing methods. Moringa leaves are processed into a dry extract and/or dry powder capable of ameliorating hematological and biochemical parameters in preclinical research. The processing method has an impact on changes in anti-nutritional and iron bioavailability of Moringa leaves which have a positive impact on indicators of iron deficiency anemia.

Keywords:
anemia Moringa oleifera processing anti-nutrition iron bioavailability hematology biochemistry

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	M. Mahdi Zangeneh, M. Pooyanmehr, and A. Zangeneh, “Evaluation of the anti-anemic potential of Glycyrrhiza glabra aqueous extract in Phenylhydrazine-treated rats,” Iran. J Pharmacol Ther, vol. 2017, pp. 1-9, 2017.
[2]	N. Petry et al., “The proportion of anemia associated with iron deficiency in low, medium, and high human development index countries: A systematic analysis of national surveys,” Nutrients, vol. 8, no. 11, pp. 1-17, 2016.
[3]	Yulaeka, A. Suwondo, T. Suherni, S. Hadisaputro, and M. C. Anwar, “effect of consuming guava leaves (psidii folium) extract on the level of blood profile in teenage girls at vocational high school of palebon semarang, indonesia,” Belitung Nurs. J., vol. 3, no. 5, pp. 548-554, 2017.
[4]	R. Yip, “yip 1994_Iron deficiency_ contemporary scientific issues and international programmatic approaches - PubMed.” J Nutr . 1994 Aug;124(8 Suppl):1479S-1490S., 1994.
[5]	J. Díaz-Castro et al., “Influence of nutritional iron deficiency anemia on DNA stability and lipid peroxidation in rats,” Nutrition, vol. 24, no. 11-12, pp. 1167-1173, 2008.
[6]	P. Aisen, C. Enns, and M. Wessling-Resnick, “Chemistry and biology of eukaryotic iron metabolism,” Int. J. Biochem. Cell Biol., vol. 33, no. 10, pp. 940-959, 2001.
[7]	M. Lesjak and S. K. S. Srai, “Role of dietary flavonoids in iron homeostasis,” Pharmaceuticals, vol. 12, no. 3, pp. 1-21, 2019.
[8]	WHO, The global prevalence of anaemia in 2011. 2011.
[9]	WHO and FAO, “Guidelines on food fortification with micronutrients,” Retrieved from http//www.who.int/nutri tion/publi catio ns/guide_ food_forti ficat ion_micro Nutr. ents.pdf., 2006.
[10]	J. Carrier, E. Aghdassi, J. Cullen, and J. P. Allard, “Iron supplementation increases disease activity and vitamin E ameliorates the effect in rats with dextran sulfate sodium-induced colitis,” J. Nutr., vol. 132, no. 10, pp. 3146-3150, 2002.
[11]	Permenkes, peraturan menteri kesehatan republik indonesia nomor 88 tahun 2014 tentang standar tablet tambah darah bagi wanita usia subur dan ibu hamiL, no. 1840. 2014.
[12]	K. Jimenez, S. Kulnigg-Dabsch, and C. Gasche, “Management of iron deficiency Anemia,” Gastroenterol. Hepatol., vol. 11, no. 4, pp. 241-250, 2015.
[13]	Z. Tolkien, L. Stecher, A. P. Mander, D. I. A. Pereira, and J. J. Powell, “Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: A systematic review and meta-analysis,” PLoS One, vol. 10, no. 2, pp. 1-20, 2015.
[14]	T. Permatasari, D. Briawan, and S. Madanijah, “Efektifitas Program Suplementasi Zat Besi pada Remaja Putri di Kota Bogor,” Media Kesehat. Masy. Indones., vol. 14, no. 1, p. 1, 2018.
[15]	A. A. Adedapo, O. M. Mogbojuri, and B. O. Emikpe, “safety evaluations of the aqueous extract of the leaves of moringa oleifera in rats,” J. Med. Plants Res., vol. 3, no. 8, pp. 586-591, 2009,.
[16]	T. C. Adias, A. O. Ajugwo, T. Erhabor, and C. U. Nyenke, “Pumpkin Extract (Telfairia occidentalis) on Routine Haematological Parameters in Acetone-Induced Oxidative Stress Albino Rats,” Am. J. Food Sci. Technol., vol. 1, no. 4, pp. 67-69, 2013.
[17]	R. Rajeswari, B. Pushpa, … K. N.-K. J. of, and U. 2013, “Dehydration of amaranthus leaves and its quality evaluation.,” Karnataka J. Agric. Sci., vol. 26, no. 26(2), pp. 276-80, 2013.
[18]	F. Anwar et al., “Moringa oleifera: A Food Plant with Multiple Medicinal Uses,” Phyther. Res., vol. 22, no. 4, pp. 544-549, 2007.
[19]	B. Moyo, P. J. Masika, A. Hugo, and V. Muchenje, “Nutritional characterization of Moringa (Moringa oleifera Lam.) leaves,” African J. Biotechnol., vol. 10, no. 60, pp. 12925-12933, 2011.
[20]	A. F. A. Razis, M. D. Ibrahim, and S. B. Kntayya, “Health benefits of Moringa oleifera,” Asian Pacific J. Cancer Prev., vol. 15, no. 20, pp. 8571-8576, 2014.
[21]	L. J. Fuglie, “THE MORINGA TREE A local solution to malnutrition?The miracle tree: Moringa oleifera: natural nutrition for the tropics.,” Nature’s Pharm., no. 221, pp. 22-35, 2003.
[22]	K. Thapa, M. Poudel, and P. Adhikari, “Moringa oleifera: A Review Article on Nutritional Properties and its Prospect in the Context of Nepal,” Acta Sci. Agric., vol. 3, no. 11, pp. 47-54, 2019.
[23]	N. Z. A. Rani, K. Husain, and E. Kumolosasi, “Moringa genus: A review of phytochemistry and pharmacology,” Front. Pharmacol., vol. 9, no. FEB, pp. 1-26, 2018.
[24]	A. Hamidiyah and R. Hikmah, “Penanggulangan Anemia melalui Kader Kokoa Moringa Oleifera (Komo),” J. Community Engagem. Heal., vol. 1, no. 2, pp. 1-5, 2018.
[25]	U. C. A. S. Isnainy, L. Arianti, and D. Rosalia, “Pengaruh Konsumsi Ekstrak Daun Kelor Dan Madu Terhadap Peningkatan Hb Ibu Hamil Di Wilayah Kerja Puskesmas Way Halim Kota Bandar Lampung,” Malahayati Nurs. J., vol. 2, no. 1, pp. 57-67, 2020.
[26]	A. Estiyani, A. Suwondo, S. Rahayu, S. Hadisaputro, M. N. Widyawati, and K. A. Susiloretni, “the Effect of Moringa Oleifera Leaves on Change in Blood Profile in Postpartum Mothers,” Belitung Nurs. J., vol. 3, no. 3, pp. 191-197, 2017.
[27]	L. Indriani, C. Zaddana, N. M. Nurdin, and J. S. M. Sitinjak, “Pengaruh Pemberian Edukasi Gizi dan Kapsul Serbuk Daun Kelor (Moringa oleifera L.) terhadap Kenaikan Kadar Hemoglobin Remaja Putri di Universitas Pakuan,” Media Pharm. Indones., vol. 2, no. 4, p. 200, 2019.
[28]	M. Fitriyaa and W. Wijayanti, “Upaya Peningkatan Kadar Hemoglobin Melalui Suplemen Tepung Daun Kelor Pada Remaja Putri,” Proceeding of The URECOL, pp. 86-94, 2020.
[29]	E. Emmanuel and Emmanuel, “Phytochemical and anti-nutritional studies on some commonly consumed fruits in lokoja, kogi state of Nigeria,” Gen. Med. Open, vol. 2, no. 3, pp. 1-5, 2018, doi: 10.15761/gmo.1000135.
[30]	A. Pandey, “Moringa Oleifera Lam. (Sahijan) - A Plant with a Plethora of Diverse Therapeutic Benefits: An Updated Retrospection,” Med. Aromat. Plants, vol. 1, no. 1, 2012.
[31]	R. I. Bakare, O. A. Magbagbeola, A. I. Akinwande, and O. W. Okunowo, “Nutritional and chemical evaluation of Momordica charantia,” J. Med. Plants Res., vol. 4, no. 21, pp. 2189-2193, 2010.
[32]	M. Ali, M. N. Shuja, M. Zahoor, and I. Qadri, “Phytic acid: How far have we come?,” African J. Biotechnol., vol. 9, no. 11, pp. 1551-1554, 2010.
[33]	A. B. Sallau, S. B. Mada, S. Ibrahim, and U. Ibrahim, “Effect of boiling, simmering and blanching on the antinutritional content of Moringa oleifera leaves,” Int. J. Food Nutr. Saf., vol. 2, no. 1, pp. 1-6, 2012.
[34]	C. Alidou, A. Salifou, J. Djossou, and M. Mohamed, “Roasting effect on anti-nutritional factors of the Moringa oleifera leaves,” vol. 3, no. xxxx, pp. 1554-1564, 2016.
[35]	N. N. Umerah, A. I. Asouzu, and J. I. Okoye, “Effect of Processing on the Nutritional Composition of Moringa olifera Leaves and Seeds,” Eur. J. Nutr. Food Saf., vol. 11, no. 3, pp. 124-135, 2019.
[36]	A. O. Ademiluyi, O. H. Aladeselu, G. Oboh, and A. A. Boligon, “Drying alters the phenolic constituents, antioxidant properties, α-amylase, and α-glucosidase inhibitory properties of Moringa (Moringa oleifera) leaf,” Food Sci. Nutr., vol. 6, no. 8, pp. 2123-2133, 2018.
[37]	S. Anita, M. Aravindh, and E. Ramya, “Influence of Probioticated Moringa Oleifera Leaf Extract for Treatment of Anaemia Using Animal Model,” Int. Res. J. Pharm., vol. 8, no. 5, pp. 101-107, 2017.
[38]	D. D. Gallaher et al., “Iron Bioavailability from Moringa oleifera Leaves Is Very Low | The FASEB Journal,” fasebj, 2017.
[39]	A. A. J. Armel, F. N. Edith, and M. C. Moses, “In vitro Protein Digestibility and Iron Bioavailability According to Agro-Ecological Zone and Stage of Maturity of Moringa oleifera Lam Leaves,” European Journal of Nutrition & Food Safety. pp. 90-103, 2020.
[40]	R. van der Merwe, J. Kruger, M. G. Ferruzzi, K. G. Duodu, and J. R. N. Taylor, “Improving iron and zinc bioaccessibility through food-to-food fortification of pearl millet with tropical plant foodstuffs (moringa leaf powder, roselle calyces and baobab fruit pulp),” J. Food Sci. Technol., vol. 56, no. 4, pp. 2244-2256, 2019.
[41]	O. Oladeji, K. Taiwo, S. Gbadamosi, B. Oladeji, and M. Ishola, “Studies on Chemical Constituents and Nutrients Bioavailability in Moringa oleifera Leaf and Seed,” J. Sci. Res. Reports, vol. 14, no. 1, pp. 1-12, 2017.
[42]	T. Mongwaketse, “Iron and zinc bioaccessibility from African leafy vegetables : implications for nutrition Mini-dissertation submitted in partial fulfilment of the requirements for the degree Master of Science in Nutrition at the Potchefstroom Campus of the North-West Uni,” 2014.
[43]	A. Mun’im, M. U. Puteri, S. P. Sari, and Azizahwati, “Anti-anemia effect of standardized extract of moringa oleifera lamk. Leaves on aniline induced rats,” Pharmacogn. J., vol. 8, no. 3, pp. 255-258, 2016.
[44]	H. M. Osman, M. E. Shayoub, E. M. Babiker, B. Osman, and A. M. Elhassan, “Effect of Ethanolic Leaf Extract of Moringa oleifera on Aluminum-induced Anemia in White Albino Rats,” vol. 5, no. 4, pp. 255-260, 2012.
[45]	S. S. Ameh and O. F. Alafi, “Effect of Ethanol Extract of Moringa Oleifera Leaves in Protecting Anaemia Induced in Rats by Aluminium Chloride,” IOSR J. Biotechnol. Biochem., vol. 4, no. 6, pp. 34-52, 2018.
[46]	W. Ricika, “The Effectiveness Of Moringa oleifera L (Moringa oleifera L) Fraction On The Improvement Of Hemoglobine Levels Of Betinine Rat (Rattus norvegicus) Anemia Model Of Iron Deficiency,” Biomedical Journal of Indonesia, vol. 6, no. 3. pp. 63-70, 2020.
[47]	A. O. Ajugwo, P. E. Mounbegna, T. S. Kemajou, and V. C. Ofokansi, “Effects of Moringa oleifera leaves extract on haematological parameters of phenylhydrazine anaemia induced wistar rats,” Int. J. Public Heal. Saf., vol. 2, no. 4, pp. 1-4, 2017.
[48]	A. Coulibaly, N. B. Gnangoran, J. B. N. Oussou, and M. nahounou Bleyere, “Evaluation of Moringa oleifera Lam leaves (Moringaceae) diets against induced anemia in Wistar rats,” J. Nutr. Food Sci, vol. 2, no. 3, pp. 101-106, 2020.
[49]	N. B. Gnangoran, M. N. BLEYERE, J.-B. N. OUSSOU, A. COULIBALY, and P. A. YAPO, “Comparative Effects Between A Total Aqueous Extract and A Diet Enriched with Moringa oleifera Leaves in Wistar Rats with Anemia,” J. Med. Biol. Sci. Res., vol. 6, no. 3, pp. 35-41, 2020.
[50]	D. Hermayanti and F. Syafitri, “EFEKTIFITAS EKSTRAK DAUN KELOR (Moringa oleifera lam) DALAM MEMPERBAIKI PROFIL SERUM IRON, SATURASI TRANSFERIN, DAN TOTAL IRON BINDING …,” Herb-Medicine Journal, vol. 3, no. April. pp. 1-5, 2020.
[51]	D. Hermayanti, W. Setiawan, and R. M. Azhar, “The Effect Of Moringa Leaf (Moringa Oleifera Lam) And Vitamin C Combination Extract In Improving Anemia Indicators Deficiency Of White Rice Iron Male Diet Low Rice Iron,” Jurnal Saintika Medika, vol. 16, no. 2. pp. 104-114, 2020.
[52]	U. D. Indrayani, H. Sarosa, A. Hussaana, and B. Widiyanto, “The Effects Comparisons of Sauropus androgynous, Moringa oleiefera alone and in combination on iron deficiency in anemia rats,” Bangladesh J. Med. Sci., vol. 18, no. 1, pp. 136-140, 2019.
[53]	R. Safitri and R. Retnaningsih, “Role Of Moringa Oleifera Leaf Extract In Increasing Hemoglobin Levels In Pregnant Rats With Anemia,” J. Heal. Sci., vol. 14, no. 1, pp. 8-13, 2021.
[54]	A. Mun’im et al., “Anti-anemia effect of standardized extract of moringa oleifera lamk. Leaves on aniline induced rats,” Pharmacogn. J., vol. 8, no. 3, pp. 255-258, 2016.
[55]	E. Madukwe, A. Ugwuoke, and J. Ezeugwo, “Effectiveness of dry Moringa oleifera leaf powder in treatment of anaemia,” Int. J. Med. Med. Sci., vol. 5, no. 5, pp. 226-228, 2013.
[56]	A. Thakur, V. Sharma, and A. Thakur, “An overview of anti-nutritional factors in food,” Int. J. Chem. Stud., no. January, pp. 2472-2479, 2019.
[57]	A. Popova and D. Mihaylova, “Antinutrients in Plant-based Foods: A Review,” Open Biotechnol. J., vol. 13, no. 1, pp. 68-76, 2019.
[58]	K. O. Soetan and O. E. Oyewole, “The need for adequate processing to reduce the anti- nutritional factors in plants used as human foods and animal feeds : A review,” vol. 3, no. 9. pp. 223-232, 2009.
[59]	M. Samtiya, R. E. Aluko, and T. Dhewa, “Plant food anti-nutritional factors and their reduction strategies: an overview,” Food Prod. Process. Nutr., vol. 2, no. 1, pp. 1-14, 2020.
[60]	K. W. Waldron, M. L. Parker, and A. C. Smith, “Plant Cell Walls and Food Quality,” Compr. Rev. Food Sci. Food Saf., vol. 2, no. Oliver 1997, pp. 101-119, 2003.
[61]	A. A. Akindahunsi, “EFFECT OF SOME POST-HARVEST TREATMENTS ON THE BIOAVAILABILITY OF ZINC FROM SOME SELECTED TROPICAL VEGETABLES,” La Riv. Ital. Delle Sostanze Grasse, vol. 76, pp. 285-287, 1999.
[62]	V. DEWANTO, X. WU, K. K. ADOM, and A. R. H. LIU, “Thermal Processing Enhances the Nutritional Value of Tomatoes by Increasing Total Antioxidant Activity,” J. Agric. Food Chem, vol. 50, pp. 3010-3014, 2002.
[63]	M. H. Lyimo, S. Nyagwegwe, and A. P. Mnkeni, “Investigations on the effect of traditional food processing, preservation and storage methods on vegetable nutrients: A case study in Tanzania,” Plant Foods Hum. Nutr., vol. 41, no. 1, pp. 53-57, 1991.
[64]	T. Baysal, F. Icier, S. Ersus, and H. Yildiz, “Effects of microwave and infrared drying on the quality of carrot and garlic,” Eur. Food Res. Technol., vol. 218, no. 1, pp. 68-73, 2003.
[65]	C. Suprihartini, A. Ulilalbab, and F. A. Budiman, “Efek Penambahan Tepung Daun Kelor Pada Fermentasi Tempe Terhadap Kadar Vitamin C Dan N-Amino Tempe Kelor (Pelor),” Heal. J. 1, vol. 12, no. 1, pp. 369-374, 2021.
[66]	S. S. Hur, S. W. Choi, D. R. Lee, J. H. Park, and T. H. Chung, “Advanced Effect of Moringa oleifera Bioconversion by Rhizopus oligosporus on the Treatment of Atopic Dermatitis: Preliminary Study,” Evidence-based Complement. Altern. Med., vol. 2018, 2018.
[67]	A. Chawafambira, M. M. Sedibe, A. Mpofu, and M. Achilonu, “Probiotic Potential, Iron and Zinc Bioaccessibility, and Sensory Quality of Uapaca kirkiana Fruit Jam Fermented with Lactobacillus rhamnosus Yoba,” International Journal of Food Science, vol. 2020. 2020.
[68]	A. Djonu, S. Andayani, and H. Nursyam, “Identification of moringa oleifera leaves content fermented by rhizopus oligosporus,” Int. J. Sci. Technol. Res., vol. 7, no. 4, pp. 102-104, 2018.
[69]	T. Bhanja, A. Kumari, and R. Banerjee, “Enrichment of phenolics and free radical scavenging property of wheat koji prepared with two filamentous fungi,” Bioresour. Technol., vol. 100, no. 11, pp. 2861-2866, 2009.
[70]	H. Kobayashi et al., “Efficacy and safety of a traditional herbal medicine, hochu-ekki-to in the long-term management of Kikyo (Delicate Constitution) patients with atopic dermatitis: A 6-month, multicenter, double-blind, randomized, placebo-controlled study,” Evidence-based Complement. Altern. Med., vol. 7, no. 3, pp. 367-373, 2010.
[71]	H. Shi, E. Yang, Y. Li, X. Chen, and J. Zhang, “Effect of Solid-State Fermentation on Nutritional Quality of Leaf Flour of the Drumstick Tree (Moringa oleifera Lam.),” Front. Bioeng. Biotechnol., vol. 9, pp. 1-16, 2021.
[72]	T. B. Dey and R. C. Kuhad, “Enhanced production and extraction of phenolic compounds from wheat by solid-state fermentation with Rhizopus oryzae RCK2012,” Biotechnol. Reports, vol. 4, no. 1, pp. 120-127, 2014.
[73]	M. R. Adedayo, J. K. Akintunde, A. Sani, and A. A. Boligon, “Effect of dietary supplement from mono- culture fermentation of Moringa oleifera seeds by Rhizopus stolonifer on hematology and markers linked to hypercholesterolemia in rat model,” Food Sci Nutr, vol. 6, no. January 2017, pp. 1826-1838, 2018.
[74]	K. Sano and H. Ogawa, “Chapter 4 Hemagglutination ( Inhibition ) Assay,” vol. 1200, pp. 47-52, 2014.
[75]	B. Xie, T. J. Halter, B. M. Borah, and G. H. Nancollas, “Aggregation of calcium phosphate and oxalate phases in the formation of renal stones,” Cryst. Growth Des., vol. 15, no. 1, pp. 204-211, 2015.
[76]	R. S. Kelly et al., “Blood erythrocyte concentrations of cadmium and lead and the risk of B-cell non-Hodgkin’s lymphoma and multiple myeloma: A nested case-control study,” PLoS One, vol. 8, no. 11, 2013.
[77]	N. Panth, K. R. Paudel, and K. Parajuli, “Reactive Oxygen Species: A Key Hallmark of Cardiovascular Disease,” Adv. Med., vol. 2016, pp. 1-12, 2016.
[78]	B. G. Forget and H. Franklin Bunn, “Classification of the disorders of hemoglobin,” Cold Spring Harb. Perspect. Med., vol. 3, no. 2, 2013.
[79]	J. K. Akintunde, G. Oboh, and A. A. Akindahunsi, “Inhibition of Key Markers Linked With Spermatogenesis and Cellular ATP by Subchronic Exposure to Leachate in a Rat Model,” Arch. Environ. Contam. Toxicol., vol. 68, no. 1, pp. 159-168, 2015.
[80]	I. Iskandar, V. Hadju, S. As ’ad, and R. Natsir, “Effect of Moringa Oleifera Leaf Extracts Supplementation in Preventing Maternal Anemia and Low-Birth-Weight,” Int. J. Sci. Res. Publ., vol. 5, no. 1, pp. 2250-3153, 2015.
[81]	M. Saarela, G. Mogensen, R. Fondén, J. Mättö, and T. Mattila-Sandholm, “Probiotic bacteria: Safety, functional and technological properties,” J. Biotechnol., vol. 84, no. 3, pp. 197-215, 2000.
[82]	K. Tiihonen, T. Suomalainen, S. Tynkkynen, and N. Rautonen, “Effect of prebiotic supplementation on a probiotic bacteria mixture: Comparison between a rat model and clinical trials,” Br. J. Nutr., vol. 99, no. 4, pp. 826-831, 2008.
[83]	S. L. Vilanculos and U. Svanberg, “Degradation of phytate in composite wheat/cassava/sorghum bread by activation of intrinsic cereal phytase,” African J. Food Sci., vol. 15, no. 1, pp. 1-9, 2021.
[84]	N. N. Thierry, T. N. Léopold, M. Didier, and F. M. C. Moses, “Effect of Pure Culture Fermentation on Biochemical Composition of Moringa oleifera Lam Leaves Powders,” no. May 2017, 2013.
[85]	A. C. Mallillin et al., “Mineral availability and dietary fiber characteristics of Moringa oleifera,” Food Public Heal., vol. 4, no. 5, pp. 242-246, 2014.
[86]	R. F. Hurrell, M. Reddy, and J. D. Cook, “Inhibition of non-haem iron absorption in man by polyphenolic-containing beverages,” Br. J. Nutr., vol. 81, no. 4, pp. 289-295, 1999.
[87]	E. Y. Kim, S. K. Ham, M. K. Shigenaga, and O. Han, “Bioactive dietary polyphenolic compounds reduce nonheme iron transport across human intestinal cell monolayers,” J. Nutr., vol. 138, no. 9, pp. 1647-1651, 2008, doi: 10.1093/jn/138.9.1647.
[88]	M. E. Walters, R. Esfandi, and A. Tsopmo, “Potential of food hydrolyzed proteins and peptides to chelate iron or calcium and enhance their absorption,” Foods, vol. 7, no. 10, 2018.
[89]	Y. Li, H. Jiang, and G. Huang, “Protein hydrolysates as promoters of non-haem iron absorption,” Nutrients, vol. 9, no. 6, pp. 1-18, 2017.
[90]	E. O. Silva and A. P. F. R. L. Bracarense, “Phytic Acid: From Antinutritional to Multiple Protection Factor of Organic Systems,” J. Food Sci., vol. 81, no. 6, pp. R1357-R1362, 2016.
[91]	I. O. Igwilo, F. C. Ezeonu, S. C. Udedi, K. I. Ubaoji, N. A. Ozumba, and H. A. Ogbunugafor, “Nutrient composition and anti-nutritional factors in a local cultivar of Moringa oleifera (Lam) flowers,” An Indian J., vol. 7, no. 2, pp. 86-90, 2011.
[92]	M. D. Thurber and J. W. Fahey, “NIH Public Access,” vol. 48, no. 3, pp. 1-13, 2010, doi: 10.1080/03670240902794598.Adoption.
[93]	E. . Madukwe, A. . Ugwouke, and J. . Ezeugwu, “Effectiveness of dry Moringa oleifera leaf powder in treatment of anaemia,” vol. 5, no. May, pp. 226-228, 2013.
[94]	F. W. Nurjanah, S. Hadisaputro, and D. Fatmasari, “Long Bean Leaf Extract for Improving Haematological Status of Female Adolescent with Anemia that Gets Fe Supplementation,” J. Kesehat. Masy., vol. 16, no. 1, pp. 81-87, 2020.
[95]	P. Santiago, “Ferrous versus ferric oral iron formulations for the treatment of iron deficiency: A clinical overview,” Sci. World J., vol. 2012, 2012.
[96]	A. E. Shija, S. F. Rumisha, N. M. Oriyo, S. P. Kilima, and J. J. Massaga, “Effect of Moringa Oleifera leaf powder supplementation on reducing anemia in children below two years in Kisarawe District, Tanzania,” Food Sci. Nutr., vol. 7, no. 8, pp. 2584-2594, 2019.
[97]	V. S. Nambiar, K. Patel, C. Gosai, S. Nithya, and R. Desai, “Effect of beta carotene from dehydrated drumstick leaf powder on the haematological indices of non-pregnant non-lactating young women aged 18-25 yrs (preliminary trials).,” Int. J. Pharm. Biol. Arch., vol. 3, no. 3, pp. 646-653, 2012.
[98]	S. Gebremedhin, “Effect of a single high dose vitamin A supplementation on the hemoglobin status of children aged 6-59 months: Propensity score matched retrospective cohort study based on the data of Ethiopian Demographic and Health Survey 2011,” BMC Pediatr., vol. 14, no. 1, 2014.
[99]	F. B. Michelazzo, J. M. Oliveira, J. Stefanello, L. A. Luzia, and P. H. C. Rondó, “The influence of vitamin A supplementation on iron status,” Nutrients, vol. 5, no. 11, pp. 4399-4413, 2013.
[100]	K. Petersson et al., “Acoustofluidic hematocrit determination,” Anal. Chim. Acta, vol. xxx, pp. 1-6, 2017.
[101]	V. S. Nambiar and S. Seshadri, “Bioavailability trials of β-carotene from fresh and dehydrated drumstick leaves (Moringa oleifera) in a rat model,” pp. 83-95, 2001.
[102]	Y. Astuti, “Hubungan antara Asupan Protein, Zat Besi dan Vitamin C dengan Kadar Hb pada Anak Umur (7-15) tahun di Desa Sidoharjo, Samigaluh, Kulon Progo,” Mutiara Med., vol. 10, no. 2, pp. 172-179, 2010.
[103]	Z. Taimeh et al., “Erythrocyte aging as a mechanism of anemia and a biomarker of device thrombosis in continuous-flow left ventricular assist devices,” J. Hear. Lung Transplant., vol. 36, no. 6, pp. 625-632, 2017.
[104]	E. Yabalak, Z. Emire, A. O. Adıgüzel, S. Könen Adıgüzel, and A. M. Gizir, “Wide-scale evaluation of Origanum munzurense Kit Tan & Sorger using different extraction techniques: Antioxidant capacity, chemical compounds, trace element content, total phenolic content, antibacterial activity and genotoxic effect,” Flavour Fragr. J., vol. 35, no. 4, pp. 394-410, 2020.
[105]	S. Susanty, “Metode Ekstraksi Untuk Perolehan Kandungan Flavanoid Tertinggi Dari Ekstrak Daun Kelor (Moringa oleifera Lam),” J. Konversi, vol. 8, no. 2, pp. 31-36, 2019.
[106]	I. Oduro, W. O. Ellis, and D. Owusu, “Nutritional potential of two leafy vegetables: Moringa oleifera and Ipomoea batatas leaves,” Sci. Res. Essays, vol. 3, no. 2, pp. 057-060, 2008.
[107]	D. Hastuty, V. Hadju, and A. Ariyandy, “The effect of giving extracted moringa oleifera leaves plus Royal Jelly supplement on erythrocyte index of anemia pregnant women in Takalar District,” European Journal of Molecular and Clinical Medicine, vol. 7, no. 6. pp. 701-710, 2020.
[108]	W. Bhalchandra, Y. A. Alqadhi, and A. S. Ninawe, “Ameliorative Role of Bee Honey and Royal Jelly Against Cisplatin Induced Alteration in Hematological Parameters in Male Wister Albino Rat,” Int. J. Pharm. Pharm. Sci., vol. 10, no. 4, p. 110, 2018.